General Medicine and Primary Care

Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial

Andrew Appelboam, FRCEM, Adam Reuben, FRCEM, Clifford Mann, FRCEM, James Gagg, FRCEM, Prof Paul Ewings, PhD, Andrew Barton, MSc, Trudie Lobban, MRCP, Mark Dayer, FRCP, Jane Vickery, MSc, Prof Jonathan Benger, MD on behalf of the REVERT trial collaborators

The Lancet. 2015; DOI:10.1016/S0140-6736(15)61485-4

Published Online: 24 August 2015

Background: The Valsalva manoeuvre is an internationally recommended treatment for supraventricular tachycardia, but cardioversion is rare in practice (5–20%), necessitating the use of other treatments including adenosine, which patients often find unpleasant. Researchers assessed whether a postural modification to the Valsalva manoeuvre could improve its effectiveness.

Methods: The study authors did a randomised controlled, parallel-group trial at emergency departments in England. They randomly allocated adults presenting with supraventricular tachycardia (excluding atrial fi brillation and flutter) in a 1:1 ratio to undergo a modified Valsalva manoeuvre (done semi-recumbent with supine repositioning and passive leg raise immediately after the Valsalva strain), or a standard semi-recumbent Valsalva manoeuvre. A 40 mm Hg pressure, 15 s standardised strain was used in both groups. Randomisation, stratified by centre, was done centrally and independently, with allocation with serially numbered, …

Host: Matt Birnholz, MD

Guest: Edward R. Sauter, MD, PhD, MHA

In the clinical arena, discussions on breast cancer prevention and treatment often center on what is considered most "cutting edge," from genetic mechanisms of disease to new combination pharmacotherapies to breast-conserving surgical innovations. But another field of study, targeting the potential roles of nutrition in breast cancer risk, remains commonly neglected by the medical community. What parts do nutritional choices and habits play in breast cancer development, and how can clinicians make better risk assessments given this information?

Dr. Edward Sauter, Professor of Surgery and Director of the Cancer Treatment and Prevention Center at the University of Texas Health Sciences Center, joins Dr. Matt Birnholz to discuss emerging connections between nutrition and breast cancer.

Host: Brian P. McDonough, MD, FAAFP

Dr. Brian McDonough welcomes Dr. Amy Price, staff physician in the Department of Family Practice at Eastern Virginia Medical School. Dr. Price authored an article titled "Bipolar Disorders: A Review" in American Family Physician, journal of the AAFP. She explains the keys to recognizing, diagnosing, and treating bipolar disorder in primary care settings.

Host: Brian P. McDonough, MD, FAAFP

How can pharmacy practice inform the primary care and family medicine communities about approaching challenging diabetes cases? Christa George, Pharm.D, Associate Professor in the departments of Clinical Pharmacy and Family Medicine at the University of Tennessee Health Science Center, joins Dr. Brian McDonough to discuss Type 2 Diabetes from the unique vantage point of the pharmacist.

Host: Brian P. McDonough, MD, FAAFP

Patients with obsessive-compulsive disorder (OCD) bring unique challenges to the primary care practice environment and require personalized therapeutic approaches to address both psychiatric and somatic health issues. Dr. Jill Fenske, Clinical Assistant Professor of Family Medicine at the University of Michigan Medical School, joins Dr. Brian McDonough to guide clinicians toward a better understanding of this complex disorder with multiple varied manifestations.

Host: Brian P. McDonough, MD, FAAFP

Dr. Brian McDonough welcomes Dr. Jonathan Firnhaber, Clinical Assistant Professor of Family Medicine at East Carolina University School of Medicine, to provide top recommendations for prevention, assessment, and treatment of skin cancer at the primary care level.

Guest: Olufunmilayo (Funmi) Olopade, MD, FACP

Host: Maurice Pickard, MD

Host Dr. Maurice Pickard welcomes Olufunmilayo (Funmi) Olopade, MD, FACP, Walter L. Palmer Distinguished Service Professor of Medicine & Human Genetics, Associate Dean for Global Health, and Director of Center for Clinical Cancer Genetics at the University of Chicago Medicine, Chicago, IL. Dr. Olopade reviews the latest information and best practices in establishing an interdisciplinary program in improving chronic disease treatment worldwide. She reviews challenges and progress toward providing better education, research and training, and service infrastructures addressing global health issues within the United States and around the world.

Host: Brian P. McDonough, MD, FAAFP

Dr. Brian McDonough welcomes Dr. Gail L. Torkildsen, staff ophthalmologist at Andover Eye Associates and one of the leading Dry Eye Principal Investigators in the world. Dr. Torkildsen has served as P.I. on over 20 client-sponsored Dry Eye studies since 2002. In this discussion she takes listeners on a tour of common eye problems faced in primary care, and how clinicians can better prepare themselves to address issues such as Meibobian gland disorders, blepharitis, dry eyes, and conjunctivitis with greater confidence.

Host: Brian P. McDonough, MD, FAAFP

Dr. Brian McDonough welcomes Dr. Tina Thethi, Assistant Professor of Medicine in the section of Endocrinology and Metabolism at Tulane University Health Sciences Center. Dr. Thethi provides the inside scoop on diabetes topics of particular interest to endocrinologists in practice today, from pre-diabetes management to continuous glucose monitoring to novel drug research and development.

Host: Brian P. McDonough, MD, FAAFP

A clinical pearl in the arena of eye care is that serious eye problems tend to manifest serious symptoms and signs, which makes vision loss one of the key findings in a diagnostic workup. Yet vision testing is commonly neglected in primary care practice even when patients present with eye-related complaints. What are the most important steps a clinician can take when assessing eye problems, and where does the primary care practitioner fit into the ophthalmologic care continuum? Dr. Brian McDonough welcomes Dr. Sumitra Khandelwal, Assistant Professor of Ophthalmology at Baylor College of Medicine, to examine the top issues in eye care for generalists and ophthalmic specialists.