Chronic sleep loss decreases performance - One night of good sleep is not enough to recover from chronic sleep deficit

On average, a person needs about eight hours a night to preserve performance.

Acute sleep loss is being awake for more than 24 hours in a row and chronic sleep loss is getting only about four to seven hours of sleep per night.

While most people caught up on acute sleep loss with a single night of 10 hours sleep, those with chronic sleep loss showed deteriorating performance for each hour spent awake.

People are largely unaware that they are chronically sleep-deprived but they are more vulnerable to sudden sleepiness, inattentiveness, and potentially, accidents and errors.

Three days is not enough to recover from chronic sleep loss, but they still do not know how many days or weeks may be needed.

References:
Chronic sleep loss hampers performance. Reuters, 2010.

Image source: Sleeping kitten. Wikipedia, Tilman Piesk, public domain.

Electronic Prescribing Decreases Prescribing Errors Seven Fold

For e-prescribing adopters, error rates decreased nearly sevenfold, from 42.5 per 100 prescriptions at baseline to 6.6 per 100 prescriptions one year after adoption.

For non-adopters, error rates remained high at 37 per 100 prescriptions at baseline and 38 per 100 prescriptions at one year.

Illegibility errors were very high at baseline, and not surprisingly, were completely eliminated by e-prescribing (87.6 per 100 prescriptions at baseline for e-prescribing adopters, 0 at one year).

Prescribing errors may occur much more frequently in community-based practices than previously reported. This study findings suggest that stand-alone e-prescribing with clinical decision support may significantly improve ambulatory medication safety.

References:
Electronic Prescribing Improves Medication Safety in Community-Based Office Practices. Journal of General Internal Medicine, 2010.

Gene test decreases warfarin-related hospitalizations by 28%

Patients who received a test of two genes connected to warfarin sensitivity were 28 percent less likely to be hospitalized for a bleeding episode or blood clot than those whose safe and effective warfarin dosing was determined by traditional trial and error method.

The genetic tests, which are easily done with a cheek swab or blood sample, need only be performed once ever for each patient and cost somewhere between $200 and $400 - far less than even a brief hospital stay.


Warfarin Sensitivity Genotype Test - Mayo Clinic Video.

References:
Gene test can cut warfarin hospitalizations | Reuters.

Beyond statins: Thyromimetic eprotirome decreases LDL

Dyslipidemia increases the risk of atherosclerotic cardiovascular disease and is incompletely reversed by statin therapy alone in many patients. Thyroid hormones lower levels of serum low-density lipoprotein (LDL) cholesterol and has other potentially favorable actions on lipoprotein metabolism. Consequently, thyromimetic drugs hold promise as lipid-lowering agents if adverse effects can be avoided.

In this 12-week trial, the thyroid hormone analogue eprotirome was associated with decreases in levels of atherogenic lipoproteins in patients receiving treatment with statins.

Similar reductions were seen in levels of serum LDL, apolipoprotein B, triglycerides, and Lp(a) lipoprotein. No change in levels of serum thyrotropin or triiodothyronine was detected, although the thyroxine level decreased in patients receiving eprotirome.

References:

Use of the Thyroid Hormone Analogue Eprotirome in Statin-Treated Dyslipidemia. NEJM, 2010.

Image source: Wikipedia, public domain.

Vitamin D receptor activation with paricalcitol decreases albuminuria in type 2 diabetes

Vitamin D is a steroid hormone and a component of a complex endocrine pathway sometimes called 'vitamin D endocrine system' (Medscape, 2012).  Despite treatment with renin—angiotensin—aldosterone system (RAAS) inhibitors, patients with diabetes have increased risk of progressive renal failure that correlates with albuminuria.

281 patients with type 2 diabetes and albuminuria who were receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were enrolled in this study.

Patients were assigned to receive 24 weeks' treatment with:

- placebo
- 1 μg/day paricalcitol
- 2 μg/day paricalcitol

Paricalcitol (trade name Zemplar, Abbott Laboratories) is an analog of calcitriol, the active form of vitamin D.

The primary endpoint was the percentage change in mean urinary albumin-to-creatinine ratio (UACR).

The change in urinary albumin-to-creatinine ratio (UACR) was: −14% in the 1 μg paricalcitol group, and −20% in the 2 μg paricalcitol group.

The addition of 2 μg/day paricalcitol to RAAS inhibition safely lowers albuminuria in patients with diabetic nephropathy, and could be a novel approach to lower renal risk in diabetes.

References:
Selective vitamin D receptor activation with paricalcitol for reduction of albuminuria in patients with type 2 diabetes (VITAL study): a randomised controlled trial. The Lancet, Volume 376, Issue 9752, Pages 1543 - 1551, 6 November 2010.

Image source: Paricalcitol, Wikipedia, public domain.