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Guidelines for Diagnosing OSA

Guidelines for Diagnosing OSA

Between 10% and 17% of Americans have moderate to severe sleep apnea, according to recent estimates. The prevalence of the condition has been increasing in recent years, due in part to the escalating obesity rate in the United States. However, an estimated 80% of those with sleep apnea remain undiagnosed. Addressing the Issue “Polysomnographs are considered the reference standard for an obstructive sleep apnea (OSA) diagnosis, but it requires specialized facilities,” explains Dr. Qaseem, lead author of the recent guidelines on OSA from the American College of Physicians (ACP). “Polysomnographs are also resource intensive and expensive and require patients to stay overnight for observation. As an alternative to polysomnographs, portable monitors are increasingly being used because they are much cheaper and more convenient for patients.” Portable monitors are broken down into types II through IV, with polysomnographs being designated as type I (Table 1). Two Recommendations The ACP recommends that a sleep study be performed for patients with unexplained daytime sleepiness. “This is a weak recommendation based on low-quality evidence,” Dr. Qaseem says, “but we believe that there is a need to have a targeted approach to diagnosing OSA. This starts with evaluation of the risk factors and common symptoms. Patients with daytime sleepiness have been shown to be the most responsive to OSA treatment, whereas there is a lack of evidence supporting treatment benefits to improve other outcomes, such as hypertension, diabetes, or coronary disease, especially in patients without daytime sleepiness.” To perform a sleep study in these patients, the ACP recommends polysomnographs for diagnostic testing. “If polysomnographs are available, they should be used,” adds Dr. Qaseem. “Portable...
Assessing Asthma Control

Assessing Asthma Control

The Asthma Control Test (ACT) has long been used as a quick survey to assess how well asthma symptoms are controlled among patients aged 12 and older, while the Childhood ACT (CACT) is used for such testing in younger children. More recently, the Asthma APGAR system has emerged as an alternative to ACT/CACT because of an implied ability to assess asthma control and reasons for inadequate control. However, little is known about how the Asthma APGAR system compares with ACT/CACT in the assessment of asthma control. Comparing Tests For a study published in Mayo Clinic Proceedings, Barbara P. Yawn, MD, MSc, MSPH, and colleagues sought to compare the impact of the Asthma APGAR system versus that of ACT/CACT on patient outcomes. Participants required daily asthma therapy and were asked to complete ACT in written form, several other asthma-related questions, and then the Asthma APGAR test. Children aged 5 to 11 completed the CACT, often with help from a parent. “The ACT and APGAR tests are highly comparable,” says Dr. Yawn, whose study results showed an overall agreement of 84.4% between the tests. “However, ACT doesn’t identify factors that may contribute to poorly controlled asthma. In contrast, the APGAR test was able to identify an actionable item for asthma control in more than three-quarters of cases. For pulmonologists, this can help speed up care by informing us about where to look for problems. The Asthma APGAR system was designed to not only help identify poor or inadequate control, but also to highlight the most common reasons why it isn’t under control. Our study demonstrated that the Asthma APGAR system could...

Social Media Tips for Doctors

Recently, I was asked for personal advice on using Twitter. There are many articles out there that say we (physicians) don’t know how to properly use social media. Social media can be a very powerful tool in medicine. It can not only help us get medical information out there to our patients, but it can also help us connect with people, colleagues, and organizations to give us more visibility—whether for career advancement, media contacts, or just to get our voices heard. Social Media Basics: These are some of the tips I have come up with for doctors who want to take advantage of the many opportunities social media can offer: 1. Never communicate to patients through social media outlets. It is a set up for disaster and HIPAA violations. 2. Social media can be used for educating patients. Patients can follow you on these pages to get information about your practice and whatever medical information you wish to share. Twitter… 3.  Twitter is useful for growing your professional connections. It can be leveraged so you get known and also connect with other doctors, healthcare information technology people, media, etc. Patients can follow you on Twitter, but it generally is not a useful method of providing patient information because tweets are limited to 140 characters. 4. Choose your followers carefully. Block those who spam or troll you (“trolls” are people who negatively post with the deliberate intent of provoking a reaction). Many people will try to sell you things. Monitor your account because it is not uncommon for it to be hacked. 5. Grow your network. Have a group that...
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