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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
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.
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.
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.
