24/7
I hope you, like me, have been taking a break and making the most of the chance to get outside. to see friends and family and catch up on sleep.
For millions of dedicated healthcare workers – and the patients and families they serve, the holiday season is the busiest time of the year: more admissions with higher clinical complexity, longer average stays and increased risk of mortality compared to other times of the year – Clinical complexity and hospital admissions in the December holiday period.
So I was fascinated and heartened to read the pre-print of this consensus paper, co-authored by many of the brightest and most thoughtful scientists and clinicians from around the world following a workshop at the Lorentz Centre in Leiden just last year – Challenges and Recommendations for Integrating Circadian Medicine in Critical Care: A Roadmap.
The abstract is emphatic:
‘Circadian rhythms are often severely disrupted in critically ill patients in the Intensive Care Unit (ICU). The ICU environment, characterized by irregular light-dark signals, continuous nutrition, and round-the-clock interventions, contributes to this disruption by providing weak and conflicting timing cues to the circadian system. Extensive scientific research has demonstrated that circadian rhythms play a vital role in regulating physiology and maintaining overall health. Therefore, integrating circadian principles into critical care may represent a promising strategy to improve patient outcomes in the ICU.’
The paper is really clearly written – and well worth a read. It’s interesting to see the overlaps between these acute care settings and chronic or sustained residential care:
- The need for agreed protocols to evaluate circadian entrainment in individuals with complex conditions who are also taking medications that affect hormone signalling and other markers used in healthy individuals.
- The need for agreed protocols to measure the impact of interventions to enable reliable comparison within and between studies and extending beyond the period of hospitalisation.
- The need for a patient-centred approach to research and any proposed interventions to integrate personal preferences and sensitivities.
- The need to consider pragmatic methodologies that offer reliable insights into the benefits for patients, families and cost in a real-world setting: traditional Randomised Control Trials impose such strict criteria in terms of eligibility and controlled conditions, that the process is expensive and time-consuming for staff and the results are hard to generalise.
- The importance of interdisciplinary engagement to identify barriers to effective integration of circadian interventions, and education to embed these practices into everyday routines.
While it may take years for these insights to filter through to a hospital or care home near you or near me, it feels as though we are on the brink of a new understanding of the value of light and a brighter holiday season for all.
You don’t have to see the whole staircase, just take the first step.
– Martin Luther King
As I wrap up the year, grateful for the adventure so far and excited and not a little daunted by the winding road ahead, this quote is often in my mind. All we can do is put one foot in front of the other and find ways to marvel at the scenery along the way.
Strawberry smoothie in mid-winter?
I try to eat fresh fruit and vegetables in season: while recognising it’s more complicated than I can begin to understand, I worry about the air miles and energy use, monoculture and food poverty in countries that have invested in cash crops to satisfy my passing whim for a strawberry smoothie in the depths of winter.
Plus, as this great article from the Frontiers for Young Minds points out, your body responds optimally to foods that correspond to the environmental conditions and helps our circannual clock to adapt to the natural seasonal cycle – eating out of season desynchronises the internal and external worlds – Eat Fruits In-Season to Give Rhythm to Your Life.
But I’m on a mission to detox, and strawberries are hailed as a superfood when it comes to boosting antioxidant capacity, immune response et al – Dietary Strawberries Improve Biomarkers of Antioxidant Status and Endothelial Function in Adults with Cardiometabolic Risks in a Randomized Controlled Crossover Trial.
What if the next generation of LED lighting, combined with AI optimisation, could let me have my (strawberry) cake and eat it?
This fascinating study engineered the spectrum of greenhouse lighting and a particle swarm optimisation algorithm to direct the light precisely where it was needed at critical times in the plant development to reduce energy use while optimising yield and reproductive performance. The results are impressive, increasing the height of the plants by 55% and the weight of the fruit by 36% compared to the standard 12-hour protocol – A Low-Energy Lighting Strategy for High-Yield Strawberry Cultivation Under Controlled Environments.
This greenhouse version is a brilliant solution to my desire for a colourful snack – and could be grown much closer to home. But it’s still not as tasty, does not deliver the same antioxidant potential, or last as long on the shelf, as those grown in the open air using a soilless cultivation system – Comparison of the Growth, Physio-Biochemical Characteristics, and Quality Indices in Soilless-Grown Strawberries under Greenhouse and Open-Field Conditions. I can’t help wondering if that’s because there is something about daylight that we can’t (yet) reduce to a formula.
I won’t say ‘no’ to a hothouse-grown healthy treat – especially if it helps my system to recover from a couple of weeks’ of holiday indulgence.
But now I have some evidence to back up my intuition that they just don’t deliver the same delicious tang as as the real thing – strawberries still warm from my allotment with a dollop of clotted (Dorset) cream.