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Background: Neighborhoods are critical to understanding how environments influence health outcomes. Prolonged environmental stressors, such as a lack of green spaces and neighborhood socioeconomic disadvantage, have been associated with higher allostatic load levels. Since allostatic load levels experienced earlier in life have stronger associations with mortality risk, neighborhoods may be uniquely suited to monitor and mitigate the impacts of environmental stressors. Researchers often study allostatic load in neighborhoods by utilizing administrative boundaries within publicly accessible databases as proxies for neighborhoods. Methods: This systematic review of reviews aims to identify commonly used biomarkers in the measurement of allostatic load, compare measurement approaches, inventory databases to study allostatic load, and spotlight considerations referenced in the literature where allostatic load is studied in neighborhoods. The review was conducted using the search term “allostatic load” in the MEDLINE, CINAHL, and PsychINFO databases. The search results were filtered to include reviews. Results: The search returned 499 articles after deduplication. Overall, 18 synthesis reviews met the inclusion criteria and were retained for extraction. The synthesis reviews analyzed represented 238 studies published from 1995 to 2020. The original ten biomarkers were most often used to measure allostatic load. More recently, body mass index and C-reactive protein have additionally been frequently used to measure allostatic load burden. Conclusions: The scientific contributions of this study are that we have identified a clear gap in geographic considerations when studying allostatic load. The implication of this study is that we have highlighted geographic concepts when conducting neighborhood-level research using administrative databases as a neighborhood proxy and outlined emerging future trends that can enable future study of allostatic load in the neighborhood context.

“In Our Unit” highlights unique practices, innovations, research, or resourceful solutions to commonly encountered problems in critical care areas and settings where critically ill patients are cared for. If you have an idea for an upcoming “In Our Unit, ” send it to CRITICAL CARE NURSE, 101 Columbia, Aliso Viejo, CA 92656; fax, (949) 362-2049; e-mail, ccn@aacn.org. By using RN-driven, evidencebased practice, our unit safely reduced the amount of sedating drugs our patients received. Immediately after undergoing open-heart surgery, patients are brought to our intensive care unit (ICU) intubated and anesthetized, receiving propofol, with routine orders to wean and extubate under physician-specified parameters. It is primarily the responsibilit y of bedside registered nurses (RNs) to judge sedation level and turn off the propofol. When the patient meets parameters as measured by arterial blood gas values, the RN and the respiratory therapy staff determine whether the patient can be safely extubated. In 2001, our nurses recovered 1300 open-heart surgery patients in our 22-bed cardiac ICU. Our unit’s mean extubation time was 12.5 hours after surgery, significantly higher than the national mean number of hours. The goal of our practice issue was to reduce the amount of mean extubation time in our unit. Prolonged intubation increases a patient’s risk of ventilator-associated complications and delays the recovery and rehabilitation process.