Management of hypertension in primary care

Background: The European Society of Cardiology and the European Society of Hypertension define hypertension as systolic blood pressure ≥140 mmHg Hg, or diastolic blood pressure ≥90 mmHg Hg, or both. Hypertension is a challenging condition in view of it being asymptomatic, highly prevalent and requiring continuous follow-up by the family physician. Objective: To implement the available guidelines into clinical practice for better patient health.Method Multiple databases were used to perform the literature search including PubMed, National Institute of Clinical Excellence, Scottish Intercollegiate Guidelines Network, and the Turning Research Into Practice database. The following keywords were applied: hypertension, blood pressure, and primary care. Results: Blood pressure needs to be measured by a device which is regularly calibrated. This could be a traditional mercury sphygmomanometer, aneroid sphygmomanometer or the automated sphygmomanometer. The cuff size should be adjusted according to the patient’s arm circumference and the patient should be seated comfortably with the arm rested such that the cuff is at the same level as the heart. During the initial assessment, the blood pressure should be measured in both arms and then the arm with the highest reading is used for subsequent measurements. Ambulatory blood pressure monitoring should be offered if the blood pressure is found to be over 140/90mmHg (measured at least twice) during the initial assessment. Conclusion: Appropriate management of hypertension will contribute significantly towards an improvement in overall patient health.peer-reviewe

Traffic, diesel and asthma : a literature review

This article details the major pollutants from motor vehicle exhaust, mainly particulate matter, nitrogen dioxide and polycyclic aromatic hydrocarbons. The emphasis is on motor vehicle emissions from diesel powered engines, which have become a significant source of air pollution in urban areas. The impact of motor vehicle pollutants on respiratory health is explored, and the major studies relating asthma to high volume of traffic and proximity to major traffic arteries are reviewed.peer-reviewe

Choice of theme in John Fowles's Mantissa

I have chosen the second chapter of my thesis (The Theme of Art and the Artist in John Fowles's Mantissa) as opposed to any of the remaining five for publication because I believe it to be largely self-sufficient. However, a short note on the study as a whole is, I think called for here. The basis of the thesis is the discussion of the major thesis of John Fowles's novel Mantissa (1982), with special emphasis on the literary devices which the author chose to use in order to develop it.peer-reviewe

Primary fallopian tube carcinoma presenting with a solitary metastasis in a Spigelian hernia

Primary fallopian tube carcinoma (PFTC) is a rare gynaecological tumour. Histologically, this type of tumour resembles other tumours of the female reproductive tract, predominantly serous tumours. These cancers are often difficult to distinguish from ovarian cancers and are generally treated with the same standards of surgery and chemotherapy. Diagnosis of PFTC is rarely made preoperatively. Very often, the diagnosis is made either at the operating table or by the pathologist. In this report we present a rare case of PFTC with a solitary metastatic deposit in a right Spigelian hernia, the latter being the initial presenting complaint.peer-reviewe

Canada's Experience with a Flexible Exchange Rate in the 1950s: Valuable Lessons Learned

Schembri studies Canada's post-World War II experience in introducing a floating exchange rate, including its effects on the Canadian economy and its influence on the development of macroeconomic theory. In particular, Canada's flexible exchange rate and high degree of capital mobility with the United States provided an unprecedented experiment for macroeconomic policy. The successes and difficulties encountered by Canadian authorities in managing monetary and fiscal policy under this regime drew the interest of researchers at the International Monetary Fund and elsewhere and had a significant impact on the development of the Mundell-Fleming model, the path-breaking innovation in modern open-economy macroeconomics.

Conference Summary: Revisiting the Case for Flexible Exchange Rates

This article summarizes the proceedings of an international research conference hosted by the Bank of Canada in November 2000. The conference marked the fiftieth anniversary of Canada's adoption of a flexible exchange rate, and its title recognizes the seminal contribution of Professor Milton Friedman's article "The Case for Flexible Exchange Rates." His keynote address to the conference is also summarized in the article. The conference papers re-examine many of the arguments raised by Friedman using recent developments in economic theory and econometric techniques. They investigate the experience of a wide range of industrialized and emerging-market economies. The main findings are that a strong case can be made for flexible exchange rates in economies that are large commodity exporters and that have credible low-inflation monetary policies and relatively well-developed financial systems.

Evaluating a trainee’s progress in surgical dexterity

The local cardiac surgical training program is modelled on a one-to-one apprenticeship encompassing a number of years. Trainee progress is regularly audited and work of increasing complexity is provided, commensurate with the trainee's ability. Speed and accuracy are desirable surgical goals and reflect a high level of decision-making and dexterity. The trainee's surgical speed over a period of time was monitored as one measure of progress. The mean time required to complete a coronary anastomosis (graft time) decreased from 12.8±1.9minutes in the first year of training to 9.0±1.9minutes in year four, inter-group variance (ANOVA) was highly significant from year two to year three and from year three to year four (p<0.001). Risk stratification was utilised in the selection of patients for the trainee. Parsonnet score increased from 5.1±3.5 in year one to 6.0±5.0 in year four. Similarly, EuroSCORE increased from 2.1±1.8 to 2.4±2.1. Additionally, variable life-adjusted display (VLAD) plots were constructed in order to provide a visual representation of performance against predicted outcome by EuroSCORE. Successive VLAD plots demonstrate the changing practice of the trainee as it came to resemble more closely that of his instructor and this was achieved without jeopardising patient outcome.peer-reviewe

Interhemispheric epidermoid cyst

A 44-year-old man presented following a tonicclonic seizure. Intracranial epidermoid cysts account for approximately 1% of primary intracranial tumours. They are benign slow growing tumours derived from ectodermal inclusions during neural tube closure.peer-reviewe