Postgraduate medicine
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Postgraduate medicine · Jul 2012
ReviewSleep deprivation in resident physicians, work hour limitations, and related outcomes: a systematic review of the literature.
Extended work hours, interrupted sleep, and shift work are integral parts of medical training among all specialties. The need for 24-hour patient care coverage and economic factors have resulted in prolonged work hours for resident physicians. This has traditionally been thought to enhance medical educational experience. ⋯ Resident work hour limitations have been mandated by the Accreditation Council for Graduate Medical Education in response to patient safety concerns. Studies evaluating the impact of these regulations on resident physicians have generated conflicting reports on patient outcomes, demonstrating only a modest increase in sleep duration for resident physicians, along with negative perceptions regarding their education. This literature review summarizes research on the effects of sleep deprivation and shift work, and examines current literature on the impact of recent work hour limitations on resident physicians and patient-related outcomes.
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Postgraduate medicine · Jul 2012
ReviewRelationship between sleep disorders and the risk for developing type 2 diabetes mellitus.
Sleep is increasingly being recognized as an important factor in the homeostasis of multiple body functions, including blood glucose metabolism. One of the most common sleep disorders, obstructive sleep apnea, is not only highly prevalent in patients with type 2 diabetes mellitus, but may contribute to the development of abnormalities in blood glucose metabolism. ⋯ Other common sleep disorders, such as insufficient sleep, shift work disorder, and restless legs syndrome, may also have a significant influence on the development and management of diabetes and its complications. The purpose of this article is to review the recent literature on the relationship between sleep disorders and blood glucose metabolism.
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Postgraduate medicine · Jul 2012
Accuracy of noninvasive and invasive point-of-care total blood hemoglobin measurement in an outpatient setting.
The purpose of this study was to determine the accuracy of noninvasive hemoglobin measurement using pulse CO-oximetry (Pronto® SpHb®, Masimo Corp.) and a commonly used, invasive, point-of-care, automated spectrophotometer (HemoCue 201+®, HemoCue, Inc.), in comparison with hemoglobin measurements obtained from a laboratory hematology analyzer (measuring total blood hemoglobin) in the outpatient setting. ⋯ Noninvasive SpHb® testing had bias and SD similar to those of HemoCue 201+®. Because SpHb® measurement is noninvasive, it may offer additional patient and provider benefits.
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Postgraduate medicine · Jul 2012
Multicenter Study Clinical TrialSafety and efficacy of the LAP-BAND AP® adjustable gastric band in the treatment of obesity: results at 2 years.
The objective of this analysis is to report interim, 2-year results for morbidly obese patients who have undergone laparoscopic adjustable gastric banding in the LAP-BAND AP® EXperience (APEX) trial. ⋯ The LBAP safely and effectively facilitated weight loss in morbidly obese patients, with clinically meaningful improvements in quality of life and obesity-related comorbidities. The durability of these results will be further described with additional follow-up through 5 years.
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Postgraduate medicine · Jul 2012
ReviewCOPD and associated comorbidities: a review of current diagnosis and treatment.
Health care utilization and costs associated with chronic obstructive pulmonary disease (COPD) continue to increase, notwithstanding evidence-based management strategies described by major respiratory societies. Cardiovascular diseases, asthma, diabetes and its precursors (obesity and metabolic syndrome), depression, cognitive impairment, and osteoporosis are examples of common comorbidities that can affect or be affected by COPD. Appropriate diagnosis and management (from a pharmacologic and nonpharmacologic perspective) of COPD and its associated comorbidities are important to ensure optimal patient care. An evolving understanding of COPD as a multimorbid disease that affects an aging population, rather than just a lung-specific disease, necessitates an integrated, tailored disease-management approach to improve prognoses and reduce costs.