The journal of the Royal College of Physicians of Edinburgh
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Atrial fibrillation (AF) is an arrhythmia of increasing prevalence associated with a reducible risk of stroke. We conducted a systematic review to address five questions relating to how we can best detect AF: 1. Are there useful screening tests to determine who should have a 12-lead electrocardiogram (ECG)? Potential screening tests, all with acceptable sensitivity, include pulse palpation, single-lead ECG and newer technologies such as modified sphygmomanometers or a finger probe device. ⋯ What is the impact of the use of different ECG monitoring strategies (e.g. Holter monitoring, serial ECGs, continuous ECG) on AF detection rates post-stroke? In patients post-stroke, a single ECG will miss cases of PAF which can be detected by longer duration monitoring such as Holter monitoring, cardiac event recorders and serial ECGs. Further research into the cost-effectiveness of these methods, the duration of monitoring required and the clinical significance of the PAF detected is needed.
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J R Coll Physicians Edinb · Jan 2012
Clinical TrialIntravenous fluid use in the acutely unwell adult medical inpatient: improving practice through a clinical audit process.
Our Trust developed a clinical guideline to improve the prescribing and use of intravenous (IV) fluids based on the British consensus guidelines on IV fluid therapy for adult surgical patients. We audited the effect of targeted interventions to improve performance against this guideline. ⋯ We have shown that the process of prescribing, administering and monitoring IV fluid use can be significantly improved through a range of targeted multi-disciplinary interventions.
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J R Coll Physicians Edinb · Jan 2012
EditorialThe role of bariatric surgery in the treatment of type 2 diabetes mellitus.
Medical treatments for patients with type 2 diabetes mellitus and class II and above obesity (body mass index greater than 35 kg/m2) are currently limited to treatment of diabetes and prevention of its vascular complications. Bariatric surgery is by far the most effective treatment not only for weight loss, but also for improvement or remission of diabetes. This editorial examines the current evidence for the impact of bariatric surgery on weight loss and type 2 diabetes.
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J R Coll Physicians Edinb · Jan 2012
Biography Historical ArticleA sceptic and an empiric in medicine: George Young (1692-1757) and the beginnings of the Scottish medical Enlightenment.
The Edinburgh surgeon-apothecary and physician George Young was an empiric who emphasised observation, practical experience and a sceptical approach to evidence in medicine. He was an early member of the Rankenian Club, a group of young intellectuals whose ideas were to be at the heart of Scottish Enlightenment thinking. ⋯ Young was an important, but to date relatively neglected, figure in the early years of the Edinburgh Medical School and the Scottish Enlightenment. This paper describes what is known of his life and work, aims to assess his legacy and suggests that he deserves greater recognition and appreciation.
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J R Coll Physicians Edinb · Jan 2012
Case ReportsRadiation dose at CT coronary angiography: how low can we go?
Computed tomography (CT) coronary angiography is now a widely available and reliable test accessible on basic CT platforms that can exclude coronary heart disease with confidence. It is fast, cheap and, if properly carried out by trained and accredited staff in carefully selected patients, useful information can be obtained with acceptably low radiation exposure in some cases.