brain

Narcolepsy

Nathan Hinkle — Fri, 11 Sep 2026 05:00:00 +0000

Date Added:

September 11, 2026

Journal/Publication:

JAMA

Publisher:

The American Medical Association

Publication Date:

September 9, 2026

Pages:

E1-E2

URL:

Narcolepsy

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

doi: 10.1001/jama.2026.14685

Keywords

MeSH

RPR Commentary: A concise review of what we currently understand about narcolepsy. James W. Mold, MD, MPH

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Narcolepsy is a chronic neurologic disorder that causes severe daytime sleepiness and impaired quality of life. Symptoms typically begin around age 10 to 20 years, yet diagnosis is often delayed for more than a decade.1 Narcolepsy is classified into narcolepsy type 1 (NT1; narcolepsy with cataplexy) and narcolepsy type 2 (NT2; narcolepsy without cataplexy), with estimated global prevalences of 19 and 23 per 100 000 persons, respectively.2

Author/s:

Kiran P. Maski, Thomas Scammell

Does This Child Have a Concussion?: The Rational Clinical Examination Systematic Review

Megan George — Thu, 09 Apr 2026 23:08:13 +0000

Date Added:

April 9, 2026

Journal/Publication:

JAMA

Publication Date:

April 6, 2026

URL:

Does This Child Have a Concussion?: The Rational Clinical Examination Systematic Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Poster

DOI (1):

10.1001/jama.2026.1233

Keywords

PMID (1):

41941197

MeSH

A review of the evaluation of children with head injuries to detect evidence of concussion. James W. Mold, MD, MPH

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Importance: Concussion is a mild traumatic brain injury with associated abnormalities in brain function, rather than structural injury. An estimated 1.1 million to 1.9 million pediatric concussions occur annually in the US.

Objective: To determine the accuracy of clinical history and physical examination findings for identifying concussion in children and adolescents who have had a plausible mechanism of injury.

Data sources and study selection: PubMed, Embase, ClinicalTrials.gov, Cochrane Library, CINAHL, Web of Science, and Google Scholar were searched from January 2002 through December 2025 without language restrictions. Observational studies including patients aged 2 to 18 years evaluated for concussion in outpatient, emergency, or inpatient settings were included.

Data extraction and synthesis: Four reviewers independently extracted study characteristics and diagnostic accuracy data and assessed study quality with the Rational Clinical Examination levels of evidence.

Main outcomes and measures: Sensitivity, specificity, and likelihood ratios (LRs) for symptoms and physical signs associated with concussion were calculated using random-effects meta-analysis when summary measures were appropriate.

Results: Of 7110 screened abstracts, 23 studies (level 4 evidence; case-control design) met inclusion criteria. The presence of mental fog (LR, 11.8-12.0; specificity, 0.96), noise sensitivity (LR, 6.9; 95% CI, 3.6-13.1; specificity, 0.94), nausea (LR, 6.7; 95% CI, 3.1-14.6; specificity, 0.93), and light sensitivity (LR, 6.4; 95% CI, 2.1-19.7; specificity, 0.93) were most useful for increasing the likelihood of a concussion diagnosis. The absence of headache was the most useful symptom for decreasing the likelihood of concussion (LR, 0.20; 95% CI, 0.10-0.39; sensitivity, 0.74). Signs that increased the likelihood of concussion were abnormal near-point convergence, which is the inability to maintain ocular convergence on a near target (LR, 7.0; 95% CI, 2.0-24.9; specificity, 0.97); abnormal smooth pursuits, which are jerky, irregular eye movements when tracking a target (LR, 6.5; 95% CI, 2.4-17.5; specificity, 0.96); and saccades, which are inaccurate or slow eye movements with overshooting or undershooting when looking between 2 or more targets (LR, 4.8; 95% CI, 1.8-13.1; specificity, 0.92); however, none of these findings had a sensitivity of more than 0.40. A consensus statement by the International Conference on Concussion in Sport recommends the Sport Concussion Assessment Tool to systematize the comprehensive evaluation of patients with symptoms concerning for concussion.

Conclusions and relevance: While no single finding was sufficient to confirm or exclude concussion, the presence of mental fog, noise and light sensitivity, nausea, or ocular abnormalities were most useful to identify patients more likely to have had a concussion, while absence of a headache made a concussion less likely. These symptoms and signs are integrated into structured clinical assessments to support the clinical diagnosis and management of pediatric concussion.

Author/s:

Sonal N. Shah, Haley M. Chizuk, Hiu-Fai Fong

Lung cancer crash course

Aubrey Delammermore — Sat, 22 Apr 2023 05:00:00 +0000

Date Added:

April 22, 2023

Journal/Publication:

Canadian Family Physician

Publisher:

College of Family Physicians of Canada

Publication Date:

April 1, 2023

Issue:

Volume:

Pages:

266-268

URL:

Lung cancer crash course

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.46747/cfp.6904266

Keywords

liver

brain

Survival Rate

Small Cell Lung Carcinoma

Canada

PMID (1):

37072209

MeSH

Lung Neoplasms*

Carcinoma, Non-Small-Cell Lung

early detection of cancer

Carcinoma, Squamous Cell

A concise review of the diagnosis, classification, and treatment and treatment of lung cancer. James W. Mold, MD, MPH

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Lung cancer has the highest mortality rate of any cancer in Canada, causing 25.5% of all cancer deaths, with a 5-year survival rate of only 19%. More than half of lung cancers are metastatic at diagnosis, with common sites of metastases in the brain, bone, liver, and adrenal glands. Lung cancer is a heterogeneous group of cancers broadly separated into small cell lung cancer (SCLC)—approximately 15% of all lung cancer cases—and non–small cell lung cancer (NSCLC), which is further divided into predominantly adenocarcinoma and squamous cell carcinoma subtypes. More than 80% of lung cancer cases are related to smoking, meaning smoking cessation remains the cornerstone of lung cancer prevention. Low-dose computed tomography is a valuable screening tool for lung cancer that can identify lung cancers at an earlier stage and reduce lung cancer–specific mortality and all-cause mortality. Although lung cancer screening is recommended by the Canadian Task Force on Preventive Health Care, it is currently available in only a few Canadian provinces.

Author/s:

Wilkinson, A. N.

Some benefits from donepezil in Alzheimer’s disease

Brian Desmarais — Thu, 20 Jun 2019 12:57:52 +0000

Date Added:

June 20, 2019

Journal/Publication:

British Journal of General Practice

Publication Date:

March 1, 2013

Issue:

Volume:

608

Pages:

150

URL:

Some benefits from donepezil in Alzheimer’s disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.3399/bjgp13X664333

Keywords

MeSH

Cholinesterase Inhibitors

Synaptic Transmission

brain

RPR Commentary: This is a summary of the data available to date on the effectiveness of donepezil for treatment of patients with Alzheimer’s Disease. I told patients and their families that if a small improvement in functional abilities would make a huge difference in quality of life (e.g. could remain at home 6 months longer), it is probably worth trying donepezil. Otherwise the expense and side effects are not worth the very small benefit. 5 to 10mg seems to be enough. James W. Mold, MD, MPH

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CLINICAL QUESTION

How effective is exercise-based cardiac rehabilitation on mortality, morbidity, and health-related quality of life (QOL) in patients with coronary heart disease (CHD)?

BOTTOM LINE

Compared to usual care, in medium to longer-term follow-up (≥12 months) exercise-based cardiac rehabilitation was found to be effective in reducing overall and cardiovascular mortality in patients with CHD, and appeared to reduce the risk of hospital admissions in the shorter term (<12 months follow-up). There was no reduction seen in the risk of total myocardial infarction, coronary artery bypass graft, or percutaneous transluminal coronary angioplasty.

Author/s:

McAvoy, B.R.