bluuebunny/crossref_metadata_2025 huggingface dataset:
Neisseria
Authors: Harrison Dr Mark
Published: May 2013

4.1 Neisseria meningitidis, 174

4.2 Neisseria gonorrhoeae, 175

• Gram negative aerobic cocci.

• ‘Pyogenic cocci’ - produce purulent material comprised largely of white blood cells.

• ‘Meningococcus’, the most frequent cause of meningitis.

• Affects young, healthy individuals.

• Outbreaks of meningitis in winter/early spring occur particularly in schools, institutions, and amongst the military....
Pertussis
Authors: Harrison Dr Mark
Published: May 2013

5.1 Epidemiology, 178

5.2 Basis of infection, 178

5.3 Clinical features, 178

5.4 Basis of diagnosis, 179

5.5 Medical management, 179

• ‘Whooping cough’, caused by Bordatella pertussis

• Gram negative rod, aerobic

• Highly contagious.

• Uncommon in UK children due to immunization....
Pseudomonas
Authors: Harrison Dr Mark
Published: May 2013

9.1 Basis of infection, 189

9.2 Clinical features of infection, 189

9.3 Basis of diagnosis, 189

9.4 Principles of treatment, 190

9.5 Implications within hospital setting, 190

• Pseudomonas aeruginosa is the primary pathogen.

• Found in soil, water, plants, and animals.

• Grows in moist environments including hot tubs, wet intravenous tubing, and other water-containing vessels....
Chlamydia
Authors: Harrison Dr Mark
Published: May 2013

10.1 Chlamydia trachomatis, 191

• An obligate intracellular parasite

• 3 species:

▪ Chlamydia trachomatis causes diseases of genitourinary tract and eye

▪ Chlamydia psittaci is a respiratory pathogen, transmitted by contact with birds, causes psittacosis

▪ Chlamydia pneumoniae causes atypical pneumonia

• Incubation period 1-3 weeks...
Malaria
Authors: Harrison Dr Mark
Published: May 2013

19.1 Epidemiology, 221

19.2 Usual clinical features, 222

19.3 Basis of diagnosis, 222

19.4 Therapy, 222

• Protozoal disease.

• Plasmodium species -

▪ Falciparum (15%)

▪ Vivax (80%)

▪ Ovale

▪ Malariae

• High-risk areas: Central/South America, SE Asia, sub-Saharan Africa.

• Transmission:...
Basic cellular physiology
Authors: Harrison Dr Mark
Published: May 2013

1.1 Homeostasis, 224

1.2 Compartments and fluid spaces in health, 225

1.3 Key aspects of cell structure and function, 227

1.4 Vessel fluid dynamics, 230

1.5 Blood and blood flow, 232

1.6 Basis of the neurological action potential, 234

1.7 Conduction of the generated action potential, ...
Renal physiology
Authors: Harrison Dr Mark
Published: May 2013

5.1 Kidneys, 310

5.2 Mechanism of filtration, 313

5.3 Acid-base balance, 323

5.4 Potassium balance, 327

5.5 Calcium balance, 327

For the full anatomy of the kidneys see Section A.4.11 of Chapter A4.

• Within the dense, connective tissue of the renal capsule, the kidney substance is divided into:...
Endocrine physiology
Authors: Harrison Dr Mark
Published: May 2013

6.1 Pituitary function, 330

6.2 Adrenal function, 333

6.3 Endocrine pancreas, 335

6.4 Thyroid physiology, 337

6.5 Calcium and bone physiology, 338

• The pituitary sits in the sella turcica (pituitary fossa, part of the sphenoid bone). See Figure C.6.1.

▪ Separated from the brain by the diaphragma sellae (a reflection of dura mater)....
Gastrointestinal system
Authors: Harrison Dr Mark
Published: May 2013

1.1 Antacids, 342

1.2 Alginates, 343

1.3 Antispasmodics (antimuscarinics), 343

1.4 Ulcer-healing drugs, 344

1.5 Acute diarrhoea, 344

1.6 Chronic bowel disorders - inflammatory bowel disease, 345

1.7 Laxatives, 345

Drug management is based upon symptom severity and often requires patient lifestyle changes in order to achieve maximal success....
Central nervous system
Authors: Harrison Dr Mark
Published: May 2013

4.1 Hypnotics and anxiolytics, 373

4.2 Antipsychotics, 374

4.3 Antimania drugs, 376

4.4 Tricyclic antidepressants, 377

4.5 Nausea and vomiting (N&V), 377

4.6 Analgesics, 379

4.7 Non-opioid analgesics, 379

4.8 Opioid analgesics, 380

4.9 Antiepileptics, 382

4.10 Status epilepticus, 383

• Hypnotics - Used to treat sleeping disorders (sleeping tablets)...
Endocrine system
Authors: Harrison Dr Mark
Published: May 2013

6.1 Diabetes, 403

6.2 Thyroid disease, 405

6.3 Corticosteroids, 406

• Diabetes mellitus (DM) is characterized by persistent hyperglycaemia. This can be caused by the body's failure to produce insulin (type 1 DM) or by increased insulin resistance (type 2 DM).

• Type 1 DM usually presents in younger people with polyuria, polydipsia, and weight loss. Long-term treatment of Type 1 DM is with insulin, the preferred regime being a long-acting insulin, with a short-acting insulin being given with meals (Basal-Bolus regime). Initial management can be difficult due to ‘honeymoon’ period where the pancreas still produces small amounts of insulin....
Cardiovascular system
Authors: Harrison Dr Mark
Published: May 2013

2.1 Control of blood pressure and heart rate, 445

2.2 Control of heart rate, 446

2.3 Cardiac output (CO), 447

2.4 Measurement of cardiac output (CO), 450

2.5 Blood flow peripherally, 451

2.6 The cardiac cycle, 454

2.7 ECG, 458

2.8 Pharmacological manipulation of the heart and peripheral circulation, ...
Inflammatory response
Authors: Harrison Dr Mark
Published: May 2013

1.1 Normal vs. abnormal, 492

1.2 Inflammatory markers, 496

• Initial reaction of tissue to ‘injury’

▪ Vascular phase: Dilatation and increased permeability

▪ Exudative phase: Fluid and cells escape from the permeable vessels

▪ Ends with: Resolution, suppuration, organization, progression to chronic inflammation...
Infection
Authors: Harrison Dr Mark
Published: May 2013

3.1 Upper respiratory tract, 500

3.2 Lower respiratory tract and pneumonia, 500

3.3 Meningitis and encephalitis, 501

3.4 Myocarditis and endocarditis, 503

3.5 Hepatitis, 504

3.6 Gastroenteritis, 505

3.7 Urinary tract infection (UTI), 506

3.8 STD, 507

3.9 Pelvic inflammatory disease (PID), 507

3.10 Cellulitis, ...
Haematology
Authors: Harrison Dr Mark
Published: May 2013

5.1 Anaemia, 515

5.2 Leukaemia, 516

5.3 Lymphoma and myeloma, 517

5.4 Coagulation, 518

• Less than normal number of RBCs or less than normal haemoglobin

• By size of RBC

▪ Macrocytic - Larger than normal

▪ Microcytic - Smaller than normal

▪...
The History of a Genetic Disease
Authors: Emery Alan E. H. , Emery Marcia L. H.
Published: May 2013

This resource traces the history of Duchenne Muscular Dystrophy in detail along with a commentary of Edward Meryon's research, which has led to our current understanding of the disease, with full references and informative, historically relevant illustrations.
Resuscitation
Authors: Stacey Victoria
Published: May 2013

Advanced Life Support (ALS) - Cardiac arrest in special circumstances - Anaphylaxis - Post-resuscitation care - Peri-arrest arrhythmia management - Peri-arrest tachycardias - Peri-arrest bradycardias - Shock - SAQs
2030 - The Future of Medicine
Authors: Barker Richard
Published: May 2013

This resource tackles questions that relate to the way medicine will be practised in the future, and provides some answers. It does not shrink from the uncomfortable challenges that lie ahead, as demand surges and new technologies add to the strain. It lays out ten levers that stand a fighting chance of closing the healthcare equation, of balancing supply and demand.
Introduction and summary
Authors: Barker Richard
Published: May 2013

Sometimes our future is hidden in plain sight. This is true of the future of our healthcare, as explored in this book—written for all those involved in healthcare, practitioners and patients, who want to know what awaits them.

Over the last couple of years, the credit crunch has driven a near-collapse of the world's financial systems. With the benefit of hindsight, many say this could have been avoided. But it all seemed to happen so fast. Much of the prosperity of the last two decades was built on unaffordable levels of debt, debt that had built up over years, yet could bankrupt seemingly impregnable banks overnight. Everyone asked: how did we not see this meltdown coming? Could we have done anything to head it off?...
Healthcare demand— insatiable?
Authors: Barker Richard
Published: May 2013

Chapter 2 discusses the demand for healthcare, and the combined impact of ageing, of new disease threats, and ever-heightened expectations about health.
Taking responsibility—a healthcare agenda for the next 20 years
Authors: Barker Richard
Published: May 2013

Chapter 4 discusses an agenda for change, and deals with how the levers should be pulled. When faced with a major problem too often we say: 'they' must do this and that, meaning politicians and policymakers. But all
of us—professionals, suppliers, care managers, and patients—have vital roles to play in creating the momentum for change.
Conclusion—the US, the UK, and the Middle Way
Authors: Barker Richard
Published: May 2013

Chapter 5 reflects on the very different problems and challenges of the two systems on which this book focuses most—the US and the UK. What can they learn from each other? Is there a way forward that combines
thebest of both?
Oxford Handbook of Clinical Immunology and Allergy
Authors: Spickett Gavin
Published: May 2013

The Oxford Handbook of Clinical Immunology and Allergy is a unique, practical and clinically relevant guide for clinicians and laboratory staff to assist with the diagnosis and management of immunological/allergic disease, and the correct selection and interpretation of immunological tests, and has been expanded to include the latest developments, drugs, diagnostic tests, and therapy options in the field.
Secondary immunodeficiency and other host-defence syndromes
Authors: Spickett Gavin P
Published: May 2013

Introduction

Classification of secondary immunodeficiency

Human immunodeficiency virus 1 and 2

Epstein–Barr virus

Other viral infections

Acute bacterial infections

Chronic bacterial sepsis

Bronchiectasis

Fungal and parasitic infections

Malignancy

Myeloma

Lymphoma: Hodgkin’s disease

Non-Hodgkin’s lymphoma

Chronic lymphocytic leukaemia (CLL)

Chronic myeloid leukaemia (CML) and myelodysplastic syndromes...
Autoimmunity in gastrointestinal disease
Authors: Spickett Gavin P
Published: May 2013

Autoimmune enteropathy

Achalasia

Eosinophilic gastroenteritis (including oesophagitis)

Crohn’s disease

Ulcerative colitis (UC)

Whipple’s disease

Coeliac disease

Sclerosing mesenteritis

Autoimmune pancreatitis

Irritable bowel syndrome (IBS)

Autoantibodies against gut enterocytes have been associated with:

• Coeliac-like enteropathy (DQ2 positive), unresponsive to gluten-free diet, with villous atrophy.

•...
Autoimmune haematological disorders
Authors: Spickett Gavin P
Published: May 2013

Immune thrombocytopenia (ITP)

Autoimmune haemolytic anaemia

Autoimmune neutropenia

Paroxysmal nocturnal haemoglobinuria (PNH)

Aplastic anaemia (AA) and pure red cell aplasia

Anti-factor VIII antibodies (acquired haemophilia)

Heparin-induced thrombocytopenia (HIT)

Thrombotic thrombocytopenic purpura and haemolytic–uraemic syndrome

Anti-phospholipid syndrome (Hughes’ syndrome)

• ITP can occur at any age and is characterized by thrombocytopenia, with increased marrow megakaryocytes, and shortened platelet survival....
Connective tissue disease
Authors: Spickett Gavin P
Published: May 2013

Rheumatoid arthritis: aetiology, clinical features, and immunopathology

Rheumatoid arthritis: immunological tests, treatment, and childhood RhA

Juvenile chronic arthritis (JCA) and Still’s disease

Adult Still’s disease

Ankylosing spondylitis (AS) and related spondyloarthropathies

SAPHO syndrome

Psoriatic arthritis

Reactive arthritis (including Reiter’s syndrome)

Systemic lupus erythematosus (SLE) and variants...
Allergy tests
Authors: Spickett Gavin P
Published: May 2013

Introduction

Allergen-specific IgE

Allergen-specific IgG antibodies

Basophil activation test

CD23, soluble (Fcε‎ receptor)

C3a, C4a, and C5a (anaphylotoxins)

Challenge tests

Drug allergy testing

Eosinophil cationic protein (ECP)

Eosinophil count

Flow-CAST® and CAST-ELISA®

Histamine-release assays

Immunoglobulin E (total IgE)

IgE autoantibodies/IgE receptor antibodies...
Cellular investigations
Authors: Spickett Gavin P
Published: May 2013

Introduction

Flow cytometry

Tissue culture

Proliferation assays

Immunohistology

Cytokine, chemokine, soluble protein assays

Apoptosis assays

Adhesion markers

Bronchoalveolar lavage (BAL) studies

CD40 ligand expression

Complement membrane regulatory factors

Cytokine and cytokine receptor measurement

Cytotoxic T cells

FOXP3 (regulatory T cells—IPEX syndrome)

Genetic and protein studies...
Tissue typing
Authors: Spickett Gavin P
Published: May 2013

Introduction

Matching procedures: detecting pre-formed circulating antibodies

Mixed lymphocyte reaction (MLR)

HTLp and CTLp frequency

Tissue typing: serological methods

Molecular HLA typing

KIR typing

HLA testing as a disease marker

Human anti-animal antibodies

Chimerism studies

Useful websites

• Key elements for successful transplantation are:

•...
Quality and Managerial Issues
Authors: Spickett Gavin P
Published: May 2013

Introduction

Structure of the NHS and the NHS plan

Clinical Pathology Accreditation (CPA)

Medicines and Healthcare Products Regulatory Authority (MHRA)

Quality management system (QMS)

Concepts of quality assurance in the laboratory

Quality control (internal)

Quality control (external) 1: EQA schemes

Quality control (external) 2: benchmarking and CE marking...
Legal aspects of fitness for work
Authors: Howard Gillian S.
Published: May 2013

The English legal system is based on the common law. The common law system in England and Wales developed from the decisions of judges whose rulings over the centuries have created precedents for other courts to follow and these decisions were based on the ‘custom and practice of the Realm’. The system of binding precedent means that any decision of the Supreme Court—the new name for the former House of Lords (the highest court in the UK)—will bind all the lower courts, unless the lower courts are able to distinguish the facts of the current case and argue that the previous binding decision cannot apply, because of differences in the facts of the two cases. However, since the UK joined the European Union (EU), the decisions of the European Court of Justice (ECJ) now supersede any decisions of the domestic courts and require the English national courts to follow its decisions. (Scotland has a system based on Dutch Roman law, and some procedural differences although no fundamental differences in relation to employment law.) The Human Rights Act 1998 became law in England and Wales in 2000 (and in Scotland in 1998) in order to incorporate the provisions of the European Convention on Human Rights into UK law. The two most important Articles applicable to employment law are Article 8(1), the right to respect for privacy, family life, and correspondence, and Article 6, the right to a fair trial.
Disability and equality law
Authors: Howard Gillian S. , Williams Tony
Published: May 2013

The Equality Act 2010 (EqA) (which applies in Great Britain and not in Northern Ireland) replaces the Disability Discrimination Act 1995 (DDA) and all the other antidiscrimination statutes and regulations (e.g. Sex Discrimination Act 1975; Race Relations Act 1976). The EqA has updated, added to, and consolidated the various definitions of discrimination that existed in the previous legislation. It makes discrimination because of various ‘protected characteristics’ unlawful. Disability is one of the ‘protected characteristics’. This chapter focuses on the disability discrimination provisions of the EqA but covers some of the other ‘protected characteristics’ in passing. Originally, antidiscrimination legislation was piecemeal, inadequate, and disparate. The EqA has pulled together the various pieces of antidiscrimination legislation, added explicit detail in some areas (e.g. includes a new definition of indirect disability discrimination), new concepts (e.g. ‘discrimination on the grounds of combined characteristics’) and modified the former approach under the disability discrimination legislation concerning comparisons with an ‘able-bodied’ person. These issues are explained in the following sections.
Epilepsy
Authors: Brown Ian , Prevett Martin C.
Published: May 2013

Epilepsy is a common condition that affects large numbers of working people. In about one-third, epilepsy is the only condition, and in others there are additional neurological, intellectual, or psychological problems. Uncontrolled epileptic seizures can lead to injury and may impact on education and employment, but antiepileptic drug (AED) treatment is effective in approximately 70 per cent of people with epilepsy. Many people do not disclose a history of epileptic seizures when applying for a job or during a routine examination at the workplace. This may cause major problems for the individual and the employer and, on occasions, inadvertently contravene the HSW Act or invalidate insurance cover. However, the disability provisions of the Equality Act 2010 now confer some protection on those with epilepsy. The unenlightened attitudes of some employers have led to secrecy or denial by those affected. The possibility of dangerous situations arising at work, or dismissal without recourse to appeal, may be the consequence. A competent occupational health service, trusted by both shop-floor and management, can be invaluable in resolving conflicts and giving advice. Responsibility for the employment and placement of a person with epilepsy rests with the employer and they should take appropriate medical advice. Each case must be judged on its merits in light of the available information, which must include a sound and complete understanding of the requirements of the job. Employees with epilepsy must be regularly reviewed. The development of good rapport and mutual trust will encourage employees to report any changes in their condition or treatment that have arisen.
Fitness for work after surgery or critical illness
Authors: Williams Tony , Thomas Bill
Published: May 2013

Occupational health practitioners are frequently asked for advice on fitness to return to work after surgery. Providing the best answer is not always clear cut, as there is little evidence and a great deal of misunderstanding among patients and clinicians. One patient may be back at work within a week of a hysterectomy while another insists she is not fit to return after 5 months. There are medical issues here, but these are often confounded by inappropriate beliefs, unhelpful motivators, and uneducated advice. Perhaps the problem is best illustrated in a simple study published in the British Medical Journal in 1995. Majeed et al.1 asked 100 general surgeons and 90 GPs to recommend time off work for patients aged 25 or 55 years in sedentary, light manual, and heavy manual roles. The answers varied so widely that it was apparent that those giving advice had no full understanding of the issues. For example, after unilateral inguinal hernia repair in a 25-year-old returning to heavy manual work, surgeons’ recommendations varied from 1 to 12 weeks, and GP recommendations varied from 2 to 13 weeks. Often, however, there is a limitation in the evidence base. An expert working group, attempting to develop guidelines for the Royal College of Obstetricians and Gynaecologists (RCOG), found it easy to agree that a woman who had a vaginal hysterectomy would probably be at risk from heavy lifting within the first 4 weeks because of the nature of the surgery undertaken, but found no empirical evidence to support this. It is therefore difficult to quantify the actual risk and the advice finally given by the group was to adapt a 4-week cut off point. This represented a substantial shift from the 12 weeks not uncommonly recommended but in the absence of evidence to the contrary, it was considered that this was the best advice that could be provided.
Ill health retirement
Authors: Poole Jon
Published: May 2013

Doctors who give advice to pension scheme trustees or administrators should be aware of the eligibility criteria for that scheme and the meaning of terms used in the regulations, the statutory guidance, or explanatory notes published by the scheme. Most schemes require that the doctors who act as their medical advisors have a qualification in occupational medicine. The evaluation of evidence in support of an application for IHR should be robust but fair and care should be taken to avoid conflicts of interest for doctors involved in the treatment of the patient. The medical standards to which doctors work in making these judgements should be explicit and they should audit their rate of IHR against national data, if equitable decisions are to be made and confidence in the process is to be maintained.
Health and transport safety: fitness to drive
Authors: Carter Tim , Major Heather G. , Evans Sally A. , Colvin Andrew P.
Published: May 2013

Fitness to work in all modes of transport, where this may put members of the public or other workers at risk, has long been an area of public concern. Because inadequate performance may endanger fellow workers or the public and put expensive assets at risk, frameworks for statutory regulation have been developed. This chapter uses fitness to drive, the area of widest interest, as an example, but each mode of transport has its own pattern of performance requirements and hence fitness standards, although they have much in common. Separate appendices cover fitness to work in the rail industry, as a seafarer, and in aviation. The risks to the safety of others posed by performance deficits or incapacitation has meant that decisions on fitness are frequently taken not for the benefit of the person examined but to safeguard those at risk as a consequence of their actions. Hence hard decisions often have to be taken and for this reason standards for medical aspects of fitness are usually formal and often published. They are usually applied by physicians acting on behalf of regulatory authorities and have associated review or appeal mechanisms available to those who have been failed or restricted. Standards are necessarily based on the balance between public risk and potential loss of employment, with the former predominating. The evidence base for current standards is of variable quality and this is often a cause of contention. Patient groups and equal opportunities organizations may find it difficult to accept the concept of standards based on epidemiological evidence of risk. They may cite equality legislation to encourage applicants to demand individual assessment of risk and job adaptations to allow employment, often in situations where this is impossible. In addition to long-term health problems that are handled by reference to such formal standards, transport workers may also have short-term decrements in performance from injury, minor illness, or medication. In some areas, e.g. aviation, even short-term decreases in medical fitness are subject to national or international regulation.
Health promotion in the workplace
Authors: Boorman Steve , Banks Ian
Published: May 2013

This chapter aims to provide a summary of the development of modern approaches to health promotion in the workplace, illustrated by a number of case studies from UK businesses active in this area. The workplace is an effective forum for health promoting activities and the examples highlight that careful planning and targeting may increase the likelihood of success. Many employers expect such programmes to have high cost, or be difficult to organiseize, but the increasing resources available from third -sector and public health programmes may be accessed by partnership approaches to deliver high- quality programmes, with minimal cost. Comprehensive occupational health should encompass prevention and health promotion, within the continuum ranging from pro-active health support to more reactive intervention to address injury or illness.
Viva 1
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 1 asks what is the likely diagnosis, risk factors for this condition, the two main components seen in the histology of mature tissue from this condition, the management options, and the risks of surgical treatment.
Viva 3
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 3 asks for a description of the picture, how the thumb condition should be graded radiologically, why subluxation occurs in this condition, how the hyperextension deformity of the MCP joint could be explained, and what are the management options. It continues by asking how to treat the patient, who has unremitting carpo-metacarpal (CMC) joint pain despite full non-operative treatment and who is fit for surgery, and the advantages and disadvantages and surgical risks with simple excision arthroplasty?
Viva 5
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 5 asks for a description of these radiographs, a classification of this injury, followed by an assessment of this patient's isolated injury, and how this injury initially and definitively should be managed.
Viva 6
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 6 asks for a description and explanation of these radiographs, the indications for internal fixation of scaphoid fractures, and if acute non-displaced fractures should be fixed. It also asks what the complications of this injury are, and how the management of an established non-union of a scaphoid fracture should be planned.
Viva 7
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 7 asks for a description of what can be seen in the image, and the cause of this condition. It also asks for the staging system for this condition, what else should be looked for on the radiographs, and the management options.
Viva 8
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 8 asks for a description of what can be seen on this radiograph of a 22-year-old with ulnar-sided wrist pain, and the expectations of soft tissue structure involved. It then asks for simplification of the anatomy of this complex structure, and management options for this condition.
Viva 12
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 12 provides a photograph of a 7-year-old girl sitting in a comfortable position. Her mother is concerned because she walks with her feet turned in. What is the assessment based on findings on your examination that the child has extremely lax ligaments and increased internal rotation of both hips, and how is ligamentous laxity graded in children. What is the response to the mother's query about surgical treatment for this condition?
Viva 16
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 16 deals with a call to assess a newborn child on the maternity ward, and asks for a description of the clinical photograph and components of the deformity, followed by a classification of the severity of the condition.
Viva 20
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 20 shows a post-operative radiograph view of a boy's pelvis. Offer the underlying diagnosis and what procedure has he had, followed by a description of the underlying disease and who gets it. Then classify this condition and describe the principles of management?
Viva 23
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 23 shows a patient who fractured a femur 4 months ago, but is still getting significant pain. Describe what can be seen on the radiograph and how it can be managed, as well as what factors influence fracture healing.
Viva 24
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 24 asks for a description of the deltopectoral approach to the glenohumeral joint, along with the patient set-up, primary, and secondary portals for ankle arthroscopy?
Viva 26
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 26 shows a radiograph performed on a child who presented with bowed legs, and asks for a diagnosis, an explanation of rickets and its causes, and how else might a child with rickets present, and how it should be investigated.
Viva 27
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 27 shows a device used in clinical practice, and asks for a description of Virchow's triad and the risk factors for formation of a deep vein thrombosis (DVT). Describe how to quote risk levels to patients undergoing total hip replacement (THR) and total knee replacement (TKR), followed by appropriate DVT prophylaxis policy for THR in a 70-year-old man with no significant additional risk factors?
Viva 32
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 32 shows the chemical structure of a material commonly used in joint arthroplasty — what is it, what is it made of, what happens when the powder and liquid are mixed, what are its material properties, and what factors influence its properties?
Viva 36
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 36 asks what a hypothesis is, what a null hypothesis is, how someone would go about setting up a clinical trial, and what Type 1 and Type 2 errors are?
Viva 39
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 39 shows part of a questionnaire. Identify this questionnaire and when is it used, followed by other ways there are of assessing outcome from surgery, and how might outcome measures be used in practice?
Viva 43
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 43 shows a rugby player who landed awkwardly after a line out. Describe what is seen and which joint is involved. Identify and describe the Lisfranc joint, and describe Lisfranc injuries and which type this is. This is an isolated injury. What is the best method to proceed, what should be looked for on plain radiographs, what is the operative plan for this fracture, and what should be said to this patient about his long-term outcome?
Viva 44
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 44 shows a radiograph of a foot of a 20-year-old roofer who fell from his ladder sustaining this isolated injury. Describe what is seen in this radiograph, followed by the management of this patient in the emergency department, further investigations that should be ordered and how these are helpful, and then how best to treat this fracture and any published evidence in this area?
Viva 45
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 45 shows a 77-year-old woman who fell off her bicycle sustaining an injury. Describe what this radiograph shows and how to classify this fracture. Then describe what you would like to know about the patient, your initial management, how to manage this patient, and how to manage this fracture if it occurred in a 42-year-old. This patient presented at 10 p.m. Should she be operated on that night?
Viva 46
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 46 shows a 40-year-old who sustained an injury in a RTA. Describe what is in this picture and explain the initial management, including primary treatment upon admission, a way of classifying these fractures, how to definitively treat this fracture, what the AO principles are, and what complications to warn the patient about?
Viva 48
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 48 shows a young patient who was the passenger in a high-speed RTA. What does this radiograph show and what would the initial management be in the emergency department be. Once in theatre how would this injury be treated and what is the management once the dislocation is reduced? A CT scan shows an additional posterior wall fracture – what are the indication for fixing the posterior wall fracture, and how would this fracture be fixed, and what complications should the patient be warned about?
Viva 52
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 52 shows a 35-year-old left-handed man who sustained this injury whilst arm wrestling. Describe these radiographs and how to go about managing this injury. It is documented by the casualty officer that the patient has dense radial nerve palsy. How would this alter management? His radial nerve palsy has been managed expectantly, but after 4 months there has been no improvement. What should be done now? What are the principles of tendon transfers? Which should be used here?
Viva 64
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 64 shows a 25-year-old football player who sustained a twisting injury to his left knee. He has already had an arthroscopy at ‘St Elsewhere’ and brings intra-operative pictures. What does his arthroscopy picture show? What is important in the initial assessment of this patient? The patient now has recurrent instability and has been unable to return to sport. The examination confirms an anterior cruciate ligament (ACL) injury and he has a full ROM. What are the management options now? Upon decision to reconstruct the ACL, what graft would be used?
Viva 68
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 68 asks what is understood by the term heterotopic ossification (HO)? How can this affect patients clinically following hip arthroplasty surgery? Are there any risk factors for developing HO and what measures can be taken to prevent this condition developing? How is established HO managed?
Viva 73
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 73 asks for the name of the spinal deformity in the photograph, and at what age and in which sex it most commonly presents? What factors affect progression of the deformity? How is it classified?
Viva 77
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 77 describes a 19-year-old man who participates in rugby at an elite level. He dislocated his left shoulder during a match 4 weeks ago. This was his first dislocation. It required reduction in A&E. He has no neurological problems and has regained full range of movement but his shoulder feels unstable. What type of instability is he most likely to have? How should he be treated and what surgical options are available? Describe the deltopectoral approach.
Viva 78
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 78 asks for a description of these radiographs and the most likely diagnosis. How should this lesion be investigated further? What are the principles of performing an open tumour biopsy? Outline the treatment options once the lesion has been identified and staged. Are there any prognostic indicators?
Recovery, narrative theory, and generative madness
Authors: Lewis Bradley
Published: May 2013

This chapter examines conceptual and related aspects of a narrative approach to recovery of people with mental illness. A narrative model of psychiatry provides an ideal philosophical touchstone for work in recovery. The recovery movement calls for clinicians who are comfortable with and who encourage empowered clients. It calls for clinicians who can empathically connect with clients’ desires and preferences, and who are willing to let the clients take the lead in making decisions. This does not mean that professionals have no role in recovery. Even with empowered consumers there still remains a place for professionals with the skills necessary to help people to find their path to recovery. What is important is to see that these professional skills, at their heart, are narrative skills. Narrative psychiatry creates clinicians who put the client's experience at the forefront. And narrative psychiatry creates clinicians who understand the many languages of psychic life. They are as comfortable talking about religion, creativity, and politics as they are discussing neurotransmitters, cognitive distortions, and psychodynamics. The recovery movement makes it clear that many consumers wish for just this kind of clinician.
Some social science antinomies and their implications for the recovery-oriented approach to mental illness and psychiatric rehabilitation
Authors: Kravetz Shlomo , Hasson-Ohayon Ilanit
Published: May 2013

This chapter discusses the problematic nature of paradox and antinomy. It will show how certain selected paradoxes and antinomies (i.e. free will vs. determinism, value vs. fact, and idiographic vs. nomothetic description) have a particular relevance for theoretical, empirical, and applied issues central to the social sciences in general and to psychiatric rehabilitation in particular. Thus controversy about the assessment of the effectiveness of psychiatric rehabilitation within a recovery framework may be especially difficult to resolve due to the value vs. fact antimony. This antimony implies that such questions as whether elimination of symptoms or the enhancement of autonomy should be a major recovery goal cannot be decided on the basis of empirical research alone. Possible ways of integrating a dialogical approach with empirical research will be explored as an essential step toward resolving such theoretical, empirical, and applied issues.
Being ill and getting better: recovery and accounts of disorder
Authors: Cooper Rachel
Published: May 2013

The aim of psychiatric treatment is to help patients to get better, but working out what getting better should be taken to mean can be problematic. This chapter explores how one's view of what counts as recovery will depend on the account of disorder that one adopts. Accounts of disorder can be split into two main categories. Biologically based accounts (paradigmatically those of Christopher Boorse) claim that disorder is purely a matter of biological dysfunctioning. According to such accounts the aim of treatment will be to restore functioning such that ultimately the patient's psychological subsystems will function in the same way as those of other humans of the same age and gender. Accordingly, whether a patient is getting better will be seen as the sort of thing that can be fairly assessed by standardized rating scales. In contrast, accounts which hold that disorder is a value-laden concept will lead one to view recovery differently. According to such accounts, for a condition to count as a disorder it must be bad. It will be argued that whether a condition is bad or not will vary with factors such as the social environment, and also with the aims, desires, and self-understanding of the individual patient. One consequence of this is that a condition that was once bad for the patient can be rendered neutral or good for them not only by altering the functioning of their psychological subsystems, but also by altering the patient's social environment or their own assessment of the situation. This means that measuring “recovery” will not be a straightforward matter. The chapter ends by considering how treatment efficacy might best be assessed according to such a view of recovery.
Recovery and stigma: issues of social justice
Authors: Flanagan Elizabeth , Zeev Dror Ben , Corrigan Patrick
Published: May 2013

This chapter draws upon the findings of qualitative and quantitative research to address stigma and social justice as they relate to recovery from mental illness. Stigma towards people with mental illness has been identified as a primary impediment to people's recovery from mental illness and inclusion as full members of a community. Recovery has long been understood as an issue of social justice. However, stigma research has often been dominated by a medical approach, according to which stigma will disappear when serious mental illness is cured, because symptoms that elicit stigma are no longer evident. In reality, essential to moving forward is an understanding of stigma as a matter of social injustice. As such, it is framed in the same light as other forms of prejudice and discrimination that have hounded the modern world, such as racism, sexism, and ageism, to name just a few. As social injustice, mental illness stigma is largely the responsibility of the societies that created it. Framing mental illness stigma in terms of an ethics reminds us that people with mental illness are just that—people. As such they are entitled to the same human rights that are enjoyed by everyone in their community and culture—a primary tenet of the recovery movement. A combination of social science research and background in the recovery movement can strengthen this case, as illustrated here.
Recovery and advocacy: contextualizing justice in relation to recovery from mental illness in East Asia
Authors: Chiu Marcus Yu-Lung
Published: May 2013

Given the backdrop of generally under-funded psychiatric care, overwhelming medical dominance, and a lack of vigorous advocacy for adequate mental healthcare, this chapter sets out to discuss the concepts of recovery and advocacy both in relation to each other and in relation to their particular socio-economic-cultural context in the Asian setting, as applied to mental health issues. The chapter has several aims. The first aim is to spell out why recovery and advocacy are two complicated and perhaps problematic concepts in the Asian context. The second aim is to deconstruct the forces that shape the concept and expectation of recovery and an individual's own power position in advocacy in cultures where the individuals and their families are held responsible for the care and recovery of the ill person. The third aim is to discuss the conflicting situation of mental health professionals (particularly psychiatrists, psychologists, nurses, social workers, and occupational therapists) in Asia, as many of these professionals endorse the universal values of respect, love, and care for patients on the one hand, while on the other hand they do not consider themselves appropriate for advocacy on behalf of patients. The fourth aim is to discuss why knowledge-based psychoeducation can help as well as subjugate caregivers at one and the same time. The fifth aim is to explore the dilemma of working within the cultural constraints of harmony and submission versus “going radical”, and to discuss how cultures of modesty or the “middle way” guide the development of alternatives to professional/paternalistic dominance. In relation to these ethical and other issues, the chapter draws on the author's experience of working with caregivers in Hong Kong, Taiwan, Korea, Thailand, and Malaysia.
General principles of management of patients
Authors: Reynard John , Brewster Simon , Biers Suzanne
Published: May 2013

Communication skills 2

Documentation and note keeping 4

Patient safety in surgical practice 6

Communication is the imparting of knowledge and understanding. Good communication is crucial for the surgeon in his or her daily interaction with patients. The nature of any interaction between surgeon and patient will depend very much on the context of the ‘interview’, whether you know the patient already, and on the quantity and type of information that needs to be imparted. As a general rule, the basis of good communication requires the following:
...
Urological investigations
Authors: Reynard John , Brewster Simon , Biers Suzanne
Published: May 2013

Assessing kidney function 38

Urine examination 40

Urine cytology 42

Prostatic-specific antigen (PSA) 43

Radiological imaging of the urinary tract 44

Uses of plain abdominal radiography (the ‘KUB’ X-ray—kidneys, ureters, bladder) 46

Intravenous urography (IVU) 48

Other urological contrast studies 52

Computed tomography (CT) and magnetic resonance imaging (MRI) ...
Bladder outlet obstruction
Authors: Reynard John , Brewster Simon , Biers Suzanne
Published: May 2013

Regulation of prostate growth and development of benign prostatic hyperplasia (BPH) 72

Pathophysiology and causes of bladder outlet obstruction (BOO) and BPH 73

Benign prostatic obstruction (BPO): symptoms and signs 74

Diagnostic tests in men with LUTS thought to be due to BPH 76

The management of LUTS in men: NICE 2010 Guidelines ...
Incontinence and female urology
Authors: Reynard John , Brewster Simon , Biers Suzanne
Published: May 2013

Incontinence: classification 128

Incontinence: causes and pathophysiology 130

Incontinence: evaluation 132

Stress and mixed urinary incontinence 136

Surgery for stress incontinence: injection therapy 138

Surgery for stress incontinence: retropubic suspension 140

Surgery for stress incontinence: suburethral tapes and slings 142

Surgery for stress incontinence: artificial urinary sphincter ...
Trauma to the urinary tract and other urological emergencies
Authors: Reynard John , Brewster Simon , Biers Suzanne
Published: May 2013

Initial resuscitation of the traumatized patient 506

Renal trauma: classification, mechanism, grading 508

Renal trauma: clinical and radiological assessment 512

Renal trauma: treatment 516

Ureteric injuries: mechanisms and diagnosis 520

Ureteric injuries: management 522

Pelvic fractures: bladder and ureteric injuries 526

Bladder injuries 532

Posterior urethral injuries in males and urethral injuries in females ...
Neuropathic bladder
Authors: Reynard John , Brewster Simon , Biers Suzanne
Published: May 2013

Innervation of the lower urinary tract (LUT) 604

The physiology of urine storage and micturition 608

Bladder and sphincter behaviour in the patient with neurological disease 610

The neuropathic lower urinary tract: clinical consequences of storage and emptying problems 612

Bladder management techniques for the neuropathic patient ...
Urological problems in pregnancy
Authors: Reynard John , Brewster Simon , Biers Suzanne
Published: May 2013

Physiological and anatomical changes in the urinary tract 640

Urinary tract infection (UTI) 642

Hydronephrosis of pregnancy 644

• Renal size enlarges: by 1cm, secondary to increased interstitial volume and distended renal vasculature, with renal volume increasing up to 30%.

• Dilatation of the collecting systems...
Urological surgery and equipment
Authors: Reynard John , Brewster Simon , Biers Suzanne
Published: May 2013

Preparation of the patient for urological surgery 698

Antibiotic prophylaxis in urological surgery 702

Complications of surgery in general: DVT and PE 706

Fluid balance and the management of shock in the surgical patient 710

Patient safety in the urology theatre 712

Transurethral resection (TUR) syndrome ...
Basic science and renal transplant
Authors: Reynard John , Brewster Simon , Biers Suzanne
Published: May 2013

Basic physiology of bladder and urethra 794

Basic renal anatomy 796

Renal physiology: glomerular filtration and regulation of renal blood flow 800

Renal physiology: regulation of water balance 802

Renal physiology: regulation of sodium and potassium excretion 803

Renal physiology: acid–base balance 804

Renal replacement therapy ...
Basic physics
Authors: Venables Karen
Published: May 2013

Chapter 2 discusses the basic physics of external beam therapy, and addresses that distribution of radiation within the patient will be affected by many factors. These include the energy and modality of the beam, the density of the tissue, the use of beam modifiers such as wedges and compensators, and the distance of the patient from the machine. The apparent distribution will also be affected by the accuracy of the algorithm used in the planning system.
Upper gastrointestinal tract
Authors: Falk Stephen
Published: May 2013

Chapter 6 discusses the upper gastrointestinal tract, and addresses that the technical challenges of these diseases are considerable related to tumour volumes, anatomical situation, and poor normal tissue tolerance particularly of the intra-abdominal contents. More contemporaneous treatment techniques such as IMRT and IGRT have not currently made significant impact in the routine treatment of upper gastrointestinal tumours in the UK.