The journal of the Royal College of Physicians of Edinburgh
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J R Coll Physicians Edinb · Dec 2018
Case ReportsRadiological neuro-Behçet's associated with bipolar disorder: first presentation of a multisystem disease.
Behçet's disease is a chronic, relapsing, systemic inflammatory disease affecting the orogenital mucosa, eyes, joints, blood vessels, nervous system and intestines. The prevalence of neurological involvement varies geographically and can include psychiatric manifestations. Current evidence for a causal association between Behçet's disease and bipolar disorder is limited to a small number of case reports. ⋯ Additionally, neuro-Behçet's should be considered in patients with bipolar disorder presenting with symptoms suggestive of Behçet's disease. The case emphasises how patients presenting with ulceration, mood disorder and visual changes should not have these symptoms considered in isolation and multisystem disease should be considered. Furthermore, the coordinated multidisciplinary approach required for the care of patients with Behçet's disease is demonstrated.
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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.
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J R Coll Physicians Edinb · Sep 2018
Biography Historical ArticleSir Alexander Morison and The Physiognomy of Mental Diseases: Part 1.
Sir Alexander Morison's The Physiognomy of Mental Diseases and the original art work that formed the basis of the book have not had the scholarly attention they deserve. The published book and the commissioned portraits have not been studied in any detail. Historians have tended to offer cursory assessments that have reflected their own preconceived ideas rather than properly engaging with the material. ⋯ Morison's work can also be located in the history of ideas about physiognomy. He himself was particularly influenced by Jean-Étienne-Dominique Esquirol, and Morison's work, in turn, influenced WAF Browne. These papers will outline Morison's career and consider in detail his book on The Physiognomy of Mental Diseases.
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J R Coll Physicians Edinb · Dec 2017
Biography Historical ArticleSir Winston Churchill: treatment for pneumonia in 1943 and 1944.
This paper reviews Churchill's illnesses in February 1943 and August/September 1944 when he developed pneumonia; on the first occasion this followed a cold and sore throat. Churchill was managed at home by Sir Charles Wilson (later Lord Moran) with the assistance of two nurses and the expert advice of Dr Geoffrey Marshall, Brigadier Lionel Whitby and Colonel Robert Drew. ⋯ Churchill recovered, and despite his illnesses continued to direct the affairs of State from his bed. On the second occasion, Churchill's illness was not made public.
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J R Coll Physicians Edinb · Dec 2017
Going beyond audit and feedback: towards behaviour-based interventions to change physician laboratory test ordering behaviour.
Studies indicate there are a variety of contributing factors affecting physician test ordering behaviour. Identifying these behaviours allows development of behaviour-based interventions. Methods Through a pilot study, the list of contributing factors in laboratory tests ordering, and the most ordered tests, were identified, and given to 50 medical students, interns, residents and paediatricians in questionnaire form. ⋯ Conclusion The audit and feedback intervention, even in short duration, affects physician ordering behaviour. It should be designed in terms of behaviour-based intervention and diagnosis of the contributing factors in physicians' behaviour. Further studies are required to substantiate the effectiveness of such behaviour-based intervention strategies in changing physician behaviour.