Advertisement
Sleep Quality: A Key to Good Health

Sleep Quality: A Key to Good Health

A good night’s sleep is a key component of good health, but patients’ sleep history often receives little attention among clinicians. When a patient complains of sleep problems, practitioners often reflexively prescribe sleeping medications without in­quiring further. When academic sleep pioneers first performed sleep studies in the 1970s, it was soon evident that sleep is multifactorial and complex. More recent studies have revealed that cyclic alternating patterns intrude into deep sleep, thereby reducing its restorative quality. Practitioners who pose questions about sleep problems and sleep quality often find that patients will have difficulty falling and staying asleep, thus necessitating a two-pronged approach. Patients’ self-descriptions may suggest either a sleep disturbance or a systemic disease. A patient’s partner can be helpful in providing further history, such as snoring, periods of apnea, or restless legs. Impactful Consequences Many cases of disrupted sleep lead to fatigue, irritability, and depression. Normal worries and concerns can trigger insomnia, while PTSD can cause severe night terrors and vivid dreams, leading to major disruptions in quality of life. For some, blood pressure remains difficult to control until patients start sleeping more soundly. Sleep disturbance can also cause fibromyalgia and an increase in pain in other conditions, such as rheumatoid arthritis, osteo­arthritis, and systemic lupus erythematosis. Many patients fall asleep reasonably easily but then wake up a few hours later and are unable to fall back asleep. This leaves them feeling exhausted in the morning. To date, there are no prescription medications approved by the FDA to deepen sleep, though many physicians use a variety of medications “off-label” for this purpose. Encourage Good Sleep Hygiene The cornerstone...
The Etiquette of Help

The Etiquette of Help

“Any surgeon to OR 6 STAT. Any surgeon to OR 6 STAT.” No surgeon wants to hear or respond to a call like that. It means someone is in deep kimchee and needs help right away. I was in the locker room, just about to strip off my scrubs and dress to go out with my wife for the evening. We had finished a full day of routine surgery—two gallbladders and a colon resection—and had plans for dinner. Our older son was home from college and had offered to watch his younger brother for us. I closed my locker and walked back out to the OR control desk. Michele, my wife and first assistant, was already there. A glance at the control board showed me that Dr. S was in room 6. She was a gynecologist, and according to the board, was doing a routine diagnostic laparoscopy. The bustle of technicians and nurses running in and out of the room indicated that it was anything but routine. We made our way to the room, and I stuck my head in. My friend Jon was the anesthesiologist. He was squeezing a bag of packed red blood cells to make them run into the IV faster. “We could use some help,” he said, calmly as ever. But he rolled his eyes toward the table. Dr S. stood there, blood coating her arms and chest, her eyes looking at me but somehow also looking far away, the thousand yard stare of someone out of their depth and very afraid. “Hey, Lou,” I said, using her first name as I stepped into the...
The Importance of HIV/STD Prevention Counseling

The Importance of HIV/STD Prevention Counseling

According to recent estimates, approximately 1.1 million people in the United States are living with HIV, and about 50,000 new HIV infections occur each year. “Reducing transmission remains a key part of HIV prevention,” says Yuko Mizuno, PhD. “To further reduce the spread of HIV, an increased emphasis must be placed on preventing transmissions among individuals who already have the infection.” Research shows that those who are aware of their HIV status are more likely to take the necessary steps to protect themselves and their partners. Dr. Mizuno says that healthcare providers play an important role in offering critical health information and services to patients living with HIV. “In fact,” she says, “the CDC recommends that providers offer prevention counseling for HIV and sexually transmitted diseases (STDs) to all patients living with HIV during their routine clinic visits. Few studies, however, have explored what percentage of people in the U.S. who are living with HIV and receiving care are exposed to HIV/STD prevention counseling and whether it is reaching those who need it the most.” Examining New Data To better understand who is being reached with HIV/STD prevention counseling and how well they are being reached, Dr. Mizuno and colleagues published a study in AIDS evaluating data from the CDC’s Medi-cal Monitoring Project (MMP). The MMP provides nationally representative estimates of behavioral and clinical characteristics of HIV-infected adults receiving care in the U.S., including the estimated prevalence of exposure to HIV/STD risk-reduction interventions. According to the findings, only about 44% of people living with HIV in active care reported receiving one-on-one HIV/STD prevention counseling from their healthcare providers (Table)....
Get Connected

Get Connected

Get the edge on your colleagues by receiving updates directly from the Physician’s Weekly editors in multiple ways. Sign up for our weekly e-newsletter Subscribe to our RSS Feed Like us on Facebook Check us out on Google+ Follow us on Twitter Join the conversation on...
[ HIDE/SHOW ]