bluuebunny/crossref_metadata_2025 huggingface dataset:
Severe COPD Patient Presenting for Retinal Detachment Surgery
Authors: Gandhi Komal , Panda Nidhi
Published: January 2019

Retinal detachment surgeries fall into the spectrum of ophthalmic emergencies as urgent (acute retinal detachment—requiring initiation of therapy in one to several hours) to semi-urgent (chronic retinal detachment—therapy can be initiated within days). Pulmonary comorbidity like Chronic Obstructive Pulmonary Disease (COPD) in patient undergoing retinal detachment surgery warrants careful perioperative anesthetic management as COPD is an important risk factor for postoperative respiratory complications (e.g., prolonged ventilation, pneumonia, increased incidences of reintubation) and prolonged hospital stay. Preoperative pulmonary optimization, careful selection of anesthesia plan, special attention to postoperative issues like pain and postoperative nausea and vomiting, along with prevention of COPD exacerbation are the key anesthesia goals in such cases.
Operating Room Fire
Authors: Williams Michael Jon , Armstead Valerie
Published: January 2019

The operating room’s environment requires constant monitoring of fire risks. The conditions placing patients at risk for surgical fires are well defined. Most of these conditions are preventable but require a group or team effort by operating room personnel. A significant number of organizations have taken the initiative in a cooperative manner to increase awareness of the potential for surgical fires and have embarked on educational efforts on how to prevent these fires. The knowledge of how to manage the different types of operating room or surgical fires is also important, in order to reduce morbidity and mortality during these sentinel events. Therefore, knowledge of fire safety equipment in the operating rooms and policies and procedures are important in the educational process. Four scenarios are presented in this chapter to cover the information relating to operating room fires.
Intraoperative Awareness
Authors: Knuth Jennifer , Gennari Lindsay , Cagino John
Published: January 2019

Awareness following general anesthesia is a rare event; however, it may have significant impact on patient satisfaction and long-term morbidity. Detecting intraoperative awareness during a general anesthetic is difficult due to the fact that the signs and symptoms are often absent in documented cases of awareness. Often, intraoperative awareness goes unnoticed until a patient reports the experience. Anesthesiologists should be cognizant of the risk factors associated with an increased risk of intraoperative awareness. Cesarean section performed under general anesthesia, cardiac surgery, and trauma surgery all carry an increased risk. Anesthesiologists should consider patient specific risk factors involving a higher than expected anesthetic requirement in developing their anesthetic plan. In the event of intraoperative awareness, the anesthesiologist’s actions and interactions with the patient are critical in improving the patient’s’ outcome and minimizing long-term psychological stress. Anesthesiologists should acknowledge the event and create a supportive relationship with the patient.
Postoperative Cognitive Dysfunction
Authors: Saasouh Wael , Rajan Shobana
Published: January 2019

Postoperative cognitive dysfunction (POCD) is an underdiagnosed serious complication occurring after a surgical procedure. It carries risks for short-term and long-term complications and may predispose an individual to a multitude of morbidities, increased healthcare-related cost, as well as death. Prevention of POCD is the most important step in avoiding morbidity, and steps to minimize its effect include early detection, proper management, and diligent follow-up. This chapter discusses, among other issues, measurement and examination of POCD, cognitive function in the preoperative and postoperative setting, intraoperative factors that influence POCD, complications of POCD, and strategies to protect patients against POCD.
Integrative Nursing and Caring Science: Universals of Human Caring and Healing
Authors: Watson Jean
Published: January 2019

This chapter uses a disciplinary ontological-ethical matrix analysis to explore the convergence of caring science and integrative nursing. A comprehensive Caring-Healing Praxis Model, consistent with the unitary-transformative perspective and informed by the moral-ethical foundation and language of caring science as well as the universals of healing offered by the principles of integrative nursing, is presented. Informed by a deep moral-ethical philosophical consciousness, the intersection of the universals of healing, made manifest through the principles of integrative nursing and the universals of caring, made manifest through the Caritas Processes, create a unifying language for the ethical, philosophical, ontological foundational structure of nursing praxis.
Integrative Nursing and Person-Centered Care
Authors: McCormack Brendan , McMillan Ailsa
Published: January 2019

Globally, person-centeredness is being actively promoted as a core underpinning philosophy of healthcare systems. Person-centeredness is more than the direct provision of care to a patient in a one-to-one relationship; it encompasses the whole context in which care is provided. This chapter presents an established framework for person-centered practice and explores this in the context of integrative nursing theory. The synergistic relationship between person-centeredness and integrative nursing is also explored, drawing upon the complementary philosophical underpinnings of both theories. A “golden thread” of caring science connects both perspectives, and this connection is discussed in the context of its benefits to persons providing and receiving care.  The chapter concludes by suggesting that a person-centered integrative approach to nursing has the potential to integrate all that is good about nursing and create a world in which individuals, families, and communities have their healthcare needs met in humane and holistic ways.
Facilitating Lifestyle Change and Health Coaching
Authors: Steele Kathy , Wagner Judy L.
Published: January 2019

This chapter focuses on the role of the health coach in supporting individuals in achieving meaningful, lasting behavior changes that promote optimal health and wellbeing throughout the lifespan. Variations in the types and definitions of coaching within the health and wellness industry are discussed, as well as key differences between health coaching and therapy and/or counseling. Key concepts of behavior change are reviewed and how the health coach can utilize powerful, learned techniques that assist individuals in recognizing personal habits that may be preventing them from achieving personal goals. Finally, this chapter discusses current trends in using health coaches in healthcare and offers simple coaching strategies that nurses can be use during every patient interaction.
Integrative Nursing Management of Nausea
Authors: Cutshall Susanne M. , VanGetson Lisa M.
Published: January 2019

This chapter provides an overview of the background for nausea and the evidence-based integrative approaches for assessment, prevention, and management of nausea and vomiting. Nausea and subsequent vomiting are common symptoms that patients may experience with medical conditions and treatments. There are many causes for nausea including medication and specific conditions and procedures. Nausea can be unpleasant and lead to other medical complications, delayed recovery, and increased medical costs; affect the quality of life and satisfaction with medical care; and contribute to future anticipatory nausea and anxiety with medical care. A multimodal integrative approach to management of nausea is often needed. Nurses trained in integrative nursing practice can play a vital role in assisting patients with strategies to prevent, treat, and manage nausea. This chapter reviews an example of clinical application of these strategies utilizing an integrative nursing approach.
Integrative Nursing Management of Depressed Mood
Authors: Peterson Barbara L. , Kristofersson Gisli K. , Kaas Merrie J.
Published: January 2019

Depression is a common but serious mood disorder that negatively affects how people think, feel, and function in their everyday life, and it can lead to other emotional and physical problems. This chapter provides a foundation for understanding depressed mood within the framework of integrative mental health nursing. Integrative mental health nursing is founded on the principles of whole-person, relationship-based care provided within the personal, lived context using a range of therapies to support the individual’s health and healing. Nursing approaches are exemplified in the chapter through a case study of an adolescent experiencing depression. Integrative nursing care for persons with depression is based on interventions that move from least intensive/invasive approaches to more, depending on need and context. Integrative nurses incorporate evidence-informed traditional and nontraditional approaches and can effectively promote wellbeing in persons with depressed moods.
Creating Optimal Healing Environments
Authors: Zborowsky Terri , Kreitzer Mary Jo
Published: January 2019

An optimal healing environment is created through the deep and dynamic interplay between people, place, process and culture. Over 1,000 papers have been published linking the physical environment to outcomes related to patients and staff. Integrative nurses are well positioned to be leaders in the planning of healing spaces. This chapter defines “healing environment”; describes research on the impact of the designed environment; and discusses the effects of such factors as nature, daylight, positive distractions, aesthetics (including color), and an ambient environment on health and wellbeing. A case study of an optimal healing environment using North Hawaii Community Hospital is presented.
Growth and Development of Hospital-Based Integrative Health
Authors: Horner Arlene , Schellinger Ellen L. , Aukerman Ranae
Published: January 2019

This chapter describes a hospital-based integrative health program which was built with a robust infrastructure and provides integrative therapies that are safe, efficacious, and informed by evidence. The hospital’s culture supports a noncentralized, integrated approach which aligns with the nursing professional practice model of person-centered holistic care. Considerations for program development included a focus on symptom management, patient fit, self-care of the workforce, and cost-effectiveness. Administrative support was essential to the success of sustaining a healthy program. Key foundational aspects include electronic medical record documentation, easy retrieval of clinical outcomes, online access to resources, and a readiness to involve all stakeholders.
Integrative Nursing in a Pediatric Blood and Marrow Transplant Program
Authors: Voss Megan Elizabeth , Kreitzer Mary Jo
Published: January 2019

This chapter gives an overview of the planning, design, implementation, and evaluation of an integrative health program in an academic health center. Pediatric blood and marrow transplant patients are one of the most fragile patient populations in the world. In this chapter, the safe and effective use of integrative therapies is discussed. This nurse-led program is one of the most comprehensive of its kind in pediatric blood and marrow transplantation (BMT). This chapter can serve as a guide to any health professional looking to integrate the principles of integrative nursing and/or integrative therapies into professional practice.
Integrative Nursing and the Environment
Authors: Luck Susan
Published: January 2019

This chapter focuses on how the external environment impacts health and wellbeing. Through an integrative nursing perspective, healthy environments are a critical component of whole person health, and the role of the integrative nurse in furthering the health of individuals and communities is explored in depth. The evolving roles within an integrative nursing perspective are addressed, including integrative nursing leadership in advocating for creating healthier communities and impacting public health policy. The chapter looks to the legacy of nursing in environmental health and the importance in the modern world to address the global issues influencing health and disease. The goal of the chapter is to heighten awareness of the influence of the environment in human health and the role of integrative nursing leadership to implement strategies and influence policies that support community health and the wellbeing of all people, local to global.
Integrative Nursing and Informatics
Authors: Austin Robin R.
Published: January 2019

In today’s complex health environment, health information technology can be an effective tool to manage the health of individuals, populations, and communities. It is essential to understand how health technology can be leveraged to shift the focus of health toward wellness and prevention. This chapter provides an overview of health informatics, with a special focus on nursing informatics and consumer health informatics. Specific examples highlight how nursing informatics can support and facilitate integrative nursing practice and principles. Consumer health informatics focuses on the health consumer and how the patient engagement movement is aligned with integrative nursing. Exemplars are provided to highlight the use of nursing informatics and consumer health informatics to enhance integrative nursing principles in the clinical setting and promote patient health outcomes. Last, the topics of big data analytics and future trends are discussed.
Integrative Nursing and Global Health
Authors: Rosa William E. , Upvall Michele J.
Published: January 2019

Global health is an emergent topic in nursing research and practice. The essence of integrative nursing is, ultimately, about a global lens in how people view health, wellbeing, individuals, systems, and the interconnectedness between them. There is power in taking a global stance in the challenges that face nurses as a profession, a people, a human race, and an international community of concerned citizens. The willingness to embrace a global stance on health is influenced by a host of questions that must be taken into consideration: what is needed, who is involved, when is it time to move forward, why is it important, where to start, and how to engage. A global stance offers a starting point of shared power and an integrative paradigm with which to lead the effort. It resounds the call to heal from a space of compassionate moral imagination.
Integrative Nursing in Iceland
Authors: Gunnarsdottir Thora Jenny , Kristofersson Gisli K.
Published: January 2019

Nurses in Iceland play a central role in the healthcare system. There is a unique opportunity in Iceland to introduce and implement the principles of integrative nursing due to a very strong, ambitious, and well-educated nursing profession. There was much interest among Icelandic nurses to attend the first integrative nursing symposium held in Reykjavik 2015, which has led to awareness of the principles of integrative nursing. Research has shown an increase in the last few years in the use of integrative therapies and healing practices by nurses to manage symptoms and improve clinical outcomes at the National Hospital. There are, however, still challenges and barriers that need to be overcome.
What Is Personality?
Authors: Svrakic Dragan M. , Divac-Jovanovic Mirjana
Published: January 2019

This chapter reviews the neuroscience of brain and mind development. Recent advances in cognitive neuroscience, such as the concept of nonconscious working memory, support the psychanalytic concept of early object relations, which are believed to be the “elementary particles of the mind”: each contains a percept, a self-reflection, and the related affect and thus is not divisible to lower order units of mental experience. The functional brain networks giving rise to mental faculties (cognition, motivation, and emotions) are informed by these highly personal units of experience. Such “personalized” mental faculties self-organize into semistable subsystems within the mind, each providing a specific adaptive advantage to the mind as a whole. The impact of sociocultural transitions on human mental life, as well as the concepts of normal, postmodern, and fluid self in the context of conservativism, postmodernism, and liquid modernity, are discussed in detail.
Some Psychological Effects of Changing Public Attitudes on U.S. Vietnam Veterans
Authors: Dohrenwend Bruce P. , Murphy Eleanor , Yager Thomas J. , Hatch Stephani L.
Published: January 2019

This chapter discusses the substantial effect that changing public attitudes toward the Vietnam war had both on veterans’ own attitudes toward the war and on demoralization in the U.S. armed forces toward the end of the war. In addition, as hypothesized, veterans’ negative attitudes at the time of their own entrances and exits from Vietnam, and negative changes in veterans’ initially favorable attitudes, were related to the period of the war in which they served and positively associated with demoralization. Because measurement of veterans’ attitudes toward the war at their entrance and exit occurred long after their service in Vietnam, it is possible that memory distortions played a role in these findings. However, the data indicate that retrospective bias cannot account for the differences in declining favorable and increasing negative attitudes toward the war related to veterans’ time of war entry.
What Are We to Make of Reasoning in Modern Medicine?
Authors: Montgomery Erwin B.
Published: January 2019

The suasive power of clinicians depends on the projection of certainty; with that suasive power, responsibilities to the patient have not diminished even if the clinicians’ authority has. Certainty is reflected in understanding, which is more than knowledge. Understanding allows reasoning beyond the specifics of knowledge, beyond the particulars. The variation in human manifestations represents either variation or diversity. In variation, all specific instances are variations on some canonical form. Diversity holds each instance as an entity unto itself. The epistemic choice of variety as variation or diversity determines medical reasoning. Biomedical research is confronted with the same challenges. The resort is to a special form of logic and epistemology that is organic, responding to needs, and synthetic, the product of humans. This evolutionary logic embraces a necessary use of logical fallacies. Science requires these fallacies, and thus scientism is limited and cannot replace medical reasoning.
Medical Epistemology
Authors: Montgomery Erwin B.
Published: January 2019

Deductive approaches in medical decision-making have an air of certainty borrowed from philosophical deduction, as for example, in the hypothetico-deductive approach. However, deduction, although certain, is limited because it cannot contribute to new knowledge other than proving some claims to knowledge as false (using modus tollens). Syllogistic deduction requires modification to gain utility, such as the partial and practical syllogisms. However, these forms are logically invalid in that they do not ensure certainty in the conclusions. The partial syllogism can be rendered more certain by the use of probability. However, the necessity of a medical decision requires dichotomization of the continuous probability variable. A cutoff threshold applied to the probability is necessary to enable a dichotomous decision, such as whether to treat or not treat a patient. The practical syllogism introduces the notion of cause and effect, which also may influence medical decisions, although often in a counterproductive manner.
Deduction, Induction, and Abduction
Authors: Montgomery Erwin B.
Published: January 2019

Decisions can be explicated as logical arguments, often poised as deductive and conveying a sense of certainty. Yet these arguments often are logical fallacies, such as the Fallacy of Confirming the Consequence, otherwise known as abduction (e.g., the argument if the patient has disease A then test B would be abnormal; test B is abnormal therefore the patient has disease A). This is invalid. The patient may have disease A but it cannot be certain; hence the logical fallacy. The necessary use of the partial syllogism can be made more rigorous by the use of probabilities and further by analysis of the probabilities of probabilities that constitute statistics. Other fallacies used in medical reasoning include the Fallacy of Pseudotransitivity. Induction, a form of logic, also has limits and risks that require mitigation for sound medical reasoning. These fallacies can be rescued so that risks are mitigated.
Evolution of Medical Reasoning
Authors: Montgomery Erwin B.
Published: January 2019

The challenge to certainty in the face of enormous variability generates an epistemic conundrum. The response to this conundrum has driven the evolution of medicine. The rationalist/allopathic tradition holds that an economical set of principles and facts exists from which each patient’s unique situation can be constructed. There are striking parallels between the allopathic tradition and science. Indeed, it was the ascendency of biomedical science that enabled allopathic medicine to triumph over competitive schools of medicine, such as the empirics in the form of homeopaths. The ascendancy of scientific medicine that allopathics claimed is now institutionalized. However, such economization risks the inverse problem in that there may not be any unique explanation for a particular disease phenomenology, thus giving rise to the possibility of misdiagnosis and mistreatment. Nonetheless, the rationalist/allopathic tradition follows from Aristotle’s metaphysics translated into medical terms by Galen, whose influence is still felt.
The Centrality and Origins of Hypotheses
Authors: Montgomery Erwin B.
Published: January 2019

Hypotheses are central to the hypothetico-deductive approach in medical diagnosis and to the scientific method in research. Arguably, hypotheses are central to induction as reflected in the a priori problem of induction. Yet conspicuously absent from discussions of medical reasoning is any explicit critical analysis of the origin and quality of hypotheses as they often are attributed to some psychological process. However, there are specific manners in which hypotheses can be generated, such as by interpolation among and extrapolation beyond known knowledge claims such as data. Interpolations and extrapolations in the causal mechanisms that underlie knowledge claims can also generate hypotheses. Metaphors are a source as well. Perhaps an unrecognized metaphor critical to reductionism that underlies rationalist/allopathic medicine and biomedical research is the process metaphor. Each approach has advantages as well as risks. The latter can be estimated by the notion of epistemic risk, which contains epistemic distance and epistemic degrees of freedom.
Dynamics
Authors: Montgomery Erwin B.
Published: January 2019

Living organisms, in health or disease, are dynamic, changing over time—physiology. The complexity of living organisms means understanding dynamics may be difficult if inferred only from the static—anatomy. Conflation of anatomy with physiology has led to misunderstanding. The challenge is to reduce the enormous variety of dynamics to an economical set of principles and facts. A conundrum is created in terms of how to organize the dynamics, for example, in terms of the mechanisms of the dynamics or in terms of the outcome of those mechanisms. The same outcome can result from different dynamics; thus, defining the dynamics in terms of outcomes achieves an economization of principles. The outcome could be understood as telos, which refers to the intention or purpose of the dynamics. Yet this is highly problematic and could underlie medical and scientific misreasoning. Furthermore, chaos and complexity present a great challenge to understanding dynamics.
Irreproducibility in Biomedical Science
Authors: Montgomery Erwin B.
Published: January 2019

Widespread irreproducibility of biomedical research has raised concerns. Journal editors and grant administrators are calling for greater safeguards. The causes go far beyond fraud, lack of transparency, and poor statistical analyses, as commonly thought. The root cause may stem from the same epistemic issues that confront medical reasoning, the necessary use of logical fallacies. However, the use of these fallacies increases the risk of uncertainty and subsequent irreproducibility. Furthermore, many procedures in data analysis actually result in an irretrievable loss of information by the Second Law of Thermodynamics as Applied to Information, thereby increasing the risk for irreproducibility. The second law holds that any irreversible process, such as operating only from the central tendency, as in the mean of a sample, results in a loss of information about the actual sample. The loss of that information makes the study less informative about the management of the individual patient.
Confidentiality and Release of Medical Information
Authors: Ley Rebekah , Hayes Natalie
Published: January 2019

The duty of confidentiality that a doctor owes to a patient is probably as old as the practice of medicine and is essential for trust between doctors and their patients. However, it is not an absolute duty and there are instances when a doctor is entitled, and in certain circumstances obliged, to disclose confidential information without patient consent to do so. This chapter is concerned with doctor–patient confidentiality and when medical information can reasonably be released. Confidentiality is covered by a mixture of UK statute, common law, tort law, and the European Convention on Human Rights. It is also a core component of the professional guidance given to doctors by the profession’s regulatory body, the General Medical Council, to which all doctors registered with it are expected to adhere.
Mental Health Law
Authors: Holland Anthony , Fistein Elizabeth , Walsh Cathy
Published: January 2019

Mental health is everyone’s concern, an idea epitomized by the campaign tag line of the Royal College of Psychiatrists, ‘No Health Without Mental Health’. This chapter will demonstrate how an understanding of a patient’s mental health within his/her social and family context is central to clinical practice. We will consider the legal basis for the treatment of mental ill-health and how it can complicate the treatment of physical illness and lead to ethical and legal concerns. The general legal principles that govern health interventions are explored, and two specific statutes for England and Wales—the Mental Capacity Act 2005 and the Mental Health Act 1983 (as amended 2007)—are both considered in some detail. It will be shown how a sound appreciation of the clinical issues, an understanding of the law, and an ability to apply that law in clinical settings are essential when faced with situations involving mental ill-health.
Introduction
Authors: Lucius-Hoene Gabriele , Holmberg Christine , Meyer Thorsten
Published: January 2019

In the last thirty years, illness narratives have not only been used as research data linking subjective suffering with medical practice, identities, social meanings, and cultural significance, but their use has also spread to practical purposes in different areas, thus widening the scope of narrative medicine. This chapter discusses why this change needs a critical reflection. It presents the richness and chances of illness narratives as well as the epistemological, methodological, and methodical problems which arise when their narratological properties are neglected. The chapter provides an overview of the book and discusses methodological and epistemological challenges, ethical and communicational aspects, and narratives in psychotherapy, rehabilitation, and vocational training, training of students and medical staff, diagnostics, decision-making, health care, and in the media.
Stories, illness, and narrative norms
Authors: Hydén Lars-Christer
Published: January 2019

Collecting illness narratives has become an established way to explore illness experiences. Often both collecting and analysing illness narratives are based on taken for granted narrative norms about how a narrative should look in order to be counted as a narrative and as researchable. Autobiographical illness stories are for instance generally supposed to be coherent and true. Many persons, especially with neurocognitive disorders, have problems living up to and adhere to these narrative norms, thus telling stories that risk being considered as non-stories or as incoherent and fragmented stories. A number of examples of conflicts between narrative norms and illness stories will be discussed. In conclusion, it is argued that researchers must use data collecting methods as well as analytical strategies that allow for alternative ways of telling stories.
Using narratives for medical humanities in medical training
Authors: Kiss Alexander , Steiner Claudia
Published: January 2019

The University of Basel, Switzerland has developed a longitudinal medical humanities curriculum based on illness narratives and narrative medicine. The ultimate learning goal of medical humanities as taught in Basel is to foster narrative competence. A good doctor needs to be a good listener, a good storyteller, and should ideally be able to co-create an illness narrative together with a patient. Medical humanities consist of mandatory and optional elements. Blending evidence-based medicine, which is based on larger numbers of patients with similar characteristics, with narrative-based medicine, which is based on patients’ uniqueness, this programme provides medical students with the opportunity to develop and practice narrative medicine over the course of the six years of medical studies. This chapter discusses the programme and its place in medical education.
Engaging the vulnerable encounter
Authors: Heape Chris , Larsen Henry , Ryöppy Merja
Published: January 2019

This chapter describes how improvised participatory theatre can be used to encourage change in professional healthcare practice. It focuses on chronic pain, with a brief example from another healthcare project. The principal interest is to demonstrate how theatre processes, for the most carried out as participatory workshops, can be used to explore and influence healthcare practice. The chapter shows how health and illness narratives can be considered temporal, improvised, and performative phenomena that are narrated to life through actual practice. The idea is that narratives of practice emerge from the dynamic, moment-to-moment, and reflexive engagement with actual practice rather than as idealized or generalized accounts about practice. The emphasis is therefore on engendering narratives of practice as a narrating-between-people in a situation as opposed to considering narratives as after-the-fact accounts.
Using illness narratives in clinical diagnosis
Authors: Gülich Elisabeth
Published: January 2019

This chapter argues that illness narratives are a suitable instrument for differential diagnosis in practice. The study discussed is based on a corpus of doctor–patient interactions, i.e., encounters with patients suffering from epileptic or non-epileptic seizures and/or anxiety disorders, and for most of whom differential diagnosis is very difficult. The basic assumption put forward here is that the types of narrative can give clues to identify the types of seizures or attacks. The focus is on the ‘methods’ patients use in verbalizing the ‘auras’ preceding the seizures and the course of the seizures or attacks themselves. In particular, it pays attention to the procedures of resolving difficulties of verbalization, which occur during the production of the narrative. It demonstrates that preferences in the choice of narrative techniques allow a distinction between patients with epileptic seizures and patients with other types of fits or with panic attacks. Finally it suggests that knowledge of recurrent narrative patterns can help to recognize the syndrome presented, on condition that the doctor encourages narrative reconstructions and listens carefully.
Understanding and using health experiences to improve healthcare—examples from the United Kingdom
Authors: Hinton Lisa , Locock Louise , Ziebland Sue
Published: January 2019

This chapter explores the variety of ways in which people’s narrative accounts of their health experiences can be harnessed to inform practice, service development, and health policy, as well as a more traditional research agenda. The case has been made that collecting data on patient experience as an activity in isolation is not enough. Health experiences should be used to improve care. But what are the most effective ways to achieve this? This chapter presents examples of projects conducted in the United Kingdom where patient narratives collected as part of the Healthtalk project (www.healthtalk.org) were used for health service improvement. Examples include secondary analysis, and co-design projects using experience based co-design and an accelerated approach to co-design.
When public and private narratives diverge
Authors: Grob Rachel , Schlesinger Mark
Published: January 2019

Individuals experience illness and healthcare in diverse ways. Advocates striving to create system change, however, typically simplify representations of patient experience. These ‘crafted’ public narratives better accord with journalists’ ideals of compelling, coherent, attention-grabbing stories. But condensing diverse experiences into univocal narratives has costs: some patients’ voices are silenced, and vital ethical issues are overlooked. This chapter uses a case study of advocacy around newborn screening (NBS) to explore the origins and implications of crafted public narratives. It traces the emergence of a single ‘urgency narrative’ used by advocates to promote expanded screening and compares its impact on media coverage and policy-making across the United States and among five English-speaking nations. It shows that crafted narratives are most influential in countries where NBS policies are set subnationally, since geographic variation both fosters advocates’ search for compelling narratives and makes those narratives more evocative, enhancing their impact on policy-making.
Illness narratives in political communication
Authors: Bandtel Matthias
Published: January 2019

This chapter explores political actors’ illness accounts published in the media. Until recently, politicians’ health conditions have been a prominent topic in political discussions and electoral campaigns. This broad interest relates to the multiple functions of the body in political contexts. This chapter discusses the links between individual forms of body presentation and institutional representation. It also covers a discourse-analytical case study that examines the illness narratives of two German state ministers and reveals the highly normative expectations regarding body presentations in the field of politics. On the one hand, the illness is portrayed as an excuse for political failures. On the other hand, political bodies are constructed that gain additional competences through the illness experience. Furthermore, political actors’ mediated illness narratives transfer societal problems of power and control to the site of individual bodies. Finally, it addresses how political processes become tangible for wider audiences, which is crucial for contemporary media societies.
Studies of disease occurrence
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

This chapter reviews the options for population selection in undertaking investigations aimed at estimating the occurrence of a disease. In terms of measuring disease occurrence, an important issue will be determining the appropriate target population. The choice will depend on being able to access the population, how representative it is, the size of the population, and the population data accuracy. It will not always be possible to use an ‘ideal’ population, there will be different options and the advantages and disadvantages of each will need to be determined. The same principles apply, however, if the object of the study is to investigate the occurrence of a risk factor, such as cigarette smoking, or other human attributes.
Preparation of collected primary data for statistical analysis
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

Although epidemiological studies are increasingly based on the analysis of existing data sets (including linked data sets), many studies still require primary data collection. Such data may come from patient questionnaires, interviews, abstraction from records, and/or the results of tests and measures such as weight or blood test results. The next stage is to analyse the data gathered from individual subjects to provide the answers required. Before commencing with the statistical analysis of any data set, the data themselves must be prepared in a format so that the detailed statistical analysis can achieve its goals. Items to be considered include the format the data are initially collected in and how they are transferred to an appropriate electronic form. This chapter explores how errors are minimized and the quality of the data set ensured. These tasks are not trivial and need to be planned as part of a detailed study methodology.
Introductory data analysis
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

This chapter builds on the previous one on the analysis of descriptive epidemiological studies and illustrates statistical methods appropriate for analysis of analytical epidemiological studies. It mainly focuses on data obtained from case–control and cohort studies, but also considers other study designs presented in Chapter 6. There are also several practical examples to help with the analysis and interpretation of the results of analytical epidemiological studies. In practice, relatively little mathematical calculation is done without computers. In this chapter, however, formulae are presented for the main measures of effect together with worked examples. Indeed, when data are available in tabulated form, as opposed to raw data files, it is frequently an easy task to calculate the important measures ‘by hand’. The formulae presented will permit the reader, for example, to check or further explore data published by others.
Association or causation
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

Epidemiological studies can only show associations they cannot prove that a link is causative. Even in the bias free study with minimal confounding, a strong association does not mean that, for example, the presence of the risk factor has a direct biological link to the disease in question. There are several tests that can be used to increase the confidence that an association has biological meaning and needs to be considered. It is interesting always to differentiate factors that are on the ‘path’ to disease but not the underlying cause. The appropriateness of all these steps is dependent on the validity of the association.
Neurocritical Care
Authors: Kellum John A.
Published: January 2019

Neurocritical Care provides “at the bedside” guidance on the medical knowledge and technical skills required to care for critically ill patients with neurologic conditions such as cerebrovascular disorders, neurotrauma, neuro-oncology, refractory seizures, neuromuscular diseases, infections, alterations in consciousness, and perioperative neurosurgical care. It provides information on the clinical conditions, basic and advanced neuro-monitoring, and addresses some unique special populations. Part of the Pittsburgh Critical Care Medicine series, this compact volume is an ideal reference for physicians and trainees working in either a general intensive care unit or specialty neurointensive care unit. Readers will gain an understanding of background knowledge and concrete solutions to questions and situations encountered in daily practice.
Encephalopathy and Delirium
Authors: Keegan Joshua , Moran Colleen
Published: January 2019

Delirium has high prevalence in the intensive care unit (ICU) and carries high morbidity. Delirium is often underrecognized, and implementation of validated screening strategies increases detection rates. Strategies to minimize delirium include limitation or avoidance of certain medications (especially benzodiazepines), frequent reorientation, maintenance of normal sleep/wake cycles, and provision of hearing and vision aids. Optimal treatment of delirium once it occurs is unclear, but antipsychotics may have beneficial effects. Sedative medications to manage pain and agitation are often necessary in the ICU; however, they may contribute to delirium. The agent used should be targeted to the patient’s specific situation. Daily sedation interruptions and targeting light rather than deep sedation help to minimize the doses used. In a subset of patients specific to the neurologic ICU, deeper sedation may be required to avoid intracranial pressure crises.
Intracerebral Hemorrhage
Authors: Adeoye Opeolu
Published: January 2019

Spontaneous intracerebral hemorrhage (ICH) is a severe form of stroke with no proven treatments to date. However, multiple clinical trials in the past decade have contributed to the growing knowledge in the field, and ongoing trials will further inform clinical management. Completed and ongoing trials have informed blood pressure management, surgical management, hemostasis, treatment of coagulopathy, treatment of intraventricular hemorrhage, and neuroprotection, among others. This chapter discusses recent advancements in ICH, how those advancements have informed clinical management, and future directions for innovative research that may lead to proven interventions for ICH.
External Ventricular Drainage
Authors: Agarwal Nitin , Ducruet Andrew F.
Published: January 2019

External ventricular drainage, or ventriculostomy, refers to surgical placement of a catheter into the ventricle to achieve temporary cerebrospinal fluid diversion and remains one of the most frequently performed neurosurgical interventions. External ventricular drainage is an essential therapeutic strategy for a myriad of neurological disease processes causing hydrocephalus or increased intracranial pressure including traumatic brain injury, subarachnoid hemorrhage, and intracranial hemorrhage with intraventricular extension. In select cases, lumbar drains may provide a suitable alterative to an external ventricular drain (EVD). Complications related to both EVD and lumbar drain placement include malfunction, infection, and hemorrhage. This chapter reviews the indications, surgical technique, postoperative management strategies, and potential complications associated with external ventricular drainage.
Managing the Postoperative Neurosurgical Patient
Authors: Ripepi Daniel , Moran Colleen
Published: January 2019

Managing the postoperative neurosurgical patient involves timely recognition and management of specific issues that arise in the immediate postoperative period. The likelihood that a specific complication will arise for a given patient is influenced by the nature of the procedure, the anesthetic techniques used, and the patient’s preoperative comorbidities. The risk of some complications can be reduced with appropriate preoperative assessment and medical optimization. The management and treatment of postoperative complications is equally important, and often management techniques used are unique among neurosurgical patients. Included among the common postoperative management issues in neurosurgical patients are postoperative nausea and vomiting, pain control, sodium balance, postoperative fever, airway management, blood pressure management, and fluid therapy. Management strategies along with rationale for these postoperative concerns are discussed in this chapter.
Rehabilitation in Neurocritical Care
Authors: Reznik Michael E. , Wagner Amy K.
Published: January 2019

Rehabilitation is a process that should begin in the neurointensive care unit. Once a rough prognosis has been made within the context of goals of care discussions, and a decision has been made to proceed with measures geared toward recovery, the focus of clinical care should begin to shift toward the transition to rehabilitation in order to maximize functional gains. In the acute care setting, this necessitates the collaboration of a multidisciplinary team, including physical medicine and rehabilitation, physical and occupational therapy, speech and language pathology, neuropsychology, social work, and nursing. Among the most challenging issues facing intensivists and the rehabilitation team in the critical care setting is the management of the various rehabilitation-related medical complications associated with acquired brain injury, including decreased level of arousal, agitation, sleep disturbances, depression, dysautonomia, bowel and bladder dysfunction, and spasticity. This chapter highlights current management strategies for dealing with these issues.
Sacral Endplate Penetrating Screw for Lumbosacral Fixation: A Cadaveric Biomechanical Study
Authors: Grigoryan Grigor , Inceoglu Serkan , Danisa Olumide A , Cheng Wayne
Published: January 2019

BACKGROUND

Cortical bone trajectory is a relatively new alternative for instrumentation of the lumbar spine. When performing lumbosacral instrumentation, a novel S1 endplate penetrating screw (EPS) has been recently shown to have higher insertional torque than the traditional trajectory screw, but the biomechanical properties of this new trajectory are yet to be verified with the cadaveric studies.

OBJECTIVE

To evaluate 2 screw trajectories in sacra using cyclic loading and pullout tests, and to determine whether bone quality had different effects on the 2 trajectories.

METHODS

Nine cadaveric sacra were used, 5 of which had normal bone mineral density (BMD) and 4 were osteoporotic. Each side of the sacra was randomly assigned to either EPS trajectory or S1-alar screw (S1AS) trajectory. Each screw then underwent cyclic loading followed by pullout force measurement. A mixed-design 2 way ANOVA test was used to detect differences between the groups.

RESULTS

The EPS group had less relative rotation at the bone–screw interface during cyclic loading than the S1AS group (P = .016) regardless of bone quality. The pullout force following the cyclic loading was significantly higher in the EPS group (2349 ± 838 N) than the S1AS group (917 ± 909 N) in normal bone (P < .0001). The difference was more pronounced in osteoporotic bone with the EPS (1075 ± 216 N) compared to the S1AS (365 ± 422 N;P < .0001).

CONCLUSION

The S1 EPS trajectory is significantly more stable against loosening and has a higher pullout force compared to the S1AS trajectory. The difference between the 2 trajectories is more pronounced in osteoporotic bone.
Property as a Moral Phenomenon
Authors: Moller Dan
Published: January 2019

Libertarians emphasize the significance of private property, but explaining the moral foundations of property is notoriously difficult. This chapter argues that property does not rest on a single factor such as labor, as Locke proposed. Instead, property emerges from a wide array of morally significant factors that support someone’s claim to control over an asset, including not just labor but discovery, creation, and many other actions. On this view, Locke misunderstood his own theory and cast it far more narrowly than he should have. The resulting picture vindicates private property as a moral phenomenon and not merely a social convention, as Hume and his followers maintain.