What Is a Necessary Knowledge Base for Sleep Professionals?

Sleep medicine is multidisciplinary, and sleep medicine professionals should be trained to evaluate and treat all 88 sleep disorders. Sleep medicine specialists require a fund of knowledge that goes beyond what is obtained during a pulmonary fellowship. Skills required for a pulmonary sleep professional include: sleep medicine, neurobiology, psychiatry, neuro-psychology, neurology, pediatrics, and even limited exposure in otolaryngology, oral maxillofacial surgery, and dentistry. There is a paucity of publiished information concerning curricular requirements. Required skills for a sleep professional include proficiency in the clinical skills of sleep medicine as well as the technical skills of polysomnography. There is a very large knowledge content area requirement in both the basic sciences of sleep and the clinical aspects of sleep medicine. There are also important clinical skills content areas. As with all medical professionals, sleep professionals should have the highest ethical standards and a strong sense of responsibility toward their patients. A sleep medicine professional also has to be knowledgeable about administrative and legal aspects specific to sleep medicine. This essay reviews a sleep professional knowledge base model with emphasis on the requirements for a pulmonary sleep professional.     

A user's guide to enhancing geriatrics in an undergraduate medical school curriculum: the ten-step model to winning the "geriatric game"

In 1999, the University of Rochester School of Medicine and Dentistry committed to major restructuring of its undergraduate medical school curriculum. A distinguishing feature of this reform was the planned emphasis on and integration of several core topics or themes throughout the 4 years of the curriculum. One of these curricular themes was aging. The faculty in geriatrics was presented with an unparalleled opportunity to develop a geriatrics curriculum of major proportions through the development of an aging theme. Through a user's guide approach based on the authors' experience to date, this article identifies the 10 steps necessary to "win the geriatric game" successfully integrating an aging theme into an undergraduate medical school curriculum. Since the initiation of the aging theme, several new courses, cases, and conferences have been added or enhanced, affecting all 4 years of the curriculum. Key operational challenges included successful engagement of course directors, tracking the actual experience of the aging theme, and evaluation of students' attainment of learning objectives and eventual career choices. The authors' experience suggests that an aging theme can successfully enhance the geriatrics curricular content of undergraduate education and strongly affect students across all 4 years. This 10-step approach may serve as a model for other universities committed to integrating geriatrics across the full undergraduate medical curriculum.     

A vertically integrated geriatric curriculum improves medical student knowledge and clinical skills

The objective of this study was to determine the effect of a vertically integrated curriculum intervention on the geriatric knowledge and performance in clinical skills of third-year medical students. This observational cohort study conducted at the University of Michigan Medical School evaluates the performance of 622 third-year medical students from the graduating class years of 2004 through 2007. An integrated curriculum intervention was developed and implemented for the class of 2006. Its elements included identification and tracking of geriatric learning outcomes in an individualized Web-based student portfolio, integration of geriatric content into preclinical courses, development of a geriatric functional assessment standardized patient instructor, and an experience in a geriatrics clinic during the ambulatory component of the third-year internal medicine clerkship. Medical student performance was assessed on a geriatric knowledge test and during a geriatric functional assessment station administered during an Observed Structured Clinical Examination (OSCE) at the beginning of the fourth year. Student performance on the geriatric functional assessment OSCE station progressively improved from pre-intervention performance (mean performance+/-standard deviation 43+/-15% class of 2005, 62 + 15% class of 2006, 78+/-10% class of 2007; analysis of variance, P<.001). Similarly, student performance on the geriatric knowledge test was significantly better for the classes of 2006 and 2007 than for the class of 2005 (model F ratio=4.72; P<.001). In conclusion, an integrated approach to incorporating new educational geriatric objectives into the medical school curriculum leads to significant improvements in medical student knowledge and in important clinical skills in the functional assessment of older patients.     

Undergraduate allergy teaching in a UK medical school: mapping and assessment of an undergraduate curriculum.

BACKGROUND: Concerns have been expressed by patient and professional bodies, and the UK Parliamentary Health Select Committee, about the poor standard of allergy teaching in UK medical schools. It is argued that this deficiency is an important contributing factor to the generally poor quality of care experienced by patients with allergic disorders. Allergy services are currently being reviewed by the Scottish Executive and Department of Health for England. OBJECTIVE: To describe and map the teaching of allergy-related topics in the formal undergraduate curriculum of a UK medical school. METHODS: We undertook a systematic analysis of learning objectives and other electronic documentation of modules taught during the five years of undergraduate medical training at the University of Edinburgh. RESULTS: Allergy and allergy-related topics are mentioned within the learning objectives of 11 (26%) of the 43 modules in the five-year MBChB curriculum. Our overall assessment reveals significant gaps in the described curriculum regarding allergy-related topics. CONCLUSION: Although formal teaching on allergic disorders has been identified in a number of modules throughout the five years, it is not comprehensively described in the course documentation and significant gaps exist. We accept that the delivered curriculum may not be captured by the level of detail present in the learning objectives and recommend that further mapping and triangulation is undertaken through student focus groups and information gathering from teaching staff. We also recommend that in the absence of informal and clinical attachment opportunities in allergic disorders, the stated learning objectives be developed into a coherent vertical element throughout the medical curriculum. This, together with an advocate and suitable assessment, would increase the impact of allergy training on students and emphasise the knowledge and skills required to deliver high quality allergy care.     

Education and training in the field of sleep medicine

Sleep disorders are highly prevalent but are under-recognized and under-diagnosed by the majority of health care providers. This article reviews recent studies of sleep medicine education in the United States and abroad and the reasons offered by most instructors for the lack of adequate education at their institutions. Quantity and quality of sleep medicine education have been lacking. Knowledge assessment is an important aspect of educational research, and several instruments for the assessment of sleep knowledge have been developed. A noteworthy development is the Sleep Academic Award program of the National Center on Sleep Disorders Research. This twenty-site, NIH-funded program has developed model interventions and sleep training curricula that are being widely disseminated. Sleep medicine fellowship training programs have also been established in the past decade and serve as the major vehicle for advanced specialty training. Finally, a number of strategies for introducing sleep medicine topics and issues into the medical curriculum have been proposed. Considering the paucity of publications in this area, our review was not restricted to studies in the past year.     

Medical Students' Recognition and Application of Geriatrics Principles in a New Curriculum

Given the aging U.S. population, it is imperative that medical students recognize and apply geriatrics principles. To address this need, in 2006, the Warren Alpert Medical School of Brown University integrated geriatrics content into a new medical school curriculum. Preclinical and clinical medical students submitted written reflective journals in response to prompts regarding the geriatrics content of the new medical school curriculum, including their didactic and clinical experiences. An interdisciplinary team used a structured qualitative approach to identify themes, including the recognition and application of geriatrics principles. Thirty medical student journalers submitted 405 journal entries. Themes regarding students' emerging understanding of geriatrics principles included a growing understanding of geriatrics principles, recognition of the importance of psychosocial factors and patient preferences in caring for older adults, recognition of the complexities of treating older adults and application of geriatric principles to clinical situations, and understanding of physicians' roles in managing the care of older adults. Medical student reflective journaling allows medical educators to obtain timely feedback on curricular innovations and helps illuminate the process by which medical students learn to recognize and apply core geriatrics principles.     

Sleep and sleep disorders

Sleep is a complex neurological state, with its primary function of providing rest and restoring the body's energy levels. The importance of sleep could be seen from the fact that people spend about one-third of their lifespan in sleep. Normal human sleep is divided into non-rapid eye movement (NREM) and rapid eye movement (REM) sleep, and the alteration between NREM and REM occurs about 4-5 times during a night of normal sleep. Human NREM sleep could be classified into four stages, namely, stage I, II, III and IV, representing successively deeper stages of sleep. Sleep is an active rhythmic neural process produced by several brain areas, of which the preoptic and other basal forebrain areas play a major role in the generation of NREM sleep. Interaction of the pedenculo-pontine and lateral dorsal tegmental areas with the dorsal raphae nucleus and locus coeruleus, is important for REM sleep generation. Suprachiasmatic nucleus of the hypothalamus and the pineal gland ensure that sleep and wakefulness follow a circadian periodicity of nearly 24 hours. Alterations in the quality, quantity and pattern of sleep result in sleep disorders. Persistent and repeated interruption of sleep affects the health of an individual. Undiagnosed and untreated wake/sleep complaints cause not only misery to the sufferer, but it also has socio-economic consequences. Sleep disorders cover a wide spectrum of diseases. Though there are more than 100 identified sleep/wake disorders, most sleep complaints can be categorised into five, namely, hypersomnia, insomnia, circadian rhythm disorders, parasomnias, and sleep disorders associated with mental, neurological, and other medical disorders. Researches during the last 50 years, and the advances made in clinical sleep medicine, have lead to more effective treatments for the myriad human sleep disorders. It is not possible to assign a specific reason for many of the sleep disorders, but some aspects of sleep and wakefulness are genetically influenced. But, most commonly, sleepiness during waking hours, results from volitional or forced sleep deprivation during previous nights, due to social, economic and environmental reasons. So, public awareness about sleep disorders should be an essential part of any programme aimed at global management of sleep disorders.     

Sleep disorders in adolescents and young adults: Insights into types,relationship to obesity and high altitude and possible lines of management

A sleep disorder is a medical disorder of the sleep pattern of a person that may be serious enough to interfere with normal physical, mental and emotional functioning. Disruptions in sleep can be caused by a variety of causes, from teeth grinding to night terrors. Sleep disorders are usually prevalent among adolescents and young adults, possibly due to factors related to life style, dietary habits, hormonal and emotional disturbances. Other factors that may precipitate sleep disorders include environmental, psychological and genetic factors. Sleep disorders may lead to serious psychological and mood disorders and may even affect the immune system. Management of sleep disorders depends on amelioration of the precipitating factors and the use of certain drugs that may help to restore the normal sleep-wake cycle. This review sheds light on sleep disorders in adolescents and young adults regarding their types, etiology, dangers and possible lines of management.     

Sleep and older patients

Sleep disturbances are common among older adults. The elderly population reports more symptoms associated with poor sleep initiation and maintenance and increased daytime napping. Sleep problems may be caused by various factors, including medication use, medical and psychiatric illnesses, and primary sleep disorders. The consequences of poor sleep quality may include cognitive impairment, daytime sleepiness, and reduced quality of life. The evaluation and management of these disorders is discussed in this review.     

A case-oriented web-based curriculum in geriatrics for third-year medical students

OBJECTIVES: This paper describes the development, implementation, and evaluation of a case-oriented, web-based curriculum in geriatric medicine for third-year medical students. DESIGN: Single cohort, pre/post trial. SETTING: University of Kansas School of Medicine, Kansas City, Kansas. PARTICIPANTS: Third-year medical students (n = 130). INTERVENTION: A web-based curriculum, offered during a clinical geriatrics clerkship, is composed of 13 case-oriented, web-based modules spanning key topics in geriatric medicine. Each module topic is also reviewed in a post-module, faculty-led discussion session. MEASUREMENTS: A pre-and post-rotation test of knowledge was completed. Student feedback about the curriculum was collected through web-based and written evaluation. MAIN RESULTS: Pre-and post-rotation comparison of examination scores demonstrated an average increase of 13 correct items on a 40-item exam. Seventy-five percent of students rated each module favorably at the time of completion (range 53-89%). Most modules (10/13) were rated as excellent or good after all modules had been completed. CONCLUSIONS: A case-oriented web-based curriculum in geriatrics was rated favorably by third-year medical students. Students' knowledge increased in key geriatric topics. Student feedback allows for continuous improvement of the curriculum. This model of curricular innovation may be useful for other institutions seeking to develop or enhance geriatric medicine content in the medical school curriculum.     

Educational innovations in academic medicine and environmental trends

Fifteen educational innovations in academic medicine are described in relation to 5 environmental trends. The first trend, demands for increased clinical productivity, has diminished the learning environment, necessitating new organizational structures to support teaching, such as academies of medical educators, mission-based management, and faculty development. The second trend is multidisciplinary approaches to science and education. This is stimulating the growth of multidisciplinary curricular design and oversight along with integrated curricular structures. Third, the science of learning advocates the use of case-based, active learning methods; learning communities such as societies and colleges; and instructional technology. Fourth, shifting views of health and disease are encouraging the addition of new content in the curriculum. In response, theme committees are weaving content across the curriculum, new courses are being inserted into curricula, and community-based education is providing learning experiences outside of academic medical centers. Fifth, calls for accountability are leading to new forms of performance assessment using objective structured clinical exams, clinical examination exercises, simulators, and comprehensive assessment programs. These innovations are transforming medical education.     

Sleep history is neglected diagnostic information

Sleep problems are treatable causes of morbidity and mortality, but little is known about how often the history fundamental to diagnosis is obtained. We recorded the frequency of sleep histories during encounters with simulated patients by 20 experienced primary care practitioners, 23 uninstructed medical interns, and 22 interns who had previous instruction about sleep disorders. Sleep histories were uncommonly obtained by uninstructed physicians (0% of practitioners, 13% of interns), but trained interns more often (81.8%) asked about sleep. If sleep problems are to be prioritized, major changes in physician education and behaviors are essential. Focused instruction about sleep influences physician behavior. Supported by National Heart, Lung, and Blood Institute Sleep Academic Award 1K07HLO 3647-012HL1CCP-1 (SI) and by Grant 1K07HL0 2479-01A1.     

Sleep Disorders

Sleep disorders are frequent and can have serious consequences on patients’ health and quality of life. While some sleep disorders are more challenging to treat, most can be easily managed with adequate interventions. We review the main diagnostic features of 6 major sleep disorders (insomnia, circadian rhythm disorders, sleep-disordered breathing, hypersomnia/narcolepsy, parasomnias, and restless legs syndrome/periodic limb movement disorder) to aid medical practitioners in screening and treating sleep disorders as part of clinical practice.     

Complementary and alternative medical therapies: implications for medical education

Increased use of complementary and alternative medicine (CAM) has made it imperative that these topics be included in medical education from the preclinical years through residency and beyond. There has been progress in this direction in recent years, with a steady increase in the number of medical schools that include CAM therapies in their curricula. There remains, however, a lack of clear goals and concrete suggestions for implementing these changes. This article examines the questions that arise when medical educators consider how to incorporate CAM therapies as an integral part of the medical curriculum. It offers practical suggestions for finding time in an already packed curriculum, getting started, including faculty and students in the process, and sustaining the initiative with the necessary administrative and institutional support.     

Sleep disorders over the full range of chronic kidney disease

Sleep disorders are common and underrecognized in patients at all stages of chronic kidney disease. They include sleep apnea, insomnia, excessive sleepiness, restless legs syndrome and periodic limb movement disorder. They can be related to underlying uremia or comorbidities. Sleep disorders can affect the quality of life, and some are associated with increased morbidity and mortality. Clinical assessment, polysomnography and other standardized assessments are required for diagnosis. Therapeutic approaches include improvement in uremia management, treatment of comorbidities or specific interventions directed at individual sleep disorders. Diagnosis and treatment of sleep disorders in this population may improve quality of life and patient survival.     

Sleep disturbance in menopause

Sleep disturbance during menopause is a common and important complaint faced by many women. There are many factors that may play a role in this problem, including vasomotor symptoms and changing hormone levels, circadian rhythm abnormalities, exacerbation of primary insomnia, mood disorders, coexistent medical conditions as well as lifestyle factors. Sleep can be measured both objectively and subjectively; however, correlation between the two measures is not high. Most of the menopause-related sleep disturbances have been reported as qualitative in nature; however, there have also been studies showing changes in objective measures. This discrepancy has implications with regard to evaluation of research in sleep and menopause, as well as application in the clinical setting. Investigations of inadequate sleep and sleep problems during the menopausal period and obtaining a thorough understanding of the factors contributing to these problems are essential in formulating treatment strategies. Such strategies can vary from hormonal treatment and medications to lifestyle and behavioural modification.     

Evidence-Based Recommendations for the Assessment and Management of Sleep Disorders in Older Persons

Sleep-related disorders are most prevalent in the older adult population. A high prevalence of medical and psychosocial comorbidities and the frequent use of multiple medications, rather than aging per se, are major reasons for this. A major concern, often underappreciated and underaddressed by clinicians, is the strong bidirectional relationship between sleep disorders and serious medical problems in older adults. Hypertension, depression, cardiovascular disease, and cerebrovascular disease are examples of diseases that are more likely to develop in individuals with sleep disorders. Conversely, individuals with any of these diseases are at a higher risk of developing sleep disorders. The goals of this article are to help guide clinicians in their general understanding of sleep problems in older persons, examine specific sleep disorders that occur in older persons, and suggest evidence- and expert-based recommendations for the assessment and treatment of sleep disorders in older persons. No such recommendations are available to help clinicians in their daily patient care practices. The four sections in the beginning of the article are titled, Background and Significance, General Review of Sleep, Recommendations Development, and General Approach to Detecting Sleep Disorders in an Ambulatory Setting. These are followed by overviews of specific sleep disorders: Insomnia, Sleep Apnea, Restless Legs Syndrome, Circadian Rhythm Sleep Disorders, Parasomnias, Hypersomnias, and Sleep Disorders in Long-Term Care Settings. Evidence- and expert-based recommendations, developed by a group of sleep and clinical experts, are presented after each sleep disorder.     

Undergraduate allergy teaching in a UK medical school: comparison of the described and delivered curriculum.

BACKGROUND: Concerns have been raised about the adequacy of allergy teaching in UK undergraduate medical curricula. Our previous work, which involved undertaking a systematic analysis of the documented curricular learning objectives relating to allergy teaching in a UK medical school, found references to allergy teaching in each of the five years of study but also identified some apparent omissions in allergy teaching. These may represent actual gaps in relation to allergy training, or alternatively may reflect dissonance between the described and delivered curricula. OBJECTIVE: To compare the described and delivered undergraduate curricula on allergy and allergy-related topics in a UK medical school. METHODS: We identified and e-mailed the individuals responsible for each of the 43 modules in the five-year undergraduate medical programme at the University of Edinburgh, enquiring about the delivery of allergy-related teaching within their modules. We then compared these responses with the results of the previous study mapping allergy-related teaching across the undergraduate curriculum. RESULTS: Fifty-one individuals were identified as being responsible for leading the 43 modules in the curriculum. Forty-nine (96%) of these module organisers responded to our enquiry; these individuals represented 41 of the 43 modules (95%). Module organisers reported that allergy-related teaching and learning was delivered in 14 modules (33%), was absent in 13 (30%) modules, and may occur to varying degrees within a further 10 (23%) modules. Module organisers' responses about the delivered curriculum on allergy were consistent with the findings from documented learning objectives in 21 (49%) modules. They also reported allergy teaching and learning in modules which had not been identified by examination of the learning objectives; however, there were still important gaps in the allergy-related curriculum. CONCLUSIONS: Information gathered from teaching staff confirms that specific teaching and learning on allergic disorders is currently being delivered in all five years of the undergraduate curriculum. However, comparison between the described and delivered curricula on allergy revealed discrepancies highlighting the complex nature of the undergraduate curriculum and the difficulties involved in mapping specific teaching themes within them. This assessment has revealed gaps in allergy training which need to be addressed.     

缺血性卒中患者的睡眠障碍：病理生理学机制和治疗

睡眠障碍是缺血性卒中的一种常见并发症,如不及时诊断和治疗,可影响卒中的康复和复发。根据梗死部位的不同,睡眠障碍的表现形式多样。对于卒中后睡眠障碍的治疗,目前临床上多采取药物和物理治疗相结合的方法。近年来,随着多导睡眠监测技术的广泛应用,卒中后睡眠障碍已能得到明确和细致的诊断。针对卒中后睡眠障碍的治疗可明显改善患者的预后。