bluuebunny/crossref_metadata_2025 huggingface dataset:
Child and adolescent mental health services—roles, functions, and management in an era of change
Authors: Shooter Mike , Lagier Alison
Published: November 2023

To understand the complexity of the changes that CAMHS are going through in their structure and function, and to appreciate the problems of managing CAMHS through those changes, we need a model. It is difficult to think of a better model than that which CAMHS practitioners so often use for those in their care—child development. What are the tasks facing the developing child and what style of parenting is needed for healthy development to take place? The good enough parent, in its broadest Winnicottian sense, is one who provides a secure envelope within which a child can experiment with acceptable risks; one who patrols the boundaries within which the child is free to establish its own identity—attitudes to self, family, peer group, and community; how those attitudes are expressed; and to what lengths it is permissible to follow them in social relationships.
Measuring quality in CAMHS: policy, frameworks, and evidence for practice and commissioning
Authors: Joughin Carol
Published: November 2023

The drive to ensure quality in mental health service provision began in the UK in the 1960s following a series of hospital scandals. Increasing workloads, limited resources, the development of new treatment approaches, and raising expectations from the public have fuelled the need to demonstrate high-quality service provision. Demonstrating the quality of health service provision is complex and there is still ambivalence over its meaning and the best framework to ensure that it is delivered.
Data collection, clinical audit, and measuring outcomes
Authors: Wolpert Miranda , Thompson, Margaret , Tingay Karen
Published: November 2023

Any child and adolescent mental health service within the NHS seeking to evaluate outcomes on a routine basis must address the following questions: What is the aim of routine outcome evaluation? Whose views of outcome should be taken into account? What needs to be evaluated? How should it be evaluated? How should the results be used? How should this be resourced? In this chapter, we explore possible answers to these questions and suggest practical ways forward, drawing on our experiences of establishing routine outcome evaluation in Bedfordshire and Luton CAMHS and Southampton CAMHS, respectively.
Total Hip Replacement—robotic-assisted Technique
Authors: Bauer André
Published: November 2023

Historically, total hip replacement was the first procedure performed in humans to remove destroyed joints and restore function through implanting an artificial joint surface. After a short period of partial replacement only of the femoral head’s surface, THR in the way we still perform it today was introduced: the acetabulum is replaced by a polyaethylen or metal cup with a plastic inlay, and the proximal femur with neck and head is replaced by a component, which is placed into the proximal part of the bone, after head and neck were cut of above the trochanteric level.
Personal Context
Authors: Brennan James , Moynihan Clare
Published: November 2023

If someone had told me that this time last year I would discover I had breast cancer, I would have thrown up my hands in horror and have said smugly, “Don’t be ridiculous. I’m fit and healthy, I’m vegetarian, I don’t smoke and only drink the recommended weekly allowance of wine! I run, I have a good job and have done well in my career, I have a family and my outlook on life is positive and it will, well, never happen to me. People like me don’t get cancer”. It was a kick in the teeth to discover that in July 1992 I had a malignant lump in my breast – a week later I was experiencing a lumpectomy and the removal of malignant lymph nodes under my arm. Since then when the lump was discovered until now I have been to hell and back and for a long time during chemotherapy I thought that I never would be back. But I am. Well, almost. I am starting work again next week and am at last beginning to live my life once more.
Peritoneal and intestinal dialysis after the Second World War
Authors: Cameron J Stewart
Published: November 2023

In contrast to work on haemodialysis, in which three successful artificial kidney machines were developed at different sites during the conflict of the Second World War, almost nothing was done or published on peritoneal dialysis during this period. However, at the end and immediately after the war a number of workers re-examined the possibility of treating acute, potentially reversible renal failure using dialysis from body cavities: of these intestinal dialysis had some impact initially, but peritoneal dialysis proved most successful and was pursued more vigorously. In part, this surge in the development of peritoneal dialysis was brought about by the emergence of the concept of a syndrome of ‘acute reversible renal failure’, in addition to the long-recognized chronic irreversible forms of kidney disease; this is a story we shall deal with in Chapter 10.
Good news and bad news: treatment of renal anaemia, the rising tide of diabetics with end-stage renal failure and withdrawal from dialysis
Authors: Cameron J Stewart
Published: November 2023

That anaemia was a regular feature of renal failure was, as we saw in Chapters 2 and 16, known from the work of Robert Christison in the 1830s [1] and a major problem in the early days of dialysis [2,3]. The 1980s saw a dramatic resolution of the problem, to the great benefit of patients on dialysis. Indeed one can argue that this has been the single most important advance in the treatment of chronic renal failure by dialysis since its inception in 1960.
The growth of dialysis for long-term renal failure in its fiscal and sociopolitical context
Authors: Cameron J Stewart
Published: November 2023

A major part of the recent history of dialysis arises from the social, ethical and political problems that long-term dialysis treatment precipitated during the 1960s and subsequently. Never before had there been a life-saving treatment which was both successful, but repetitively and cumulatively expensive to the point where it seemed that society could not afford to treat all who might benefit. A full discussion of these ethical and sociopolitical issues (which remain with us, albeit with different boundaries) would require another book, and has already generated several major reviews [1–4].
Origins of assertive outreach
Authors: Burns Tom , Firn Mike
Published: November 2023

Assertive outreach is not new in mental health practice in the UK. The publication of Stein and Test’s landmark paper in 1980 (Stein and Test 1980) is often taken as its starting point, and certainly led to increased international attention. However, the practice of taking services to severely mentally ill patients rather than requiring them to attend hospitals and clinics had been long established in the UK and in several European countries. Querido in Amsterdam had started his mobile clinic in the 1930s (Querido 1968). The French developed their ‘secteur’ approach, which involved limited home visiting, in the 1960s (Kovess et al. 1995). In the US, Pasamanick had explored the value of home visiting in discharged schizophrenia patients (Pasamanick et al. 1964).
Supportive psychotherapy
Authors: Bloch Sidney
Published: November 2023

Supportive psychotherapy has several meanings. In this chapter I will refer to a form of psychological treatment used for patients with enduring and disabling psychiatric conditions for whom basic change is an unrealistic goal. Applying the term in this way, supportive therapy is probably one of the most commonly practised psychotherapies. In addition to its use in psychiatry, the therapy is also applied by, among others, general practitioners and social workers. Supportive therapy as a mode of psychological treatment can be traced back to the 1930s when Paul Schilder (1938) referred to supportive techniques such as advice, catharsis, reassurance, and modelling.
Scholarly and Professional Objectives in Legal Education: American Trends and English Comparisons
Authors: Langbein* John H
Published: November 2023

I have been asked to discuss for English law teachers the great changes that American legal education has been undergoing in recent years. The main theme I wish to sketch is that, over the past generation, the English and American legal academies have exchanged their leadership roles. In the mid-1960s when I first encountered both systems of legal education as a student at the two Cambridges, English legal education was in important respects more scholarly than American. American law schools devoted themselves almost exclusively to training for the legal profession. Today, the leading American law schools have transformed themselves into temples of scholarship, while English law schools have striven to become stronger as training centers for the profession. There is much that is benign in these developments, but also some strands that I find quite worrisome.
Person-Environment Fit Theory: Conceptual Foundations, Empirical and Directions Future Research
Authors: Edwards Jeffrey R , Caplan Robert D , Harrison R Van
Published: November 2023

Theories of stress have long recognized the importance of both the person and environment in understanding the nature and consequences of stress. Person constructs relevant to stress research include Type-A behavior (Friedman and Rosenman, 1959), locus of control (Rotter, 1966), hardiness (Kobasa, 1979), and coping styles (Menaghan, 1983). The environment has been construed as stressful life events (Rabkin and Struening, 1976), daily hassles (DeLongis et al., 1982), and chronic stressors such as role conflict and ambiguity (Kahn et al.,1964;Jackson and Schuler, 1985), role overload and underload (French and Caplan, 1972), and job demands and decision latitude (Karasek and Theorell, 1990). This dual emphasis on the person and environment in stress research is characteristic of the interactive perspective in psychology (Lewin, 1951; Magnusson and Endler, 1977; Murray, 1951; Pervin, 1989), which indicates that behavior, attitudes, and well-being are determined jointly by the person and environment.
Essential skin biology: structure, function, and immunology
Authors: Path Rona M
Published: November 2023

The skin is a large and complex structure. An understanding of basic structure and function should help make your approach to skin disease more logical and increase your interest in the skin as a major organ of the body with a wide range of physiological functions.
Problems of skin pigmentation
Authors: Path Rona M
Published: November 2023

A 38-year-old, fair-skinned, auburn-haired woman comes to consult you about two irregular macules on her shoulder. She was born in South Africa and lived in that country until she came to the UK as a student aged 19. She has large numbers of freckles and also large numbers of naevi, mainly on her trunk and limbs. She misses the warm South African sunshine and uses a sunbed regularly at home.
Methadone treatments
Authors: Gossop Michael
Published: November 2023

The origins of methadone are generally traced back to the Second World War when the drug was synthesized as a substitute for morphine by German chemists at 1.G. Farben. After the war, in 1947, methadone was used as a medication for pain relief or as a cough suppressant. Soon afterwards, during the late 1940s, studies of its pharmacological effects identified the abuse liability of methadone.
Causes for concern: issues for attention
Authors: Gossop Michael
Published: November 2023

Several issues have been identified as requiring further attention within addiction treatment services. Some have been defined in structural terms (e.g. gender or ethnicity). Some have been defined in functional or behavioural terms (homelessness, drug addicts with drinking problems, patients who are non-responsive to treatment). Some are organizational issues (liaison between different health-care services, coordination of treatment interventions, or problems of treatment planning and implementation).
History taking and examination
Authors: McCartan Bernard , McCreary Christine
Published: November 2023

The revised edition of The First Five Years – A Framework for Undergraduate Dental Educationsets out in detail the aim of undergraduate dental education (GDC 2002). In paragraph 19, under the heading of Generic Learning Outcomes, the first skill specifically alluded to is the ability: ‘to obtain and record a comprehensive history, perform an appropriate physical examination, interpret the findings and organize appropriate further investigations’.Documents from the Quality Assurance Agency (QAA 2002) and from the European Commission Advisory Committee on the Training of Dental Practitioners (EC 2000) mention similar skills. The QAA makes the following specific points in relation to the graduating dentist’s abilities under the heading of history, examination, and diagnosis:
Health and safety
Authors: Stirrups David
Published: November 2023

It is not the purpose of this chapter to cover aspects of clinical activity such as infection control and radiological matters that are covered in Chapter 1.5 and Chapter 1.11 respectively, but rather to look at those other aspects of the practice organization where it is appropriate and in some instances, a legal necessity, to have in place systems to ensure as safe a working environment as practical. The General Dental Council (GDC 2002) expects that new graduate will be familiar with the principles that lead to safe dental practice: In addition the QAA Benchmarking Statement for Dentistry (QAA 2002) stated, in relation to the working environment: It is the first and last bullet points of paragraph 72 (above) that are the particular concern of this chapter – adhering to health and safety legislation and ensuring a safe and efficient working environment. The specified learning outcome that relates to Health and Safety is recorded in paragraph 111 (GDC 2002) ‘be familiar with the legal and ethical obligations of registered dental practitioners’.
Infection control in dentistry
Authors: Martin Mike
Published: November 2023

The GDC The First Five Years(2002) document refers to medical emergencies in the undergraduate curriculum in the following paragraphs: Infection control is also referred to in the Subject Benchmark Statements for Dentistry (QAA 2002) as follows: Under ‘The nature and extent of programmes in dentistry’, paragraph 1.8 ‘Graduating dentists must appreciate the need to deliver dental care in a safe environment for both patients and staff in compliance with health and safety regulations. They must be familiar with the principles and practice of infection control.’Under ‘Subject knowledge and understanding’, paragraph 2.7 states that ‘graduating dentists should demonstrate knowledge and understanding of sources of infection and the means available for infection control’.
Dental public health
Authors: Pine Cynthia , Harris Rebecca
Published: November 2023

Dental public health (also known as ‘community oral health’ and ‘community dentistry’) is the branch of dentistry that aims to prevent oral disease and maintain oral health by focusing on societal influences and working with communities as opposed to individual patients. By studying dental public health the dental undergraduate will develop an understanding of how the nature of the community, access to material goods and services, and broad cultural composition will impact on disease experience, type of dental services people prefer, their likely attendance and ability to maintain their own dental health (Pine and Harris 2006). The study of dental public health therefore requires an understanding of the relevant aspects of:
Pharmacological management of pain and anxiety
Authors: Mason Andrew
Published: November 2023

Safe and effective management of pain and anxiety can be considered to be a cornerstone of good patient management and dental practice. Delivering this requires a level of background, theoretical knowledge that underpins a sound clinical technique. The requirements for undergraduate training are explicitly laid out in The First Five Years:The control of anxiety and pain is fundamental to the practice of dentistry and requires full awareness of the social and psychological needs of the individual patient. Building on a sound knowledge of the prevalence and nature of dental phobias and anxieties in respect of dental treatment and the relevant basic sciences, students should be able to assess the suitability of the various methods of managing and controlling anxiety. They should recognise those patients requiring referral for specialist care. In addition students should be able to advise patients on the advantages, limitations and advisability of different forms of pain and anxiety control appropriate to treatment to be undertaken.
Paediatric dentistry Treatment of primary and mixed dentition
Authors: Davenport Elizabeth , Baxter Patricia
Published: November 2023

The 2003 survey of child dental health documented a reduction of 20 per cent in dental caries experience in the oldest children since the previous survey ten years earlier. This was not so for the five-year-olds with little improvement noted over the same time period (ONS 2003). Whilst considering the pattern of dental disease in children, there remains a significant proportion that is untreated. Hence the need to ensure that on graduation dentists have the basic skills to restore the primary and mixed dentition, and know when to appropriately refer a child for specialist advice and help with their management.
Key skills in integrated dental care
Authors: Holsgrove Gareth , Stirrups David , Mossey Peter , Davenport Elizabeth
Published: November 2023

Key skills are the skills that are commonly needed for success in a range of activities in education and training, work and life in general. They are the generic, transferable skills which all students develop during the course of their academic studies. Other skills, not covered elsewhere in this book, are also needed for successful clinical practice and will be discussed towards the end of this chapter. Communication skills and team working are covered elsewhere in this book. In the GDC’s The First Five Yearsthey state that undergraduate dental education should: And They suggest that the dental graduate needs the following attributes. In relation to information technology they advise: Further advice on expectations on information technology is given in paragraph 70.
Disputed diagnoses
Authors: Dowrick Christopher
Published: November 2023

The argument and evidence presented in the previous chapter were based on two assumptions. First, that depression is a valid concept in the sense that it refers to something which is specific and unitary, a definable entity, a thing in itself. Second, that it is a useful concept because it provides a basis for intervening to improve people’s health. In this chapter I will explain why I think that both of these assumptions are open to question. I will show that the validity of depression as a medical concept is debatable, for four main reasons: it is based on a set of assumptions which are the subject of vigorous psychiatric border disputes; in primary care it overlaps with a wide range of common physical diagnoses and with medically unexplained symptoms; from the patient’s perspective it cannot readily be dissociated from social difficulties; evidence for a biological basis is weak. The utility of the concept is also questionable.
Future challenges for cost-effectiveness modelling of health care interventions
Authors: Briggs Andrew , Claxton Karl , Sculpher Mark
Published: November 2023

This book has attempted to introduce the reader to some of the more sophisticated aspects of applying cost-effectiveness models to health care decision problems relating to the implementation of new technologies. We started by briefly reviewing the common types of decision model employed for this task in Chapter 2 and went on to consider more sophisticated extensions to the standard ‘cohort’ model in Chapter 3. Chapter 4 considered how parameter uncertainty could be captured in our decision models through the use of parametric distributions, while Chapter 5 showed how this uncertainty in the input parameters of the model could be analysed in terms of the uncertainty relating to decision itself, principally through the use of CEACs.
Reliability And Validity (Including Responsiveness)
Authors: Hays Ron D , Revicki Dennis
Published: November 2023

An understanding of the reliability and validity of health-related quality of life (HRQoL) measurement is needed to develop or select the best HRQoL measures for any given application. This chapter summarizes reliability and validity, and how these properties are used to evaluate HRQoL survey instruments. Reliability refers to the extent to which a measure yields the same number or score each time it is administered, all other things being equal (i.e., true change has not occurred in the attribute being measured). Classical test theory regards observed responses as consisting of the sum of true score and error. True score for an individual is assumed to be invariant on repeated measurements. However, two parallel measurements will.
Translating And Evaluating Questionnaires: Cultural Issues For International Research
Authors: Marquis Patrick , Keininger Dorothy , Acquadro Catherine , Loge Christine de la
Published: November 2023

Advances in new technologies (Schieber et al. 1993; Gold et al. 1996) and changes in lifestyles have resulted in a shift from acute life-threatening illnesses to an increased prevalence of chronic and long-term illnesses (CDC 1994, 2002) in an ageing population (Fieldstein 1993). To better understand the consequences of chronic conditions on patients ‘ lives and to evaluate the benefit of new treatments, researchers are developing more meaningful end points based on patients ‘ perceptions. Therefore, Patient Reported Outcomes (PRO) questionnaires, including quality of life questionnaires, are being developed, evaluated and used in clinical research with increasing frequency.
Response shift: you know it ‘s there but how do you capture it? Challenges for the next phase of research
Authors: Schwartz Carolyn , Sprangers Mirjam , Fayers Peter
Published: November 2023

Health is not a given. Whether confronted with sudden or gradual changes in health, individuals must accommodate and adapt to these changed conditions. There is an increasing recognition that when people experience changes in health, they may change their internal standards, their values, and/or their conceptualization of health-related quality of life (HRQoL).These ‘response shifts ‘ make comparisons over time difficult to interpret. For example, in the context of treatment evaluations, response shifts may attenuate estimates of treatment effects if patients adapt to treatment toxicities or disease progression over time. Consequently, patient adaptation to treatment toxicities or to improvements in health may result
Preference-Based Measures: Utility And Quality-Adjusted Life Years
Authors: Feeny David
Published: November 2023

Preference-based measures are playing an increasingly important role in the assessment of health-related quality of life (HRQoL) as an outcome measure in clinical trials and other studies, in supporting decision analyses, and in supporting economic evaluations and health technology assessments of screening, prevention, and treatment interventions. The chapter will discuss the conceptual foundations of preference-based measures, describe the two basic approaches to preference-based measurement, summarize evidence on reliability, construct validity, responsiveness (longitudinal construct validity), and predictive validity, and briefly describe selected applications.
An introduction to basics
Authors: Macdonald Elisabeth
Published: November 2023

Good communication between medical staff and patient is important because it forms the basis of all future health-care transactions. Communication needs to be patient centred and informative. It needs to promote trust and confidence between participants of equal status. Good communication is important to avoid the harm that could ensue in terms of patient dissatisfaction, non-adherence to the advice given, psychological damage, physical harm, litigation or even death. Beneficial effects have been demonstrated on health outcomes and not only patients but health-care workers also benefit from a satisfactory exchange.
Special adult groups
Authors: Macdonald Elisabeth
Published: November 2023

The special groups requiring a particular approach and appropriate conversation style include adolescents, non-compliant adults, the elderly, the elderly frail, the hard of hearing and the bereaved. Different approaches are needed for each group.
Loss and Grief in School Communities
Authors: Rowling Louise
Published: November 2023

Over the past decade or so, global terrorism and violence have become part of the everyday lives of individuals, communities, and nation states, not only because of the exposure given to events by the global media coverage, but also due to the targeting of previously ‘safe’ environments such as: workplaces, social gatherings in clubs and hotels, and schools. A critical point in terms of potential impact on people in this exposure is the intimacy in the reporting of these tragic events.
Appendix to Chapter 4 Clinical epidemiology. What it can and cannot tell us
Authors: Gutteridge John M C , Halliwell Barry
Published: November 2023

Statistical techniques have been developed and refined to help detect the causes of human disease. Since these techniques were first applied to infectious diseases, this medical discipline is called epidemiology, a term originally referring to its application to epidemic diseases such as smallpox, plague, and so on. Epidemiology attempts to relate the occurrence of disease in a given population to some common factor. Early examples include the relation of cholera to consumption of infected drinking water, and the association of some forms of lung cancer with cigarette smoking.

Most epidemiological studies are either retrospective or prospective. In the former, patients with a particular disease are studied to identify aspects of their lifestyle that may be common to them all. By contrast, prospective studies examine a population and see what happens to the individuals with time. An example would be measuring the level of selenium in the blood of 5000 patients and then following them to see which developed cancer or heart disease.
Appendix to Chapter 5 Human phagocytes: useful dealers of death and destruction
Authors: Gutteridge John M C , Halliwell Barry
Published: November 2023

The production of O2• ™ and H202 by some types of white blood cell is one example of a useful role for these oxygen-derived species, but it can become a source of tissue damage if their production is too widespread or goes on for too long.

Human blood contains large numbers of neutrophils (about 2.5 —7.5 million per ml in healthy subjects), amoeba-like white blood cells whose function is to recognize, engulf, and destroy foreign organisms, such as bacteria and viruses (Figure Al). This process of engulfment is called phagocytosis, and cells which can do it are often called phagocytes. Indeed, infection usually causes a rise in the ‘ white blood cell count’ (number of cells per ml of blood) as the body mobilizes more of these cells to fight the infection.
Resource Allocation
Authors: Green Stephen A , Bloch Sidney
Published: November 2023

One of society’s most demanding responsibilities is its need to determine how to allocate resources in order to provide necessary services and promote discretionary projects. The task, which requires broad-based agreement on social needs and procedures for establishing the level of support each activity receives, is complicated by pluralistic preferences. People feel differently, for example, about whether resources should be weighted towards health, environmental or military activities, opinions that reflect their values regarding what constitutes right and wrong in the balance of social priorities. Resource allocation is, therefore, a process of moral deliberation, and this section specifically explores the significance of this ethical issue to psychiatry.
Bacterial structure and physiology
Authors: Bagg Jeremy , MacFarlane T Wallace , Poxton Ian R , Smith Andrew J
Published: November 2023

Most bacteria are either spherical (coccus) or rod-shaped (bacillus), and are usually arranged in a manner characteristic of the genus, growing either singly, in clusters or in chains. The dimensions of a bacterium are typically in the order of 1 μm (Fig. 2.1). As described in the previous chapter, bacteria are typical prokaryotes. Most bacteria can be divided into one of two types, Gram-positive and Gram-negative, by means of the Gram stain, which is summarized in Fig. 2.2. Although developed empirically by Christian Gram, a Danish microbiologist, in the 1880s as a convenient method for classifying bacteria, it also gives a great deal of information on the structure of the bacterial cell envelope.
Bacterial genetics and molecular biology
Authors: Bagg Jeremy , MacFarlane T Wallace , Poxton Ian R , Smith Andrew J
Published: November 2023

Genes are the elements of the hereditary material of living cells that carry the information to code for all the necessary components and reactions of life. At cell division the genes are replicated and a copy goes to each daughter cell. It was not until the 1950s that deoxyribonucleic acid (DNA) was recognized as being the substance of genes. During the past half century the subject of molecular biology has developed into a major discipline, underpinning many of the other fields of biology and medicine. Molecular biology had its roots in bacteriology, and many of the continuing advances in the subject still depend on bacteria. Molecular biology is a vast and rapidly developing subject, much of which is beyond the scope of this book. This chapter will give a brief introduction to the basics of the subject, describe some of the important aspects of bacterial molecular genetics, and demonstrate some of the uses to which molecular biological techniques are being directed.
Immunization
Authors: Bagg Jeremy , MacFarlane T Wallace , Poxton Ian R , Smith Andrew J
Published: November 2023

The introduction of immunization against infectious disease has been one of the most successful developments in medicine. It was pioneered at the end of the eighteenth century by Edward Jenner to prevent smallpox and due to the remarkable success of world-wide vaccination programmes in the latter half of the twentieth century, the disease has been totally eradicated from the planet. The aim of immunization is to produce protection for the population against natural clinical infection with pathogenic micro-organisms by means of a range of artificial and safe procedures. Immunization is only one of the measures that are available to control infectious disease and its efficacy and cost must be assessed against other forms of protection, for example safe water supply and sewage disposal, a high standard of food hygiene, good socio-economic living conditions, as well as organized surveillance of infectious disease with early detection and prompt treatment and prevention. The mortality and morbidity of a number of infectious diseases have been dramatically reduced by immunization, while many others are not currently amenable to control by specific vaccines.
Respiratory tract infections
Authors: Bagg Jeremy , MacFarlane T Wallace , Poxton Ian R , Smith Andrew J
Published: November 2023

Although inhaled air contains many particles, including micro-organisms, the host defence mechanisms in the respiratory tract frequently prevent infection. However, if there are large numbers of pathogenic organisms within the inspired air or if the host defences are compromised, then infection may ensue. There are ‘professional invaders’ which can infect healthy respiratory mucosa, for example Streptococcus pyogenes. In addition, there are ‘secondary invaders’ which only infect if the host defences are weakened, for example Pneumocystis jiroveci in AIDS patients. Respiratory tract infections may be caused by bacteria, viruses, protozoa, or fungi and are important in dentistry because the causative agents may be spread through respiratory and oral fluids. Thus, both patients and the dental team are exposed to these microbes during treatment, particularly when splatter and aerosols are generated.
Dental caries
Authors: Bagg Jeremy , MacFarlane T Wallace , Poxton Ian R , Smith Andrew J
Published: November 2023

Dental caries can be thought of as a chronic infection of enamel or dentine in which the microbial agents are members of the normal commensal flora. Lesions result from the demineralization of enamel or dentine by acids produced by plaque micro-organisms as they metabolize dietary carbohydrates. Once the surface layer of enamel has been lost, the infection invariably progresses via dentine, with the pulp becoming firstly inflamed and later necrotic. Dental caries occurs in all Western countries but there is an uneven distribution of decay in the population. For example, in Scotland towards the end of the twentieth century all of the decayed teeth were found in 54% of children and more than half of the untreated caries was present in just 10% of children. In less developed countries where changes in diet, especially with respect to carbohydrate content, have occurred, the prevalence is rising.
Infections of the pulp, periapical tissues and bone of the jaw
Authors: Bagg Jeremy , MacFarlane T Wallace , Poxton Ian R , Smith Andrew J
Published: November 2023

As discussed in previous chapters, bacteria are responsible for both dental caries and periodontal diseases. Extension of these diseases commonly causes infection in the adjacent tissues, notably the pulp, periapical area and oro-facial soft tissues. More rarely, infection may become established in the bone of the jaw to cause osteomyelitis. These infections, which are usually acute and are among the most common seen by dentists, will be covered in this chapter. Inflammation of the pulp (pulpitis) may follow exposure to a range of irritants. These include thermal, mechanical or chemical stimuli, in addition to micro-organisms which are the focus of this chapter. Since the pulp is enclosed within the hard tissues of the tooth, it is unable to expand during the acute inflammatory phase of pulpitis, with a resultant rise in internal pressure. This not only results in severe pain but also impairs the circulation within the inflamed pulp, which may cause pulpal necrosis and subsequent periapical disease. The possible outcomes are illustrated in Fig. 25.1. Whilst the most common cause of pulpal necrosis is dental caries, others include accidental trauma to the tooth, exposure of the pulp during instrumentation and spread of infection from a deep periodontal pocket.
Stroke
Authors: Cramer Steven C
Published: November 2023

Stroke remains a major source of morbidity and mortality. Approximately 1 in 15 deaths in the US is attributable to stroke, making this the third leading cause of death after heart disease and cancer. However, approximately 85% of patients survive the stroke, living an average of seven years thereafter. Most are left with significant disability. Stroke can affect any aspect of brain function. The nature of post-stroke deficits can vary widely, as can severity. In the weeks and months following a stroke, most patients show spontaneous improvement in behaviours affected by stroke. However, this recovery is highly variable and generally incomplete. As a result, stroke is the leading cause of adult disability in the US and many other countries. A number of investigations have examined the brain events that underlie spontaneous recovery of function after stroke. The majority has focussed on motor or language recovery. A number of brain mapping techniques has been used to investigate recovery, each with its relative strengths. FMRI has been the tool for many of these, given its good temporal and excellent spatial resolution.
Antibody-directed enzyme prodrug therapy (ADEPT)
Authors: Sharma Surinder K , Bagshawe Kenneth D , Begent Richard H J
Published: November 2023

Conventional cancer chemotherapeutic agents lack selectivity and in the past effort has mainly been focused on high-dose systemic chemotherapy, which tried to balance minimal adverse effects to normal tissues with maximal antitumour activity. To achieve selectivity, the focus since the 1960s has been to search for substances that differentiate malignant tumours from normal tissue. These biochemical factors that characterise specific types of cancer are known as tumour-associated antigens or tumour markers. The most widely studied tumour-associated antigen is carcinoembryonic antigen or CEA (Gold and Freedman 1975) that is overexpressed in almost all cancers of the colon and several others. Although the tumour-associated antigens are not specific for cancer, they are sufficiently overexpressed in many cancers to allow localisation of antibodies directed against them (Begent et al. 1980; Goldenberg et al. 1978; Mach et al. 1974) and targeted cancer therapy has emerged as a novel approach in the treatment of both haematological and solid tumours (Carter 2001; Stern and Herrmann 2005).
Individualising cancer therapy
Authors: Lim Wan-Teck , McLeod Howard L
Published: November 2023

Cancer is a complex disease with variable phenotypes determined by different genes. Aside from curative surgery in the early stages of cancer, treatment of advanced cancer includes cytotoxics, biologics, or radiation. These modalities affect both tumour and normal tissue, leaving in its wake significant toxicity. The benefits of cytotoxic drugs are determined to different extents by patient biology, absorption, distribution, metabolism, excretion, and by tumour biology. In patients with advanced disease, where the goal is palliative and not curative, the best modern therapies still only benefit the minority in terms of improving response rates and survival and the disease ultimately relapses in a short period of time. This is compounded by toxicity of varying degrees experienced by patients resulting in a low risk-benefit ratio.
Ethical rehabilitation practice
Authors: McGrath Joanna Collicutt
Published: November 2023

On p. 47 I stated that the aim of rehabilitation is to support the person with acquired brain injury (ABI) in establishing a new sense of identity continuous with, but not stuck in, the past, while managing the medical complications, pain, and emotional distress that arise during the process. Background or setting conditions can sustain and nurture the sort of good, and thus ethical, practice that is necessary for this process. This chapter begins with a brief consideration of these conditions before moving on to specify detailed guidelines under each of the ethical practice principles generated in Chapter 4.
A heuristic for managing ethical dilemmas
Authors: McGrath Joanna Collicutt
Published: November 2023

In this short chapter I present a simple checklist to help manage the sorts of ethical dilemmas that arise in acquired brain injury rehabilitation. The check- list is summarized in Figure 6.1. While it is basically a list of consecutive actions, there are some feedback loops. These indicate that decisions and actions need constant monitoring in relation to both their immediate consequences and the moral principles that generated them in the first place (see discussion on pp. 67 and 71–72).
Introduction pathology
Authors: Carton James , Daly Richard , Ramani Pramila
Published: November 2023

Pathology is the study of disease and therefore forms a central part of medicine. A sound knowledge of the pathology of a disease allows the clinician to understand its symptoms and signs, potential complications, the basis of its treatment, and its likely course.

Pathology has a language of its own and it is necessary to familiarize yourself with some of the common terms used when discussing diseases.
Inflammation
Authors: Carton James , Daly Richard , Ramani Pramila
Published: November 2023

Inflammationis the body’s response to cellular injury. It serves to dilute and remove injurious agents and trigger healing of the damaged tissue. Although inflammation is intended to be a protective response, it may also be harmful when inappropriately activated.

Inflammation is elicited by any form of cellular damage including infection, physical injury, chemical injury, and ischaemia. Be careful not to equate inflammation with infection. Whilst infection is often accompanied by inflammation, there are many diseases characterized by inflammation which are not caused by infection, such as autoimmune diseases, and even some infectious diseases where inflammation is absent, e.g. variant Creutzfeldt–Jacob disease.
Neoplasia
Authors: Carton James , Daly Richard , Ramani Pramila
Published: November 2023

A neoplasm is an abnormal mass of tissue which shows uncoordinated growth and serves no useful purpose. The word neoplasm literally means ‘new growth’ and is often used synonymously with the word tumour which simply means ‘swelling’.

Malignant neoplasms are also called cancers. Cancer is a major cause of morbidity and mortality across the world. Currently in the UK, one in three people will be diagnosed with cancer during their lifetime. One in five of these will die as a result of the cancer. As cancer is more common with increasing age, the ageing population means that cancer will become even more common.
Cardiovascular disease
Authors: Carton James , Daly Richard , Ramani Pramila
Published: November 2023

An adequate blood supply is vital for every organ and tissue in the body. The main role of the cardiovascular system is to continuously deliver oxygenated blood and remove deoxygenated blood from the tissues. Diseases of the cardiovascular system are the most common causes of death in the Western world, and most can be distilled down to two basic problems:
Gastrointestinal disease
Authors: Carton James , Daly Richard , Ramani Pramila
Published: November 2023

This chapter concerns itself with diseases of the oesophagus, stomach, small intestine, large intestine, and anus managed by gastroenterologists and gastrointestinal surgeons. Diseases of the accessory organs of the gastrointestinal tract such as salivary glands, liver, gallbladder, and pancreas come under the remit of other specialties and are dealt with in Chapters 9 and 19.

The oesophagus is a muscular tube lined by squamous epithelium which connects the pharynx to the stomach. Its function is to transport food and liquid to the stomach, and to ensure that gastric contents do not regurgitate back up. This is achieved through a complex mechanism which coordinates peristaltic contractions with intermittent relaxation of the lower oesophageal sphincter.
Skin disease
Authors: Carton James , Daly Richard , Ramani Pramila
Published: November 2023

The skin is the largest organ in the body and forms the interface between the body and the environment. It acts as an important barrier, protecting the body from changes in external conditions and preventing loss of important body constituents such as water. The skin is also important in insulation, temperature regulation, and sensation.
Nervous system and muscle disease
Authors: Carton James , Daly Richard , Ramani Pramila
Published: November 2023

The main function of the nervous system is to receive, transmit, and analyse information. Information is gathered by sensory systems, integrated by the brain, and used to generate output signals.
Multisystem disease
Authors: Carton James , Daly Richard , Ramani Pramila
Published: November 2023

There are a group of diseases whose effects cannot easily be assigned to any one particular organ system. Many of these so-called ‘multisystem’ diseases are immunologically mediated and often produce prolonged non-specific symptoms such as fatigue, weight loss, and fever, together with symptoms related to a variety of different organ systems. Multisystem diseases may therefore present to a number of specialties including rheumatology, dermatology, nephrology, and haematology.
Pronunciation Guide
Authors: Buck Timothy
Published: November 2023

An important feature of German speech is the phenomenon known as the glottal stop (as heard, for example, in Cockney wa’er for water-or indeed sometimes in standard English speech, reinforcing a stressed vowel: he I 15 lying!). It occurs before vowels in initial position or following a prefix as well as at the junction of compounds in which the second element begins with a vowel, e.g.
Adjectives and Adverbs
Authors: Buck Timothy
Published: November 2023

In predicative use, the adjective in German is not inflected, e.g. die Musik ist schön the music is beautiful, das Wasser ist heiß the water is hot. Used attributively, i.e. preceding a noun, it is inflected (as shown below), e.g.
Prepositions
Authors: Buck Timothy
Published: November 2023

For detailed treatment of individual prepositions see pp. 117-154. Prepositions in German govern particular cases: accusative (e.g. für for, ohne without), genitive (e.g. trotz in spite of, während during) or dative (e.g. aus out of, from, mit with). Some prepositions govern two cases accusative and dative-depending on circumstances.
Word Formation
Authors: Buck Timothy
Published: November 2023

Chen (Pl. Same), N. Diminutive suffix (making the noun neuter and usually causing the stem-vowel to be mutated where possible), e.g. das Lämmchen little lamb (Lamm lamb); nouns in -e and -en lose these endings before -chen, e.g. das Schürzchen little apron (Schürze apron), das F#x00E4;dchen little thread (Faden thread).
Rich and Poor
Authors: Daunton Martin
Published: November 2023

In their preface to the 1851 census, George Graham and Horace Mann were confident that Britain could escape from the ‘stationary state’. The world of Malthus, Mill, and Engels was giving way to new possibilities, not only because the ‘hare’ of population became much slower but also because the ‘tortoise’ of resources put on a spurt of growth. Much higher levels of GNP per capita now became possible, breaking through the limits of the late eighteenth and early nineteenth centuries.
Ratio Decidendi and Obiter Dictum
Authors: Cross Rupert , Harris J W
Published: November 2023

According to the preliminary statement of the English rules of precedent contained in the last chapter, every court is bound to follow any case decided by a court above it in the hierarchy, and appellate courts (other than the House of Lords) are bound by their previous decisions. This statement is too concise because it does not indicate that the only part of a previous case which is binding is the ratio decidendi (reason for deciding). The principal object of the present chapter is to consider what is meant by the ratio decidendi of a case when the phrase is used by judges and other lawyers and by what methods it may be determined. This will show what is entailed by ‘following’ or ‘applying’ a case and by being ‘bound; by a previous decision, although these matters are not discussed until the beginning of the next chapter. The ratio decidendi is best approached by a consideration of the structure of a typical judgment. The contemporary English judge almost invariably gives reasons for his decision in a civil case. Assuming that the trial is by a judge alone without a jury, he generally summarizes the evidence, announces his findings of fact, and reviews the arguments that have been addressed to him by counsel for each of the parties. If a point of law has been raised, he often discusses a number of previous decisions.