Insomnia is one of the most common sleep concerns raised by patients both to primary care as well as sleep specialists. Chronic insomnia has a lifetime prevalence of approximately 30% in the general population, resulting in roughly $100 billion dollars healthcare expenditures annually. Given the complexity of insomnia this can become burdensome for primary care providers. In this article we will highlight the main issues and how to manage these individuals in the primary care clinic.
Lung Cancer remains one of the leading causes of cancer related diagnoses and deaths in Missouri and across the United States. It is a major source of morbidity, mortality, and economic impact in Missouri. Over the past several years, major insights to the underlying risk factors of lung cancer have been discovered. Lung cancer screening has evolved and there are new updates to guideline recommendations on screenings. Here we outline the epidemiology and etiology of lung cancer, mitigation strategies for risk factor reduction, and review updates to lung cancer screening recommendations.
Visual floaters can significantly affect quality of vision. Although these opacities are visible on ophthalmoscopy, objectively measuring severity has been difficult. The standard approach has been to monitor individuals for complications rather than treating the floaters. With advances in surgical instrumentation and techniques, ophthalmologists have multiple options for treating visually significant floaters, most commonly pars plana vitrectomy and laser vitreolysis. This article aims to review the literature discussing methods for diagnosing and treating floaters.
This article reviews how pharmacy benefit managers (PBMs) play a role in the delivery of modern healthcare services. A discussion regarding the lack of transparency regarding PBM services, consolidation of the market and vertical integration, as well as a typical flow of payments related to medications is provided. Authors review what higher drug costs are doing to patients, and provide an overview of what is happening to fight these trends.
Sarcoidosis is a disease hallmarked by granulomatous inflammation of nearly all organ systems. Though it has been widely recognized for over 100 years, much remains unknown about the etiology and pathophysiology of the disease. Due in part to this is ambiguity, diagnosis and treatment, algorithms have been difficult to create and even harder to develop a strong evidence base for. In this article, we attempt to consolidate the guidelines, recommendations, and algorithms provided by multiple societies across the US and abroad. We have assembled these into a concise quick-reference format article for those looking for a cohesive approach to the diagnosis and management of sarcoidosis, including when it doesn't respond to initial therapy. We also delve into a new and promising treatment that is in the investigation pipeline, but not yet ready for implementation.
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