bluuebunny/crossref_metadata_2025 huggingface dataset:
Large-Project Management
Authors: Frieling Jeffrey G. , Misulis Karl E. , Frisse Mark E.
Published: May 2019

Clinical information systems are complicated and highly interdependent with other operational technologies. They are costly in acquisition, implementation, and operation. The consequences of a poor system cascade to the work and performance of every individual affected by system performance. Effective project management and project governance are essential. Even if electronic health records or other clinical systems are fairly mature, every upgrade, replacement, or enhancement may have unintended consequences. Hence, project management never fully ceases, and project governance is an ongoing effort. This chapter focuses on large-project management, specifically the inception, creation, execution, and assessment of plans of the magnitude of an electronic health record (EHR) installation or conversion.
Clinical Teams
Authors: Frisse Mark E. , Misulis Karl E.
Published: May 2019

Healthcare delivery is a collaborative activity involving many individuals playing myriad roles. Clinical informatics often emphasizes the role of physicians, nurses, pharmacists, and other staff acting in concert to ensure that key clinical tasks are performed. Only recently have clinical informatics systems begun to model the complex interactions of the team supporting care in the home. Most posthospitalization care and most chronic care management require coordination across teams working from delivery organizations and both the formal and informal teams delivering care in the home. This degree of coordination requires targeted communication and maintenance of both a care record and a care plan.
Specialties
Authors: Misulis Karl E. , Frisse Mark E.
Published: May 2019

Electronic health records are often initially tailored for general medical and surgical needs in hospitals and ambulatory care settings. The design, functionality, and anticipated workflow serve those arenas well, but serve many other specialties less well. This chapter considers some of the specialties and niche arenas that need additional and altered functionality. These systems must be adapted significantly to meet the needs of all patients. Pediatrics, medical specialties, surgical specialties, and emergency medicine are just some of the areas that require special attention and focus from clinical informatics professionals. The decision has to be made whether the enterprise electronic health record will be forced into use in a specific arena or whether a specialty system will be used.
Health Information Exchange in Practice
Authors: Frisse Mark E. , Misulis Karl E.
Published: May 2019

Even when restricting the focus of care to hospitals and ambulatory clinics, most individuals seek care from many practitioners operating in different locations and often employing different electronic health records. Early efforts at creating interoperable data exchange among these systems have often disappointed users and administrators. Effective collaboration is a prerequisite for effective healthcare delivery. Even if using different EHRs, every clinician and caregiver should share a common clinical record set and means of communicating to other providers. Recent collaborative efforts among major electronic health record vendors are simplifying exchange of information among hospitals and large clinics, but they have not yet sufficiently addressed the necessary broader exchange of healthcare data among the caregivers in alternative settings and in the home.
Population Health Management
Authors: Frisse Mark E. , Misulis Karl E.
Published: May 2019

As systems become more capable of transmitting and aggregating data, new analytic methods promise both a deeper understanding of population needs and new ways of bringing actionable data to the point of care. These techniques will be critical as payment for care migrates from fee-for-service models to episodic and risk-based bundles. The growing integration of data measuring social determinants will help both delivery and public health professionals gain new insights into richer, more meaningful, and more effective means of care. The combination of new data, new analytics, and technologies capable of penetrating to every point of decision-making promise to foster innovative and meaningful approaches to patient care.
Researchers
Authors: Frisse Mark E. , Misulis Karl E.
Published: May 2019

Formal research efforts are traditionally managed by trained professionals pursuing systematic investigations seeking improvements based on more rigorous data. An abundance of clinical data liberates research from selected academic institutions and invites broader participation by healthcare professionals. Local registries can allow for informal local analysis and advanced data integration and sharing initiatives can support national and even international research collaborations. Successful approaches rely on enforcement of data standards, application of privacy-protecting technologies, and use of ontologies and other data-mapping tools to ensure reliable interpretation of clinical data. Randomized clinical trials may remain the gold standard, but other, less costly data management approaches can provide many insights with scale and rapidity.
Coronary Artery Bypass Grafting
Authors: Daubenspeck Danisa , Chaney Mark A.
Published: May 2019

An estimated 92 million adults in the United States have cardiovascular disease, costing about $316 billion dollars in annual health care expenditures. Furthermore, it is estimated that about 16 million Americans greater than 20 years old have coronary artery disease (CAD), which results in a disruption of the oxygen supply-demand relationship in the myocardium and can have adverse effects on the function of the heart. Management of CAD involves both nonsurgical and surgical interventions, of which coronary artery bypass grafting (CABG) is the main surgical option. The majority of CABG surgery is done with the assistance of the cardiopulmonary bypass circuit (CPB), although in the last 30 years there has been a trend toward performing CABG without CPB, also known as off-pump CABG. Many cardiac surgical patients have other medical comorbidities that make significant contributions to their ability to recover. Management of the patient requiring CABG, both with and without CPB, poses several challenges for the cardiac anesthesiologist. These include planning for appropriate monitoring of hemodynamics and oxygenation, obtaining adequate intravascular access, and anticipating and reacting to changes in pathophysiology related to CPB.
Transfusion Dilemma/Coagulation TEG
Authors: Duce Lorent , Frantz Amanda
Published: May 2019

The healthcare team is presented with a unique challenge when providing bloodless surgery to patients of the Jehovah’s Witness faith who refuse allogenic transfusions based on religious beliefs. The Jehovah’s Witness faith interprets New and Old Testament passages of the Bible, including Genesis 9:4, as God commanding against “eating blood,” thus preventing believers from receiving transfusions of blood products. When it comes to complex cardiac surgery, where blood loss and coagulopathy are common, the physician and patient must establish a plan for blood conservation and optimization of hemoglobin preoperatively. Knowledge of management options during the preoperative period as well as treatment options for blood loss is imperative to honor patient autonomy and avoid ethical dilemmas.
Fast-Track Recovery
Authors: Torres Arturo G. , McGough Edward
Published: May 2019

Fast-track cardiac care (FTCC) encompasses the entire spectrum of perioperative care for the cardiothoracic surgical patient. From the preoperative assessment to postoperative care, the main goal is to expedite recovery while minimizing the inherent risks associated with cardiac surgery. The practice of prolonged mechanical ventilation due to high-dose narcotic anesthesia has evolved to early protocolized extubation pathways facilitated by multimodal anesthesia. The goal of the postoperative care phase is focused on reducing or completely bypassing the intensive care unit and ultimately decreasing hospital length of stay. Yet, here is where FTCC seems unable to achieve its goals due to multifactorial barriers. An integral part of successful FTCC is constant reevaluation of the patient through each of the perioperative phases (pre-, intra-, and postoperatively).
The social experience of cancer
Authors: Eva Gail
Published: May 2019

A diagnosis of cancer leads to many changes in a person’s social identity, including changes in roles and family relationships. It often results in disruptions to employment, loss of income, and financial problems, and this can impair self-esteem. Families have to cope with challenges to family cohesion and resilience. Children may be particularly vulnerable, and nurses can help to support both children and their families through periods of adjustment. Family members or friends providing care have their own needs and challenges, taking on additional roles and responsibilities for which they may feel ill-prepared. Cancer occupies a powerful place in public consciousness and the media, often seen as an enemy to be fought. Cancer stories can also be framed as a struggle or in sporting metaphors, e.g. ‘race for life’. Gender affects perceptions of how people react to cancer, e.g. that men are more stoical and women more emotional. Age is also an important social factor, with both older and younger patients having particular needs that should be addressed. Nurses need to develop the capacity to respond to culturally diverse populations, in order to meet the needs of patients representing all parts of society. Some patients may feel a sense of stigma as a result of cancer, particularly if their appearance is changed or if they feel a sense of guilt about their illness. Nurses can support them in maintaining self-esteem and overcoming stigma.
Haematological cancers
Authors: Eyre Toby
Published: May 2019

This chapter examines the epidemiology, genetics, clinical presentation, and classification of these diseases and presents current treatment approaches for each. First are the acute leukaemias: acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML). Chronic myeloid leukaemia and chronic lymphoid leukaemias follow. Hodgkin's lymphoma is described, along with current treatment with chemotherapy and limited radiotherapy. Non-Hodgkin's lymphoma is divided into low-grade and high-grade pathology. Treatments, including chemotherapy and rituximab, are covered. Myeloma and its treatment options are reviewed, including chemotherapy, bisphosphonate therapy, and radiotherapy. Throughout this chapter is emphasized the importance of clinical trials in driving the rapid improvements in treatment of these diseases. Nursing issues related to each disease are covered within each of their specific section.
Blood product support
Authors: Eyre Toby
Published: May 2019

This chapter covers the use of blood products for patients with cancer. Issues of compatibility, ABO grouping, and rhesus are all discussed. The use of red cell transfusions is explored, covering up-to-date guidelines on their use. Transfusion reactions and their management are also described. The chapter then explores the use of platelet transfusions, as well as commonly seen reactions. There is also a look at specialized aspects of blood product use, including cytomegalovirus testing and irradiated blood products for immunocompromised patients. The final section looks specifically at the nurse's role, including patient education, safety checking, and patient monitoring.
Normal function and movement
Authors: Ledoux William , Iaquinto Joseph
Published: May 2019

In this chapter, we will begin with a basic overview of the principles of human movement, anatomy, and function, before discussing the foot structure–function relationship. We will then briefly review the principles and techniques of gait analysis, followed by a review of walking and the gait cycle and the response of ankle cartilage during gait. Next, a description of normal movement and foot function, reviewing tissue- and joint-specific function, as well as complex systematic foot function, will be given. Finally, a review of some specialized techniques for studying foot function, including computational modelling, biplane fluoroscopy, and cadaveric gait simulation, will be provided.
Osteoarthritis
Authors: Keenan Anne-Maree , Munteanu Shannon
Published: May 2019

In this chapter, we will cover osteoarthritis. First we will provide an overview, with definitions, pathogenesis and risk factors, and clinical features, followed by recommendations for holistic management of the disease. A detailed discussion on the prevalence and impact of foot disease is then given, by area of the foot. Specific non-pharmacological and pharmacological management are described, and surgical options are outlined. Finally, clinical trials and the future direction of research are covered.
Rheumatoid arthritis
Authors: Backhouse Mike , Siddle Heidi
Published: May 2019

In this chapter, we will cover rheumatoid arthritis. First we will describe the epidemiology, aetiology, and pathogenesis of rheumatoid arthritis, followed by the histological changes in joints. Clinical features of the disease are described and how it affects the foot and ankle at disease onset and in the early stages. The disability and impact of the disease is considered prior to describing systemic treatment methods. Specific foot disease associated with rheumatoid arthritis is covered, split by area of the foot. Imaging requirements are outlined, including disease-specific considerations, and specific management options are discussed. Finally, clinical trials and the future direction of research are covered.
Spondyloarthropathies
Authors: Turner Deborah , Helliwell Philip
Published: May 2019

The spondyloarthropathies include ankylosing spondylitis and psoriatic arthritis. The hallmark clinical features are inflammatory spinal disease, dactylitis, and enthesitis, together with an asymmetrical oligoarthritis, often of the lower limbs. Psoriaform skin and nail changes are also frequently seen, and, less commonly, but characteristically, a mutilating arthritis with severe deformity of the toes. These unique features often allow a diagnosis to be made purely on clinical examination of the lower limbs. However, these features also provide challenges for local treatments as skin disease may complicate the use of orthoses and percutaneous steroid injections. However, the importance of mechanical factors in the pathogenesis of these disorders almost mandates a combined mechanical and pharmacological approach to treatment.
Surgery
Authors: Backhouse Mike , Harris Nick
Published: May 2019

Surgery plays an important role in treating foot and ankle conditions yet is often poorly understood. This chapter uses the available evidence to provide an overview of common surgical procedures and their outcomes. It is not intended to be instructional but, instead, we hope it will help inform clinicians about surgical options and their outcomes, as well as offering advice on the perioperative management of people undergoing foot and ankle surgery.
Organizing care
Authors: McAdam Jane , Helliwell Maggie
Published: May 2019

Commissioning any service within the National Health Service (NHS) involves planning, agreeing, organizing, and monitoring services. However, this simple statement hides a complex world that is dependent on an understanding of epidemiology of populations, of complex datasets within those populations, health needs assessments, evidence appraisal, and a knowledge of service specification, contracting, negotiating, and procurement. Planning and organizing podiatry care within the UK NHS falls behind such ‘giants’ as cancer, diabetes, and heart disease, but slow progress is occurring. This chapter will cover the background to commissioning and organizing care within the NHS with specific reference to the field of podiatry.
Cost-effectiveness analysis of public health interventions
Authors: Edwards Rhiannon T.
Published: May 2019

Building on Chapter 2, which introduced the reader to the purpose, principles, and statistical methods of cost-effectiveness analysis, this chapter provides a case study of a cost-effectiveness analysis undertaken alongside a trial of a public health intervention conducted by Edwards and colleagues into enhancing ventilation in homes of children with asthma. The association between poor housing and ill-health has long been recognized. This chapter reproduces in full a paper reporting the CHARISMA study, one of the first economic evaluation studies worldwide alongside a pragmatic randomized controlled trial of improving heating and ventilation in the homes of children with asthma. In summary, tailored ventilation and heating modifications moved 17 per cent of children in the intervention group from below the original median (‘severe asthma’) to above that median (‘moderate asthma’), while only 3 per cent of controls moved from ‘severe’ to ‘moderate’. Thus, a net 14 per cent of children (or 29 per cent of children with ‘severe’ asthma) became ‘moderate’.
Cost–benefit analysis for applied public health economic evaluation
Authors: McIntosh Emma , Baba Camilla , Botha Willings
Published: May 2019

Chapter 9 introduces the reader to the stages of cost–benefit analysis (CBA) as specifically applied to public health intervention economic evaluation. The specific focus of this chapter follows on from the messages of Chapter 6 on the relevance of, and methods for, quantifying the ‘outcomes’ of public health interventions in monetary form for CBA. Two case studies focus on the use of stated preference discrete choice experiment (SPDCE) methodology for valuation of multi-attribute benefits comprising health, non-health, and process outcomes of the type likely to occur in PHIs.
International perspectives and future directions for research and policy
Authors: Edwards Rhiannon T. , McIntosh Emma , Winrow Eira
Published: May 2019

This final chapter of the book provides an international perspective on health economics applied to public health intervention evaluation, with international examples offered. The chapter sets out research priorities for public health economics: increased use of behavioural economics; ethical considerations of the use of financial incentives in behaviour change; valuing green space in the built environment and valuing nature; exploring the roll of prevention and public health in a circular economy; increased use of cost-benefit analysis (CBA); standardization of return on investment (ROI) and social return on investment (SROI); navigating the research funding environment; precision public health; why many public health programmes fail to demonstrate effectiveness and cost-effectiveness; the need for payer thresholds for changes in population health; the challenge posed by assets based interventions; widening the range of costs measured; and publication of economic evaluation of public health interventions (PHIs). The chapter concludes with a review of the entire book and a suggested checklist for the conduct, analysis, and reporting of economic evaluation of PHIs.
Introduction and clinical scenarios
Authors: Atkinson Paul , Jarman Bob , Harris Tim , Gangahar Rip , Lewis David , Bowra Justin , Lamprecht Hein
Published: May 2019

Point-of-Care Ultrasound in Emergency Medicine and Resuscitation provides a curriculum-based guide to the integration of ultrasound into everyday practice for clinicians in emergency medicine and critical care medicine and for resuscitation. In addition to describing commonly used protocols, we focus on how ultrasound can be used to help to answer specific clinical questions and provide guidance for procedures at the point of care, augmenting traditional clinical skills. This chapter introduces the general concepts of using ultrasound at the bedside, describes how to use point-of-care ultrasound (PoCUS), and provides clinical scenarios as examples of where PoCUS can improve clinical care.
The chest
Authors: Bowra Justin , Loubani Osama , Atkinson Paul
Published: May 2019

Lung ultrasound is more accurate than clinical examination and chest X-ray for pleural disease (e.g. pneumothorax, pleural effusion) and pulmonary disease (e.g. consolidation, pulmonary oedema/fibrosis). Begin with a curved probe with the depth set at 15 cm and with the probe placed perpendicular to the ribs, with ‘filters’ (tissue harmonics and compounding) ideally turned off. M-mode may assist but normally is not required. Change to a linear probe for fine detail (pleural space and subpleural consolidation). Doppler is not normally recommended but has been used to differentiate pleural fluid from thickening and to differentiate the causes of consolidation.
The abdomen
Authors: Bowra Justin , Loubani Osama , Atkinson Paul
Published: May 2019

Abdominal point-of-care ultrasound (PoCUS) for intra-peritoneal fluid in trauma is one of the earliest, and now most accepted, uses of PoCUS in emergency medicine and resuscitation. It is an essential part of the e-FAST (Extended Focused Assessment in Trauma) examination. Abdominal PoCUS can also guide diagnosis and management of right upper quadrant pain and renal colic. PoCUS can also ‘rule in’ (but not ‘rule out’) bowel obstruction and appendicitis. Regardless of the clinical situation, PoCUS is used to answer specific binary questions, rather than to perform an exhaustive survey of the abdomen.
Musculoskeletal ultrasound
Authors: Lewis David
Published: May 2019

Musculoskeletal (MSK) point-of-care ultrasound (PoCUS) increases point-of-care diagnostic accuracy and guides management for localized injuries, infections, and inflammation. It should be considered an adjunct to the MSK clinical assessment. The area of interest is examined in two planes (long- and short-axis), utilizing a high-frequency transducer. A machine-split screen can be used to compare the area of interest with the contralateral normal; however, an understanding of the normal ultrasound appearance of MSK structures and knowledge of relative anatomy is required to become proficient.
Small parts ultrasound
Authors: Rubin Michael , Ritcey Brandon , Woo Michael Y
Published: May 2019

Small parts ultrasound is the use of PoCUS to evaluate many of the superficial organs such as the eyes, testes, and thyroid gland, among others. Patients presenting with eye complaints display a wide spectrum of pathology, from benign conditions to serious pathology that, if not recognized and treated in a timely fashion, can result in severe sequelae. In emergency medicine, scanning the orbital contents for ophthalmic emergencies, such as retinal detachment, as well as the scrotum and testes for conditions such as testicular torsion are commonly used small parts PoCUS indications.
Paediatric ultrasound
Authors: Fischer Jason , McLean Lianne
Published: May 2019

This chapter highlights the increasing use of point-of-care ultrasound (PoCUS) in children. The size and body habitus of infants and children are often ideal for sonographic visualization and make PoCUS an ideal imaging modality for paediatric patients. PoCUS applications that have been traditionally used for adult patients are increasingly being adopted for the care of children. Paediatric-specific applications are also being developed for problems common and unique to paediatrics. Focused abdominal scans for appendicitis, intussusception, and pyloric stenosis are now frequently used in patients presenting with abdominal pain or vomiting. PoCUS can differentiate lung pathology and is helpful in the assessment of suspected skull fractures in non-verbal infants. Ongoing integration of PoCUS into shock, trauma, and triage algorithms support its increasing role in paediatric emergency and critical care.
Respiratory
Authors: Monaghan Tanya M. , Thomas James D.
Published: May 2019

This chapter is about respiratory system, and covers chronic obstructive pulmonary disease, interstitial lung disease, lobectomy, pleural effusion, pneumothorax, tuberculosis, pneumonia, obstructive sleep apnoea, cystic fibrosis, Kartagener’s syndrome, bronchiectasis, superior vena cava obstruction, and cor pulmonale.
Neurological
Authors: Monaghan Tanya M. , Thomas James D.
Published: May 2019

This chapter concerns neurological medicine, and covers dermatomes, peripheral nerves and tendon reflexes, peripheral neuropathy, hemiplegia, myotonic dystrophy, proximal myopathy, motor neurone disease, cerebellar syndrome, myasthenia gravis, cervical myelopathy, median nerve palsy, ulnar nerve palsy, radial nerve palsy, wasting of the small muscles of the hand, syringomyelia, polymyositis, Parkinson’s disease, Friedreich’s ataxia, Charcot–Marie–Tooth disease, subacute combined degeneration of the cord, tabes dorsalis, cerebellopontine angle syndrome, paraplegia, visual field defect, nerve palsy, nystagmus, Horner’s syndrome, ptosis, large pupil, small pupil, Holmes–Adie–Moore syndrome, Argyll Robertson pupil, internuclear ophthalmoplegia, facial palsy, bulbar palsy, pseudobulbar palsy, and cauda equina syndrome.
Endocrine
Authors: Monaghan Tanya M. , Thomas James D.
Published: May 2019

This chapter concerns the endocrine system, and covers goitre, hyperthyroidism, Graves’s disease, hypothyroidism, acromegaly, Cushing’s syndrome, Addison’s disease, hypopituitarism, polycystic ovarian syndrome, Turner’s syndrome, and Klinefelter’s syndrome.
Skin
Authors: Monaghan Tanya M. , Thomas James D.
Published: May 2019

This chapter concerns dermatology, and covers describing a skin lesion, benign melanocytic naevus, melanoma, basal cell carcinoma, squamous cell carcinoma, seborrhoeic dermatitis, psoriasis, dermatomyositis, digital clubbing, tuberous sclerosis, hereditary haemorrhagic telangiectasia, xanthomata, vitiligo, pseudoxanthoma elasticum, lichen planus, Raynaud’s phenomenon, Peutz–Jeghers syndrome, Sturge–Weber syndrome, Ehlers–Danlos syndrome, eczema, and urticaria.
Biomarker identification and clinical validation
Authors: Kennedy Richard D. , Salto-Tellez Manuel , Paul Harkin D. , Johnston Patrick G.
Published: May 2019

Most cancer therapy is given in a ‘one size fits all’ manner depending on the anatomical site involved and basic histopathology, with drug dosage calculated from clinical trials using toxicity as an endpoint. An improved understanding of cancer at a molecular level has led clinicians to question how we develop novel drugs and select appropriate patients in the clinic. A biomarker is a characteristic that is objectively measured and evaluated as an indicator of normal biologic processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention. Biomarkers can potentially be used to tailor a patient’s treatment to improve survival and reduce unnecessary toxicity. Though many cancer-related biomarkers have been published in peer-reviewed articles, few have made an impact on patient care because of a failure to demonstrate clinical validity. This chapter explains biomarker discovery and delivery with a view to describing what constitutes a valid biomarker suitable for clinical use.
Pacemaker principles
Authors: Gamble James , Leeson Paul
Published: May 2019

This chapter covers the basis of the pacemaker. The history of pacemakers through to latest technological advances is outlined, followed by basic heart and venous system anatomy. The components of a pacemaker are described and illustrated, and special types of pacemaker are briefly defined. The mechanisms by which a pacemaker senses and an overview of pacing is described. Nomenclature and common modes are discussed and illustrated, with guidelines for implementation to help the reader. Sinus node dysfunction, atrioventricular (AV) node indications, and methods of preventing various arrhythmias are discussed by type of problem. Practical advice on choosing pacing modes are presented using a flow diagram.
Implantable loop recorder
Authors: Leeson Paul , Gamble James
Published: May 2019

This chapter covers the use of insertable loop recorders (ILR) to provide extended rhythm monitoring for patients with syncope or presyncope but without arrhythmia. The cost effectiveness is noted. Indications and contraindications for ILR implantation are described, and positioning technique is illustrated. Implantation, from patient preparation to post-operative care is described. Programming and complications are briefly summarized, along with common pitfalls with ILRs. Finally, the interpretation and explanation of the output is discussed.
Implantable cardioverter defibrillator principles
Authors: Chelliah Rajesh , Khiani Raj
Published: May 2019

This chapter covers the principles of implantable cardioverter defibrillators (ICDs). Indications and potential problems for insertion of an ICD are described, including the evidence base for insertion based on randomized trials. International clinical guidelines are summarized. The mechanism and components of an ICD are defined, including diagrams to show the pulse generator, electrodes, and a section on which lead to choose. Arrhythmia detection, sensitivity, oversensing, and rate determination are all discussed. Supraventricular tachycardia (SVT) discriminators, pacing for anti-tachycardia and bradycardia, anti-tachycardia pacing (ATP) delivery, defibrillation, and configuration of shock vector are covered. The importance of avoiding inappropriate shocks is briefly outlined, and strategies for home monitoring are featured.
Cardiac resynchronization therapy
Authors: Mitchell Andrew , Roberts Paul
Published: May 2019

This chapter examines some of the challenges of cardiac resynchronization therapy (CRT). The procedure continues to be technically difficult and in recent years there have been advances in technology that have helped successful implantation and response to the therapy. A methodical approach to left ventricular lead placement is described in the chapter, along with troubleshooting guidance for the difficult case. Technological developments such as quadripolar leads have changed practice and so this is described in detail. New concepts of CRT are emerging such as left ventricular endocardial pacing and left ventricular only pacing. Appropriate follow-up of patients following implantation is important. All of these clinical issues are described in this chapter, ensuring a comprehensive practical guide to all aspects of CRT.
System and lead extractions
Authors: Gamble James , Leeson Paul
Published: May 2019

This chapter covers system and lead extractions, including the principles and indications for decisions to explant or extract leads, methods of patient preparation, and techniques. The specific tools for lead extraction, such as a locking stylet, needle’s eye snare, and extraction sheaths are explained. The EDS and laser systems for described. The superior venous approach and femoral venous extraction are explained in a step-by-step method, including practical tips. Factors that increase the risk of complications are defined, along with the major and minor problems that can occur in a lead extraction.
Lifestyle issues, patient concerns, and devices
Authors: Timperley Jonathan
Published: May 2019

This chapter covers patient education about implants, including management of wound care, indications for seeking medical attention, and what to do in the event of shocks. Fitness to drive regulations in the UK are described, including for group 1 and group 2 licences. Questions that will commonly be asked by patients with a newly implanted device are answered to aid patient understanding, and finally the procedure in the case of an inappropriate shock are discussed.
Magnetic fields and extraordinarily bright radio emission in the X-ray faint galaxy group MRC 0116 + 111
Authors: Mernier F , Werner N , Bagchi J , Simionescu A , Böhringer H , Allen S W , Jacob J
Published: May 2019

MRC 0116 + 111 is a nearby (z = 0.132) poor galaxy group, which was previously known for exhibiting a bright diffuse radio emission with no central point-like source, presumably related to a past activity of the active galactic nucleus (AGN) in its central cD galaxy. Here, we present an X-ray observation (∼30 ks of cleaned XMM–Newton/EPIC exposure) of this system, allowing us for the first time a detailed comparison between the thermal and non-thermal components of its intragroup medium (IGrM). Remarkably, we find that the radio-to-X-ray luminosity ratio is among the highest ever observed for a diffuse extragalactic source so far, while the extent of the observed radio emission is about three times larger than its observed soft X-ray emission. Although powerful AGN activity may have disturbed the dynamics of the thermal IGrM in the form of turbulence, possibly re-energizing part of the relativistic electron population, the gas properties lie within the LX–T scaling relation established previously for other groups. The upper limit we find for the non-thermal inverse-Compton X-ray emission translates into a surprisingly high lower limit for the volume-averaged magnetic field of the group (≥4.3 $\mu$G). Finally, we discuss some interesting properties of a distant (z ≃ 0.525) galaxy cluster serendipitously discovered in our EPIC field of view.
Sculpting the valley in the radius distribution of small exoplanets as a by-product of planet formation: the core-powered mass-loss mechanism
Authors: Gupta Akash , Schlichting Hilke E
Published: May 2019

Recent observations revealed a bimodal radius distribution of small, short-period exoplanets with a paucity in their occurrence, a radius ‘valley’, around 1.5–2.0 R⊕. In this work, we investigate the effect of a planet’s own cooling luminosity on its thermal evolution and atmospheric mass loss (core-powered mass-loss) and determine its observational consequences for the radius distribution of small, close-in exoplanets. Using simple analytical descriptions and numerical simulations, we demonstrate that planetary evolution based on the core-powered mass-loss mechanism alone (i.e. without any photoevaporation) can produce the observed valley in the radius distribution. Our results match the valley’s location, shape and slope in planet radius–orbital period parameter space, and the relative magnitudes of the planet occurrence rate above and below the valley. We find that the slope of the valley is, to first order, dictated by the atmospheric mass-loss time-scale at the Bondi radius and given by d logRp/d logP ≃ 1/(3(1 − β)) that evaluates to −0.11 for β ≃ 4, where Mc/M⊕ = (Rc/R⊕)β(ρc∗/ρ⊕)β/3 is the mass–radius relation of the core. This choice for β yields good agreement with observations and attests to the significance of internal compression for massive planetary cores. We further find that the location of the valley scales as $\rho _{\rm c*}^{-4/9}$ and that the observed planet population must have predominantly rocky cores with typical water–ice fractions of less than ${\sim } 20{{\, \rm per\, cent}}$. Furthermore, we show that the relative magnitude of the planet occurrence rate above and below the valley is sensitive to the details of the planet-mass distribution but that the location of the valley is not.
Doc2Hpo: a web application for efficient and accurate HPO concept curation
Authors: Liu Cong , Peres Kury Fabricio Sampaio , Li Ziran , Ta Casey , Wang Kai , Weng Chunhua
Published: May 2019

We present Doc2Hpo, an interactive web application that enables interactive and efficient phenotype concept curation from clinical text with automated concept normalization using the Human Phenotype Ontology (HPO). Users can edit the HPO concepts automatically extracted by Doc2Hpo in real time, and export the extracted HPO concepts into gene prioritization tools. Our evaluation showed that Doc2Hpo significantly reduced manual effort while achieving high accuracy in HPO concept curation. Doc2Hpo is freely available at https://impact2.dbmi.columbia.edu/doc2hpo/. The source code is available at https://github.com/stormliucong/doc2hpo for local installation for protected health data.
Joint Outcomes Following Surgery for Superior Tibiofibular Joint-Associated Peroneal Intraneural Ganglion Cysts
Authors: Wilson Thomas J , Stone Jonathan J , Howe B Matthew , Rock Michael G , Spinner Robert J
Published: May 2019

BACKGROUND

Intraneural ganglion cysts are joint-connected, with the primary pathology residing in the associated joint. For peroneal intraneural ganglion cysts, the surgical strategy can include resection of the synovial surface of the superior tibiofibular joint (STFJ). However, the rate of instability postoperatively is unclear.

OBJECTIVE

To evaluate the rate of STFJ instability, following surgery for peroneal intraneural ganglion cysts. The second goal of the study was to assess the relationship between volume of resection of the STFJ and risk of extraneural recurrence.

METHODS

We performed a retrospective analysis of a cohort of patients with peroneal intraneural ganglion cysts. We analyzed clinical factors, including recurrence, and assessed the rate of postoperative STFJ instability. We created 3-dimensional models of the STFJ pre- and postoperatively to compare the volume of resection in recurrent cases and nonrecurrent cases using a case-control design.

RESULTS

The total cohort consisted of 65 subjects. No patient had evidence of radiological or clinical instability of the STFJ postoperatively. Extraneural radiological recurrence occurred in 6 (9%) patients. No intraneural recurrences were observed. The average volume of resection for patients with recurrence was 1349 mm3 (SD = 1027 mm3) vs 3018 mm3 (SD = 1433 mm3) in controls that did not have a recurrence (P = .018).

CONCLUSION

This study supports performing an aggressive STFJ resection to minimize the risk of extraneural recurrence. Superior tibiofibular joint resection is not associated with postoperative joint instability. A smaller volume resection is correlated with recurrence risk.
Integrated Management of Downy Mildew on Slicing Cucumber With Fungicides and Host Resistance But Not Trellising
Authors: Keinath Anthony P.
Published: May 2019

The objective of this study was to evaluate fungicide applications, host resistance, and trellising, alone and in combination, as management practices for downy mildew on slicing cucumber. A split-split plot experimental design was used with three and four replications in spring and fall 2017, respectively. The whole-plot treatment was fungicide, four applications of chlorothalonil (Bravo Weather Stik 6SC) alternated with three applications of cyazofamid (Ranman 400SC), or water. Split plots were nontrellised or trellised with four strings supported by stakes. Split-split plots were cultivar Bristol, which is intermediately resistant to downy mildew, or cultivar Speedway, which is susceptible to downy mildew with similar parentage as Bristol. In both seasons, area under the disease progress curve (AUDPC) values were lower with fungicides than water for both cultivars. In the spring, AUDPC for Bristol was lower than for Speedway regardless of fungicide treatment. In the fall, Bristol had a lower AUDPC than Speedway with fungicides, but the AUDPC did not differ between the two cultivars with water. The mean AUDPC for trellised plants (376.2) was lower than for nontrellised plants (434.0; P = 0.007). Fungicide applications increased marketable and total fruit weights in both seasons (P ≤ 0.0002). Marketable weight with fungicides was almost double (93% greater) the marketable weight with water. Marketable weight was 55% greater for Bristol than for Speedway in spring, but yields did not differ between cultivars in fall (season-by-cultivar interaction, P ≤ 0.0003). Because trellising had no effect on marketable yields (P = 0.11), trellising is not recommended for managing downy mildew on slicing cucumber. Of the three management techniques examined, fungicides had the largest effects on disease and yields, followed by cultivar resistance.
Biocontrol Activity of Three Pseudomonas in a Newly Assembled Collection of Phytophthora infestans Isolates
Authors: De Vrieze Mout , Gloor Ramona , Massana Codina Josep , Torriani Stefano , Gindro Katia , L’Haridon Floriane , Bailly Aurélien , Weisskopf Laure
Published: May 2019

Late blight caused by the oomycete Phytophthora infestans constitutes the greatest threat to potato production worldwide. Considering the increasing concerns regarding the emergence of novel fungicide-resistant genotypes and the general demand for reducing inputs of synthetic and copper-based fungicides, the need for alternative control methods is acute. Several bacterial antagonists have shown anti-Phytophthora effects during in vitro and greenhouse experiments. We report the effects of three Pseudomonas strains recovered from field-grown potatoes against a collection of P. infestans isolates assembled for this study. The collection comprised 19 P. infestans isolates of mating types A1 and A2 greatly varying in fungicide resistance and virulence profiles as deduced from leaf disc experiments on Black’s differential set. The mycelial growth of all P. infestans isolates was fully inhibited when co-cultivated with the most active Pseudomonas strain (R47). Moreover, the isolates reacted differently to exposure to the less active Pseudomonas strains (S19 and R76). Leaf disc infection experiments with six selected P. infestans isolates showed that four of them, including highly virulent and fungicide-resistant ones, could be efficiently controlled by different potato-associated Pseudomonas strains.

[Formula: see text] Copyright © 2019 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Prevalence, Predictors, and Implications for Appropriate Use of Active Surveillance Management Among Black Men Diagnosed With Low-risk Prostate Cancer
Authors: Taku Nicolette , Narayan Vivek , Wang Xingmei , Vapiwala Neha
Published: May 2019

Background:

Consensus guidelines recommend that active surveillance (AS) be considered in the management of men with low-risk prostate cancer (LRPC). The objective was to evaluate the prevalence and predictors of an AS approach in black men (BM) diagnosed with LRPC after inclusion of AS in LRPC consensus guidelines.

Materials and Methods:

BM and white men (WM) diagnosed with LRPC (prostate-specific antigen ≤10 ng/mL, Gleason score [GS] ≤6, clinical stage T1-T2a) between 2010 and 2013 were identified from the National Cancer Database. Logistic regression models were used to assess the likelihood of AS over time and to examine associations between sociodemographic characteristics (SDCs) and the receipt of AS. A subanalysis was performed to assess the likelihood of GS upgrading on prostatectomy specimens for cases that received definitive treatment with radical prostatectomy.

Results:

Overall, 9% of BM (N=15,242) with LRPC were managed with AS. The likelihood of BM undergoing AS increased from 2010 and for all subsequent years of the study period (P<0.001). Uninsured BM were twice as likely as those with private insurance to undergo AS (odds ratio [OR]=1.97; 95% confidence interval [CI], 1.51-2.58; P<0.001). BM were less likely than WM (N=86,655) to receive AS (OR=0.82; 95% CI, 0.77-0.87; P<0.001). However, on multivariate analysis adjusted for SDCs, there was no significant difference in AS utilization between the 2 race groups. Nearly half of BM (47.5%) treated with radical prostatectomy had a postprostatectomy GS≥7, and BM were 17% more likely to experience postprostatectomy upgrading to GS≥7 when compared with WM (OR=1.17; 95% CI, 1.08-1.26; P<0.001).

Conclusions:

The utilization of AS for BM with LRPC seems to be increasing, is influenced by SDCs, and may not differ from AS utilization among WM. Careful consideration of prostate biopsy technique and sampling as well as SDCs at time of treatment planning may be necessary to ensure adequate evaluation of prostatic disease and appropriate disease management for BM with LRPC.
Integration of Ultrasound Into the Physician Assistant Curriculum
Authors: Rizzolo Denise , Krackov Rachel E.
Published: May 2019

Purpose

Over the past 10 years, successful ultrasound integration into medical education has resulted in 8 residencies and 52 undergraduate medical schools requiring ultrasound training for graduation. Physician assistants (PAs) are trained in the medical model, yet very little is known about the integration of ultrasound into their curricula. This study examined how ultrasound is used, if at all, in the PA education curricula.

Methods

Physician assistant program directors (PDs) were sent a survey addressing ultrasound integration into their curricula. Questions focused on the use of ultrasound to teach didactic courses and on inclusion of point-of-care ultrasound (POCUS) scanning skills as an adjunct to the physical examination. The survey also asked about students' feelings toward ultrasound integration into the curricula.

Results

Investigators contacted 201 PDs, and 107 (53.2%) PDs responded. Twenty-five of the respondents (23.4%) reported using ultrasound in the basic sciences. The top 3 reasons for not including ultrasound in preclinical courses were no ultrasound machine, expense, and no faculty trained in ultrasound. Seventy-three of the respondents (68.2%) thought that POCUS scanning skills should be included in the curriculum. More than 83% felt that faculty or adjunct faculty should teach those skills.

Conclusion

This survey demonstrated that there is great interest in integrating ultrasound into the PA curriculum but that many challenges inhibit implementation. Lack of access to ultrasound machines and to trained faculty are the biggest challenges to integrating ultrasound into the PA curriculum. Physician assistant programs face content and competency challenges similar to those that medical schools face, as well as several challenges that are unique to PA education. Future research is needed to address these issues.
Using the Core Competencies for New Physician Assistant Graduates to Prioritize Admission Criteria for PA Practice in 2025
Authors: Goldgar Constance , Hills Karen J. , VanderMeulen Stephane P. , Snyder Jennifer A. , Kohlhepp William C. , Lane Steven
Published: May 2019

In a fast-changing medical and educational environment, it is incumbent upon the physician assistant (PA) education community to periodically consider what the future practice environment might look like for our graduates. Changes in technology, regulation, reimbursement, health system economics, and health care delivery are among the many forces shaping the practice environment of the future. The 2018 Physician Assistant Education Association (PAEA) Presidents Commission reflected on what PA practice might look like in 2025 and used the Association's Core Competencies for New PA Graduates to consider what characteristics might therefore be required of the PA graduates who will practice in this future. We postulate that the future PA practice environment will require enhanced skills in such areas as interpreting technology-driven clinical data for patients and practices, consulting effectively with increasingly specialized members of health care teams, understanding population health and predictive analytics, and knowing how to access and critically assess new medical information. Working backward, we identify certain noncognitive attributes that will likely need to be prioritized in our admission processes and suggest some tools that can be used to assess them. These attributes include ethical responsibility, communication, critical thinking, situational judgment, and professionalism. As with all Presidents Commission articles, this piece is intended primarily to stimulate thought, dialogue, and future research. We encourage all faculty to participate in this dialogue, through the new PAEA Digital Learning Hub (https://paealearning.org/learn/digital-learning-hub/) and other channels.