bluuebunny/crossref_metadata_2025 huggingface dataset:
Thinking skills: ethical reasoning and problem solving in psychiatric ethics
Authors: Dickenson Donna , Fulford Bill (Kwm)
Published: November 2023

In Chapter 1 we found that the ethical problems we face in psychiatry are often a good deal trickier, both practically and theoretically, than those arising in other areas of medicine. We thus need sharper tools to tackle them effectively. The tools for ethical problem solving in medicine come from a variety of sources — psychology, social science, anthropology, political theory, law, and many other disciplines. We will be drawing on some of these later on in thinking about the cases in this book. Perhaps most important of all, though, are the thinking skills — the strategies for analysing and thinking through ethical problems — that we get from philosophy.
Human Growth after Birth
Authors: Sinclair David , Dangerfield Peter
Published: November 2023

Growth is a process which affects every individual from the hour of birth to the hour of death and forms a background to almost every medical discipline, and Human Growth After Birth has been extremely successful in five editions. This book is written in a clear and approachable style and is the only publication which provides an elementary overview of the various manifestations of human growth. Professor David Sinclair, Professor of Human Anatomy, University of Aberdeen, wrote the first five editions, the last of which was published in 1989. Dr Peter Dangerfield, Department of Human Anatomy, University of Liverpool has updated the book for this new edtion while maintaining the unique style and appeal of the text. The new edition covers recent concepts in cell growth, the cell cycly and growth inhibitors. This book also contains the latest information on genes and the human genome. The sections on the growth of the CNS and on reproduction and infertility have been revised in line with current thinking. The references have been fully updated and boxed further reading has been added. Key points are highlighted throughout, and there are a number of new illustrations.
Definitions and epidemiology
Authors: Wrightson Philip , Gronwall Dorothy
Published: November 2023

Mild head injuries make substantial demands on health services. They take up a good deal of time in EDs, and they may need expensive imaging and sometimes short term use of hospital beds. Later a small proportion of patients have persisting symptoms which keep them off work for long periods and require costly rehabilitation and disability pay. For both economic and clinical audits it is important to know how many injuries there are, how they are managed and why, and for how long patients are disabled.

However, there are problems in defining what is meant by mild head injury. Plainly it is part of a continuum extending from injuries that are trivial to those which threaten life. Where we place the marker which separates the ‘mild’ injury from a severe one will depend on our needs and interests.
Mechanisms and pathology
Authors: Wrightson Philip , Gronwall Dorothy
Published: November 2023

The mechanical factors in mild head injury and the cellular pathology that follows have been difficult to unravel. Human studies, of necessity, have been limited to clinical observation and to the imaging and neurophysiological studies that have been ethically justifiable, with occasional autopsy material available from people who have had a mild head injury and have died from other causes. Experimental injury in subhuman primates has worked out the important mechanical factors and some of the pathology, but the model is an expensive one and there have been ethical difficulties, so that its usefulness is probably over.
Neurological assessment
Authors: Wrightson Philip , Gronwall Dorothy
Published: November 2023

In a previous chapter we discussed the cognitive and behavioural symptoms seen when recovery from mild head injury is delayed or incomplete. here we will deal with the somatic symptoms, describing the clinical features, the examination, concepts of mechanism, and specific treatment. Some of the conditions can be managed by the generalist to whom this book is addressed, others will need to be referred to specialists.

Headache is the commonest symptom recorded in most studies of mild head injury. Most patients expect to have a headache in the first few days after injury. When symptoms persist or recur later it may be more natural to complain of headache than of the more subtle problems of memory and concentration or of anxiety and depression. Often therefore it is the first symptom mentioned, though others may be more disabling. It is nevertheless a symptom which means a great deal to the patient and needs to be managed efficiently and with respect.
Medication
Authors: Wrightson Philip , Gronwall Dorothy
Published: November 2023

The most pressing part of the management of MHI is to set up and support a practical daily programme which addresses cognitive and behavioural problems and the all-important factor of fatigue. Sometimes this is not enough and a patient’s progress is halted by poor sleep, by irritability or impulsive behaviour, and particularly by depression. Early onset of fatigue may still be preventing the return to full-time work, and the patient may only be able to think constructively for the first few hours of the day.
Sports injuries
Authors: Wrightson Philip , Gronwall Dorothy
Published: November 2023

In the authors’ city sport is responsible for about 20 per cent of the head injuries seen at emergency departments and allowed home, and for about 7 per cent of those admitted to hospital. Sports injuries themselves are usually mild but several considerations give them a special importance. The player will want to continue playing, at once or later, and so will risk another injury. Further injury within a week or two of the first risks a catastrophic reaction. Multiple minor injuries can cause a permanent loss of brain function.
Vascular access for the ‘difficult’ patient
Authors: McCann Richard L
Published: November 2023

The population of patients dependent upon dialysis therapy for survival continues to expand both in the United States and abroad. The patients being added to this group are older and more medically challenging every year. Data from the United States Renal Data System (USRDS) indicate that the median age at which patients begin hemodialysis therapy has steadily increased during the past decade and now exceeds 63 years of age.
Primary Care for Older People
Authors: Iliffe Steve , Drennan Vari
Published: November 2023

Primary Care for Older People is a contemporary reference work on health problems in later life written exclusively by primary care professionals for primary care professionals that: integrates nursing and medical perspectives on clinical practice and service organisation. understands that well-intentioned changes in practice and service provision can have harmful effects on patients, professionals and the health service is still able to offer positive guidance to individual practitioners, practices and Primary Care Groups, about best practice and innovative multi-disciplinary care for an ageing population. It is aimed at doctors, nurses, health visitors and social workers who are trying to combine care of individuals with an understanding of the needs of whole communities. Its themes are relevant to teachers in different professional disciplines, to members of Primary Care Group and Trust Boards, to planners and managers of primary care services, as well as to practitioners. The authors bring to this book their experience in general practice and community nursing, their expertise in service development and management, and their awareness of primary care research. Dr. Steve Iliffe has been an inner-city general practitioner in London since 1978, and is Reader in General Practice at the Royal Free and University College Medical School, where he is co-director of the Centre for Ageing Population Studies (CAPS) and manages the Primary Care for Older People research and development programme. He can be contacted at s.iliffe@ucl.ac.uk. Vari Drennan has been a community health service manager , specialist health visitor for older people and health visitor since 1980 and is currently a senior lecturer in primary care nursing in the Department of Primary Care & Population Sciences at the Royal Free and University College Medical School. She can be contacted at v.drennnan@ucl.ac.uk,
Balanced chromosome rearrangements
Authors: Young Ian D
Published: November 2023

Balanced chromosome rearrangements are those in which there is no overall loss or gain of chromosome material. Unlike single gene disorders, for which precise calculation of risks to offspring is usually possible, the segregation of chromosome rearrangements does not readily conform to any mathematical model which permits exact risk figures to be derived. Therefore the genetic counselor faces a difficult task when presented with an individual known to carry a balanced chromosome rearrangement. To some extent this role is eased by the widespread availability of prenatal diagnostic cytogenetic services, so that the provision of a precise risk for malsegregation might be seen as of minor importance and very much subsidiary to a discussion of the hazards and limitations of chorion villus sampling and/or amniocentesis. Nevertheless many individuals, particularly those for whom selective termination of pregnancy is unacceptable, will wish to be given some idea of the likelihood that a pregnancy could result in an abnormal baby.
The development of magnetic brain stimulation
Authors: Mills K R
Published: November 2023

The idea that nerve cells could be excited by magnetic fields is not new. It was in 1896 that D’Arsonval first reported to the Societe de Biologie in Paris that when a subject’s head was placed in a strong time-varying magnetic field, phosphenes were perceived. He states: About one month ago, in a verbal communication to the society, I reported that an intense alternating magnetic field of 110 V/30 Amp and 42 Hz gave rise to phosphenes and dizziness when the head was placed within it, making some subjects feel faint. It is not necessary to have so powerful a field to produce phosphenes. With a coil consisting of a bundle of soft iron wires 5 cm diameter and 30 cm long, phosphenes appear. This alternating magnetic field also modifies the state of muscular contraction and easily produces in human subjects other effects, the study of which I am following at the moment.
Anatomy and physiology
Authors: Mills K R
Published: November 2023

This chapter will consider the anatomy and physiology of motor areas of the cerebral cortex and spinal cord. The effects of cortical stimulation in primates, which has greatly facilitated interpretation of responses in humans, will be reviewed. The action of afferent inputs to the motor cortex and cord whereby motor actions may be modified are also covered as is the use of magnetic brain stimulation to investigate a number of other physiological phenomena such as muscle fatigue and sleep.
Quotations
Authors: Mcdonald Peter
Published: November 2023

As an adult she had her organs removed one by one. Now she is a mere shell with symptoms where her organs used to be. Private patients, if they do not like me, can go elsewhere; but the poor devils in the hospital I am bound to take care of.
Affective disorders
Authors: Evans Mavis , Patricia Mottram
Published: November 2023

This chapter provides an overview of affective disorders in a general hospital setting. Pertinent diagnostic issues are covered with particular reference to common depressive signs and symptoms. Diagnostic pitfalls are considered, such as the effects of culture, comorbid depression and dementia, depressive pseudodementia, and somatization. The role of depression screening instruments is reviewed. Important management issues are reviewed in the context of the prognosis of depressive disorders. Guidelines for management are provided. The diagnosis and differential diagnosis of manic disorders is examined. Management issues are considered.
Psychosis and medical illness
Authors: Almeida Osvaldo P
Published: November 2023

Delusions and hallucinations are relatively common amongst older adults treated in the general hospital. This chapter reviews the concept of psychosis, the biological and psychological mechanisms likely to be involved in its origin, the most frequent causes of psychotic symptoms in later life, and the evidence currently available on how best to manage these patients.
Organic mental disorders
Authors: Taylor David G , Shah Ajit K
Published: November 2023

This chapter aims to give an overview of the principal organic mental disorders encountered in old age psychiatry consultation liaison settings. A brief overview is given of those aspects of the diagnostic process having particular relevance to organic mental disorders. Individual disorders are then covered, including delirium, dementia, amnestic disorder, and other disorders. The dementia section places special emphasis on the three most common conditions of old age, namely dementia of the Alzheimer’s type (DAT), vascular dementia (VaD), and dementia with Lewy bodies (DLB). Emerging pharmacotherapeutic interventions for DAT in the form of cholinesterase-inhibitor therapy are reviewed. Finally, a number of other conditions are considered, including aphasia, apraxia, agnosia, executive disorder, and personality change. Case studies occur throughout the text, to illustrate commonly encountered liaison consultation scenarios.
Holistic approaches to cancer: general principles and the assessment of the patient
Authors: Daniel Rosy
Published: November 2023

Rosy Daniel has specialized in holistic medicine since completing her GP vocational training in 1989. She worked for ten years at the Bristol Cancer Help Centre (1989–99), becoming Medical Director in 1995. Since leaving this post she has been working to help develop Integrated Healthcare Systems in Britain as well as Health Creation initiatives for the promotion of health and well-being among the general public. Day to day she works as a holistic doctor in Bristol and London as well as teaching, writing, and broadcasting on the subject of the Holistic Approach to Health.
Acupuncture: Jacqueline Filshie and Adrian White
Authors: Barraclough Jennifer
Published: November 2023

Jacqueline Filshie is a Consultant in Anaesthesia and Pain Management at the Royal Marsden NHS Trust, Sutton, Surrey and London and Honorary Senior Lecturer, Institute of Cancer Research, Sutton, Surrey, UK. Adrian White is Senior Lecturer, Department of Complementary Medicine, University of Exeter, UK. Acupuncture is a form of therapy in which needles are inserted into skin and underlying tissues in special sites, known as acupuncture points, either as a treatment or in order to improve health. It may have evolved from massage therapy, the points being sites of particular tenderness. By the time of the first written records, the Yellow Emperor’s Classic of Internal Medicine dating from about 150 BC, acupuncture was already an established and systematic therapy in which clinical observations and deductions were interpreted according to the philosophy of the age, Taoism.
The role of nutrition
Authors: Goodman Sandra
Published: November 2023

This chapter explaining the role of nutrition in relation to cancer prevention and treatment does not rightfully belong in a book devoted to complementary approaches to cancer care; it should be part of mainstream medical care for cancer patients. Health-promoting nutrition, recognized by leading epidemiologists, oncologists, and molecular biologists alike to be a factor in reducing cancer risk by some 30–40% (WCRF 1997), should form a major part of the curriculum for medical students, be taught to all children from primary school age, practised within our daily lives, and should form an integral part of cancer treatment for all cancer patients.
The focused mind: hypnosis, relaxation, guided imagery, and meditation
Authors: Edmonds Claire , Phillips Catherine , Cunningham Alastair
Published: November 2023

The authors are based in Toronto, Canada. Claire Edmonds is a research associate at the Ontario Cancer Institute, where she studies the effects of psychosocial interventions on both the quality of life and survival of cancer patients. She is also a psychotherapist, leading groups that focus on support, coping, and the spiritual concerns of cancer patients. Catherine Phillips is a researcher and therapist with the Healing Journey Program at Princess Margaret Hospital. Alastair Cunningham is a senior scientist and psychologist at the Ontario Cancer Institute. His research interests include mind-body theory, and investigating the effects of adjunctive psychological therapy on quality and length of life in cancer patients.
Psychospiritual therapy
Authors: Cunningham Alastair , Stephen Joanne , Phillips Catherine , Watson Kimberley
Published: November 2023

The authors are based in Toronto, Canada. Alastair Cunningham is a senior scientist and psychologist at the Ontario Cancer Institute. His research interests include mind-body theory, and investigating the effects of adjunctive psychological therapy on quality and length of life in cancer patients. Catherine Phillips is a researcher and therapist with the Healing Journey Program at Princess Margaret Hospital. Joanne Stephen and Kimberley Watson are doctoral candidates and researchers with the Healing Journey Program.
Complementary care and the sceptical surgeon
Authors: Baum Michael
Published: November 2023

Michael Baum is a Professor of Surgery at the Royal Free and University College Medical Schools, and Consultant Surgeon to the University College London Hospitals Trust. Prior to this he served as Professor of Surgery at King’s College, London and the Royal Marsden Hospital, London. His research interests include clinical trials in the development of treatment for early breast cancer. He chairs the largest collaborative group for clinical trials in this country. He was recently appointed chairman of a national steering committee to introduce arts and humanities into the undergraduate curriculum, and has written extensively on the social anthropology of alternative medicine and the philosophy and ethics of clinical research.
Hormone therapy
Authors: Mason Malcolm , Moffat Leslie
Published: November 2023

Prostate cancer requires the male sexual hormone, testosterone, in order to continue growing. It has been known for over 50 years that by interfering with or depriving the tumour of testosterone, its cells will die. Testosterone deprivation (also called ‘androgen deprivation’, or simply ‘hormone therapy’) will keep a tumour under control for some time - maybe for some years. However, it usually does not completely eradicate it, but rather, reaches a state of ‘detente’ between the body and the tumour. The most obvious means of androgen deprivation, is to remove the testicles.
Alternative treatments
Authors: Mason Malcolm , Moffat Leslie
Published: November 2023

The Medical Establishment can frequently appear as very authoritarian. When patients suggest alternative treatments, they are often greeted with a shrug, but rarely with any genuine interest on behalf of the physician. There are a number of physicians who are prepared to entertain alternative treatments, but almost all reputable physicians will suggest alternative treatments as an addition to stand, ard treatment, and not as a substitute.
Prostate cancer and sex
Authors: Mason Malcolm , Moffat Leslie
Published: November 2023

Sex is part of healthy living for all of us. The sexual urge decreases in most men with time. Nonetheless, it is well known that men can father children well into their 80s. A woman’s interest in sex may decrease after the menopause, but this is not necessarily so. Most men who have prostate cancer are not in the first flush of youth and for some couples sexual activity may have virtually stopped in any case. For some men, even elderly men, the inability to have intercourse can be devastating. For others, it may not matter. Neither instance is fright’ or wrong’.
Patient assessment and surgical care
Authors: Fortune Farida
Published: November 2023

Patient assessment should be carried out on all patients before any procedure in the dental setting, whether in the general dental surgery under local anaesthetic, conscious sedation, or on premises licensed for use of general anaesthesia.
Cardiovascular system
Authors: Fortune Farida
Published: November 2023

Understanding the cardiovascular system is particularly relevant to dentistry: cardiovascular disease is the most frequent cause of death, and the increasing number of elderly people in the population are particularly liable to disorders of the cardiovascular system.
Infections
Authors: Fortune Farida
Published: November 2023

Fever is caused by the release of endogenous pyrogens from monocytes. Microorganisms, endotoxins, drugs, tumours, sensitized lymphocytes, and immune complexes may all release pyrogens when triggered. The core body temperature varies between 37.0 and 37.5 °C and is controlled from the hypothalamus. Body temperature has a circadian rhythm with the core body temperature being 0.5–1.0 °C higher in the evening: an increase in temperature to above the normal core temperature is defined as fever. Incidence of fever is independent of sex, age, race, and geography.
Psychiatry
Authors: Fortune Farida
Published: November 2023

Psychosocial disorders are an essential component of human disease. It is extremely important when dealing with patients to be able to establish good rapport and recognize any abnormal psychosocial problems.
Endocrine disorders and disorders of bone metabolism
Authors: Fortune Farida
Published: November 2023

The pituitary gland produces hormones which regulate the function of the endocrine organs such as the thyroid gland, the adrenal cortex, the breast, and the gonads, as well as targeting non-endocrine organs and tissues. Each pitu- itary hormone is regulated by hypothalamic-derived substances as well as regulated in a negative-feedback loop by substances produced by its target organs. Negative feedback occurs at both hypothalamic and pituitary levels.
Introduction: illness and healthcare in the community
Authors: Taylor Ross J , Smith Blair H , Teijlingen Edwin R van
Published: November 2023

individuals because they could not pay (as some systems do) might be regarded as unfair or even unethical. There are, however, more subtle forms of discrimination and inequity many of which have been discussed throughout the book.
Organization of medical care
Authors: Taylor Ross J , Smith Blair H , Teijlingen Edwin R van
Published: November 2023

been to provide all necessary health care for everyone in the country, regardless of means and free at the point of need. One problem has been that as medicine becomes more technical and expensive (e.g. coronary artery by-pass grafts for heart disease), and as people become more educated and assertive, public expectation of what the NHS should be able to provide has risen progressively. At the same time it is not widely appreciated that the USA government spends just as much on public provision of health care as does the UK government (Table 14.2), but gets much less for its money. In the USA public health care covers only the very elderly and the poor.
Parent-child interaction and children’s well-being: reducing conduct problems and promoting conscience development
Authors: Gardner Frances , Ward Sarah
Published: November 2023

Conduct problems in childhood are clearly detrimental to emotional well-being, in both the short and long term. Children with conduct problems have increased rates of depression, peer problems, and school failure. Longitudinal studies indicate that their long-term outlook is also poor. In adulthood, not only are these children at greater risk of physical and mental illness but they also tend to fare much less well academically, in employment, and in relationships with others (Robins 1991). The WHO defines health in these broad terms, as ‘a state of total emotional and physical well-being, not merely the absence of illness’.
Musculoskeletal ultrasound in rheumatology
Authors: O’Connor Philip J , Wakefield Richard
Published: November 2023

Rheumatology is one of the last remaining imaging areas in which new applications are currently being developed. The ability of ultrasound (US) to image both soft tissues and the bone surface at high resolution lends itself well to the assessment of musculoskeletal conditions. For both radiologists and clinicians highresolution US is an increasingly popular imaging tool for the management of musculoskeletal conditions. Technological improvements in image quality and user interface have facilitated this growth in clinical interest.
Thermography and laser Doppler imaging in rheumatology
Authors: Newton David J , Khan Faisel , Belch Jill JF
Published: November 2023

Within the field of rheumatology, imaging has proved to be the most objective way of assessing joint disease and its progression. For many years this was confined to conventional radiography, where radiographic changes in bones signified joint damage that could be quantified if necessary. Conventional radiographs have been used as diagnostic aids, and X-ray features and measurements are well established. The advances in rheumatological medicine have, however, increased demands for earlier and more accurate evaluation of these diseases.
Rheumatoid arthritis
Authors: Cobby Mark , Kirwan John
Published: November 2023

Rheumatoid arthritis (RA) is an inflammatory disease with great variability within and between patients. It is a relatively common condition and the prevalence of RA in Europe ranges from 1 to 3 per cent. The median age of onset is 30–50 years, it is more frequent in women, and the prevalence increases with age as, once acquired, it remains for life. RA is the most common type of inflammatory arthritis treated by rheumatologists, and comprises up to 25 per cent of all referrals to rheumatology clinics and 75 per cent of follow-up work.
Systemic lupus erythematosus
Authors: Bickerstaff Maria C M , Renton Peter , Isenberg David
Published: November 2023

Systemic lupus erythematosus (SLE) is a syndrome of multifactorial aetiology, which principally affects women during the childbearing years. Although the skin and joints are the most commonly affected, virtually every organ and/or system of the body may be involved. The course of the disease is typically one of remission and exacerbation. In the past 50 years mortality figures have improved radically from 50 per cent 5-year survival to approximately 80 per cent 15-year survival.
Seronegative spondylarthropathies
Authors: Wordsworth Paul , McNally Eugene
Published: November 2023

The seronegative spondylarthropathies comprise a group of related disorders with certain shared clinical, immunogenetic, and radiographic characteristics. In addition to peripheral joint disease, there is a varying predilection for involvement of the axial skeleton, particularly the sacroiliac joints. Many of these disorders are associated with the HLA-B27 gene, in addition to showing other weaker immunogenetic associations. Typically, they are not associated with the presence of rheumatoid factor.
Soft-tissue rheumatism and sports medicine
Authors: Cooper Robert , Till Simon
Published: November 2023

Despite the fact that the majority of sports-related injuries involve the soft tissues, a considerable number of acute and chronic bone and joint conditions are also associated with sport. The full scope of sports medicine lies beyond the remit of this chapter. We will illustrate the role of imaging in the diagnosis and management of those soft-tissue conditions that present most frequently to the rheumatologist without a special interest in sports medicine, and briefly describe some of the common problems seen by the sports medicine practitioner as we demonstrate a regional approach to establishing a differential diagnosis.
Child abuse and primary care
Authors: Carter Yvonne H , Bannon Michael J
Published: November 2023

General practice and primary care are at the centre of the British National Health Service (De Maeseneer et al. 2000). They offer an effective, efficient service that is highly valued by patients. Recently The NHS Planfor England has stimulated debate on the core values of general practice, its quality and training, and hence on its ability to deliver high quality patient care (Secretary of State for Health 2000). This chapter will describe the roles of the general practitioner and other members of the primary health care team (PHCT) generally in patient care and more specifically in the detec- tion and management of child abuse.
Physical abuse
Authors: Hobbs Chris
Published: November 2023

Research has shown that physical methods of controlling children remain popular. In community studies, for example the work of Marjorie Smith from the Institute of Child Health in London, confirmed that 14% of all children suffered severe experiences of physical punishment. Many children including babies suffered regular physical chastisement in the form of hitting (9 out of 10 children are hit at some time), physical restraint or being tied and bound. In the severe group the possibility of permanent physical or psychological harm was present.Although the usual picture of the disciplinarian father using physical force to discipline the children is ingrained in our thinking, this research revealed that it was the mothers who were responsible for more of this behaviour even when their greater contact with the children was taken into account.
Child sexual abuse
Authors: Mott Alison
Published: November 2023

General practitioners and health visitors, as a result of their close relationship with families in their communities, have an important role to play in the diagnosis and initial management of the child who has been sexually abused. Since the child and alleged perpetrator may both be registered with the practice, suspicion of abuse has to be handled carefully and it may be difficult to judge when concerns about abuse are sufficient for action to be taken. However, all members of the primary health care team are legally and ethically required to report all types of suspected abuse. General practitioners are not responsible for making the diagnosis of sexual abuse, but are obliged to identify children suspected of being abused and to refer them to social services.
Ethics and the child protection process
Authors: Slowther Anne-Marie
Published: November 2023

The area of child protection is challenging, and at times disturbing, for the general practitioner. The evidence on which to base a diagnosis, or suspicion of child abuse is often not as clear-cut as that involved in physical or even psychological disorders. The doctor ‘s core relationship with her individual patient may be in conflict with her role as a member of a multi-agency team in which she is not the principal decision-maker. Her role as a family doctor means that she may have conflicting responsibilities to different members of the same family, all of whom are her patients. In addition, her duties to the wider public, and her legal duties, may be in conflict with what her individual patients ‘ want, and indeed with what she feels would be in their best interests. Although these issues occur in many aspects of a GP ‘s work, they are thrown into sharp relief in all stages of the child protection process: prevention, diagnosis, reporting and management.
The health needs of looked after children and the role of the primary care team
Authors: Mather Mary
Published: November 2023

A young care leaver, speaking at a seminar, was asked by a member of the audience what had made him a ‘success ‘ despite the difficulties he had experienced growing up in care. He cited as an example someone who had listened to him, a doctor who had seen him as a child. He asked the doctor ‘Do you sometimes give people drugs just to keep them quiet? ‘ The doctor replied that he didn ‘t, but that it was an interesting question and he should keep on asking questions. This single remark by a doctor had made him feel valued, had given him positive encouragement and made him feel that he could make a contribution to society.All general practitioners, often without appreciating the significance, will encounter looked after children during their working lives. Interested and compassionate general practitioners can make a real difference in the lives of young people in the care system.
The child protection process: an international perspective
Authors: Hetherington Rachael
Published: November 2023

First there was child welfare; then the ‘battered baby ‘ syndrome; then child abuse; and then child protection. This is roughly how the response of services in this country has developed since the major shifts in structures and services that followed the wartime experiences of the evacuation of children and the subsequent creation of the National Health Service and the welfare state. During the 1950s and 1960s, while the post-war child welfare services were being developed in the UK, research in the US was beginning to establish the knowledge which led to the definition of child abuse (followed by child sexual abuse). This knowledge swiftly became available in the UK and in other European countries, and everywhere began to affect policies and practice in state interventions in families. Development was not uniform in the speed at which it took place, and the nature of developments depended on the systems that already existed. In the UK we have tended to look to the US rather than other European countries for new ideas and approaches and for this reason and because of a shared language, child abuse became a focus of concern earlier in this country than else- where. However, by the second half of the 1980s, new legislation on child welfare and child protection was being debated not only in this country, but in most other European countries.
The clinical assessment of the patient with gastrointestinal symptoms
Authors: Mazuryk Mary-Ellen
Published: November 2023

Gastrointestinal symptoms are a common source of distress in advanced cancer patients. A survey of 1000 palliative care patients has revealed that four of the 10 most frequently observed symptoms were gastrointestinal in nature. These included anorexia, weight loss, constipation, and early satiety (1). Other common gastrointestinal symptoms included in the 21 overall most common symptoms were nausea, vomiting, taste change, and dysphagia. Furthermore, these symptoms were rated as clinically significant in 60%–80% of cases. Symptom severity tended to vary according to tumour type for some symptoms. For example, dysphagia was most prevalent in patients with oesophageal or head and neck tumours and nausea and vomiting was most prevalent in patients with gynaecological malignancies. The median number of symptoms experienced at a given time was 10–12, implying that the majority of patients will be suffering with several different gastrointestinal symptoms.
Cancer anorexia/cachexia syndrome: epidemiology, pathogenesis, and assessment
Authors: Strasser Florian , Bruera Eduardo
Published: November 2023

Anorexia/cachexia is a frequent problem in patients with advanced cancer, and is distressing for both patients and families (1). However, since many cachexia-associated symptoms, such as anorexia and asthenia, are ‘silent’ symptoms, as compared with pain or shortness of breath, its importance is often underestimated and therefore underdiagnosed (2). Cachexia can be separated into primary (metabolic) and secondary (starvation) cachexia, which occur often together, and are often confused with each other (Table 4.1). Since treatments for them are frequently different, the paraneoplastic, metabolic cancer cachexia syndrome (the ‘primary cachexia’) needs to be distinguished from impaired nutritional intake secondary to obstacles in the gastrointestinal (GI) tract, and other causes for ‘secondary cachexia’ (Table 4.2). Anorexia is, besides weight loss, a leading symptom of the paraneoplastic, metabolic cachexia syndrome, therefore we use the term cancer anorexia/cachexia syndrome (ACS). ACS is one of the most important causes for the symptom complex of asthenia, weakness, and fatigue, which, beside pain, is the most common symptom in patients with advanced cancer (3). This chapter focuses on the three areas of epidemiology, pathogenesis, and assessment of ACS, providing a basis for understand actual and future treatments.
Hiccup
Authors: Walker Paul
Published: November 2023

Every person has experienced hiccups of a transient nature. These short spells are commonly experienced by healthy individuals and disappear spontaneously or with simple measures. Fortunately, prolonged episodes of hiccup are rare, but when they do occur, cause significant distress to the patient and caregiver. It has been reported to cause significant discomfort, fatigue, sleep deprivation, weight loss, and depression (1–3).

The known record for prolonged hiccup is held by an individual who hiccupped every 11/2 seconds for 69 years and 5 months (4). There is a paucity of scientific information related to this phenomenon with much of the literature consisting of case reports outlining specific etiologies or treatments. Launois et al. have written the most recent comprehensive review of this topic (1).
Gastrointestinal motility disorders
Authors: Davis Mellar P , Walsh Declan
Published: November 2023

A three-month prevalence survey from 10 international sites using 5581 face-to-face inter- views revealed that 46% of subjects experienced one or more of 14 different gastrointestinal symptoms (217). Upper gastrointestinal symptoms were experienced in 28%, reflux symptoms by 7.7%, ulcer-like dyspepsia in 4.1%, and dysmotility-like dyspepsia (nausea, bloating, and satiety) in 15.5% (217). Women experienced more reflux and dysmotility than men. Reflux symptoms increased and dysmotility decreased with age (217).
Chronic nausea and vomiting
Authors: Ripamonti Carla , Bruera Eduardo
Published: November 2023

There is no standard definition of chronic nausea in terms of duration in advanced cancer patients. According to Pereira et al. (1) the presence of nausea for more than one week in the absence of a well-identified and self-limiting cause, such as chemotherapy or radiation therapy, may be defined as chronic nausea. In advanced cancer patients, the frequency of nausea is higher than vomiting and varies from 6% to 98% (Table 8.1) (1–19). However, no study reports how long nausea is present. Nausea occurs both at an early stage of the unresectable disease (11,12), in advanced disease (1,2,4,6,7,9,11–14,20) as well as during the last weeks and days of life (5,16,18,20). Nausea is reported to be distressing for 33%–75% of patients (12,13,19). Bruera et al. (17) found a frequency of greater than 90% among patients admitted to a tertiary Palliative Care Unit. Although the frequency was extremely high, in this patient population managed with metoclopramide-based protocol the intensity was lower than other symptoms such as pain or asthenia.
Abdominal pain
Authors: Mercadante Sebastiano
Published: November 2023

Excluding pain directly originating from the abdominal wall, which has somatic characteristics, abdominal pain in cancer is due predominantly to a visceral involvement. Visceral cancer pain originates from a primary or metastatic lesion involving the abdominal or pelvic viscera. In a survey on prevalence, causes, and mechanisms of pain in advanced cancer patients followed at home, abdominal pain was found to have an incidence of 45%. Two-thirds of patients presented a visceral pain, although mixed pain syndromes were observed in more than half of these patients (1).

The viscera have a complex peripheral nervous system and different neurophysiological understandings of visceral pain have been reported. Unlike their cutaneous counterparts, visceral nociceptors appear not to be a simple acute warning system. Many viscera are innervated by receptors that do not evoke conscious perception. Visceral nociceptors, how- ever, have a wide range of response, and may be activated in the presence of inflammation or tissue injury. Therefore, visceral afferents are considered polymodal, giving excitatory responses to different stimuli, including inflammation, stretching, and distension (2).
Radiotherapy in treating gastrointestinal symptoms
Authors: Janjan Nora , Delclos Marc , Ballo Matthew , Crane Christopher
Published: November 2023

Within this decade 11 million cases of cancer were diagnosed and 5 million people have died from cancer. Over 70% of all cancer patients develop symptoms from either their primary or metastatic disease (1–4). Approximately half the patients diagnosed with cancer will develop metastatic disease. Cancer of the lung, prostate, breast, and rectum constitute more than 50% of all cancer deaths. There is a profound need for expertise in palliative care in oncology. Quality of life is now recognized as an endpoint of secondary importance only to survival (5,6).
Drug therapy for cancer-associated anorexia
Authors: Jatoi Aminah , Loprinzi Charles L
Published: November 2023

Anorexia is a distressing symptom for patients with advanced cancer. In The Death of Ivan IIych , Tolstoy alludes to the anguish and global sense of loss that accompanies loss of appetite (1):

… all foods became increasingly distasteful and disgusting to him … his mind went back to the raw… plums of his childhood, their peculiar flavor and the flow of saliva when he sucked their stones, and along with that taste came a whole series of memories of those days… .

Equally eloquent and equally troubling are observations from family members who served as care-givers during the later stages of their loved one’s illness. In a series of interviews among cancer patients and their care-givers, Holden quotes a husband as he cares for his wife who is losing both her appetite as well as her battle with cancer (2):

It is so frightening for me to see her lose weight. I knew something was drastically wrong. I blamed myself for not feeding her the right things.
Clinical governance and education and training
Authors: Pringle Mike , Southgate Dame Lesley
Published: November 2023

As we enter the third millennium, the accountability of medical practitioners is national news in the United Kingdom. The issues are complex, but we do well to remember that they are essentially unchanged in many respects from those that have been debated since the emergence of a recognizable medical profession. By the early part of the nineteenth century, advances in physiology, pathology, and chemistry were still not reflected in medical practice. In addition, there was widespread cynicism amongst the general public, many of whom considered doctors useless or dangerous, views based on observations of the outcomes of treatments such as bleeding or purging in the face of epidemics. In England there were opposing views about the solution. Some favoured control by mandatory licensing, others advocated complete freedom of choice for patients with anybody free to practise medicine. These advocates of a free market argued that regulation would lead to a self-serving restriction of others by the medical profession. Then, as now, these events concerned the profession, the public view of the effectiveness of medical practice and the trustworthiness of doctors, and the government of the day through its law-making powers.
Learning from Patients
Authors: Wilkie Patricia
Published: November 2023

Every patient provides two questions-what can be learnt from the patient and secondly what can be done for him. Formal scientific medical education began in the eighteenth century in the autopsy room. Students examined the cadaver. Neither the deceased not their relatives were likely to have consented or been actively involved in this educational process.
Sepsis syndrome and infective complications of acute renal failure
Authors: Goddard Jane , Cumming Allan
Published: November 2023

The connection between sepsis and acute renal failure is a ‘two-way street’. Sepsis is a dominant cause of acute renal failure and renal dysfunction is a common and important component of the sepsis syndrome and consequent multiorgan failure. In turn, patients with acute renal failure are at increased risk of infective complications which at best prolong their illness and at worst may contribute to mortality. This chapter deals with both sides of this relationship in turn, beginning with the pathophysiology of the sepsis syndrome and the role of sepsis in the causation of acute renal failure.
Travel and vaccination in renal patients
Authors: Burns Aine
Published: November 2023

Patients suffering from renal failure, whether victims of pharmacologically inflicted and/or pathophysiologically mediated immunosupression (Chapter 2) are at greater risk of succumbing to and dying from infectious diseases. Preventive and treatment strategies used in the general population are not as effective in renal patients. The enormous success of renal replacement therapies and particularly renal transplantation over the past three to four decades has led to an explosion in the numbers of ‘at-risk’ renal patients. Improved patient well-being has also led to an expectancy by patients and their families of travel abroad despite the inherent added risk of infection that this brings. The more widespread use of ever more powerful immunosupressant drugs will be likely to further increase the susceptibility to infection in renal patients in the future.
Introduction to Judith Butler
Authors: Bowie Malcolm
Published: November 2023

Judith Butler’s lecture, delivered in the Sheldonian on 6 March 2002, was a deeply moving occasion. In that tiered and ornamented space, through which so many local speech-makers had already passed and in which so many grandiloquent lectures on matters of public concern had previously been delivered, Butler spoke with unerring directness about a matter that had seldom been addressed there, even obliquely. She spoke about the oppression of sexual minorities, and about the hope for humanity at large that an end to such oppression might bring. Inhumanity was her theme; and yet, as her successive propositions found their target, a new, enlarged and inclusive vision of what it is to be human began to emerge. The whole performance was compelling in its moral authority, and it is encouraging to know that the lecture will now reach a much wider audience by way of the printed page. Butler describes both the brutality and the subtle discriminatory practices to which gays, lesbians and transgendered people are exposed in Western and non Western societies, and the exemplary courage and lucidity with which she proceeds will be a source of inspiration to campaign groups and concerned individuals around the world.
On Being Beside Oneself: On the Limits of Sexual Autonomy
Authors: Butler Judith
Published: November 2023

What makes for a liveable world is no idle question. It is not merely a question for philosophers. It is posed in various idioms all the time by people in various walks of life. If that makes them all philosophers, then that is a conclusion I am happy to embrace. It becomes a question for ethics, I think, not only when we ask the personal question, what makes my own life bearable, but when we ask, from a position of power, and from the point of view of distributive justice, what makes, or ought to make, the lives of others bearable? Somewhere in the answer we find ourselves not only committed to a certain view of what life is, and what it should be, but also of what constitutes the human, the distinctively human life, and what does not. There is always a risk of anthropocentrism here, if one assumes that the distinctively human life is valuable, or most valuable, or the only way to think of the problem of value. But perhaps to counter that tendency it is necessary to ask both the question of life, and the question of the human, and not to let them fully collapse into one another.