Non-valvular atrial fibrillation and stroke : implications for management

Nonvalvular Atrial Fibrillation is more prevalent with increasing age. It is associated with a six-fold excess risk of stroke; and a cumulative lifetime stroke risk of 35%. 15% of ischaemic strokes are directly attributable to it. Five trials have established the safety of warfarin in reducing the risk by 70% in well selected patients, with stringent monitoring. Thromboembolism, cardiac failure, hypertension and echocardiographic abnormalities identify higher risk patients. The management of NVAF is changing from rate control, to cardioversion and anticoagulation (or use of antithrombotics) to reduce the embolic risk.peer-reviewe

Evidence-based medicine : an overview

Evidence-Based Medicine (EBM) is about combining the best clinical expertise with the best available clinical information in the literature. At face value, this statement may seem simplistic, but closer scrutiny will lead to a reappraisal. The medical literature has increased exponentially to the point where the individual clinician can no longer keep abreast. The development and practice of EBM is a long-term, self-directed process which requires 5 sequential steps .In this article the author describes in the detail the searching process.peer-reviewe

Clinical audit: a synopsis

This synopsis is a brief report of the proceedings of the Clinical Audit Seminar organized by the Continuing Professional Development (CPD) Committee, held on the 29th October 2002. The seminar attracted a broad inter-professional audience, mainly consisting of doctors but also including pharmacists, nurses, and health service managers. In an effort to provide a broader focus, an effort has been made to introduce various perspectives on the topic, including one external to medicine. The idea was to try to learn concepts from other professions which could then be used to improve patient care; this practice has taken place in many industries, and is finally beginning to develop in medicine in different spheres.peer-reviewe

Clinical quality improvement and medicine

Medical practice is facing many pressures, all requiring ever-higher standards and better 'quality' in the provision of clinical care. Medicine is not alone in facing such forces, and it may be appropriate to apply the methodology used in other disciplines to address this issue; common problems are generally amenable to common solutions. The 'quality' approach was initially applied to health care in the USA, presumably because of the accent on market forces and the relationship with market share. In recent years, other health care systems have invested in this approach, applying lessons learned from management disciplines and the aviation industly. The Institute of Medicine's report on health care quality noted that 'every system is perfectly designed to obtain the results it gets' fll The European Union has thus far not included quality as a formal item on its agenda; however, with increasing mobility of patients and health professionals, there is pressure for legislative action addressing risk management and quality improvement. The development of a European approach to ensure the highest quality standards, free movement in the European Union, as well as the medical devices industry, are all areas that are raising interest. Overall, it behooves the individual clinician to be aware of developments in the area.peer-reviewe

Torsade de Pointes : a diagnostic pitfall

Torsade de pointes is an unusual arrhythmia which is found in certain well defined clinical situations. The authors present two cases of Torsade de pointes which were admitted on two consecutive days, where the diagnosis was not immediately appreciated. It is important that one should become familiar with the E.C.G. appearance and be aware of the possible aetiology so that appropriate treatment can be initiated.peer-reviewe