#### What you need to know Palpitations are a symptom characterised by awareness of the heartbeat, often described as a strong, skipping, fluttering, racing, pounding, thudding, or jumping sensation in the chest. Some patients describe a sensation of having to cough or their breath being taken away. However, patients occasionally mean something other than palpitations, such as chest discomfort, which may need a different line of investigation. Most palpitations are benign (being atrial, nodal, or ventricular extrasystoles1), and probably less than half of cases are due to heart rhythm abnormalities or arrhythmias. Anxiety is a common cause of palpitations; up to a third have psychological causes.2 Infrequently, however, they may be incapacitating and can lead to syncope or sudden cardiac death. Equally, a large proportion of patients with palpitations (67% in one study3) are diagnosed as having panic, stress, or anxiety when, instead, they have an …

Objective To assess the effect of electrically heated mittens on physical hand function in people with osteoarthritis of the hands compared with control mittens. Design Randomised controlled trial. Setting Osteoarthritis outpatient clinic, Copenhagen, Denmark. Participants 200 people with hand osteoarthritis aged 42-90 years. 100 participants were assigned to the intervention group and 100 to the control group. Interventions Electrically heated mittens or control mittens (heating elements disconnected) worn for at least 15 minutes daily for six weeks. Main outcome measures The primary outcome was change in hand function measured on the function subscale of the Australian/Canadian hand osteoarthritis index (AUSCAN; score 0-100 points) at six weeks. Key secondary outcomes included changes in the AUSCAN hand pain subscale (score 0-100 points), global rating of hand osteoarthritis related problems (0-100 visual analogue scale), and grip strength (newtons) at six weeks. Analysis of secondar