Arch Intern Med
-
Comparative Study
Sleepiness and sleep in patients with both systolic heart failure and obstructive sleep apnea.
Adverse effects of obstructive sleep apnea (OSA), including sleep deprivation, can contribute to the progression of heart failure. The usual indication to diagnose and treat sleep apnea is subjective sleepiness. Previous studies suggest that patients with both heart failure and obstructive sleep apnea often do not complain of sleepiness, albeit their sleep time may be reduced. Therefore, we tested the hypothesis that patients with heart failure have less sleepiness and sleep less compared with subjects without heart failure for a given severity of OSA. ⋯ Patients with heart failure have less subjective daytime sleepiness compared with individuals from a community sample, despite significantly reduced sleep time, whether or not they have OSA. In patients with heart failure, the absence of subjective sleepiness is not a reliable means of ruling out OSA.
-
Evidence from laboratory and epidemiologic studies suggests that decreased sleep duration or quality may increase diabetes risk. We examined whether short or poor sleep is associated with glycemic control in African Americans with type 2 diabetes mellitus. ⋯ In our sample, sleep duration and quality were significant predictors of HbA1c, a key marker of glycemic control. Combined with existing evidence linking sleep loss to increased diabetes risk, these data suggest that optimizing sleep duration and quality should be tested as an intervention to improve glucose control in patients with type 2 diabetes.
-
Information on epidemiology and prognosis of imported fever is scarce and almost exclusively limited to hospital settings. ⋯ The clinical spectrum of imported fever is highly destination specific but also depends on other factors. Plasmodium falciparum malaria was the leading cause of mortality in the study population.
-
Patients are often not told about harmful medical errors. The malpractice environment is considered a major determinant of physicians' willingness to disclose errors to patients. Yet, little is known about the malpractice environment's actual effect on physicians' error disclosure attitudes and experiences. ⋯ US and Canadian physicians' error disclosure attitudes and experiences are similar despite different malpractice environments, and reveal mixed feelings about disclosing errors to patients. The medical profession should address the barriers to transparency within the culture of medical and surgical specialties.
-
Randomized Controlled Trial
Efficacy and safety of the novel selective nicotinic acetylcholine receptor partial agonist, varenicline, for smoking cessation.
The selective nicotinic acetylcholine receptor partial agonist, varenicline tartrate, represents a novel type of therapy for smoking cessation. This study evaluated the efficacy, safety, and tolerability of 4 varenicline dose regimens, 2 with progressive dosing over the first week (eg, titrated) and 2 with a fixed dosing schedule (eg, non-titrated), for promoting smoking cessation. ⋯ Varenicline tartrate, 0.5 mg and 1.0 mg twice daily, is efficacious for smoking cessation.