Hypnotics and occupational medicine
Article Abstract:
A class of drugs that are commonly prescribed for insomnia or other sleep disorders is hypnotics. Although they are effective in inducing sleep in most people, they may not help people to stay asleep, and are probably not effective for the treatment of chronic insomnia. The most appropriate use of these drugs is to treat short-term sleep disorders that result from sleep schedule changes such as jet lag, or from a life crisis. Hypnotics are also known to cause skill impairments and can diminish motor skills, ability to make decisions, and can affect interpersonal relationships. Hypnotics also have potential adverse effects on job skills and overall performance levels when viewed in the context of occupational medicine. The effect of these drugs on performance and the pharmacological properties of this class of drugs are reviewed. Two approaches to assessing performance impairment are through laboratory tests that measure the effects of hypnotics on specific job-related skills, and by observation of actual performance of the individual while he is taking the drug. Interpretation problems exist, and it is questionable how well laboratory-derived data can actually be applied to real-life situations. Caution should always be used when there is any possibility that a drug will affect job performance. The benefits must be weighed against potential safety hazards that may result from the use of such drugs. Continuous doses over time should be considered, and rates of absorption and distribution of individuals compounds, as well as the possible accumulation of a metabolite, may result in indirect side effects and performance impairment. For example, flurazepam is known to have a slow elimination rate and residual effects of this hypnotic are likely; if taken at night on a regular basis, some daytime sedation will result. The effective management of sleep disturbance requires a good understanding of the reasons for the patient's insomnia and consideration of the action and potential side effects of the hypnotic. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Journal of Occupational Medicine
Subject: Health care industry
ISSN: 0096-1736
Year: 1990
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Clinical findings associated with acute proximal deep vein thrombosis: a basis for quantifying clinical judgment
Article Abstract:
Acute proximal deep vein thrombosis (DVT) can be difficult to diagnose based on symptoms and physical findings. Multivariate testing can assist in the diagnostic process. These techniques were used to estimate the probability of DVT in a group of 355 symptomatic patients. Records of 355 patients who underwent venography were reviewed, and data on 76 items were collected. Independent correlates of DVT were identified using 236 charts, and the results were applied to the remaining 119 patients. The findings indicated that DVT was identified by venogram in 27 percent of the cases. Five independent correlates were found that were predictive of DVT in the test group: swelling above the knee, swelling below the knee, recent immobility, cancer, and fever. In patients without clinical evidence of DVT, the incidence of DVT was five percent. In the other patients diagnosed with DVT, 15 percent had one correlate, and 42 percent had two or more correlates. If just the patients with one or more clinical correlate had undergone venogram, 97 percent of the cases would have been diagnosed. However, 26 percent of the patients underwent a venogram unnecessarily. This provides a quantitative method of estimating the probability of DVT, based on clinical findings. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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