The journal of the Royal College of Physicians of Edinburgh
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The incidence and prevalence of gout have increased, as have comorbid obesity, diabetes mellitus, hypertension, chronic kidney and cardiovascular disease. Gout is now the commonest type of inflammatory arthritis despite availability of safe, effective and potentially 'curative' urate-lowering drugs. ⋯ Advances in understanding the physiology and genetic control of urate transport in the kidney and gut have led to novel, more selective uricosuric drugs, and basic research on mediators of urate crystal-induced inflammation has pointed to alternative therapeutic targets for treating and preventing gout flares. Current guidelines for the management of gout and indications for the use of some more recently introduced drugs; febuxostat, lesinurad, pegloticase and interleukin-1 antagonists are also briefly reviewed.
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J R Coll Physicians Edinb · Jun 2019
ReviewThe importance of nontechnical skills in leading cardiopulmonary resuscitation teams.
Cardiopulmonary resuscitation (CPR) is one of the important clinical competencies for medical trainees. Since the introduction of the first guidelines for CPR in 1966, further research has resulted in more recent updates. The latest in the UK was published in 2015 by the resuscitation council. ⋯ Research performed on leadership in emergency medicine highlighted the importance of the nontechnical skills displayed by CPR team leaders. Nontechnical skills refer to cognitive, behavioural and social skills that contribute to efficient team performance, such as task management, assertiveness, situational awareness, communication and decision-making. This review discusses the importance and applicability of nontechnical leadership skills in CPR based on current evidence in the literature and the clinical practice in UK hospitals.
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Cognitive bias is increasingly recognised as an important source of medical error, and is both ubiquitous across clinical practice yet incompletely understood. This increasing awareness of bias has resulted in a surge in clinical and psychological research in the area and development of various 'debiasing strategies'. This paper describes the potential origins of bias based on 'dual process thinking', discusses and illustrates a number of the important biases that occur in clinical practice, and considers potential strategies that might be used to mitigate their effect.