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( Su Shian Lee ),( Stephanie Ward ),( Madan G Saha ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1
Background: Elderly people experience a high prevalence of insomnia and poor sleep quality. Though the risks of hypnosedatives are well documented in this population, its use is highly prevalent. This paper provides an overview of non-pharmacological strategies available, and their evidence of effectiveness for the treatment of insomnia in the elderly. Methods: A literature search was performed using electronic searches on Medline, PsychINFO, EMBASE, Pubmed and the Cochrane library databases from 1995 till 2014. Relevant publications were also sought from citations and through manual searches of review articles. Search limiters were age above 60 years and English language. Key meta-analyses, systematic reviews, interventional and observational studies were identifi ed, reviewed, and available evidences summarized. Results: To improve symptoms of insomnia, there is evidence to suggest that in cognitively intact people, cognitive behavioural therapy (CBT) is effective. This review revealed confi icting evidence in regards to the effectiveness of physical exercises, bright light therapy and thermal manipulations for the treatment of insomnia. In residential care facilities, noise reduction strategy as a stand-alone therapy for insomnia was not effective but minimizing nocturnal interventions such as incontinence and pressure care, reduced night-time sleep disruptions. Conclusion: With the exception of CBT, there is currently limited evidence to suggest that bright light therapy, physical exercises and thermal manipulation are effective for treatment of insomnia in the elderly. This is due to small number of studies, small sample sizes, short follow-up, and strict patient selection criteria in reviewed studies. However, given its lack of adverse effects in contrast to hypnosedatives, non-pharmacological interventions may be considered as the fi rst line intervention for insomnia in the elderly.
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Grégoire P. Chatain,Keshari Shrestha,Michael W. Kortz,Stephanie Serva,Patrick Hosokawa,Ryan C. Ward,Akal Sethi,Michael Finn 대한척추신경외과학회 2022 Neurospine Vol.19 No.2
Objective: Spinal arachnoid cysts (SACs) are rare lesions that often present with back pain and myelopathy. There is a paucity of literature evaluating the impact of surgical timing on neurological outcomes for primary SAC management. To compare long-term neurological outcomes in patients who were managed differently and to understand natural progression of SAC. Methods: We conducted a retrospective analysis of adult patients treated for SAC at our institution from 2010 to 2021, stratified into 3 groups (conservative management only, surgical management, or conservative followed by surgical management). Study outcome measures were neurological outcomes as measured by modified McCormick Neurologic Scale (MNS), postoperative complications, and cyst recurrence. Nonparametric analysis was performed to evaluate differences between groups for selected endpoints. Results: Thirty-six patients with SAC were identified. Eighteen patients were managed surgically. The remaining 18 patients were managed conservatively with outpatient serial imaging, 7 of whom (38.9%) ultimately underwent surgical treatment due to neurological decline. Most common presenting symptoms included back pain (50.0%), extremity weakness (36.1%), and numbness/paresthesia (36.1%). Initial/preoperative (p = 0.017) and 1-year postoperative (p = 0.006) MNS were significantly different between the 3 groups, but not at 6 weeks or 6 months postoperatively (p > 0.05). Additionally, at 1 year, there was no difference in MNS between patients managed surgically and those managed conservatively but ultimately underwent surgery (p > 0.99). Conclusion: Delayed surgical intervention in minimally symptomatic patients does not seem to result in worse long-term neurofunctional outcomes. At 1 year, postoperative MNS were significantly higher in both surgical groups, when compared to the conservative group highlighting worsening clinical picture regardless of preoperative observational status.
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