The journal of the Royal College of Physicians of Edinburgh
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Occupational medicine represents the interface between work and health. As such, its breadth encompasses issues of clinical medicine, epidemiology, occupational hygiene, toxicology, ethics, and the law. ⋯ It is not surprising that many clinicians find this challenging. The aim of this paper is to provide a summary of common work-related lung disorders, and stress the importance of considering a patients' occupation when presented with a range of respiratory symptoms.
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International travel is increasing and a significant number of travellers will develop a febrile illness during or shortly after their return from the tropics. The differential diagnosis is broad and a systematic approach to the management of these patients is required in order to establish the diagnosis and to initiate prompt and effective treatment. Fever may be due to infectious agents found only in tropical countries, or due to infections unrelated to travel and found worldwide. ⋯ Specialist advice on the investigation and management of returning travellers should be sought from infectious diseases physicians and microbiologists. Patients with malaria or enteric fever may deteriorate rapidly and travellers should be advised to seek prompt medical attention if they become unwell after travel to the tropics. This review will focus on some of the more important imported infections, diagnostic clues from the history, examination and investigations, and important considerations in their management.
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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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Despite global efforts to reduce maternal mortality, maternal deaths from bacterial sepsis have actually risen in the UK. The group A streptococcus, also known as Streptococcus pyogenes, is the leading cause of infection-related death in pregnancy and the puerperium. ⋯ Here, the epidemiology, aetiology, and management of severe peripartum sepsis are discussed, as are potential approaches to reduce risks. While fundamental changes in healthcare access can lead to dramatic reductions in maternal deaths in developing countries, an improvement in maternal sepsis deaths in the UK will require heightened awareness among both hospital and community-based clinical staff.
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J R Coll Physicians Edinb · Jun 2011
ReviewBetter clinical decision making and reducing diagnostic error.
A major amount of our time working in clinical practice involves thinking and decision making. Perhaps it is because decision making is such a commonplace activity that it is assumed we can all make effective decisions. ⋯ Until quite recently there has been a general nihilism about the ability to change the way that we think, but it is now becoming accepted that if we can think about, and understand, our thinking processes we can improve our decision making, including diagnosis. In this paper we review the dual process model of decision making and highlight ways in which decision making can be improved through the application of this model to our day-to-day practice and by the adoption of de-biasing strategies and critical thinking.