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For the practicing physician, the recognition of pain in patients with dementia can represent a challenge because these patients are often unable to verbally report their pain. Can facial expressions of pain be used as an alternative pain indicator in this population? Elliott Ross considers this question by examining relevant neurobiological research.
Signal detection theory was developed during the Second World War as a means to improve the ability of radar operators to spot enemy bombers. In this article, Oliver et al. explain how an overworked neurologist might use signal detection theory in the clinic to sift out important information from the often bewildering array of visual, verbal and auditory cues that constitute a patient's history and examination.
Long-term immunosuppression is often necessary in chronic autoimmune conditions such as myasthenia gravis. In this article, Sivakumar Sathasivam examines the mechanisms of action of steroids and other immunosuppressants, reviews randomized and nonrandomized evidence for their efficacy in generalized myasthenia gravis, and provides recommendations regarding the use of each immunosuppressant in the treatment of this condition.
Itch is a common symptom of inflammatory skin disorders, but it can also occur as a result of damage to the itch-mediating nervous system, in which case it is known as neuropathic itch. In this Review, Binder et al. describe the mechanisms underlying itch generation, introduce a classification system for itch, and propose a mechanism-based management approach to chronic neuropathic itch. The topic of neuropathic itch is explored further in an accompanying Case Study in this issue.
This Case Study describes a 64-year-old woman who presented with a 2-year history of itch on her right dorsal forearm. The patient was diagnosed with brachioradial pruritus caused by cervical disc herniation, and the symptoms resolved after surgery to decompress the sixth cervical nerve root. Various alternative treatment options for brachioradial pruritus are discussed.
In this Training Matters article, Gamaldo and Salas provide an important and timely appraisal of the current state of sleep medicine education at medical-school and postgraduate levels. They highlight the need for more extensive integration of sleep education into the training curriculum and describe some new initiatives designed to achieve this goal.
