Short Form 36 Questionnaire: Fill & Download for Free

Obstructive sleep apnea syndrome (OSA) is associated with a variety of health-related consequences. The cardiovascular effects of obstructive sleep apnea, for example, have been found to be very significant, affect morbidity and mortality, and are the subject of much research. However, more subtle but equally important, effects on the individual's overall enjoyment and happiness with life have been investigated as well. Fatigue, sleepiness, non-restorative sleep, and cognitive impairment in patients with OSA adversely affect enjoyment of the pleasurable activities of life. A significant impact on overall quality of life, as measured by reduced scores on questionnaires such as the frequently used Short Form 36 (SF-36) or the Short Form 12 (SF-12) questionnaires, has often been observed in large studies.How To Stop Loud Snoring - Click Here to Read

Since my practice consists almost exclusively of cancer patients, pain is a common symptom that I deal with. I spend perhaps a quarter of my time managing my patient’s pain. There are multiple tools for reducing the pain of malignant disease and narcotic analgesics are one of those. Foremost, and the reason many of these patients are referred to me, is radiation therapy. When a mass of cancer is eating into a bone or other organ causing pain by tissue (and hence nerve fiber) destruction, killing the majority of that particular cancer deposit will take the pressure off the symptomatic healthy tissue and thus reduce, or completely eliminate, the pain. This process may take weeks to occur, since the tumor has to go through the process of dying first.If the patient comes to me from a medical oncologist, they are usually already on an analgesic regime that manages their pain somewhat. They may, however, have just seen their medical oncologist once, and are on the “first iteration” of pain management drugs. This is usually a short acting opioid like oxycodone or hydrocodone, which may or may not be giving them the relief they need. Rather than scheduling the patient for multiple short interval visits to adjust their meds, they send them to me knowing that I will take care of fine tuning them while I am seeing them for several weeks of treatment. Most end up on a sustained release preparation, like trans-dermal fentanyl, taking the short acting agent only for “breakthrough” pain. Sometimes I see the patient directly from the surgeon and have to almost start from scratch, but either way, they are usually comfortable within a week or so of making adjustments.Most patients have pain of purely organic origin, but for many, psychological factors play a role. Sometimes an antidepressant or anti-anxiety drug will help greatly reduce their need for narcotics. An anti-inflamatory drug will frequently help also, but they may not be able to take those if they are also receiving chemotherapy.About 10–20% of the population have a special affinity for their opioid receptors. Many of these have had a history of substance-use disorder - with alcohol or other drugs. On my pre-evaluation questionnaire, I ask about this aspect of their history and we address it. Recovered alcoholics are very protective of their sobriety and are sometimes resistant to taking anything that might be mood altering, despite being in considerable physical pain. I remind them that “there is no extra credit for suffering” and that I will help them use the least amount of drugs that they need to get through this phase of their cancer journey. Taking drugs for pain is no reason to change one’s sobriety date, though not everyone in AA thinks so.There are those with substance use disorders still in denial by the time they face their cancer diagnosis and this will serve as an excuse to go “full speed ahead” with their drug use. When I hear the phrase “I accidentally dropped my bottle of percocet in the toilet”, I know I’m dealing with one of those. (I have taken several blood pressure medicines, cholesterol lowering drugs and other prescription medications for almost forty years and have never dropped one into the toilet. I’m really not sure how you could do this.) In any case, I give them one “do over” and warn them not to let it happen again.I do have naive patients who keep their narcotics in their medicine cabinet and have visitors take them - usually a drug addict nephew or someone close to them that they would never suspect. I give them a do-over, but we discuss future safeguards to avoid repeating such an occurrence.If a friend or acquaintance asks for an emergency prescription because they’ve lost theirs, I refer them to the ER or their primary care doctor - even if I’m sure they’re being sincere - we don’t have a doctor-patient relationship.Calls on weekends from “a patient’s niece taking care of their debilitated aunt who has run out of her Lortab” have been greatly simplified since hydrocodone has been made a Schedule II drug and can no longer be called in.My level of suspicion for people trying to get narcotics without a valid medical reason was developed decades ago and I don’t think it has changed in recent times due to the “opioid prescribing phobia” that has developed over the past few years. I think that it would be the same if I were seeing a primary care patient population, but of course I can’t say for sure since I don’t do that.I will say that after 36 years of prescribing controlled substances to patients, that I have NEVER been called by the DEA or BNDD about my prescribing habits, even though they include writing a dozen or so controlled substance prescriptions per week.If you are interested in “No Nonsense” answers to serious medical questions, please follow me. (>300 answers on cancer, medicine and human behavior.)

Superstitions can actually help some people because they give them an illusion of control that translates into real confidence that subsequently helps them.For example, if you wear a lucky shirt, you may feel better. That confidence, relaxation, and better feeling can translate into results. Because you're more relaxed and confident, you may do better in a social situation, or in a sport, or in any situation where good performance is beneficial.It starts when people try something different—Pepsi instead of Coca-Cola, a blue tie instead of the old red one—and find that something good happens.Soon, without realizing it, someone ... starts reaching for the Pepsi again and again.Such "conditioned superstitions" can develop when people believe there is something they can do to control a situation, despite there being no rational reason to think so, says Gita Johar, a professor of business at Columbia University who recently co-wrote a paper on the phenomenon. Recent research shows that superstitions that increase the illusion of control can help people find meaning and psychological comfort—and in some cases, even boost performance.In a 2010 experiment published in Psychological Science, golfers sank 35% more putts when playing with a ball they were told was "lucky." Sports teams from Little League to the pros are rife with players who practice a ritual or carry a charm they believe will boost their performance. Michael Jordan, for one, was famous for wearing his lucky college basketball shorts under his NBA ones.[1]Here's a bit more about the golf ball experiment, together with 3 other experiments:In the first experiment subjects were given either a “lucky golf ball” or an ordinary golf ball, and were then given a golf task to perform.In the second experiment subjects were given a motor dexterity task to perform, in which they had to tilt a cube to get 36 ball bearings into a grid of 36 holes. Half the subjects were told to simply start the game, while for the other half the researcher told them “I press the thumbs for you,” which is the German equivalent of crossing fingers.In the third and fourth experiments the subjects brought their own lucky charms, which the researchers took away to be photographed. Only half the subjects had their lucky charms returned, while the rest were told there were problems with the camera and the charm would have to remain in the other room. The subjects were then given a questionnaire to gauge their degree of confidence and optimism for the task ahead. They were then asked to complete a memory task in which they had to match pairs of face-down cards in an array of 18.In the fourth experiment the subjects again brought their own lucky charms and only half were allowed to keep them. They also completed a questionnaire, but this time were given an anagram task to complete, in which they had to make as many words as possible from a group of eight letters. They also had to set a goal for themselves.The results of all four experiments showed the superstition did improve performance. In the golf task those with the “lucky ball” performed significantly better than the control, and those doing the motor dexterity test were faster and better if the researcher wished them luck.[2][4][1] In a recent study, golfers sank 35% more putts when using a ball they were told is lucky[2] Superstition proved to improve performance[3] How Superstitions Improve Performance[4] http://pss.sagepub.com/content/early/2010/05/27/0956797610372631.abstract