Nightshift is a common work schedule in health environments, and is associated with decreased alertness and increased adverse events at work. This decrease in alertness can be predicted from biological models of sleep homeostasis and circadian influences. Naps can provide a short-term alleviation of sleep need, and the benefits of naps have been demonstrated in laboratory-based studies, and in specific controlled work environments. The efficacy of brief naps has not been demonstrated in health workers in their usual work environment. The current study examined the effects of a 30-min nap break during the nightshift in a cohort of nursing staff and scientists in their usual work environment. Measures of both subjective sleepiness and objective alertness were taken at hourly intervals throughout the nightshift, on nights where a scheduled nap was taken and nights where there was no nap. Following a nap, psychomotor performance metrics (response speed and fastest 10% reactions times) improved and self-reported sleepiness was reduced compared to nights without a nap. These improvements persisted to the end of the nightshift. Effect size estimates suggested that 20-50% of variance in these measures was explained by the interaction of time on shift and the nap intervention. Differences were found in the timing of increases in subjective and objective alertness after the nap. These findings support the effectiveness of a scheduled nap break during a nightshift to maintain alertness in health workers.

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The aims of our study were to investigate multiple daily activity outcomes in patients with diabetic foot ulcers (DFU) compared to diabetic peripheral neuropathy (DPN) and diabetes (DM) controls in their free-living environments. We examined daily activity outcomes of 30 patients with DFU, 23 DPN and 20 DM. All patients wore a validated multi-sensor device for > 5 days (>22 hours per day) to measure their daily activity outcomes: steps, energy expenditure (kJ), average metabolic equivalent tasks (METs), physical activity (>3·0 METs) duration and energy expenditure, lying duration, sleep duration and sleep quality. We found that DFU patients recorded fewer median (interquartile ranges, IQR) daily steps [2154 (1621-4324)] than DPN [3660 (2742-7705)] and DM [5102 (4011-7408)] controls (P < 0·05). In contrast, DFU patients recorded more mean ± SD daily energy expenditure (kJ) (13 006 ± 3559) than DPN (11 085 ± 1876) and DM (11 491 ± 1559) controls (P < 0·05). We found no other differences in daily activity outcomes (P > 0·1). We conclude that DFU patients typically take fewer steps but expend more energy during their normal daily activity than DPN and DM controls. We hypothesise that the increased energy expenditure for DFU patients may be due to wound healing or an inefficient gait strategy. Further investigations into this energy imbalance in DFU patients may improve healing in future.

Obstructive sleep apnoea may present with a wide range of symptoms resulting in a variety of referral pathways. A multidisciplinary approach to examination and diagnosis helps to determine the most appropriate treatment plan for each individual. The subject is seen by each member of the team, appropriate investigations undertaken and a further meeting arranged at which all opinions are discussed. A reasoned treatment regime is produced, taking into consideration the patient's wishes and overall medical condition. This paper describes the team approach currently employed in the Department of Thoracic Medicine at The Prince Charles Hospital, Brisbane, Australia. The thoracic physician and ENT surgeon work in close collaboration with their dental colleagues: an orthodontist, prosthodontist and a maxillofacial surgeon. An outline of the examination and investigations made by each is described and the multidisciplinary approach is illustrated by a description of the management of five subjects with suspected obstructive sleep apnoea.