If part of a hospital stay is to recover from a procedure or illness, why is it so hard to get any rest?
There is more noise and light than is conducive for sleep. And nurses and others visit frequently to give medications, take vitals, draw blood or perform tests and checkups — in many cases waking patients to do so.
Some monitoring is necessary, of course. Medication must be given; some vital signs do need to be checked. And frequent monitoring is warranted for some patients — such as those in intensive care units. But others are best left mostly alone. Yet many hospitals don't distinguish between the two, disrupting everyone on a predefined schedule.
Peter Ubel understands the problem as both a physician and patient. When he spent a night in the hospital recovering from surgery in 2013, he was interrupted multiple times by blood draws, vital sign checks, other lab tests, as well as by the beeping of machines. "Not an hour went by without some kind of disruption," said Ubel, a physician with Duke University. "It's a terrible way to start recovery."
It's more than annoying — such disruptions can harm patients. Short sleep durations are associated with reduced immune function, delirium, hypertension and mood disorders. Hospital conditions, including sleep disruptions, may contribute to "posthospital syndrome" — the period of vulnerability to a host of health problems after hospitalization that are not related to the reason for that hospitalization.
"In addressing a patient's acute illness, we may inadvertently be causing harm by ignoring the important restorative powers of a healing environment," said Harlan Krumholz, a Yale University physician who has been calling attention to posthospital syndrome for several years. "The key to a successful recovery after illness may be a less stressful, more supportive, more humane experience during the hospitalization."
It's an environment that, all too often, seems set up for everyone else's convenience but the patient's. To help patients deal with the stresses of hospitalization, sedatives are often prescribed. These medications, including opioids, carry their own risks, such as addiction.
"Instead, we could make the environment more conducive to rest and reduce the use of sedatives," Ubel said.
Solutions aren't hard to fathom. Ubel listed some in 2013. Hospital workers could coordinate so that one disruption serves multiple needs: a blood draw and a vitals check at the same time instead of two hours apart.
Or they could allow patients' needs to guide schedules. If a patient is at low risk and can go six or eight hours without a vitals check, for example, perhaps don't do that check once every four hours.
That's the basic conclusion of a sweeping new study issued by the World Resources Institute, an environmental group. The report warns that the world's agricultural system will need drastic changes in the next few decades in order to feed billions more people without triggering a climate catastrophe.
The challenge is daunting: Agriculture already occupies roughly 40 percent of the world's vegetated land and is responsible for about a quarter of humanity's greenhouse gas emissions. But with the global population expected to grow from 7.2 billion people today to nearly 10 billion by 2050, and with many millions of people eating more meat as incomes rise, that environmental impact is on pace to expand dramatically.
Based on current trends, the authors calculated, the world would need to produce 56 percent more calories in 2050 than it did in 2010. If farmers and ranchers met that demand by clearing away more forests and other ecosystems for cropland and pasture, as they have often done in the past, they would end up transforming an area twice the size of India.
That, in turn, could make it nearly impossible to stay below 2 degrees Celsius of global warming, the agreed-upon international goal, even if the world's fossil-fuel emissions were rapidly phased down. When forests are converted into farmland, the large stores of carbon locked away in those trees is released into the atmosphere.
"Food is the mother of all sustainability challenges," said Janet Ranganathan, vice president for science and research at the World Resources Institute. "We can't get below 2 degrees without major changes to this system."
The new study, the result of six years' worth of modeling work conducted in partnership with French agricultural researchers, is hardly the first to warn that feeding the world sustainably will be a formidable task. But the authors take a different view of the most plausible solutions.
In the past, researchers who have looked at the food problem have suggested that the key to a sustainable agriculture system is to persuade consumers to eat far less meat and waste far less of the food that's already grown.
The new report, however, cautions that this could prove difficult in practice. The authors do recommend that the biggest consumers of beef and lamb, such as those in Europe and the United States, could cut back their consumption by about 40 percent by 2050, or down to about 1.5 servings a week on average.