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
ReviewTargeting renal glucose reabsorption for the treatment of type 2 diabetes mellitus using the SGLT2 inhibitor dapagliflozin.
Sodium-glucose co-transporter 2 (SGLT2) plays a key role in glucose homeostasis as the key transporter responsible for most renal glucose reabsorption in the proximal tubules of the kidney. Dapagliflozin is a potent, selective, and reversible inhibitor of SGLT2 that lowers blood glucose levels in an insulin-independent fashion. This novel agent has been studied extensively in patients with type 2 diabetes mellitus (T2DM). ⋯ While there are no clinically significant negative effects on renal function or electrolytes, dapagliflozin treatment is associated with increased frequencies of urinary tract infections and vulvovaginitis/balanitis. With a mechanism of action that is distinct from and complementary to that of existing antihyperglycemic therapies, dapagliflozin is an effective antihyperglycemic agent that is well tolerated and may enhance weight loss. As such, dapagliflozin promises to become an important adjunctive therapy for comprehensive treatment of T2DM.
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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
ReviewDiabetic peripheral neuropathy and the management of diabetic peripheral neuropathic pain.
Diabetic peripheral neuropathy (DPN) affects approximately half of patients with diabetes. Neuropathic pain is a major complaint of patients with diabetic polyneuropathy. ⋯ This article provides an outline of the clinical subtypes, pathophysiological features, and diagnosis of DPN. Disease-modifying treatments are reviewed, with particular attention paid to DPN pain management.
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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.