This study, employing an exploratory mixed-methods approach, explores college students' use of Yik Yak, a pseudoanonymous social media platform that allows users to post short messages and engage primarily with other nearby users. Study 1 qualitatively examined student uses and perceptions of the app through 12 in-depth interviews with Yik Yak users. Study 2 conducted a content analysis of yaks (N = 3,905) from 24 colleges and universities to gain a better understanding of the content that students post and engage with inside the app. The combination of qualitative and quantitative findings offers insight into the complex phenomena of Yik Yak in a university setting. Limitations and future directions of research are discussed.
Introduction In sleep clinics, hypersomnia is a frequently encountered condition. While narcolepsy and idiopathic hypersomnia are discrete diagnoses that typically do not have co-existing psychiatric co-morbidities, sleep practitioners often have to address mental illness and/or psychotropic medication needs in these patients with hypersomnia. The reasons for co-occurrence of idiopathic hypersomnia and narcolepsy with psychiatric disorders is not well understood. This study aimed to assess the degree of overlap between psychiatric diagnoses with central hypersomnias and the temporal relationship between the development of hypersomnia and psychiatric conditions. Methods Using the University of Utah EPIC database, patients with diagnoses of idiopathic hypersomnia or narcolepsy encountered over the last decade were identified. Out of the 307 available medical records, only those that met strict criteria for diagnosis of narcolepsy and idiopathic hypersomnia were included. Medical records were reviewed for the presence of psychiatric disorders and psychotropic medication use, and to assess the prevalence of mental illness with central hypersomnia. Results Out of 119 patients that met ICSD-2 criteria for central hypersomnia, 37 were diagnosed with narcolepsy type 1 (T1N), 59 with narcolepsy type 2 (T2N) and 23 with idiopathic hypersomnia (IH). There were 69/119 (58%) patients with central hypersomnia that had psychiatric comorbidities with 23/37 (62%) of T1N, 32/59 (54%) of T2N and 14/23 (60%) of IH experiencing psychiatric problems. Approximately 45% were prescribed antidepressants or a mood stabilizer either before, during or after diagnosis of a central hypersomnia. 46% of patients on stimulants alone vs. 23% of patients on sodium oxybate had a concurrent psychiatric diagnoses or psychotropic medication use. Conclusion Given the degree of overlap between psychiatric disorders and central hypersomnias, further research is necessary to understand whether this overlap is a result of common neurological substrates driving these disorders or whether the hypersomnia is from comorbid psychiatric disorder or psychotropic medication use. The highest prevalence of psychiatric illness was seen with T1N. Patients with hypersomnia on sodium oxybate had lower rates of psychiatric co-morbidities. Whether these findings point to more optimal diagnosis and treatment of underlying hypersomnia with reduced need for psychotropic medication needs to be understood. Support (if any) None
Patient case-based simulation is a valuable tool for medical education and professional medical training. The use of patient simulations is limited in the real world by a reliance on live actors or expensive, manikin-based experiences. These experiences are limited in reach, may be inconsistent due to variation in actors, and are expensive to implement. We developed an online case simulation that reproduces many elements of the traditional live-action simulation while incorporating advantages of computer delivery, including immediate feedback on clinical choices, consistency across users, and 24/7 availability. The Patient Case Simulation was presented using an interface based on a typical Electronic Medical Record to be familiar to the medical professional audience. The simulation experience followed the standard sequence of events in a typical encounter between a medical professional and patient in a clinic setting. We conducted formative testing with over 250 users, and a summative test with 35 users. We were able to develop and refine a successful case presentation format. Results and lessons learned are presented.
Purpose: Guidelines recommend considering an initial trial of continuous positive airway pressure (CPAP) to treat central sleep apnea (CSA). However, practice patterns vary widely. This study investigated predictors for an initial trial of CPAP in patients with central apneas and whether those factors predict adequate treatment response in patients receiving an initial CPAP trial. Methods: Charts of patients receiving a diagnostic code for CSA following a sleep study during 2016-2018 at a single center were reviewed. Patient factors, initial treatment prescriptions, and subsequent changes to therapy were extracted from electronic health records. Regression models were used to estimate factors associated with an initial CPAP prescription and the likelihood of an adequate CPAP response (no subsequent therapy change or nonadherence) among patients prescribed CPAP. Results: 429/588 (73%) patients with central apneas received an initial trial of CPAP. Younger age, diagnosis by home sleep testing, non-opiate etiology of central apneas, and a lower proportion of central apneas at diagnosis were independently associated with a higher likelihood of an initial CPAP trial. A lower proportion of central apneas was associated with a higher probability of adequate response, while current smoking and opiate-related central apneas predicted an unsuccessful CPAP trial. A new finding was that older age predicted a lower likelihood of an initial CPAP prescription but did not predict a suboptimal response to CPAP. Conclusion: Clinicians may incorrectly weigh certain clinical and sleep study characteristics when deciding whether to trial CPAP for patients with central apneas.
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