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Proactive Diagnosis of Narcolepsy

Proactive Diagnosis of Narcolepsy

Narcolepsy can be a debilitating sleep disorder caused by the dysregulation of neurophysiological pathways that control the stability of sleep and wake states in patients. Narcolepsy has a worldwide prevalence of about 26 to 50 per 100,000 individuals. However, the disease is associated with high healthcare resource use, substantial functional limitations, and reduced employment and work productivity. Studies also show that patients with narcolepsy have a higher medical and psychiatric comorbidity burden. The chronicity of narcolepsy mandates that patients receive life-long treatment, regardless of their age of onset. Narcolepsy Symptom Onset The onset of narcolepsy generally occurs during a person’s second decade of life, but it’s commonly reported that there are delays between symptom onset and a narcolepsy diagnosis, sometimes for as long as 5 to 10 years. Narcolepsy tends to be clinically defined by a symptom tetrad of: 1. Excessive daytime sleepiness. 2. Cataplexy. 3. Hypnagogic or hypnopompic hallucinations. 4. Sleep paralysis. Disturbed and fragmented nocturnal sleep often reported by patients suggests that narcolepsy actually comprises a symptom pentad. However, patients typically do not show all five symptoms. Research suggests that there is an autoimmune explanation for narcolepsy. It has been associated with seasonal streptococcus infections and H1N1 influenza and vaccination. Narcolepsy has also been linked to a specific genotype of the human leukocyte antigen, HLA-DQB1*06. This genotype may underlie the observed loss of the hypocretin-producing neurons that are associated with narcolepsy. Understanding & Perceptions of Narcolepsy My colleagues and I recently published a survey—the Awareness and Knowledge of Narcolepsy—to assess the understanding and perceptions of narcolepsy. Participants included 1,000 adults, 300 primary care physicians (PCPs), and 100...
Substance Use Disorders Among Emergency Physicians

Substance Use Disorders Among Emergency Physicians

The prevalence of substance use disorders among physicians ranges between 10% and 14%, a rate that is similar to that of the general population. “Research has shown that several specialties have a higher-than-expected rate of these disorders, most notably anesthesiology, emergency medicine, and psychiatry,” says John S. Rose, MD. Despite the reported higher rates of substance use disorders and participation in Physician Health Programs (PHPs) among these specialties, few studies have focused specifically on the prognosis and recovery of emergency physicians (EPs) in PHPs. Important New Data There are little data on whether EPs who receive treatment by PHPs have similar outcomes with these programs as other physicians. To address this research gap, Dr. Rose and colleagues conducted a study using data from 16 state PHPs that followed participants with substance use disorders for 5 or more years. Published in the Western Journal of Emergency Medicine, the study compared outcomes of EPs with other practitioners who were enrolled in state PHPs. “Research has been limited regarding whether EPs perform as well as other physicians after treatment from PHPs,” Dr. Rose says. “We wanted to determine if there were any characteristics for EPs that were significantly different from those of other physicians.” For the study, investigators reviewed data on 904 physicians with a diagnosis of substance use disorders between 1995 and 2001. They compared 56 EPs with 724 other physicians and assessed rates of relapse, successful completion of monitoring, and return to clinical practice within 5 years. Overall, EPs had a higher-than-expected rate of substance use disorders. “EPs were almost three times as likely to be enrolled in a PHP...
A Closer Look at MI Among Younger Women

A Closer Look at MI Among Younger Women

Over time, the frequency of myocardial infarction (MI) in the United States has been declining overall as improvements have been made with regard to medical therapy for coronary artery disease. Although there has been a decline in the rate of ST-elevation MI (STEMI) in those aged 55 and older, the rate has remained steady in patients younger than 55 and among younger women. “Studies have shown that it’s harder to recognize the signs of MI in women,” says Luke Kim, MD, FACC, FSCAI. “Previous analyses indicate that women tend to receive less aggressive treatment than men.” Analyzing Disparities In a study presented at the Society for Cardiovascular Angiography and Interventions 2014 Scientific Sessions, Dr. Kim and colleagues analyzed data on about 13,000 women and more than 42,000 men aged 55 and younger who were hospitalized with an acute MI from 2007 to 2011 using the Nationwide Inpatient Sample database. The authors looked at temporal trends in MI as well as adverse in-hospital outcomes to compare findings by gender. The researchers observed a slight decline in the number of MIs among younger women between 2007 and 2009 but little change after that. Women had more preexisting health problems than men, including diabetes, hypertension, kidney disease, peripheral vascular disease, congestive heart failure, and obesity. Women were also more likely than men to have non-STEMIs. The study by Dr. Kim and colleagues also revealed that there were disparities in the treatment of MI. “Women who suffered an MI were far less likely than men to be treated with PCI or CABG surgery,” explains Dr. Kim. “They were also more likely to face...
Updated Guidelines for Valvular Heart Disease

Updated Guidelines for Valvular Heart Disease

According to recent estimates, just less than 3% of Americans have moderate-to-severe valvular heart disease (VHD), a condition that increases in prevalence with age. The disease affects between 4% and 9% of those aged 65 to 75 and 12% to 13% of those aged 75 and older. Many of these patients require surgical or interventional procedures, but even with these treatments, the overall survival rates associated with VHD are lower than expected. The risk of adverse outcomes due to VHD is high because of limited options for restoring normal valve function and because of failures to intervene at the optimal time point in the disease course. A Welcome Update In 2008, the American College of Cardiology (ACC) and American Heart Association (AHA) released an updated guideline for diagnosing and managing adult patients with VHD. In 2014, the ACC/AHA updated these guidelines in an effort to facilitate access to concise, relevant information at the point of care when clinical knowledge is needed the most. “In the past 5 years, we have accumulated new evidence and a better understanding of earlier research surrounding VHD,” explains Paul Sorajja, MD, FACC, FAHA, FSCAI, who was a member of the ACC/AHA writing group that developed the most recent guideline update. “Our goal was to provide clinicians with concise, evidence-based recommendations and the supporting documentation to encourage their use.” Restructured Definitions The 2014 guidelines include restructured definitions of VHD severity into four classifications—at risk, progressive, asymptomatic severe, and symptomatic severe (Table 1). “These categories were created to help clinicians determine the optimal timing of interventions,” Dr. Sorajja says. The stages consider the degree of valve...
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