Cleveland Clinic journal of medicine
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The presentation of pericardial disease can be unusual, and what is assumed to be pericardial disease may not be. Knowing pericardial and mediastinal anatomy is vital for understanding these unusual presentations. This review focuses on the history, physical examination, and fundamental diagnostic testing, integrated with pericardial and mediastinal anatomy and pathophysiology.
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Insomnia is a common and challenging complaint in older adults (> 65 years) because of age-related alterations in sleep physiology. Cognitive behavioral therapy for insomnia is the gold standard for treatment of insomnia in young as well as older patients. ⋯ Pharmacologic options for older adults include low-dose doxepin, melatonin, ramelteon, and the dual orexin receptor antagonists. A well-informed clinician can help patients navigate the risks and benefits of both pharmacologic and behavioral options.