EvergreenHealth

Abstract Introduction Approximately 29.4 million adults in the United States have obstructive sleep apnea (OSA) and prevalence continues to rise. At Oregon Health & Science University (OHSU), access to sleep medicine is limited and clinic wait times are long, often upwards of 90 days, creating significant barriers to timely diagnosis and treatment. This necessitates innovation in the diagnostic process. The electronic consult (eConsult) program at OHSU allows primary care providers to request an asynchronous chart review from a specialist to receive preliminary recommendations without a traditional in-person consultation. We aim to evaluate utilization of the eConsult program and its role in reducing wait times and increasing access to sleep medicine services at OHSU. Methods A retrospective review of the electronic health record was conducted on eConsult referrals made to the OHSU sleep medicine clinic for undiagnosed sleep apnea from January 1, 2017 through September 1, 2024. We reviewed data regarding latency between eConsult requests to sleep provider response. Results There were 3,631 eConsults for undiagnosed sleep apnea. We found that undiagnosed sleep apnea is the primary reason for eConsults, making up 57% of eConsults placed to sleep medicine. There was a 521% increase in eConsults for undiagnosed sleep apnea when comparing 2017 to 2024 and an average annual increase in eConsult volume of 450% per year. On average, 80% of eConsults received a response from a sleep provider within 72 hours (mean response latency = 1.7 days). Conclusion The volume of eConsult referrals for undiagnosed sleep apnea submitted to the OHSU sleep medicine clinic has increased steadily since its inception in 2017. This mirrors the increasing prevalence and awareness of OSA in the general population. eConsults drastically reduce latency between initial referral and sleep provider response, with the majority of recommendations provided within 72 hours. With actionable recommendations more quickly accessible, diagnostic testing can be more expeditiously ordered. This streamlined process enables more efficient triage of straightforward patients with strong suspicion for undiagnosed OSA, which can improve access to treatment and overall health outcomes. Support (if any)

BackgroundObstructive sleep apnoea (OSA) is common in commercial drivers, and associated with increased risk of crashes if untreated, making diagnosis and effective treatment crucial in this population.Study design and methodsThis is a retrospective summary of a clinical programme based on telemedicine and remote treatment monitoring developed with a national trucking company to screen new hires in the USA for OSA and implement positive airway pressure (PAP) management. New hires were informed of the programme and consented as part of their employment. Drivers who did not comply with the evaluation or with PAP after diagnosis were removed from driving commercial vehicles by the company or did not pursue further employment.ResultsA total of 975 drivers were enrolled. Among screened drivers, 35.5% were cleared without a sleep study, 15.0% were cleared following a sleep study (apnoea–hypopnoea index (AHI) <5 events·h−1), 22.1% had mild OSA (AHI 5–15) and 27.4% had moderate–severe OSA (AHI ≥15). Those with moderate–severe OSA were more obese (body mass index 36.2±6.3 kg·m−2) and had more comorbidities. Of 269 drivers starting PAP, 160 (59.5%) maintained participation in a care management programme, 80 (29.7%) resigned or were terminated, 23 (8.6%) were cleared to discontinue PAP and six (2.2%) were complex cases requiring transfer of care. Illustrating effectiveness, those that maintained participation had excellent PAP adherence (5.27±1.61 h·night−1; 88.5±12.9% days used; 79.7±17.7% days used ≥4 h).InterpretationRemote assessment of OSA and PAP management in commercial drivers is feasible and effective. This approach has wide-ranging applications, particularly in populations and areas with a lack of sleep medicine providers.

This study was designed to expand on a recent meta-analysis that identified ≤42 as the optimal cutoff on the Word Choice Test (WCT). We examined the base rate of failure and the classification accuracy of various WCT cutoffs in four independent clinical samples (N = 252) against various psychometrically defined criterion groups. WCT ≤ 47 achieved acceptable combinations of specificity (.86-.89) at .49 to .54 sensitivity. Lowering the cutoff to ≤45 improved specificity (.91-.98) at a reasonable cost to sensitivity (.39-.50). Making the cutoff even more conservative (≤42) disproportionately sacrificed sensitivity (.30-.38) for specificity (.98-1.00), while still classifying 26.7% of patients with genuine and severe deficits as non-credible. Critical item (.23-.45 sensitivity at .89-1.00 specificity) and time-to-completion cutoffs (.48-.71 sensitivity at .87-.96 specificity) were effective alternative/complementary detection methods. Although WCT ≤ 45 produced the best overall classification accuracy, scores in the 43 to 47 range provide comparable objective psychometric evidence of non-credible responding. Results question the need for designating a single cutoff as "optimal," given the heterogeneity of signal detection environments in which individual assessors operate. As meta-analyses often fail to replicate, ongoing research is needed on the classification accuracy of various WCT cutoffs.

Aim: The availability of long-term (>2years) safety outcomes of spinal cord stimulation (SCS) remains limited. We evaluated safety in a global SCS registry for chronic pain. Methods: Participants were prospectively enrolled globally at 79 implanting centers and followed out to 3yearsafter device implantation. Results: Of 1881 participants enrolled, 1289 received a permanent SCS implant(1776completed trial). The annualized rate of device explant was 3.5% (all causes), and 1.1% due to inadequate pain relief. Total incidence of device explantation >3years was 7.6% (n=98). Of these, 32subjects (2.5%) indicated inadequate pain relief as cause for removal. Implantsite infection (11 events) was the most common device-related serious adverse event(<1%). Conclusion: This prospective, global, real-world study demonstrates a high-level of safety for SCS with low rate of explant/serious adverse events. Clinical Trial Registration: NCT01719055 (ClinicalTrials.gov).

ABSTRACT This study was designed to determine the clinical utility of embedded performance validity indicators (EVIs) in adults with intellectual disability (ID) during neuropsychological assessment. Based on previous research, unacceptably high (>16%) base rates of failure (BR Fail ) were predicted on EVIs using on the method of threshold, but not on EVIs based on alternative detection methods. A comprehensive battery of neuropsychological tests was administered to 23 adults with ID (M Age = 37.7 years, M FSIQ = 64.9). BR Fail were computed at two levels of cut-offs for 32 EVIs. Patients produced very high BR Fail on 22 EVIs (18.2%-100%), indicating unacceptable levels of false positive errors. However, on the remaining ten EVIs BR Fail was <16%. Moreover, six of the EVIs had a zero BR Fail , indicating perfect specificity. Consistent with previous research, individuals with ID failed the majority of EVIs at high BR Fail . However, they produced BR Fail similar to cognitively higher functioning patients on select EVIs based on recognition memory and unusual patterns of performance, suggesting that the high BR Fail reported in the literature may reflect instrumentation artefacts. The implications of these findings for clinical and forensic assessment are discussed.

In Brief Asking questions and listening carefully using the Palliative Care Ask-Tell-Ask communication paradigm has the potential to enhance communication in normal and complicated pregnancies.

Abstract In Sahel countries in West Africa malaria remains a public health scourge. To strengthen the fight against malaria, weaknesses, and solutions must be identified before programs implementation. This study reports experiences gained from collaborations between decision-makers and researchers. This project was undertaken in the framework of the regional World Bank funded project titled: Malaria and Neglected Tropical Diseases in the Sahel (SM/NTD). The objectives of this World Bank program are to identifying bottlenecks in program implementation as well as the related research questions they enticed. National malaria control program managers and prioritization workshops were used as working method to identify research questions. These identified priority research questions were implemented in selected countries. The results of this study showed that priority issues were related to prevention, governance, drugs, monitoring, and evaluation of programs. The first five priority questions were related to (1) factors of compliance with drug doses for the second and third days during the seasonal chemoprevention (SMC) campaigns, (2) the contribution of community-based distributors to the management of severe cases of malaria in under 5 years-old children, (3) the SMC efficacy, (4) artemisinin-based combination therapy (ACTs) tolerance and efficacy according to existing guidelines, and (5) the quality of malaria control at all levels of the health system. In conclusion, this work showed the effectiveness of collaboration between implementers, programs managers, and researchers in identifying research questions. Furthermore, the results of this study will contribute to improve the implementation of malaria control programs across African countries.