Suchergebnisse

In this soon-to-be gold-standard text, a distinguished panel of experts provides a comprehensive discussion of the various medical, neurological, psychiatric, and psychological factors underlying fatigue and sleepiness in the workplace and in patients. In reviewing current best practices in managing fatigue and sleepiness conditions to improve workplace safety, the book importantly begins with an overview of fatigue's definitions and concepts. It then moves into discussing the historical perspective on sleepiness and fatigue, the definitions and classifications of fatigue, and assessments of fatigue in the laboratory and in clinical settings. The book continues by exploring medical causes of fatigue in detail; how medication and recreational agents may result in fatigue; and the treatment of sleep disorders. Additional topics include best practices in the treatment of narcolepsy and hypersomnia, a review of circadian rhythm and fatigue, the treatment of heart failure and improvement in fatigue, and the management of fatigue in hospitalized patients. A major contribution to the field, this invaluable title will be of significant interest to all clinicians concerned with safeguarding safety in the workplace by accurately diagnosing and managing patients with fatigue and sleepiness problems. Researchers will also find this title of great interest

Amir Sharafkhaneh1,2, Nancy J Petersen2, Hong-Jen Yu2, Anand A Dalal3, Michael L Johnson2,4, Nicola A Hanania11Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA; 2Houston VA HSR&D Center of Excellence, Department of Veterans Affairs Medical Center, Houston, TX, USA; 3GlaxoSmithKline, Research Triangle Park, NC, USA; 4University of Houston, College of Pharmacy, Houston, TX,USABackground: Health care utilization and costs among US veterans with chronic obstructive pulmonary disease (COPD) were compared with those in veterans without COPD.Methods: A cohort of veterans with COPD was matched for age, sex, race, and index fiscal year to a cohort of veterans without COPD (controls) using data from the Veterans Integrated Service Network (VISN) 16 from 10/1/1997 to 9/30/2004. Annual total and respiratory-related health care service utilization, costs of care, comorbidities, and respiratory medication use at the time of diagnosis were assessed.Results: A total of 59,906 patients with COPD were identified for a 7-year period prevalence of 8.2%, or 82 per 1000 population. Patients with COPD compared with controls had significantly higher all-cause and respiratory-related inpatient and outpatient health care utilization for every parameter examined including mean numbers of physician encounters, other outpatient encounters, emergency room visits, acute inpatient discharges, total bed days of care, and percentage of patients with any emergency room visits or any acute inpatient discharge. Patients with COPD had statistically significantly higher mean outpatient, inpatient, pharmacy, and total costs than the control group. The mean Charlson comorbidity index in patients with COPD was 1 point higher than in controls (2.85 versus 1.84, P < 0.001). 60% of COPD patients were prescribed medications recommended in treatment guidelines at diagnosis.Conclusion: Veterans with COPD compared with those without COPD suffer a tremendous disease burden manifested by higher rates of all-cause and respiratory-related health care utilization and costs and a high prevalence of comorbidities. Furthermore, COPD patients do not receive appropriate treatment for their disease on diagnosis.Keywords: chronic obstructive pulmonary disease (COPD), veterans, health care utilization, costs, respiratory medicine, VA, economic burden, burden of illness