bluuebunny/crossref_metadata_2025 huggingface dataset:
Substance abuse
Authors: Junkin Ross , McGrady Elizabeth M.
Published: January 2017

Substance abuse in pregnancy is a cause of maternal and neonatal morbidity and mortality. It can lead to a wide range of health, social, and psychological problems. Many of these mothers are young, single, socially deprived, and often present late for antenatal care. The prevalence is unclear as substance abuse is often concealed, but it is most common in young adults, and may be around 4% in the United Kingdom and 6% in the United States. It is estimated that 200,000–300,000 children living in England and Wales have one or both parents with a drug problem. Patterns and prevalence of substance abuse vary between and within countries, but polysubstance abuse is common. Obstetric anaesthetists may be involved in care of mothers who have known or covert substance abuse. Common problems include poor nutrition, dentition, difficult intravenous access, immunosuppression, and altered drug metabolism. Use of some illicit drugs can cause obstetric complications, and others can mimic serious issues such as pre-eclampsia. The incidence of emergency caesarean delivery is higher. Neonates tend to be premature, small for gestational age, at risk of withdrawal, and have ongoing health issues throughout life. Healthcare workers should enquire about tobacco, alcohol, and illicit drug use early in pregnancy as advice and support may motivate women to alter their lifestyle. The impact of tobacco, caffeine, alcohol, marijuana, solvents, opioids, cocaine, and amphetamine use on the mother and fetus, and the implications for the obstetric anaesthetist, are presented.
International outreach
Authors: Yuill Gordon , Millar Simon
Published: January 2017

One dead every minute. The stark reality is that somewhere between 382,910 and 437,860 women worldwide died from a direct or indirect childbirth-related cause in 1990. This is an astonishing figure that eclipses the number of deaths from natural disasters such as the 2004 Asian tsunami and the 2010 Haitian earthquake. It is made worse when we realize that many of these deaths are avoidable and that there is an enormous variation in mortality rates across the planet. In 2010, Save the Children quoted the lifetime risk in Afghanistan as 1 in 6, compared to 1 in 47,600 in Ireland. Such discrepancies between the developed and developing countries are alarming and have been cited as ‘the largest discrepancy of all public-health statistics’, substantially greater than that for child or neonatal mortality. This chapter considers the size of the problem, the global initiatives aiming to tackle it, Millennium Development Goal 5, the role that obstetric anaesthesia can play, and how those who practise in the developed world can help their neighbours in developing countries.
Generating insight and building segmentation models in social marketing
Authors: McVey Dominic , Crosier Adam
Published: January 2017

This chapter introduces the concepts of insight and segmentation and outlines their contribution to understanding audiences and targeting interventions to ensure effective social marketing. Studying the target group at the programme scoping stage develops an appreciation of the challenges they face every day. This insight and knowledge will help with understanding the audience ‘exchange’ and with building strong message propositions which will be relevant and salient to the target group. Segmentation can generate new insights into the drivers and barriers to change and help target the right groups with the most persuasive approaches. The chapter illustrates methods used for building segmentations and provides case examples.
Anaesthesia for the Elderly Patient (Oxford Anaesthsia Library)
Authors: Dodds Chris , Kumar Chandra M. , Servin Frédérique
Published: January 2017

This book provides a timely and authoritative synopsis of the current state of anaesthesia and the elderly patient at a time when the challenge of caring for the growing numbers of elderly patients is probably the greatest faced by healthcare across the globe. The book reviews important developments in the understanding of clinical practice serving the elderly. It describes the need for anaesthesia to deliver ‘best care’ to the elderly, with the aim to maintain their independent living. It then details the key features of ageing and the effect these have on physiology and pharmacology. Specific aspects of practice, including preoperative assessment; day surgery; emergency surgery; anaesthesia for orthopaedic, urological, and gynaecological surgery, as well as major abdominal surgery; neurosurgery; and critical care. Emphasis is placed on managing postoperative care and cognitive dysfunction (POCD), with additional discussion of ethical issues and the law pertaining to the elderly patient. A new chapter reviews the challenges of treating elderly patients in non-theatre environments.
Definitions, social trends, and epidemiology
Authors: Dodds Chris , Kumar Chandra M. , Servin Frédérique
Published: January 2017

The impact of the ageing population across the world is reviewed. Aging, migration, and dependency are discussed, as is the likely cost, both social and financial, in providing care to dependent elderly patients. Dependency ratios and population pyramids are used to illustrate the scale and variation of the population changes. Advances in surgical and anaesthetic practice and their effects on day-care surgery are outlined. The utility of risk indices and prehabilitation in optimizing the elderly surgical patient is explored. The political and social dimensions of providing high-quality care to an increasingly old population are discussed. The financial pressures and the increasing complexity and expense of newer therapies are challenging, and comprehensive state-funded delivery currently appears unsustainable. Finally, the impact of the changes in the expectations of the ‘baby boomers’ generation, as they age, and in relation to their increasing use of the Internet and social media, are reviewed.
Neuroanatomy
Authors: Markus Hugh , Pereira Anthony , Cloud Geoffrey
Published: January 2017

Neuroanatomy can be a daunting subject. However, it is a cornerstone of neurology. In patients with stroke, a basic knowledge is essential in determining where in the brain a stroke pathology has occurred. This chapter provides a neuroanatomical summary which can be used as a reference when you see a patient with stroke.
Imaging in stroke
Authors: Markus Hugh , Pereira Anthony , Cloud Geoffrey
Published: January 2017

Imaging plays a key role in the investigation in stroke, both to confirm the diagnosis and rule out other causes, and also to determine the underlying aetiology. This chapter covers the different imaging techniques which are commonly used in stroke care. It discusses the use of computed tomography and magnetic resonance imaging in diagnosis of both ischaemic and haemorrhagic stroke. It also covers the various angiographic imaging techniques that can be used to identify the presence of extra- and intracranial stenoses.
Unusual causes of stroke and their treatment
Authors: Markus Hugh , Pereira Anthony , Cloud Geoffrey
Published: January 2017

While most stroke is caused by the more common pathologies described in Chapter 8, more unusual cause of stroke are not uncommon, particularly in younger individuals. Their diagnosis is important because they may require specific treatments and have prognostic implications. This chapter describes some of these more unusual causes ranging from the relatively common cervical dissection, to monogenic causes of stroke, of which the most common is CADASIL. Illicit drug use, HIV, and occult malignancy have protean manifestations and stroke is one of them.
Ethical issues in stroke care
Authors: Markus Hugh , Pereira Anthony , Cloud Geoffrey
Published: January 2017

The chapter on ethical issues in stroke care sets out an ethical framework incorporating patient autonomy, beneficence, non-maleficence, and justice to inform patient-centred stroke care. It covers a broad range of legal information as relevant to stroke care in the United Kingdom such as the European Law of Human Rights, The Human Rights Act 1998, The Mental Capacity Act (MCA) 2007, and Deprivation of Liberty safeguards (DoLS). It covers widely applicable guidance around consent, cardiopulmonary resuscitation, artificial nutrition and hydration, and withholding treatment and withdrawing medical treatment. A section is included to review the various types of Prolonged Disorders of Consciousness which are rare but devastating complication of stroke. An approach to end of life or palliative care in the stroke patient is also discussed.
Sexual health
Authors: Medforth Janet , Ball Linda , Walker Angela , Battersby Sue , Stables Sarah
Published: January 2017

This chapter is mainly concerned with sexually transmitted infections and covers a range of issues, including Chlamydia, gonorrhoea, hepatitis B and C, herpes, syphilis, and other vaginal infections such as Candida, Trichomonas vaginalis, and bacterial vaginitis. Each of these is taken separately with reference to a screening programme, if appropriate, clinical symptoms and appearance, diagnosis, the latest guidance on treatment, and considerations for pregnancy. Fetal and neonatal infections, congenital transmission, treatment, and surveillance options for the neonate, along with specific advice for the mother are also given.
Helping women cope with pregnancy: complementary therapies
Authors: Medforth Janet , Ball Linda , Walker Angela , Battersby Sue , Stables Sarah
Published: January 2017

The chapter begins with general advice for women regarding the safety of complementary therapy use during pregnancy. It next goes on to define and discuss the use of individual therapies, including homeopathy, aromatherapy, Bach flower remedies, reflexology, oriental medicine (acupuncture), yoga, and herbal medicine in pregnancy.
Hypertensive disorders of pregnancy
Authors: Medforth Janet , Ball Linda , Walker Angela , Battersby Sue , Stables Sarah
Published: January 2017

A definition of hypertension and its significance in pregnancy introduce this chapter. The latest recommendations on the diagnosis, management, and treatment of essential hypertension, pregnancy-induced hypertension, pre-eclampsia, eclampsia, and HELLP syndrome are included.
Normal labour: first stage
Authors: Medforth Janet , Ball Linda , Walker Angela , Battersby Sue , Stables Sarah
Published: January 2017

This chapter covers the first stage of labour, from onset through to latent and active phases. It describes the physiology and diagnosis of the first stage of labour and gives the definitions of low- and high-risk women. It considers birth in both hospital and home settings and the current recommendations for the place of birth. The basic care and support of low-risk women during both the latent and active first stage of labour are described for both home and hospital settings. Mobility and optimum positions during the first stage, labouring in water, and current guidance regarding maternal nutrition and monitoring vital signs are discussed. Guidance on the assessment of progress by observation, abdominal and vaginal examination, monitoring fetal well-being, and record-keeping on the partogram are also considered.
Immediate care of the newborn
Authors: Medforth Janet , Ball Linda , Walker Angela , Battersby Sue , Stables Sarah
Published: January 2017

This chapter covers the immediate care of the newborn following birth. The Apgar score and a structured initial neonatal examination are described in detail. Skin-to-skin contact and bonding between the mother and neonate are covered. This aspect of care is covered in more depth in later chapters.
Decentralized Information Use
Authors: Sahay Sundeep , Sundararaman T , Braa Jørn
Published: January 2017

This chapter seeks to explore the challenge and opportunities that cloud computing and big data offer to strengthen public health informatics in LMICs. Cloud computing is slowly becoming a norm, almost representing a technical and social order which we do not fully understand, but need to accept. While there is a multiplicity of understandings associated with the cloud, we often focus only on its technical elements, while ignoring the business model that underlies it. This incomplete understanding may lead to LMICs making investments in solutions which are unsustainable, while also creating new challenges and demands for capacity. The cloud also raises key dilemmas around participation, decentralization, and ownership of data. Developments in big data, necessarily dependent on the cloud, are another source of challenges and opportunities for LMICs. Whether we like it or not, cloud computing and big data are integral elements to develop the Expanded PHI perspective, and we need to find appropriate approaches to do so.
Measuring Progress Towards Universal Health Coverage and Post-2015 Sustainable Development Goals
Authors: Sahay Sundeep , Sundararaman T , Braa Jørn
Published: January 2017

Two important global developments are likely to emerge as key drivers in shaping the requirements of public health informatics, defining its processes, and judging its performance. These are the challenges of measuring progress towards universal health coverage (UHC) and towards the achievement of the Sustainable Development Goals (post-2015 SDGs). To meet this challenge, four data sources—population surveys, primary care service data, hospital information, and Civil Registration and Vital Statistics (CRVS)—have to be rethought, restructured, and aligned within a framework architecture informed by an Expanded PHI perspective. But architecture is in itself a problematic—with different ideologies and contexts shaping it in varied, often contradictory ways. It is only an expanded understanding of public health informatics that could help address these complexities.
Health Information Systems Governance and Standards
Authors: Sahay Sundeep , Sundararaman T , Braa Jørn
Published: January 2017

Governance, as distinct from management, is a crucial but neglected issue in the context of public health informatics. Governance has two overlapping but distinct domains—health sector and IT governance. Governance is a cross-cutting issue affecting all domains discussed in the book, including the use of information, integration, cloud and big data-related issues, institutional design, and the management of complexity. A key governance challenge is the design, development, and use of standards and data policies, given the political nature of technical choices in these areas. Standards, focusing only on the technical aspects implemented in a top-down manner while ignoring the institutional and work practice-related issues, are more likely to fail than those emerging through use, bottom-up, and which add value to work processes. Governance becomes a key issue, as this function is responsible for making strategic choices and putting in place an implementation framework to make them work.
The Existential Framework of Meaning-Centered Psychotherapy
Authors: Breitbart William
Published: January 2017

This chapter briefly reviews the existential framework and context in which meaning-centered psychotherapy (MCP) for cancer patients was developed. As an introduction to MCP in the cancer setting, readers of this chapter will be exposed to basic existential philosophical and psychotherapeutic constructs that were influential in developing MCP and that will be of benefit to practitioners of MCP in the clinical setting. The contributions of such important existential psychotherapists and philosophers as Irvin Yalom, Viktor Frankl, Kierkegard, Heidegger, Jacques Derrida, and others are distilled for the reader in a manner specifically aimed at elucidating how universal existential concerns are incorporated into MCP.
Adapting Meaning-Centered Psychotherapy for Adolescents and Young Adults with Cancer
Authors: Kearney Julia A. , Ford Jennifer S.
Published: January 2017

There is a lack of validated psychotherapeutic interventions for the adolescent and young adult (AYA) cancer population, despite years of evidence of significant need. AYAs with cancer experience distress, anxiety, grief, life disruption, and loss of meaning. Meaning-making is a core developmental task of adolescence and contributes to identity development. This chapter reviews narrative and structural theories of identity development, viewed through the lens of a disruptive life event such as cancer. Clinical therapeutic issues are discussed, including the selection of AYA patients for participation in meaning-centered work, the therapeutic approach to difficult subjects such as prognosis or end of life, working with parents and caregivers, and dealing with grief and suicidality in a meaning-centered framework. Formal development of a manualized meaning-centered psychotherapy for AYAs is also discussed. A clinical vignette is presented to illustrate the main themes of a meaning-centered psychotherapeutic approach.
Cultural and Linguistic Adaptation of Meaning-Centered Psychotherapy for Chinese Cancer Patients
Authors: Leng Jennifer , Lui Florence , Chen Angela , Huang Xiaoxiao , Breitbart William , Gany Francesca
Published: January 2017

The Chinese immigrant community faces multiple barriers to quality cancer care and cancer survivorship. The clinical effectiveness of meaning-centered psychotherapy (MCP) has not been studied in racial and ethnic minority populations for whom the concept of “meaning” may likely differ from that of Westernized White populations. This chapter describes a community needs study to inform the cultural adaptation of MCP for Chinese patients with advanced cancer in accordance with Bernal et al.’s ecological validity model and the cultural adaptation process model of Domenech-Rodriquez and Weiling. It also describes key strengths and suggested areas of focus in adapting MCP for Chinese immigrant patients.
Case 10
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Gynecology section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 12
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Gynecology section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 22
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Gynecology section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 34
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the First Trimester section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 36
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the First Trimester section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 37
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Obstetrics section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 50
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Second Trimester section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 56
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Second Trimester section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 58
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Second Trimester section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 60
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Second Trimester section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 67
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Second Trimester section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 68
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Abdomen section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 73
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Abdomen section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 74
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Abdomen section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 93
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Abdomen section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 94
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Abdomen section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 95
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Abdomen section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 96
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Abdomen section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 106
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Abdomen section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 108
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Abdomen section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 110
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Abdomen section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 111
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Abdomen section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 113
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Abdomen section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 129
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Small Parts section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 131
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Small Parts section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 146
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Small Parts section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 147
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Small Parts section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 156
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Vascular section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 165
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Vascular section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 166
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Vascular section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 174
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Vascular section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 179
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Vascular section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 183
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Vascular section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 184
Authors: Scoutt Leslie M. , Hamper Ulrike M. , Angtuaco Teresita L.
Published: January 2017

This is a case from the Vascular section of Ultrasound. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Evidence for photoionization-driven variability in narrow absorption lines
Authors: Lu Wei-Jian , Lin Ying-Ru , Qin Yi-Ping , Huang Wei-Rong , Pan Cai-Juan , Huang Hong-Yan , Yao Min , Nong Wei-Jing , Yao Zhi-Kao , Lu Mei-Mei , Pan Da-Sheng , Huang Hong-Qiang , Han Qing-Lin
Published: January 2017

In this Letter, we report the discovery of a strong correlation between the variability of narrow absorption lines (NALs) and the ionizing continuum from a two-epoch spectral sample of 40 quasars containing 52 variable C iv λλ1548, 1551 absorption doublets. According to the concordance index, this sample is classified into two subsamples. Subsample I shows an anti-correlation between the variations of absorption lines and the continuum, while Subsample II exhibits a positive correlation. These results imply that these variable C iv λλ1548, 1551 absorption doublets are intrinsic to the corresponding quasars and that their variations are caused primarily by the fluctuations of the ionizing continuum. Based on our analysis, we propose that there might be two kinds of absorption gas: one that is very sensitive to the continuum variations, and another that is not. In addition, we suggest that in many cases the emergence or disappearance of NALs is caused by fluctuations of the ionizing continuum.
SIRT7-dependent deacetylation of CDK9 activates RNA polymerase II transcription
Authors: Blank Maximilian F. , Chen Sifan , Poetz Fabian , Schnölzer Martina , Voit Renate , Grummt Ingrid
Published: January 2017

SIRT7 is an NAD+-dependent protein deacetylase that regulates cell growth and proliferation. Previous studies have shown that SIRT7 is required for RNA polymerase I (Pol I) transcription and pre-rRNA processing. Here, we took a proteomic approach to identify novel molecular targets and characterize the role of SIRT7 in non-nucleolar processes. We show that SIRT7 interacts with numerous proteins involved in transcriptional regulation and RNA metabolism, the majority of interactions requiring ongoing transcription. In addition to its role in Pol I transcription, we found that SIRT7 also regulates transcription of snoRNAs and mRNAs. Mechanistically, SIRT7 promotes the release of P-TEFb from the inactive 7SK snRNP complex and deacetylates CDK9, a subunit of the elongation factor P-TEFb, which activates transcription by phosphorylating serine 2 within the C-terminal domain (CTD) of Pol II. SIRT7 counteracts GCN5-directed acetylation of lysine 48 within the catalytic domain of CDK9, deacetylation promoting CTD phosphorylation and transcription elongation.
Prevention of Surgical Site Infection in Spine Surgery
Authors: Anderson Paul A. , Savage Jason W. , Vaccaro Alexander R. , Radcliff Kristen , Arnold Paul M. , Lawrence Brandon D. , Shamji Mohammed F.
Published: January 2017

BACKGROUND: Spine surgery is complicated by an incidence of 1% to 9% of surgical site infection (SSI). The most common organisms are gram-positive bacteria and are endogenous, that is are brought to the hospital by the patient. Efforts to improve safety have been focused on reducing SSI using a bundle approach. The bundle approach applies many quality improvement efforts and has been shown to reduce SSI in other surgical procedures.

OBJECTIVE: To provide a narrative review of practical solutions to reduce SSI in spine surgery.

METHODS: Literature review and synthesis to identify methods that can be used to prevent SSI.

RESULTS: SSI prevention starts with proper patient selection and optimization of medical conditions, particularly reducing smoking and glycemic control. Screening for staphylococcus organisms and subsequent decolonization is a promising method to reduce endogenous bacterial burden. Preoperative warming of patients and timely administration of antibiotics are critical to prevent SSI. Skin preparation using chlorhexidine and alcohol solutions are recommended. Meticulous surgical technique and maintenance of sterile techniques should always be performed. Postoperatively, traditional methods of tissue oxygenation and glycemic control remain essential. Newer wound care methods such as silver impregnation dressing and wound-assisted vacuum dressing are encouraging but need further investigation.

CONCLUSION: Significant reduction of SSIs is possible, but requires a systems approach involving all stakeholders. There are many simple and low-cost components that can be adjusted to reduce SSIs. Systematic efforts including understanding of pathophysiology, prevention strategies, and system-wide quality improvement programs demonstrate significant reduction of SSI.
Clinical Experience and Results of Microsurgical Resection of Arterioveonous Malformation in the Presence of Space-Occupying Intracerebral Hematoma
Authors: Barone Damiano G. , Marcus Hani J. , Guilfoyle Mathew R. , Higgins J. Nicholas P. , Antoun Nagui , Santarius Thomas , Trivedi Rikin A. , Kirollos Ramez W.
Published: January 2017

BACKGROUND: Management of ruptured arteriovenous malformations (AVMs) with a mass-producing intracerebral hematoma (ICH) represents a surgical dilemma.

OBJECTIVE: To evaluate the clinical outcome and obliteration rates of microsurgical resection of AVM when performed concomitantly with evacuation of an associated space-occupying ICH.

METHODS: Data of patients with AVM were collected prospectively. Cases were identified in which an AVM was resected and an associated space-occupying ICH was evacuated at the same time, and divided into “group 1,” in which the surgery was performed acutely within 48 h of presentation (secondary to elevated intracranial pressure); and “group 2,” in which selected patients were operated upon in the presence of a liquefying ICH in the “subacute” stage. Clinical outcomes were assessed using the modified Rankin Scale, with a score of 0 to 2 considered a good outcome. Obliteration rates were assessed using postoperative angiography.

RESULTS: From 2001 to 2015, 131 patients underwent microsurgical resection of an AVM, of which 65 cases were included. In “group 1” (n = 21; Spetzler-Ponce class A = 13, class B = 5, and class C = 3), 11 of 21 (52%) had a good outcome and in 18 of 19 (95%) of those who had a postoperative angiogram the AVMs were completely obliterated. In “group 2” (n = 44; Spetzler-Ponce class A = 33, class B = 9, and class C = 2), 31 of 44 (93%) had a good outcome and 42 of 44 (95%) were obliterated with a single procedure. For supratentorial AVMs, the ICH cavity was utilized to provide an operative trajectory to a deep AVM in 11 cases, and in 26 cases the ICH cavity was deep to the AVM and hence facilitated the deep dissection of the nidus.

CONCLUSION: In selected patients the presence of a liquefying ICH cavity may facilitate the resection of AVMs when performed in the subacute stage resulting in a good neurological outcome and high obliteration rate.
Episode-Based Payment and Direct Employer Purchasing of Healthcare Services: Recent Bundled Payment Innovations and the Geisinger Health System Experience
Authors: Slotkin Jonathan R. , Ross Olivia A. , Newman Eric D. , Comrey Janet L. , Watson Victoria , Lee Rachel V. , Brosious Megan M. , Gerrity Gloria , Davis Scott M. , Paul Jacquelyn , Miller E. Lynn , Feinberg David T. , Toms Steven A.
Published: January 2017

One significant driver of the disjointed healthcare often observed in the United States is the traditional fee-for-service payment model which financially incentivizes the volume of care delivered over the quality and coordination of care. This problem is compounded by the wide, often unwarranted variation in healthcare charges that purchasers of health services encounter for substantially similar episodes of care. The last 10 years have seen many stakeholder organizations begin to experiment with novel financial payment models that strive to obviate many of the challenges inherent in customary quantity-based cost paradigms. The Patient Protection and Affordable Care Act has allowed many care delivery systems to partner with Medicare in episode-based payment programs such as the Bundled Payments for Care Improvement (BPCI) initiative, and in patient-based models such as the Medicare Shared Savings Program. Several employer purchasers of healthcare services are experimenting with innovative payment models to include episode-based bundled rate destination centers of excellence programs and the direct purchasing of accountable care organization services. The Geisinger Health System has over 10 years of experience with episode-based payment bundling coupled with the care delivery reengineering which is integral to its ProvenCare® program. Recent experiences at Geisinger have included participation in BPCI and also partnership with employer–purchasers of healthcare through the Pacific Business Group on Health (representing Walmart, Lowe's, and JetBlue Airways). As the shift towards value-focused care delivery and patient experience progresses forward, bundled payment arrangements and direct purchasing of healthcare will be critical financial drivers in effecting change.
Neurosurgical Emergency Transfers: An Analysis of Deterioration and Mortality
Authors: Alaraj Ali , Esfahani Darian R. , Hussein Ahmed E. , Darie Ioana , Amin-Hanjani Sepideh , Slavin Konstantin V. , Du Xinjian , Charbel Fady T.
Published: January 2017

BACKGROUND: Neurological deterioration and mortality are frequent in neurosurgical patients transferred to tertiary centers, but the precise predictors leading to them are unclear.

OBJECTIVE: To analyze and quantify risk factors predicting deterioration and death in neurosurgery transfers.

METHODS: A consecutive review of all transfers with cranial pathology to a tertiary academic neurosurgery service was performed over a 2-year period. Risk factors including demographics, medical comorbidities, hydrocephalus, anticoagulant use, transfer diagnosis, Glasgow Coma Scale score, and transfer time were reviewed.

RESULTS: A total of 1429 transfers were studied, including 154 (10.8%) instances of neurological decline in transit and 99 mortalities (6.9%). On multivariate analysis, significant predictors of decline were hydrocephalus (P = .005, odds ratio [OR] 2) and use of clopidogrel (P = .003, OR 4.3), warfarin (P = .004, OR 2.6), or other systemic anticoagulants (P < .001, OR 10.1). Age (P = .004), hydrocephalus (P = .006, OR 2.1), renal failure (P = .05, OR 2.3), and use of clopidogrel (P = .003, OR 4.6) or warfarin (P = .03, OR 2.3) were found to be predictive of death. Analysis by transfer diagnosis found patients with intracerebral hemorrhage had the highest incidence of mortality (12.7%, P = .003, OR 2). Patients who ultimately died were transferred faster than survivors, but this did not achieve significance.

CONCLUSION: Neurosurgery patients are vulnerable to deterioration in transit and exhibit several patterns predictive of mortality. Hydrocephalus, use of clopidogrel and warfarin, and intracerebral hemorrhage are each independently associated with elevated risk of deterioration and death.
Seven Ethical Issues Affecting Neurosurgeons in the Context of Health Care Reform
Authors: Dagi T. Forcht
Published: January 2017

Ethical discussions around health care reform typically focus on problems of social justice and health care equity. This review, in contrast, focuses on ethical issues of particular importance to neurosurgeons, especially with respect to potential changes in the physician–patient relationship that may occur in the context of health care reform.

The Patient Protection and Affordable Care Act (ACA) of 2010 (H.R. 3590) was not the first attempt at health care reform in the United States but it is the one currently in force. Its ambitions include universal access to health care, a focus on population health, payment reform, and cost control. Each of these aims is complicated by a number of ethical challenges, of which 7 stand out because of their potential influence on patient care: the accountability of physicians and surgeons to individual patients; the effects of financial incentives on clinical judgment; the definition and management of conflicting interests; the duty to preserve patient autonomy in the face of protocolized care; problems in information exchange and communication; issues related to electronic health records and data security; and the appropriate use of “Big Data.”

Systematic social and economic reforms inevitably raise ethical concerns. While the ACA may have driven these 7 to particular prominence, they are actually generic. Nevertheless, they are immediately relevant to the practice of neurosurgery and likely to reflect the realities the profession will be obliged to confront in the pursuit of more efficient and more effective health care.
Long-Term Endocrine Outcomes Following Endoscopic Endonasal Transsphenoidal Surgery for Acromegaly and Associated Prognostic Factors
Authors: Babu Harish , Ortega Alicia , Nuno Miriam , Dehghan Aaron , Schweitzer Aaron , Bonert H. Vivien , Carmichael John D. , Cooper Odelia , Melmed Shlomo , Mamelak Adam N.
Published: January 2017

BACKGROUND: Long-term remission rates from endoscopic transsphenoidal surgery for acromegaly and their relationship to prognostic indicators of disease aggressiveness are not well documented.

OBJECTIVE: To investigate long-term remission rates in patients with acromegaly after endoscopic transsphenoidal surgery, and correlate this with molecular and radiographic markers of disease aggressiveness.

METHODS: We identified all patients undergoing endoscopic transsphenoidal surgery for acromegaly from 2005 to 2013 at Cedars-Sinai Pituitary Center. Hormonal remission was established by normal insulin-like growth factor (IGF)-1, basal serum growth hormone <2.5 ng/mL, and growth hormone suppression to <1 ng/mL following oral glucose tolerance test. Oral glucose tolerance test was performed at 3 months after surgery, and then as indicated. IGF-1 was measured at 3 months and then at least annually. We evaluated tumor granularity, nuclear expression of p21, Ki67 index, and extent of cavernous sinus invasion, and correlated these with remission status.

RESULTS: Fifty-eight patients that underwent surgery had follow-up from 38 to 98 months (mean 64 ± 32.2 months). There were 21 microadenomas and 37 macroadenomas. Three months after surgery 40 of 58 patients (69%) were in biochemical remission. Four additional patients were in remission at 6 months after surgery, and 1 patient had recurrence within the first year after surgery. At last follow-up, 43 of 44 (74.1%) of patients remained in remission. Cavernous sinus invasion by tumor predicted failure to achieve remission.

CONCLUSIONS: Prognostic markers of disease aggressiveness other than cavernous sinus invasion did not correlate with surgical outcome. Long-term remission after surgery alone was achieved in 74% of patients, indicating long-term efficacy of endoscopic surgery.