Assessment is the initial step in management strategies. Assessment data should include documentation of predisposing factors, sleep patterns, emotional status, exercise and activity levels, diet, symptoms, medications, and caregiver routines. The sections below outline recommendations for a sleep history and physical examination. Data can be retrieved from multiple sources: the patient's subjective report of sleep difficulty, objective observations of behavioral and physiologic manifestations of sleep disturbances, and reports from the patient's significant others regarding the patient's quality of sleep. Use of the Insomnia Severity Index is suggested to screen for insomnia in clinical settings.[3,4]
The diagnosis of insomnia is primarily based on a careful, detailed medical and psychiatric history. The American Academy of Sleep Medicine has produced guidelines for the use of polysomnography as an objective tool in evaluating insomnia. The routine polysomnogram includes the monitoring of electroencephalography, electro-oculography, electromyography, effort of breathing and air flow, oxygen saturation, electrocardiography, and body position. Polysomnography is the major diagnostic tool in sleep disorders and is indicated in the evaluation of suspected sleep-related breathing disorders and periodic limb movement disorder, and when the cause of insomnia is uncertain or when behavioral or pharmacologic therapy is unsuccessful.[Level of evidence: IV]
Cartilage is a type of tough, flexible connective tissue (see Question 1).
Cartilage from cows (bovine cartilage) and sharks has been studied as a treatment for people with cancer and other medical conditions for more than 30 years (see Question 2).
Laboratory and animal studies have looked at whether bovine and shark cartilage products can kill cancer cells, make the immune system more active against cancer, and prevent the body from making the new blood vessels that a tumor needs to grow...
Disease factors, including paraneoplastic syndromes with increased steroid production; and symptoms associated with tumor invasion (e.g., obstruction, pain, fever, shortness of breath, pruritus, and fatigue).
Treatment factors, including symptoms related to surgery (e.g., pain, frequent monitoring, and use of opioids); chemotherapy (e.g., exogenous corticosteroids); and symptoms related to chemotherapy.