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David Sklar

Publications and source records attributed to David Sklar.

7 recordsLinked to original sources
PubMed2006

Signs and symptoms of sleep-disordered breathing in trauma survivors: a matched comparison with classic sleep apnea patients.

Chronic posttraumatic sleep disturbance may include sleep-disordered breathing (SDB), but this disorder of sleep respiration is usually not suspected in trauma survivors. Sleep breathing signs and symptoms were studied in 178 adults-all with SDB-including typical sleep clinic patients (N = 89) reporting classic snoring and sleepiness and crime victims (N = 89) with insomnia and posttraumatic stress. Significant differences (p < 0.0001) were common between groups. Sleep breathing complaints, loud snoring, marked obesity, and obstructive sleep apnea were prevalent in sleep clinic patients; crime victims reported more insomnia, nightmares, poor sleep quality, leg jerks, cognitive-affective symptoms, psychotropic medication usage, and less snoring but more upper airway resistance syndrome. Both groups reported high rates of fatigue or sleepiness, nocturia, morning dry mouth, and morning headaches. Awareness of these clinical features might enhance detection of SDB among trauma survivors.

Adult↗
PubMed2004

Refractory insomnia and sleep-disordered breathing: a pilot study.

OBJECTIVE: To assess an uncontrolled, open-label trial of sleep-disordered breathing (SDB) treatment on two different samples of chronic insomnia patients. METHOD: In Study 1 (Retrospective), data from one diagnostic and one continuous positive airway pressure (CPAP) titration polysomnogram were compiled from 19 chronic insomnia patients with SDB. Objective polysomnogram indicators of sleep and arousal activity and self-reported sleep quality were measured. In Study 2 (Prospective), clinical outcomes were assessed after sequential cognitive-behavioral therapy (CBT) and SDB therapy (CPAP, oral appliances, or bilateral turbinectomy) were provided to 17 chronic insomnia patients with SDB. Repeat measures included the Insomnia Severity Index, Functional Outcomes of Sleep Questionnaire, Pittsburgh Sleep Quality Index, and self-reported insomnia indices and CPAP use. RESULTS: In Study 1, seven objective measures of sleep and arousal demonstrated or approached significant improvement during one night of CPAP titration. Sixteen of 19 patients reported improvement in sleep quality. In Study 2, Insomnia Severity Index, Functional Outcomes of Sleep Questionnaire, and Pittsburgh Sleep Quality Index improved markedly with CBT followed by SDB treatment and achieved an average outcome equivalent to curative status. Improvements were large for each treatment phase; however, of 17 patients, only 8 attained a nonclinical level of insomnia after CBT compared with 15 patients after SDB therapy was added. Self-reported insomnia indices also improved markedly, and self-reported SDB therapy compliance was high. CONCLUSIONS: In one small sample of chronic insomnia patients with SDB, objective measures of insomnia, arousal, and sleep improved during one night of CPAP titration. In a second small sample, validated measures of insomnia, sleep quality, and sleep impairment demonstrated clinical cures or near-cures after combined CBT and SDB therapies. These pilot results suggest a potential value in researching the pathophysiological relationships between SDB and chronic insomnia, which may be particularly relevant to patients with refractory insomnia.

Chronic Disease↗
PubMed2004

Effect of managed care on emergency department use in an uninsured population.

STUDY OBJECTIVE: The use of managed care to decrease emergency department (ED) use has been reported with some success among Medicaid and insured populations. Our objective is to determine the effect of a managed care program (the "Program") for uninsured patients on their use of emergency, inpatient, and outpatient services. METHODS: This was a retrospective, observational study with 3 groups of patients at an urban, academic medical center: uninsured patients enrolled in the Program, uninsured patients not enrolled in the Program ("Uninsured"), and commercially insured ("Commercial") patients. All patients received services at least once annually during the 5-year study duration. Administrative databases provided data on ED visits, hospital discharges, hospital days, primary care visits, and specialty care visits during the preprogram and 4 postprogram years. RESULTS: There were 1,676 Program, 335 Uninsured, and 844 Commercial patients (2,855 total patients). Use of emergency, inpatient, and outpatient specialty clinics by all groups did not change significantly after program implementation. There was a modest increase in outpatient primary care use by Program members. CONCLUSION: Implementation of a managed care program did not significantly alter ED or inpatient hospital use patterns in an uninsured, indigent population. Providing a primary care provider and health care benefits alone was insufficient to reduce ED use in this population.

Academic Medical Centers↗
PubMed2002

Health status and intimate partner violence: a cross-sectional study.

STUDY OBJECTIVE: We identify health variables associated with a history of intimate partner violence (IPV) using self-reported and laboratory measures. METHODS: This study used a cross-sectional design. Participants were a randomized sample of English-speaking women between the ages of 18 and 50 years who presented to a large urban emergency department. Potential participants were screened in the ED for a history of physical abuse and coded as having experienced no IPV (No IPV), as having a recent history of IPV (occurring in the previous 12 months; IPVA), or as having a remote history (most recent occurrence >12 months ago; IPVHx). Participants were interviewed several days later in an outpatient setting regarding demographics, medical care use, and physical and mental health variables. Participants also received urine and blood tests and a pelvic examination. RESULTS: Self-reported health was poorest among women reporting IPVA and best among women reporting no IPVA. Women in the IPVA group differed from women with no IPV history with respect to cocaine use (odds ratio [OR] 4.8; 95% confidence interval [CI] 1.4 to 17.3), sexually transmitted diseases (OR 5.1; 95% CI 1.5 to 20.3), and nightmare frequency (OR 11.6; 95% CI 2.3 to 83.4). Women reporting IPVHx were more likely to report a history of sexually transmitted diseases than women with no IPV history (OR 4.1; 95% CI 1.6 to 11.4) and had more frequent nightmares (OR 5.0; 95% CI 1.3 to 24.9). Urine and blood tests identified only 2 variables (hemoglobin levels, mean corpuscular volume) that differed significantly between groups by IPV history; these differences were not clinically significant. CONCLUSION: Women with a recent history of IPV reported a poorer health status than women with no IPV history; laboratory testing detected few differences.

Adolescent↗
PubMedDate not supplied

Relationship of restraint use, patient injury, and assaults on EMS personnel.

OBJECTIVE: We hypothesized that the assaults on EMS personnel by patients requiring restraints can be correlated with demographic information, patient condition, and other scene information such as presence the of law enforcement. METHODS: The study was a one-year cross-sectional study of paramedic restraint use and assault on EMS personnel in an urban area. A data collection form was completed by EMS for each patient placed in restraints. Study outcome variable was "Assault on EMS personnel." Predictor variables included demographic and EMS call information, patient condition, law-enforcement related variables, and the paramedic's perception of the need for chemical restraints. To compare predictor and outcome variables, a multivariable model with odds ratios and 95% confidence intervals was used. RESULTS: The study included 271 restrained patients over a 12-month period from April 2002 to April 2003. Seventy-seven (28%) cases were positive for assaults on EMS personnel. Multivariable analysis including 8 variables, indicated the following 6 variables were associated with assault on EMS personnel: time of day between midnight and 6 am (OR = 4.4, 95% CI = 1.6-12.7); female patient (OR for males 0.6, 95% CI = 0.3-1.0); violent patient (OR = 10.1, 95%CI = 2.3-48.2); patient injured under supervision (OR = 3.9, 95% CI = 1.1-13.8); arrested patient (OR = 4.4, 95% CI = 1.1-18.5); and perceived need for chemical restraint (OR = 2.1, 95% CI = 1.2-3.9). CONCLUSION: Multiple factors are correlated with assaults on EMS personnel by patients requiring restraints. By specifically targeting patients exhibiting these factors, EMS providers can help prevent injury to themselves. Patients not exhibiting these factors may be less dangerous.

Adolescent↗