A Defence of the Thesis THAT "THE OPPORTUNITIES OF THE GENERAL PRACTITIONER ARE ESSENTIAL FOR THE INVESTIGATION OF DISEASE AND THE PROGRESS OF MEDICINE."

Atrial fibrillation: real-life experience of a rhythm control with electrical cardioversion in a community hospital

BACKGROUND

Atrial fibrillation is the most prevalent sustained cardiac arrhythmia. Electrical cardioversion, a well-established part of the rhythm control strategy, is probably underused in community settings. Here, we describe its use, safety, and effectiveness in a cohort of patients with atrial fibrillation treated in rural settings.

METHODS

It is a retrospective cohort study. Data on all procedures from January 1, 2016, till December 1, 2022, in Tarusa Hospital, serving mostly a rural population of 15,000 people, were extracted from electronic health records. Data on the procedure's success, age, gender, body mass index, comorbidities, previous procedures, echocardiographic parameters, type and duration of arrhythmia, anticoagulation, antiarrhythmic drugs, transesophageal echocardiography, and settings were available.

RESULTS

Altogether, 1,272 procedures in 435 patients were performed during the study period. The overall effectiveness of the procedure was 92%. Effectiveness was similar across all prespecified subgroups. Electrical cardioversion was less effective in patients undergoing the procedure for the first time (86%, 95% CI: 82-90) compared to repeated procedures (95%, 95% CI: 93-96), OR 0.39 (95% CI: 0.26-0.59). Complications were encountered in 13 (1.02%) procedures but were not serious.

CONCLUSIONS

Electrical cardioversion is an immediately effective procedure that can be safely performed in community hospitals, both in inpatient and outpatient settings. Further studies with longer follow-up are needed to investigate the rate of sinus rhythm maintenance in these patients.

Primary care research network progress in Scotland

Many developed industrialized countries perceive considerable value in developing practice based research networks. In this paper, the development of the Scottish Primary Care Research Network (SPCRN) from 1924-2013 is described. After a false start in the early twentieth century and some local developments 10-15 years ago, the Scottish Primary Care Research Network was finally built upon existing networks of teaching and training practices centred on research active departments of general practice and primary care. This meant that a climate already favourable to research existed and several of the necessary skills were available. Long-term funding commitment to the network by the National Health Service meant that the infrastructure could be developed in the knowledge that it would be likely to become incorporated into wider Scottish and UK systems. Two-thirds of Scottish practices regularly participate in research at a rate of 50-60 studies each year, which result in a range of publications that influence clinical decisions and health policy. As the success of the network grows, greater demands are placed upon it, and the capacity of practices to continue to engage in research may be tested.

The contribution of British general practice to our knowledge of epilepsy and its effects on people

INTRODUCTION

British general practice is a good base for epidemiological research which is evidenced by the study of epilepsy.

SOURCES OF DATA

A comprehensive search of PubMed using various keywords for articles on epilepsy research performed in British general practice.

AREAS OF AGREEMENT

Studies in the setting of general practice have contributed significantly to knowledge in the field of epilepsy, especially in relation to epidemiology, studies of prognosis and treatment patterns and psychosocial aspects.

AREAS OF CONTROVERSY

The extent to which epilepsy can be managed in general practice.

GROWING POINTS

The importance of primary care research and the importance of collaborative studies between general practice, hospital and university departments.

AREAS TIMELY FOR DEVELOPING RESEARCH

The effects of interventions at general practice level on seizure control, morbidity and mortality.

Prognostic model for HIV-1 disease progression in patients starting antiretroviral therapy was validated using independent data

SETTING AND OBJECTIVE

The Antiretroviral Therapy (ART) Cohort Collaboration published models predicting progression to AIDS or death (the complement of AIDS-free survival) and death (the complement of absolute survival). The objective is to validate the model on independent data from CASCADE.

STUDY DESIGN

Discrimination was assessed using concordance statistics, and calibration was examined by comparing predicted survival curves with the corresponding Kaplan-Meier estimates. Accuracy was assessed by comparing predicted percentage probability of survival with the Kaplan-Meier estimate at yearly intervals after start of therapy.

RESULTS

There was little loss of model discrimination when applying the model to CASCADE. Overall predicted calibration curves agreed with Kaplan-Meier survival curves. Predicted probabilities of AIDS or death at 3 years after starting HAART ranged from 4.3% in the low-risk group to 20.5% in high-risk patients, with corresponding Kaplan-Meier estimates ranging from 4.0% to 18.3%; for death predictions, the probabilities ranged from 1.2% to 7.3% and estimates from 1.1% to 8.6%.

CONCLUSION

The predictions from the model agree with observed outcomes in CASCADE to within the 95% upper and lower Kaplan-Meier estimates. The prognostic model appears to be accurate in terms of discrimination and calibration, giving reliable and transportable predictions up to 3 years after the start of HAART.