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Ineffective handoffs are associated with medical errors and adverse outcomes. Intrahospital handoffs occur at shift change, patient transfer, and service change. Handoff interventions often include structural interventions (eg, mnemonics, electronic tools, and protected time) and/or educational interventions. Many studies of handoff interventions demonstrate improvement in process measures or information transfer. One of the few studies to demonstrate a significant improvement in clinical outcomes is the I-PASS study. Future research should address the limitations of existing data and investigate emerging approaches to enhance patient handoffs, including the use of artificial intelligence as a novel model for improving intrahospital transitions of care.
This article presents an overview of sleep as a vital physiologic state that supports homeostasis, cognitive performance, and overall health. It reviews the epidemiology of sleep, emphasizing standard sleep patterns and the population burden of sleep disorders. The article then summarizes the evolution of sleep medicine, from descriptive clinical observation to experimental and electrophysiological research that established the neural basis of sleep. It concludes with an overview of contemporary management of sleep-related breathing disorders and the role of interdisciplinary sleep care.
Use of continuous subcutaneous insulin infusion (CSII, also known as insulin pump) therapy is a well-established option for outpatient management for patients with diabetes mellitus who require insulin therapy. If an individual on CSII therapy is hospitalized, it is feasible for them to continue to utilize their technology throughout the hospital stay. Proper patient selection, an approved institutional policy, and effective communication between hospital staff and the patient are all essential for outpatient CSII therapy to be safely transferred into the hospital setting. The following summary provides an update regarding the outpatient to inpatient transition of CSII therapy.
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The reported prevalence of sleep disorders in the dental population ranges between 15% and 60%. Sleep has been known to have a bidirectional relationship with systemic diseases. There has been a steady increase in the occurrence of sleep disorders over the past few decades. Among the systemic factors that have robust bidirectional relationships with sleep disorders, are cardiovascular, endocrine, aging, and medications. This article explores how sleep disorders can be etiologically related to these systemic conditions, and how sleep can be affected by the same. It also explores deeper into the management of sleep disorders that are in systemic conditions.
The impact of sleep on health has been the topic of recent research. Numerous systemic conditions and diseases may have a significant impact on sleep, and vice versa. There are complex interrelationships between sleep and health in special populations as well. This article, therefore, explores and highlights the key elements in this regard. In this article, a few of the systemic factors and conditions with the most robust effect on sleep have been selected. It is obvious that systemic conditions such as cardiovascular, respiratory, endocrine, renal, and other disorders have robust impact on sleep patterns and quality, and vice-versa.
Both sleep medicine and dental sleep medicine have undergone explosive changes over the recent few decades. Newer diagnostic approaches and technological innovations have driven these branches of medicine into the new era of succinct interdisciplinary collaborative care among these specialties. Dental clinicians have a unique opportunity to routinely screen their patients for sleep-disordered breathing and related abnormalities, ensuring prompt referral to the appropriate physician. Furthermore, the dentist has the ability to work as part of the interdisciplinary multispecialty team, addressing the burden of unmet treatment needs. The dental appliance has successfully managed cases of snoring and obstructive sleep apnea.
Neurodegeneration is mostly irreversible and progressive. Neurodegenerative diseases (NDDs) represent a large group of disorders that have varied clinical and pathologic representations. These include Alzheimer's disease, Parkinson's disease, vascular dementia, and amyotrophic lateral sclerosis, among others. A common factor in all these NDDs is sleep disorders (SDs). NDDs and SDs are bidirectional. Screening for SDs should be an integral part of a workup of NDDs. Management of one can improve the prognosis of the other.
This article provides background on the impact of Social Determinants of Health (SDOH) and the need to integrate SDOH into the electronic health record for care quality. SDOH screening, documentation, and predictive modeling are all covered. Recent literature is reviewed discussing challenges and opportunities for clinicians and health systems to improve value-based, outcome-driven quality care.
Insulin is a safe, effective, and versatile therapy for the inpatient management of diabetes. Insulin is available as long-acting and short-acting formulations, and special forms of insulin such as intermediate or ultraconcentrated insulin. Evidence supports the use of insulin in hospitalized patients as basal-bolus and basal only along with utilization of supplemental or correctional insulin. Initiation of insulin should consider patient factors like weight, age, renal function, insulin naïve, and nutritional status. Dose titration should be systematic based on persistent hyperglycemia or the development of hypoglycemia.
This article traces the historical evolution and current complexities of clinical documentation, emphasizing its transformation under regulatory, financial, and technological influences. It explores how documentation practices-shaped by stakeholders like Centers for Medicare and Medicaid Services, insurers, and legal systems-affect clinical workflows and provider burden. The article identifies major challenges, such as note bloat, inefficiency, and burnout, and reviews innovative solutions, including artificial intelligence-enhanced tools and design changes in electronic health records. It calls for stakeholder collaboration and evidence-based reform to make documentation more meaningful, efficient, and supportive of clinician well-being.
Sleep disorders are highly prevalent and significantly impair physical, cognitive, and psychological functioning. Conventional management strategies such as pharmacotherapy and cognitive behavioral therapy for insomnia are effective for many individuals, but may be limited by side effects, accessibility issues, adherence challenges, and patient preference for non-pharmacological options. Consequently, complementary and alternative medicine approaches have gained increasing attention as potential adjuncts or alternatives for managing sleep disturbances. This review examines the role of alternative therapies, including, but not limited to, mindfulness and meditation, yoga and relaxation techniques, music therapy, herbal supplements, aromatherapy, and hypnosis, in the management of sleep disorders.
Care transitions among older adults are common and made more complex by multimorbidity, polypharmacy, frailty, and fragmented care. Transitions may be prompted by changes in clinical status, including the need for end-of-life care, or social status. Numerous interventions to predict, prevent, and improve care transitions for older adults have been tested. In this article, we will provide a high-level overview of common care transitions for older adults, reasons why an older adult may experience a care transition, outcomes specific to older adults, and proposed interventions.
The benefits of sufficient high-quality sleep are well documented; however, hospitalized patients frequently experience inadequate sleep due to standard care practices requiring frequent assessments. Patient surveys identify staff interruptions and environmental noise as primary contributors. Institutional barriers, including the absence of formal sleep-promoting policies and limited staff training, further exacerbate the issue. Both pharmacologic and nonpharmacologic interventions have been developed to enhance sleep and improve outcomes such as length of stay and patient experience, though findings remain inconsistent. Evidence suggests these interventions are generally safe and further research is needed to optimize inpatient sleep quality.
Sleep disturbances and disorders in women are influenced by hormonal, physiologic, and psychosocial factors across the reproductive lifecycle. Etiologies include menstrual cycle fluctuations, perimenopausal transitions, postmenopausal hormonal decline, and conditions such as premenstrual syndrome, premenstrual dysphoric disorder, and dysmenorrhea. The presentation of common symptoms such as insomnia, fragmented sleep, or poor sleep quality, within specific hormonal phases, is crucial for accurate diagnosis. The source of sleep disruption often differs, with underlying systemic or psychiatric conditions contributing to the presentation. These disorders pose a significant diagnostic challenge due to their overlap with general sleep-related complaints, leading to misdiagnosis and inadequate treatment.
Both therapeutic and nontherapeutic medications have a profound influence on sleep architecture, a vital component of overall health. Optimizing patient outcomes requires a clear understanding of how commonly prescribed drug classes affect the quality, duration, and structure of sleep. Clinicians should carefully consider these pharmacologic effects when selecting or modifying treatment regimens, particularly in patients with comorbidities or underlying sleep disorders. The widespread use of herbal and over-the-counter preparations further underscores the importance of comprehensive medication reviews and patient education. A thorough understanding of drug sleep interactions enables clinicians to deliver more informed, individualized, and safer patient care.
Care transitions remain high-risk periods, with up to 28% of patients experiencing adverse events (AEs) or readmissions within 30 days of discharge. This article examines digital innovations reshaping postdischarge care: synchronous telehealth for scheduled follow-up, remote patient monitoring for continuous surveillance between encounters, and artificial intelligence for risk prediction and clinical decision support. Evidence demonstrates these technologies can improve outcomes when integrated into redesigned care pathways with multidisciplinary coordination. Advancing technology-enabled postdischarge care requires value-based payment reform, equity-focused design, seamless workflow integration, and comparative effectiveness research measuring preventable AEs.
Sleep and psychiatric disorders seem to have strong associations, which are bidirectional. Impaired sleep is a risk factor for psychiatric entities, and conversely, psychiatric symptoms tend to aggravate and perpetuate sleep disturbances. Sleep disorders and psychiatric diseases have other common systemic comorbidities as well. Further, there is mounting evidence to suggest that common underlying factors exist for psychiatric and sleep disorders. This article explores the bidirectional nature of sleep and psychiatric comorbidities and also the overlap in the clinical symptomatology. Insomnia seems to be the most common sleep disorder comorbid with psychiatric disorders.
The neurophysiology of sleep and the pathophysiology of substance use disorders (SUDs) involve overlaps in neurotransmitters and pathways. SUDs and substance withdrawal are accompanied by significant impairments in sleep. Conversely, sleep disturbances are known to predispose for SUDs. Sleep disorders (SDs) such as insomnia, short sleep duration, and excessive daytime sleepiness have been causally related to SUD initiation and maintenance. Management of SUDs integrally depends on the successful management of the associated SDs, and vice versa.
The prevalence of hospitalized patients with diabetes is growing. Dysglycemia in the hospital is associated with adverse outcomes, leading to increased health care costs. With this review the authors provide detailed information on the importance of inpatient diabetes management and what the best approaches are to improve glycemic control in the hospital. They recommend management strategies in the inpatient setting that focus on patients, methods of glucose monitoring, which medications can be used for hyperglycemia treatment, which diabetes team models can be used, as well as how to address dietary management of diabetes and self-management of diabetes in the hospital.