bluuebunny/crossref_metadata_2025 huggingface dataset:
Women and ageing: demographic aspects
Authors: Grundy Emily
Published: November 2023

During the course of the twentieth century the relative size of the population aged 65 and over in England and Wales has increased threefold from just 5 per cent in 1901 to over 15 per cent in 1988.1 As a result of sex differentials in mortality, women now outnumber men from about the age of 50 and the elderly population is predominantly female. As Table 1.1 shows, in 1988 women constituted 60 per cent of the whole of the elderly population and 75 per cent of the population aged 85 and over.
Health of elderly Asian women
Authors: Ebrahim Shah
Published: November 2023

It is usually assumed that where a person comes from determines their ethnicity, and this simple approach has led to the census in the United Kingdom (UK) using country of birth as the only means of classifying ethnicity. The 1991 census will use such a system, but will be refined to allow separation of Bangladeshi, Pakistani, and Indians from ‘other Asians’. Without routine data collection it is very difficult to monitor the uptake of services, measure rates of disease, and determine the need for services. In part, the lack of data has arisen because of an understandable suspicion that such data might be used for the purposes of removing people from the country, and, in part, because of the notion that ‘we are all British’ and that to classify people into ethnic groups is itself a racist activity.
Preventive measures
Authors: Mehtar Shaheen
Published: November 2023

Disinfection and sterilization are necessary to prevent cross-infection from equipment, surfaces and skin and are used in all hospitals: Decontamination renders an article safe for handling. Disinfection is used to reduce the number of micro-organisms on an object or surface, although the disinfectants used rarely destroy all the micro-organisms they come into contact with.
Medical technology 1n China
Authors: Banta H David , Jie Chen
Published: November 2023

China is the most populous country in the world, with more than I billion people. During the decades following World War II, Chinese health policy focused on the control of communicable diseases, development of primary health care, and better sanitation and nutrition. Life expectancy increased from an estimated 35 years in 1949 to 69 years in 1986 (746). As a result, China is facing disease patterns typical of more developed countries, with rising rates of chronic diseases.
Smoking
Authors: Fowler Godfrey
Published: November 2023

Tobacco smoking has been identified by the World Health Organisation as the most important preventable cause of disease and premature death. Moreover, contrary to popular belief (which perceives lung cancer as the predominant smoking risk), much of this avoidable morbidity and mortality is cardiovascular. The proportion of males in the population in Britain who smoke reached a peak at the end of the Second World War when about two thirds of men were smoking; by the 1970s, smoking had also peaked in women, when almost half were smoking.
Hypertension
Authors: Lawrence Martin , Cruickshank Kennedy
Published: November 2023

It has long been recognized that high blood pressure is a major risk factor for overall mortality and for death from cardiovascular disease in particular. Untreated malignant hypertension has a mortality of over 80 per cent within a year from detection and in 1959 treatment was first shown to reduce this at least six-fold. By 1967, in the first formal controlled trial by the Veterans Administration team, the control group of 70 untreated patients with diastolic blood pressure from 115- 129 mm Hg (‘severe’ but not necessarily malignant hypertension), followed for an average of 18 months, showed major vascular events or death in 21 (30 per cent) compared with one stroke and no deaths in the actively treated group.
Exercise
Authors: Mant David , Little Paul
Published: November 2023

Forty years ago, Morris and his co-workers in London drew attention to the higher cardiovascular morbidity of sedentary workers within similar social groups. They asked why bus drivers should suffer more heart attacks than bus conductors, why clerks more than postmen, and they suggested that one explanation was the degree of exercise taken. This led Morris to set up the UK Civil Service Study, concerned with leisure time activity in male civil servants aged 40-64, in which those who reported involvement in vigorous exercise experienced a coronary heart disease (CHD) rate approximately one third lower than that in other men. Importantly, the benefit of vigorous exercise was apparent even within groups of men with cardiovascular risk factors such as smoking, high blood pressure and high serum cholesterol levels.
Social deprivation
Authors: Coulter Angela , Mant David
Published: November 2023

Socio-economic differences in life expectancy in Britain have been reported since 1921, when the first official statistics linking mortality to social class were published. Figure 9.1 shows standardized mortality ratios (SMRs) for diseases of the circulatory system by social class for the years 1979-83. There is a two-fold mortality gradient in men and almost a four-fold gradient in women between social classes I and V.
Haemostasis
Authors: Silagy Chris
Published: November 2023

Cigarette smoking, hypertension, and lipid abnormalities are traditionally regarded as the major risk factors associated with the development of cardiovasular disease. However, in recent years the list of other potential risk factors has grown substantially; a review in 1981 identified 246 risk factors. Two reasons may help explain this increase. Firstly, the traditional risk factors alone do not entirely account for the wide variation observed in the rate of cardiovascular disease within and between communities. Secondly, there has been a marked improvement in the understanding of the pathogenesis of cardiovascular disease.
Community-based interventions
Authors: Rayner Michael
Published: November 2023

There is some debate about what constitutes community-based coronary heart disease (CHD) prevention, and amongst those who would say they are involved in it there is disagreement about how it should be carried out. However, all agree that it involves activities which take place outside of traditional medical settings such as hospitals or general practitioners’ surgeries. Doctors and other health professionals may be involved but not invariably so.
Screening policy
Authors: Mant David
Published: November 2023

Screening can never play a major role in the prevention of heart disease in the UK. By definition, screening is selective and is therefore an inappropriate general strategy to deal with a problem which afflicts the majority of the population. If it reassures people who are identified as at average relative risk, it may even prejudice a strategy to reduce the high overall risk of the entire UK population. In these circumstances, it is very important that the scientific case for screening is well founded. It is very easy for screening to do more harm than good.
Wounds
Authors: Guly H R
Published: November 2023

As noted above (p. 14) the mechanism of the wounding may give valuable clues as to the type of injuries sustained. Other questions one may need to ask include the direction of a penetrating injury, the length of a blade causing a stab wound (NB the length of the track may be longer than the length of the blade due to the elasticity of the tissues), and whether there is the possibility of a foreign body (especially with thorn injuries-ask ‘did the point of the thorn come out?’).
Head injury
Authors: Guly H R
Published: November 2023

It is important to ask enough questions to understand fully the mechanism of the head injury. A fall on to concrete is more likely to cause a fracture than a fall on to a carpeted floor. A high velocity deceleration injury such as a road accident is likely to cause severe generalized neuronal injury whereas a blow by a hard object may fracture the skull but cause little brain injury. If the object causing the blow is small, such as a hammer, the patient may have a compound depressed fracture, the severity of which may not be appreciated if the patient never lost consciousness.
Spinal cord injury
Authors: Guly H R
Published: November 2023

If a patient has a spinal cord injury whether from trauma or, less commonly in an A& E setting, from a non-traumatic cause, such as an acute cord compression or a vascular problem, it is important to document the level and to determine whether the injury is complete or incomplete. By convention, the level of a cord injury is the level of the last intact segment.
Lower limb injury
Authors: Guly H R
Published: November 2023

It is important to establish whether a patient has walked since the accident. This may be obvious (e.g. if the patient walks into the consulting room) but a patient with a knee or hip injury will often have been asked to undress and lie on a couch before being seen by the doctor and it may be necessary to ask specifically. A patient who has walked normally or run since they injured themselves is unlikely to have a serious injury, but the ability to weight bear does not always exclude a significant fracture.
Aminoacidurias and the Fanconi syndrome
Authors: Haycock George B
Published: November 2023

About two-thirds of the volume of the glomerular filtrate is reabsorbed isotonically in the proximal tubule. The energy driving this process is generated from ATP by the action of Na, K ATPase in the basolateral membrane of the tubular cell, resulting in transport of three sodium (Na) ions out of the cell in exchange for two potassium (K) ions. The resulting low intracellular Na concentration creates and maintains a steep electrochemical Na gradient from the bubular fluid to the cell interior across the brush border of the apical membrane. The brush border contains a number of transport proteins, each of which facilitates diffusive entry of Na and a specific cotransportate into the cell.
Lecithin-cholesterol acyltransferase deficiency and the kidney
Authors: Harry D S , Winder A F
Published: November 2023

In 1935, Sperry recognized that when human serum or blood was incubated, the free cholesterol concentration fell without any change in the total cholesterol. He correctly attributed this observation to the enzymatic esterification of free cholesterol with a fatty acid coming from the hydrolysis of a fatty acid-containing compound. In the early 1960s, Glomset published several papers on the nature of the enzyme involved which he designated as lecithin-cholesterol acyl transferase (LCAT) (Glomset 1962; 1963).
Glycogen storage diseases (von Gierke’s disease)
Authors: Grunfeld Jean-Pierre
Published: November 2023

The glycogen storage diseases (GSDs) include over 12 separate genetic defects that affect glycogen metabolism, primarily break down in liver or muscle, or both. Indeed, liver and muscle contain abundant quantities of glycogen. Since carbohydrate metabolism in the liver is respon sible for plasma glucose homeostasis, GSDs with liver involvement are manifested by hepatome galy and hypoglycaemia. In contrast, muscle glycogen provides substrates which enable the ATP generation necessary for muscle contraction. The presenting features of GSDs that affect the muscle are cramp, exercise intolerance, and progressive muscle weakness. In occasional cases, acute rhabdomyolysis may occur in these patients, leading to myoglobinuria and acute renal failure.
von Hippel-Lindau syndrome
Authors: Neumann Hartmut P H , Laubenberger Jijrg , Wetterauer, Ulrich , Zbar Berton
Published: November 2023

von Rippel-Lindau syndrome (VHL) is a cancer-prone inherited disorder of adulthood involv ing many organs and organ systems (Figs 26.1 and 26.2, Table 26.1). The reported prevalence in different populations was 1: 38000-1: 53000 (Maher et al. 1991; Neumann and Wiestler 1991). The disease predominantly affects the eyes (retinal angiomatosis), central nervous system (hae mangioblastoma of the cerebellum, brainstem, and spinal cord), adrenal glands and paraganglia (phaeochromocytoma), kidneys (renal cysts, renal cell carcinoma), and pancreas (pancreatic cysts). Rare manifestations involve among other organs the epididymis (epidydimal cystade noma) and inner ear (endolymphatic sac tumour). Renal involvement by von Rippel-Lindau sysdrome is not well-known and the disease is often simply regarded as involving tumours only of the eye and the cerebellum within the same patient.
Principles of molecular biology as applied to the study of disease
Authors: Calvet James P
Published: November 2023

Advances in molecular biology over the past decade have created a considerable expansion in our knowledge about basic cell function, and with it an overwhelming proliferation of terms, procedures, and protocols. Despite this, however, a large number of experimental techniques in molecular biology have become standardized and are now commonplace in the laboratories of a wide range of basic and clinical investigators.
Pathogenesis of polycystic kidney disease: basement membrane and extracellular matrix
Authors: Carone Frank A , Bacallao Robert , Kanivar Yashpal S
Published: November 2023

Polycystic kidney disease (PKD) is a genetic or acquired disorder with progressive dilatation of multiple tubular segments and/or enlargement of glomerular capsules, accompanied by fluid accumulation, growth of non-neoplastic epithelial cells, and deranged remodelling of the extracellular matrices. This results ultimately in a certain degree of renal functional impairment, which potentially can regress to normal after removal of the inductive agent(s) in experimental animal models (Carone et al. 1994; Kanwar and Carone 1984). These localized events with seg mental dysmorphogenetic lesions are conceivably related to an aberration of one or more factors which maintain normal tubular and glomerular morphological features.
Genetic heterogeneity of autosomal dominant polycystic kidney disease
Authors: Breuning M H , Peters D J M
Published: November 2023

Quite often one and the same hereditary disease can be caused by mutations at several distinct genes. ADPKD is a good example. At least two genes are involved, PKDl on chromosome 16, and PKD2 on chromosome 4.
What happens to you in kidney failure?
Authors: Cameron Stewart
Published: November 2023

In this chapter we look at what happens to you if you have kidney failure of some degree, which may or may not be progressing, but your own kidneys are still working. Some 40-50 000 people in the UK and maybe as many as 300-400 000 in the USA are in this position. Many will be already under the care of a doctor, but quite a large proportion may not know yet that they have kidney trouble. The majority will eventually require treatment for end-stage disease, by dialysis, by kidney transplantation, or both.
Health economics and prescribing
Authors: Earl-Slater Alan
Published: November 2023

Primary healthcare professionals have more reason to be interested in health economics than many currently appreciate. Anyone working to improve patient wellbeing within the restrictions incurred by limited resources (time, skills, knowledge, and funds) can benefit from an understanding of health economics. The fundamental principles addressed using health economic tools and techniques, i.e. that resources are limited and that this forces choices between different courses of actions with different costs and benefits flowing from them, are not new but have always been part and parcel of medical practice.
The future of prescribing in primary care
Authors: Hobbs Richard
Published: November 2023

As this book has demonstrated, prescribing within primary care remains a particularly complex healthcare issue. Prescribing is a high volume and high cost activity (consuming over 50% of the total expenditure on UK primary care services and some 1% of the total expenditure of the NHS).
Circles of desire: a therapeutic narrative from South Asia—translation to creolization
Authors: Jadhav Sushrut , Littlewood Roland , Raguram R
Published: November 2023

In summer 1985, as a junior doctor in psychiatry at the Indian National Institute of Mental Health in Bangalore, one of us (SJ) was running his out-patient clinic, clerking his patients, and discussing them with senior psychiatrists. We usually saw about 20 to 35 people over a period of four hours in a clinic shared by four residents and two consultants. People came from long distances, often with packed food as gifts for the doctors and porters, and with a determined hope for relief from their sufferings.
Basic concepts: your myth or mine?
Authors: Dickenson Donna , Fulford Bill (Kwm)
Published: November 2023

An important characteristic of modern mental health practice is the variety of ways in which mental distress and disorder are understood (Colombo 1997). These ‘models of disorder’ range along a spectrum from medical (or biological) conceptions of mental illness (according to which mental disorders are caused by distinct pathological lesions in the brain and hence are no different in prin ciple from bodily illnesses), through various psychological models (for exam ple, behavioural, psychoanalytic, family dynamic), to overtly moral models. According to the latter, mental disorders are, in one way or another, either problems of living for which those concerned are responsible, or labels imposed by society to justify the control of deviance.
Treatment: trick or treat?
Authors: Dickenson Donna , Fulford Bill (Kwm)
Published: November 2023

With treatment, we come full square to those issuew that are at the heart of traditional bioethics — automomy, consent, confidentiality, equal access, dual (indeed multiple!) responsibility, rationing, advance directives, and so forth.

Besides an extensive general literature, a good deal has been written about the ethical problems of treatment choice specifically in psychiatry (see Reading Guide to Chapter 2 and at the end of this chapter). One ‘big issue’ for psychia try is involuntary treatment. Psychiatry is ethically unique in that it is only for mental disorders that treatment without the consent of a fully conscious adult patient of normal intelligence is sometimes justified, not just for the protection of others, but in the interests of the person concerned. This is a ‘big issue’ prac tically: the boundary between justified and unjustified uses of involuntary treatment is the boundary between good practice and some of the worst abus es of psychiatry as a means of social control.
Psychiatric ethics: an international open society
Authors: Birley Jim
Published: November 2023

The basic education of doctors now lays less emphasis on stuffing them with facts (which may rapidly become irrelevant) and much more on teaching them attitudes about themselves, their patients and families, and their colleagues — which they will require to function as ‘good doctors’ throughout their profes sional lives. Much of this teaching will come, for better or worse, not from for mal occasions but from attitudes displayed or implied by their teachers. Attitudes are, of course, related to skills. A person’s attitude to a swimming pool, particularly to its deep end, will be affected by his or her ability to swim. This book is an introduction to the deeper end of ethics, beyond the shallows of autonomy and beneficence, which encourages the reader to develop the skills required to enjoy the experience and to communicate this enjoyment to others.
Management in the acute stage
Authors: Wrightson Philip , Gronwall Dorothy
Published: November 2023

In Chapter 2 we offered a definition of mild head injury in the acute stage. It specified that there should have been an injury to the head with a disturbance of neurological function, that when first assessed there should be a GCS score of 13–15 which was steady or improving, and that there should be no focal neurological signs. In such a patient, after looking at any other injuries and at their general condition, the question of management will be decided largely on the possibility of complications, principally intracranial haemorrhage.
Clinical picture after mild head Injury
Authors: Wrightson Philip , Gronwall Dorothy
Published: November 2023

Most people who have had a mild head injury experience unpleasant symptoms for a few days, usually of headache, lethargy, and irritability, but will be back to their normal activities in two or three weeks. In some these symptoms fail to resolve. Their headache continues and their sight and balance may be disturbed. They have difficulty with concentration and memory which prevents their returning to work, and there may be changes in their behaviour and personality. Lastly there is a small group of patients who have had less marked but still disabling symptoms for months or years before it is realized or accepted that they have been caused by a head injury.
Long-term outcome of different forms of vascular access
Authors: Burger Hendrick
Published: November 2023

The most important feature of any form of vascular access is its length of survival as a functioning access (commonly known as the secondary patency rate). There are other qualities which are also important such as primary patency, intervention-free periods, the need for hospitalization and also the ease with which the access can be handled.
Magnetic Stimulation of the Human Nervous System
Authors: Mills K R
Published: November 2023

This book provides comprehensive coverage of the technique and clinical applications of magnetic brain stimulation. It begins with an account of the invention of the technique and considers the technical aspects of how magnetic stimulators work. The anatomy and physiology of cortical motor areas are covered in sufficient detail to interpret the findings. There then follows a discussion of the effects of magnetic brain stimulation in healthy subjects, covering the visual and motor systems, and the effects of repetitive transcranial stimulation. A chapter on the practical aspects of the technique's use in a clinical setting is followed by coverage of specific clinical applications in patients with demyelinating diseases, motoneurone diseases, cerebrovascular diseases, degenerative neurological diseases, movement disorders, spinal cord and peripheral nerve diseases. The final chapters deal with the use of brain stimulation in neurosurgical monitoring and discuss potential developments of the technique in investigating neural plasticity and in treatment of psychiatric conditions. Kerry Mills is an authority, pioneer and active worker in the field; he is uniquely positioned to review the technique, from its invention through to the very latest clinical applications.
Motor Effects of Brain Stimulation
Authors: Mills K R
Published: November 2023

When the human brain is stimulated with either electrical or magnetic stimuli, a complex sequence of events ensues. The effects depend critically on the stimulus intensity and the ambient excitability of the cortex and the spinal cord. Because a large volume of cerebral tissue is exposed to current, it is not surprising that both excitatory and inhibitory effects are encountered. This chapter sets out in detail the effects in different muscles, the topography of the effects, the conditions for evoking excitatory and/or inhibitory responses, and also considers the effects of stimulating parts of the central nervous system other than the cerebral cortex, such as the cerebellum and brainstem.
Stimulation of peripheral nerves
Authors: Mills K R
Published: November 2023

Electrical stimulation of peripheral nerves has been used in clinical neurophysiology for decades. However, a number of features of electrical stimulation render it less than ideal in several clinical situations. For instance, the painful nature of stimulation can be unacceptable to patients and there is difficulty in exciting deeply placed nerves such as the femoral or sciatic. Furthermore, it is known that electrical stimuli preferentially excite large-diameter myelinated fibres, limiting the usefulness of electrical stimulation in investigating the gamut of peripheral nerve disorders. The finding that magnetic stimuli could also excite peripheral nerves therefore provoked a re-examination of nerve stimulation and a comparison of the two techniques (Chokroverty 1989). The first nerve to be studied with magnetic stimulation was the facial (Schriefer et al. 1988); this was because magnetic stimulation over the lateral parts of the scalp frequently led to facial twitches, the origin of which required investigation.
Cerebrovascular diseases
Authors: Mills K R
Published: November 2023

The diagnosis of cerebrovascular disease where there is an acute onset of hemiparesis together with the typical clinical signs and imaging findings is usually straightforward. Central motor conduction studies have, therefore, little to offer in terms of diagnosis. The principal applications of transcranial magnetic stimulation (TMS) have been as a predictor of outcome and as a way of investigating the adaptive changes in the brain following an ischaemic insult. Many patients with stroke have absent responses to magnetic brain stimulation, but of the patients in whom a response is obtained, central motor conduction time (CMCT) is usually only marginally prolonged (see Table 11.1). The weighted average ratio of CMCT in stroke patients to healthy controls from the studies listed in Table 11.1 is 1.19, that is there is on average a 19% increase in CMCT. Fewer studies have examined muscle of the lower limb where the prolongation of CMCT appears to be greater than in the arms, the weighted ratio being 1.45. A markedly prolonged CMCT, however, should result in a reassessment of the diagnosis. Corticomotor threshold has been formally measured in stroke (Catano et al. 1996) and was found to be commonly raised irrespective of the site of the lesion.
Miscellaneous neurological conditions
Authors: Mills K R
Published: November 2023

This chapter includes the results of central motor conduction studies in conditions which do not fit happily into the classifications of earlier chapters. The effects of a large number of drugs on motor evoked potentials (MEPs) have been documented and these are included here but a discussion of anaesthetic and paralysing agents is included in Chapter 18.In this rare syndrome, attacks of transient unilateral weakness occur beginning in the first year oflife. Attacks may occur on either side at different times, may last minutes to hours and may occur up to several times per week. A slowly progressive neurological deficit may develop comprising intellectual impairment, dysarthria and dystonia. The cause of the condition is unknown, but the similarity with familial hemiplegic migraine is striking. Another possibility is mitochondrial cytopathy. The origin of the progressive deteriora tion has been suggested to be due to accumulated microvascular lesions, but there is no evidence for this on magnetic resonance imaging (MRI) or magnetic resonance spectro scopy. A 23-year-old patient with this condition has been investigated between attacks and during an attack ofleft hemiplegia (Nezu et al. 1997b). Interestingly, the patient had also developed episodic ataxia (see Chapter 13) which occurred independently of the hemiplegia. Between attacks, central motor conduction time (CMCT) to the first dorsal interosseous (FDI) muscle was normal (right, 7.8 m; left, 7.3 ms). During the attack, CMCT to the left FDI was prolonged at 10.9 ms. Corticomotor threshold and peripheral nerve conduction were unchanged during the attack. Because of the transient nature of attacks, slowing of central conduction cannot be due to demyelination. The normal corticomotor threshold argues against a large shift in cortical or spinal excitability. The most likely explanation is an alteration in temporal summation at the spinal motoneuron.
Rating Scales: Screening, Observer, and Self-rating Questionnaires
Authors: Farmer Anne , McGuffin Peter , Williams Julie
Published: November 2023

Rating scales have been widely applied in a variety of types of research. These include epidemiological studies, studies undertaken in particular settings such as primary care, or in subjects with medical disorders and drug trials where repeated measures of symptom presence and severity is used to evaluate response to treatment.
Measuring Psychopathology in Specific Subject Groups
Authors: Farmer Anne , McGuffin Peter , Williams Julie
Published: November 2023

Measuring psychopathology in particular groups of subjects may require diagnostic assessments, instruments or rating scales that are tailor made to their requirements. Such subjects include children and adolescents, those with a learning disability (mental retardation), and the elderly, especially those who are cognitively impaired. Self-expression and awareness may be limited in these groups and so observer information assumes greater importance than in subjects who can give a more detailed self-report. Also the mental health problems, syndromes and disorders experienced by these three subject groups can be somewhat different to those we have already discussed in relation to non-intellectually impaired adults. For example, while the presentation of obsessive-compulsive disorder is similar in children and adults, the clinical features of depression are rather different in these two age groups (see table 8.1) (Hill 1997).
A personal view
Authors: Brewin Thurstan
Published: November 2023

Thurstan Brewin is a Fellow of the Royal College of Physicians who, after war service, trained at Guy’s Hospital, London; spent five years in Canada with the Ontario Cancer Foundation; 26 years as a Consultant in Clinical Oncology in Glasgow; and has since worked with three medical charities: Marie Curie Cancer Care, the Sue Ryder Foundation, and Healthwatch. He is the main author of two books: Relating to the Relatives and The Friendly Professional, and has written in medical journals on various subjects including clinical trials, medical ethics, and complementary medicine.
Beyond the image: art therapy and a note on poetry
Authors: Connell Camilla
Published: November 2023

Camilla Connell introduced and developed the art therapy service at the Royal Marsden from 1988 until 2000. In 1998 she published a book entitled Something understood: art therapy in cancer care (Wrexham Publications). Art therapy, or art psychotherapy, is in brief the use of art materials for the purpose of image-making in the presence of a trained art therapist.
Complementary therapies in palliative care
Authors: Barnett Mandy
Published: November 2023

This chapter will consider the place of complementary therapies in palliative care, focusing on the use of particular therapies, the evidence base for their use in the palliative care setting, and the problems encountered in evaluating their benefit. The field of palliative care has developed rapidly in the UK over the last 30 years or so 1, in recognition of the need for a more holistic approach to patients who are facing death. The aim within palliative care is to offer optimum care for a patient’s physical condition, and in addition to address psychological, social, and spiritual issues, in order both to maximize the quality of life remaining and to achieve a dignified and peaceful death. This is summarized by the definition from the European Association of Palliative Care: the active total care of a person whose disease is no longer amenable to curative therapy. Initially much of the development of palliative care took place in the voluntary sector, but there has been a steady increase in NHS involvement and funding. Alongside these developments has come the recognition of palliative medicine as a medical subspecialty2, with the subsequent creation of standards of practice and training programmes to improve the provision of specialist care across all regions.
Messages from the research
Authors: Buchanan Ann
Published: November 2023

Then, in the UK, came Child protection: messages from research (Department of Health 199 5). This summarised over 20 research studies into the workings of procedures to protect children. The key message was that, although children in dangerous situations should be protected, the focus of interven tion should change to improving the emotional well-being of much larger numbers of children damaged by living in families ‘low in warmth and high in criticism’.
Nuclear medicine in rheumatology
Authors: Ell P J
Published: November 2023

For over 30 years bone-seeking radiopharmaceuticals have been used in man to investigate skeletal metabolism, localize disease, and make a contribution to the assessment of the extent and severity of the pathology under investigation. Initial work involved the use of calcium-47 and strontium-85 in the investigation of skeletal metabolism (bone accretion and destruction) in man but radionuclides were soon applied to the investigation of pathology.
Localized pain in the lower limb
Authors: Binder Allan I , Brooks Peter T
Published: November 2023

Localized pain presents a considerable diagnostic challenge as, with few exceptions, any joint condition can present in this way. It is, however, essential to identify as early as possible those patients who are at risk of rapid deterioration and hence require vigorous early investigation and treatment. For the remainder of patients, a more measured and systematic assessment is usually acceptable.
Imaging of crystal arthritis
Authors: Forrester Alistair W , Bálint Péter V , Sturrock Roger D
Published: November 2023

The crystal arthropathies consist of a group of conditions that are characterized by the deposition of crystals both within joints and in periarticular tissues. This results both in acute inflammation and a chronic inflammatory reaction leading to tissue destruction and chronic arthritis. Crystal arthritis may be the consequence of metabolic disorders such as gout, hyperparathyroidism, and haemochromatosis but frequently is a feature of osteoarthritis where local factors are responsible for crystal formation and shedding.
Antiphospholipid antibody syndrome
Authors: Gordon Patrick A , Khamashta Munther , D’Cruz David , Hughes Graham R V
Published: November 2023

The antiphospholipid syndrome (APS) was originally described in the 1980s and comprises vascular thrombosis and/or pregnancy morbidity in the presence of antiphospholipid antibodies (aPL) (lupus anticoagulant (LA) or anticardiolipin antibodies (aCL)). When associated with an underlying systemic autoimmune disease it is defined as secondary antiphospholipid syndrome and when in isolation as primary antiphospholipid syndrome.
Imaging in metabolic bone disease
Authors: Marshall Tarnya , Marshall A T , Bearcroft P W B , Crisp Adrian J
Published: November 2023

Despite recent advances in radiological investigations, the most important technique in the evaluation and management of metabolic bone disease remains the plain radiograph, and the classical radiographic findings will be described. The roles of other imaging techniques, for example, isotope bone scintigraphy, and magnetic resonance imaging (MRI) will be discussed.
Forgotten patients – adults abused as children
Authors: Cloke Christopher
Published: November 2023

The recognition of child abuse, especially child sexual abuse, and the development of professional responses, have occurred comparatively recently. Physical abuse and the battered baby syndrome were first identified in the 1960s. Child sexual abuse shot to prominence in the late 1980s, particularly at the time of the Cleveland cases. More recently consideration has been given to the phenomenon of ‘organized abuse ‘. Over the last two decades (1980–2000) guidance for professionals working with children who are at risk or who have been abused has been issued by government and the appropriate professional bodies. Recognition of and responses to the needs of adultswho were abused as children has lagged a long way behind meeting the needs of children who have been abused. This is a very serious omission, since it is known that child abuse can have very damaging long term consequences, affecting both emotional and physical well being.
Legal aspects of child abuse
Authors: Clift Fran
Published: November 2023

The purpose of this chapter is to provide guidance for primary health care practitioners on legal aspects of the child protection process. The Children Act 1989 ( ‘the Act ‘) is the relevant statute. However, there are areas where common law still applies, for example, consent to treatment and confidentiality. Sometimes there are no strictly ‘legal ‘ provisions and in this case, guidelines from the Department of Health, the Medical Royal Colleges and other professional bodies are of great importance for informing best practice.Where important principles have been established by case law rather than statute, the case names are given in the text in brackets with the full legal reference at the end of the chapter.
Roles and responsibilities
Authors: Hendry Enid
Published: November 2023

Working Together to Safeguard Children(Department of Health et al.1999) makes it clear that safeguarding children from harm is everyone ‘s responsibility, and not simply an issue for professionals. This is an important shift in thinking and reflects the view expressed so memorably by Hilary Clinton, that to bring up a child requires a whole village. However, there are specific responsibilities, spelt out in statute and in guidance, that rest with three public sector agencies in particular: the social services, health services and the police. Other statutory and voluntary agencies and professional groups also play important roles in the prevention of abuse and the protection of children, and together form a protective network for the most vulnerable children. When this protective network is functioning effectively it can provide a vital safety net for children, preventing abuse and triggering early responses to concerns.Individual children need (A) coordinated help from all those who are in contact with them and with their parents and carers, when they are experiencing or are at risk of neglect or abuse.
Child protection and primary care organizations (PCOs)
Authors: Bastable Ruth
Published: November 2023

Rita, in Willy Russell ‘s Educating Rita(1996) was asked how she would present Ibsen ‘s very long and complex play Peer Gynt. Her essay in its entirety was, ‘Do it on the radio ‘. Asked how I would put child protection on the Primary Care Organization (PCO) agenda, I would reply in a similar vein – ‘Put it in the HImP ‘ (Health Improvement Programme). But like Rita, I have discovered there ‘s more to it than that. This chapter describes the latest reorganization of the NHS in England, with particular emphasis on the changes affecting primary care. This reorganization is then related to how change in primary care, and particularly change in general practice, can be brought about. Finally, the potential for change is related specifically to child protection issues. Most of the comments, particularly with respect to accountability and governance, apply to Scotland and Wales as well as England. The chapter will have interest for all those working in primary care, but will be especially relevant for those wishing to see change in how child protection issues are managed within the general practice setting.
Assessment and psychosocial support of patients with advanced GI malignancies
Authors: Borreani C , Miccinesi G , Tamburini M
Published: November 2023

In the advanced stages of oncological diseases a quality of life (QoL) assessment becomes necessary for the monitoring of the quality of assistance or the evaluation of the efficacy of a specific treatment, and it is useful in facilitating communication between patient and caring staff regarding specific problems and symptoms.

Thanks to the 1980s, which marked an important period for the definition of QoL theories in cancer patients and the development of instruments for QoL assessment, the use of self-rated, cancer-specific, and concise questionnaires is now recommended. The questionnaires set out to prove psychometric properties and assess the functional, physical, psychological, and social conditions of the patient as well as his/her global health.
Malignant ascites
Authors: Keen Jeremy , Fallon Marie
Published: November 2023

A recently reported survey of physicians involved in the management of malignant ascites produced comments such as ‘generally impossible to manage’, ‘it is a frustrating clinical situation’, and ‘a practical and effective solution is needed’ (1).

This chapter aims to review briefly the pathophysiology of ascites formation in malignant disease and then to examine the prevalence, associated symptoms and, in more detail, the reported methods of clinical management.

The main frustrations in the management of ascites relate to questions such as the role of diuretic therapy, imaging, and the method of paracentesis, each of which remains poorly tested in formal trials. However, new work in the pathophysiology of ascites formation may lead to more individualized and novel methods of management.
Artificial nutrition I: General approach and parenteral nutrition
Authors: Bozzetti Federico
Published: November 2023

For over 30 years artificial nutrition (AN) has had a major impact in many fields of medicine, including surgery, oncology, intensive care, gastroenterology, and transplantation.

Except in patients with primary undernutrition, who account for a small percentage in Western countries and are usually elderly individuals unable to provide themselves with adequate oral intake, AN has been used in clinical conditions in which, for a variety of reasons, the normal intake of food was impossible or contraindicated, while maintenance of nutritional status was essential for the patient to allow the primary therapy to control the disease and eventually to achieve full recovery.
Artificial nutrition II: Enteral nutrition
Authors: Gavazzi Cecilia
Published: November 2023

Oral nutrition should always be the first choice of feeding patients with advanced cancer (1,2). Every effort should be made to satisfy the patient’s requirements in terms of calories, proteins, vitamins, and minerals, utilizing a dietician’s counselling and commercially available nutritional supplements. However, patients with a markedly reduced oral intake due to dysphagia, obstruction of the high gastrointestinal tract, or severe anorexia can benefit from enteral nutrition (EN).

Enteral feeding is a physiological method of delivering nutrients to the gastrointestinal tract through a tube that can be placed into the stomach, the duodenum, or the jejunum, bypassing the first portion of the digestive system. Like oral feeding it is based on the absorption of nutrients through the intestinal mucosa and therefore should be used only in patients with functional bowels.
The Ancestry of Inferiority (1619–1662)
Authors: Higginbotham A Leon
Published: November 2023

When the first Africans arrived at Virginia in August 1619, they were initially accorded an indentured servant status similar to that of most Virginia colonists. In two letters, John Rolfe, Secretary and Recorder of the Virginia colony, reported on the arrival of the Africans. One letter stated that a Dutch man-of-war “brought not any thing but 20. and odd Negroes, which the Governor and Cape Marchant bought for victualles.” The other letter, describing the same event, stated: “[A]bout the last of Au gust, came in a dutch man of warre that sold us twenty Negars.” The references in the letters to “buying” and “selling” do not necessarily mean that these Africans were being sold into chattel slavery. During that period, the majority of the population in Virginia consisted of servants. It was common practice to refer to the transaction of acquiring a servant as “buying” a person. Buying in that sense simply meant buying the person’s services and not actually buying the person’s body. Thus, it would appear that, in 1619, the first Africans became one more group in a majority servant class made up of whites and Native Americans.
The Dream of Freedom And Its Demise
Authors: Higginbotham A Leon
Published: November 2023

To Understand the health or pathology of America’s race relations law, ne must always scrutinize the calendar year in which important statements were made, and the dates when constitutional amendments or statutes were enacted. This provides the historical context and circumstance of the legal development. What at one time may have been prophetic statements or warnings by individuals, courts,. or legislative bodies later may be come irrelevant because of intervening legal events.

Prior to the passage of the Fourteenth and Fifteenth Amendments, Justice Noah Swayne made it clear in United States v. Rhodes that he “entertain[ed] no doubt of the constitutionality of the [1866 civil rights] act in all its provisions.” He noted, however, that the statute “gives only certain civil rights. Whether it was competent for congress to confer political rights also, involves a different inquiry. We have n ot found it necessary to consider the subject.”
Unequal Justice In The State Criminal Justice System
Authors: Higginbotham A Leon
Published: November 2023

Chiseled in marble over the entrance to the United States Supreme Court is the ultimate American aspiration: “Equal Justice Under Law.” Also written with careful thought, the Preamble of the United States Constitution reads:

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

Thus, after formation of “a more perfect Union,” the next national priority was to “establish Justice.” But the American irony has been that, even after the Civil War, the judicial system has not been one of “Equal Justice Under Law.”
“Idealistic Sisterhood Has Gotten Us Nowhere”: Dressing for Political Combat
Authors: Mathews Donald G , Hart Jane Sherron De
Published: November 2023

“Of course we are going to get ERA. If it takes white gloves, we will use white gloves. If it takes combat boots, we will wear combat boots; we’ ll use both.” Uttered in 1974, the words expressed ratificationists’ confidence in winning their goal by doing “whatever it took.” “White gloves” elicited an image of nonthreatening gentility, what one North Carolina activist called being “clean and neat and proper--on our way to Sunday school.” She added that “women in combat boots know they’ re in a battle.” On their “way to Sunday school,” where ideals and proper behavior promise good results, proponents had received generous support from President Jimmy and Rosalynn Carter, prominent citizens from Hollywood to New York, and a wide range of women’ s groups.
“We Are Called and We Must Not Be Found Wanting”: ERA and the Women’ s Movement
Authors: Mathews Donald G , Hart Jane Sherron De
Published: November 2023

Commitment to the Equal Rights Amendment was mobilized in coalition. Feminists were only one constituency among the many who worked for ratification. Traditional women’ s groups such as the League of Women Voters and Church Women United joined newer organizations such as the National Organization for Women, the Women’ s Equity Action League, and the National Women’ s Political Caucus to achieve “equalty.” The goal was neither concrete nor specific but abstract and general, evoking the language of eighteenth-century revolution and twentieth-century idealism.
Men Besieged “On Account of Sex”: Bargaining in the General Assembly
Authors: Mathews Donald G , Hart Jane Sherron De
Published: November 2023

The amendment was killed in arenas where men contested with each other on a variety of issues of which the ERA was not a top priority. Ratification lost in the United States because the majorities of men favoring it were not distributed across enough states. Its loss in North Carolina can be inferred by stereotype. North Carolinians, like other Southerners, have historically defended elite male power by appeal to the myth of dependent women. Southerners are religious, and religion justifies the subjection of women. Southerners are traditionalists, and ERA challenged tradition.