Chest
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COVID-19 has caused > 7 million deaths worldwide since its onset in 2019. Although the severity of illness has varied throughout the pandemic, critical illness related to COVID-19 persists. Survivors of COVID-19 critical illness can be left with sequelae of both the SARS-CoV-2 virus and long-term effects of critical illness included within post-intensive care syndrome. Given the complexity and heterogeneity of COVID-19 critical illness, the biopsychosocial-ecological model can aid in evaluation and treatment of survivors, integrating interactions among physical, cognitive, and psychological domains, as well as social systems and environments. ⋯ The onset of vaccinations, new therapeutics, and new strains of SARS-CoV-2 virus have decreased COVID-19 mortality; however, the number of survivors of COVID-19 critical illness remains high. A biopsychosocial-ecological approach is recommended to guide care of COVID-19 critical illness survivors.
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Review
Sleep Education - A Narrative Review on Barriers and Opportunities to Grow a Diverse Sleep Team.
The increased recognition of sleep-wake disorders and their effects, along with the anticipated shortage of sleep medicine specialists, heralds a concomitant need to have more health care providers with dedicated training in the evaluation and management of sleep disorders across the life span. A narrative review of published literature on sleep education was conducted and identified factors related to diversity within the sleep team, barriers to implementation of sleep education, and strides in sleep education. Implementation of novel sleep education strategies will require creative navigation of barriers such as allocation of curricular time, availability of teaching faculty, and funding to train more members of the sleep team. Deliberate coordination within and across health professions programs, with efforts to share resources and leverage technology, will be instrumental to guide the next phase of growth in sleep education.
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Positive airway pressure (PAP) therapy is first-line therapy for OSA, but consistent use is required for it to be effective. Previous studies have used Medicare fee-for-service claims data (eg, device, equipment charges) as a proxy for PAP adherence to assess its effects. However, this approach has not been validated in a US commercially insured population, where coverage rules are not standardized. ⋯ In aggregate US commercial data with nonstandardized PAP coverage rules, concordance between existing claims-based definitions and objective PAP use was low. Caution is warranted when applying existing claims-based algorithms to commercial populations.