International Consensus Statement on Obstructive Sleep Apnea.

Background: Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA).

Methods: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats.

Sleep Medicine Milestones 2.0: designed for our field.

The Accreditation Council for Graduate Medical Education published the first sleep medicine milestones in 2015. However, these milestones were the same among all internal medicine fellowship programs; they were not specific to the specialty. Based on stakeholder feedback, the Accreditation Council for Graduate Medical Education called for the creation of specialty-specific milestones.

Relationship 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. Evidence suggests that effectively treating sleep apnea, specifically with continuous positive airway pressure, improves glycemic and nonglycemic outcomes.

Detection of postoperative sleep-disordered breathing using a portable monitoring device.

Purpose: Adverse surgical outcomes may occur more frequently in patients with sleep-disordered breathing (SDB). Despite this concern, there have been no prospective studies using objective measures of postoperative SDB to determine the scope of the problem. We designed a prospective study to determine the feasibility of identifying SDB in elective postoperative patients by the use of a type IV portable monitor (PM).

Effectiveness and acceptability of a computerized decision support system using modified Wells criteria for evaluation of suspected pulmonary embolism.

Study Objective: Ready availability of computed tomography (CT) angiography for evaluation of pulmonary embolism in emergency departments (EDs) is associated with a dramatic increase in the number of CT angiography tests. The aims of this study are to determine whether a validated prediction algorithm embedded in a computerized decision support system improves the positive yield rate of CT angiography for pulmonary embolism and is acceptable to emergency physicians.

Methods: This study was conducted as a prospective interventional study with a retrospective preinterventional comparison group.

Trends in use and yield of chest computed tomography with angiography for diagnosis of pulmonary embolism in a Connecticut hospital emergency department.

Rationale: We hypothesize that the ready availability of chest computed tomography (CT) scan, with angiography (CTA), for pulmonary embolism (PE) has resulted in its increased use in the emergency department (ED) with an associated decrease in positive studies.

Results: CTA for diagnosis of PE increased over 13-fold from 2000 to 2005. The diagnostic yield of CTA for PE decreased from 14% in 2000 to a mean (SD) of 7.

Unusual mode of mechanical failure of an AO cannulated self drilling screw. A case report.

Cannulated AO screws are commonly used for fracture fixation. Mechanical failure of screws has been well reported but this was mainly breakage of the screw head during removal. We report an unusual mode of failure of an AO self drilling cannulated screw which we have not previously experienced, where the screw threads were found to be unravelled during insertion.

Survival benefit of the full selective digestive decontamination regimen.

Purpose: We assessed the impact of the full protocol of selective decontamination of the digestive tract (SDD) using parenteral and enteral antimicrobials on mortality.

Materials And Methods: A systematic review was performed searching MEDLINE, EMBASE, the Cochrane Register of Controlled Trials, previous meta-analyses, and conferences proceedings. We included all randomized controlled trials (RCTs) comparing the full protocol of SDD, including oropharyngeal and intestinal administration of antibiotics combined with the parenteral component, with no treatment or placebo.

Coronary artery stenosis.

The near exponential rise in percutaneous coronary intervention(PCI) in the treatment of patients with coronary artery disease and the consequent decline in referral of patients for coronary artery bypass grafting (CABG) has lead to a crisis in cardiac surgery. Is CABG, one of the most successful and widely applied surgical procedures, about to follow surgery for peptic ulcer disease into obsolescence? The question has serious implications for service provision and training as well as for informed patient consent. Keith Dawkins puts the case for PCI and gives a very clear and concise account of its inexorable rise to pre-eminence.

Coronary artery bypass.

Coronary artery bypass grafting as a means of myocardial revascularisation is a remarkably successful operation. Over 25,000 procedures are carried out each year in the UK with an operative mortality of the order of 2% achieved despite an ageing surgical population. Over the last decade, a remarkable increase in the number of patients treated percutaneously by angioplasty and stenting has lead to a levelling off, or even a decline, in the number of patients treated surgically.

Otogenic Fusobacterium meningitis, sepsis, and mastoiditis in an adolescent.

Fusobacterium necrophorum is a strict anaerobic organism responsible for a number of clinical syndromes known as necrobacillosis. Although meningeal infections with anaerobes are rare, delayed diagnosis and treatment can be potentially fatal. We report a unique case of Fusobacterium meningitis, mastoiditis, and sepsis in a previously healthy adolescent.