bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of cardiopulmonary bypass
Authors: Hwang Dr Nian Chih , Sinclair Dr Michael
Published: October 2023

Normocarbia should be maintained. Blood should be sampled for acid-base balance and a baseline activated clotting time. Except for the patient with aortic stenosis, an infusion of a vasodilator such as sodium nitroprusside or nitroglycerin can usually be started via the central venous catheter at a low dose and the rate titrated according to the blood pressure response. Remember that the cardiac output is fixed in aortic stenosis and that any reduction in systemic vascular resistance may lead to hypotension and decreased coronary perfusion. Blood glucose concentration should be assessed in the diabetic patient and an infusion of insulin started to treat hyperglycaemia.
Hormone mechanisms of action (Physiology)
Authors: Laycock John , Wise Peter
Published: October 2023

a generally binds to receptors in target cell membranes b can only bind to its one (unique) receptor produces its effects by stimulating an intracellular second messenger system cannot have a genomic effect on protein synthesis always exerts its effects by generating intracellular cyclic AMP have a high affinity for that hormone can also bind other molecules (ligands) are often associated with membrane-bound G proteins d can have intrinsic tyrosine kinase activity
The adrenals (Physiology)
Authors: Laycock John , Wise Peter
Published: October 2023

is the central part of the adrenal gland

is composed of cells embryologically derived from the neural crest

receives part of its blood supply via drainage through the adrenal cortex

is the source of adrenal steroids

is innervated by postganglionic sympathetic nerve fibres
Calcium regulation, bone, and its metabolic disorders (Physiology)
Authors: Laycock John , Wise Peter
Published: October 2023

is mostly stored in the bones circulates in the blood partly bound to plasma proteins is present in muscle cells as the crystalline complex hydrated calcium phosphate apatite salt is generally present in cell cytoplasm at a concentration greater than in the blood is an essential component of cell membranes are in dynamic equilibrium with the circulating bound calcium component are transported mainly within the red blood cells in association with a globulin protein are normally present at a concentration of approximately 1.2-1.3 mmol/ litre
Moral Influence
Authors: Lomas Peter
Published: October 2023

In the previous chapter I suggested that the contemporary psychotherapist evades the issue of his or her moral influence on the patient. This is not, I think, in doubt. The real difficulty comes when one tries to think about how best moral questions should be addressed and what justifications can be made for attempting to influence the other morally in an open way.
Ethical issues
Authors: Russon Lynne , Wilkinson Stephen
Published: October 2023

Those treating patients with cancer pain are faced with ethical issues daily, even though they may not be recognized as such. However, the difficulties rarely fit into neat philosophical categories. This chapter discusses informed consent, beneficence, nonmaleficence, and the doctrine of double effect, and how such issues might influence patient care.
Nursing issues
Authors: Foyle Lorna
Published: October 2023

The holistic nature of nursing provides nurses with an unparalleled opportunity to make a significant contribution in the management of cancer pain.
Homeopathic medicine
Authors: Thompson Elizabeth A
Published: October 2023

Much has been achieved in the management of cancer pain with the range of effective pain relieving drugs now available. However these drugs do not necessarily impinge on the emotional, psychological, and existential aspects of human suffering. There is clearly a need for modalities of care that can, when used alongside orthodox treatments, address these areas of hurt. The homeopathic approach to pain is one such modality that does not attempt to separate the psyche from the soma, but offers a truly holistic perspective. The person in pain is encouraged to tell their story in their own language, placing weight on those issues that are uppermost in their mind. An individual picture is thereby built up which embraces the many influences that have come to bear on that person.
Malocclusion: aetiology and classification
Authors: McDonald F , Ireland A J
Published: October 2023

The factors involved in the aetiology of malocclusion are numerous but traditionally have been divided into general and local factors. General factors are often quoted as being skeletal factors, soft tissue factors, and habits, whilst dento-alveolar factors are often referred to as local. This division into general and local factors can give the wrong impression as to how each of these aetiological agents act in the production of a malocclusion. For example, the effect on the occlusion of incompetent lips might be limited to proclination of the upper incisors, whilst having no effect on the buccal segment teeth or lower incisors. On the other hand, the dento-alveolar factor of crowding, due to one or more large teeth, is often described as a local factor.
Patient and parent interview
Authors: McDonald F , Ireland A J
Published: October 2023

The patient and parent interview serves a number of important functions. To begin with it is likely to be the first experience the patient has of the processes involved in orthodontic treatment. It is also a time when the clinician must obtain information from the patient not only on their orthodontic concerns, but on factors which might have a bearing on any proposed treatment. Specific factors may come to light on questioning the patient about their medical and dental history. Less specific information, including straightforward and obvious domestic issues such as ease of travel for treatment, also needs to be determined. Such information might influence the clinician to modify the complexity of any proposed treatment plan.
General medicine
Authors: Leung Wai-Ching
Published: October 2023

Which of the following statements about hypothermia is/are true? a it is defined as fall of oral temperature to below 35°C b it may be caused by hypothyroidism c the] wave on the ECG is characteristic d it is often associated with a low blood pressure e death may be diagnosed in hypothermic patients with absent pupillary reflex.
Surgery
Authors: Leung Wai-Ching
Published: October 2023

Risk factors for the development of carcinoma of the breast includea a positive family history b increased agec early menopause d delayed menarche e nulliparityWhich of the following factors in breast carcinoma indicate a favourable prognosis? a high oestrogen receptor (ER) activity b smooth contour c presence of undifferentiated cells d reactive hyperplasia in the regional lymph nodes e large size.
Pathology
Authors: Leung Wai-Ching
Published: October 2023

Which of the following are examples of response of tissue by hypertrophy? a breast enlargement in puberty b prostate enlargement in advancing agec liver nodule formation in cirrhosis of the liver d enlargement of the left v ncricle as a response to hypertension e adrenal gland enlargement as a response to inappropriate ACTH secretion.
Assessment of patients, general anaesthesia, and monitoring during anaesthesia
Authors: Illingworth Karen A , Simpson Karen H , Swales Sue
Published: October 2023

A & E staff should assess each patient before contacting the anaesthetist: checklists can be useful. Anaesthetists should only give anaesthetics in the A & E department if they are happy about the condition of the patient and the equipment and assistance available. Rapid sequence induction is mandatory in patients who may have a full stomach or intra-abdominal pathology. It is also advisable in obese patients and in those given opioid analgesics. Monitoring apparatus should be checked before use.
Resuscitation techniques: airway management, ventilation, and defibrillation
Authors: Illingworth Karen A , Simpson Karen H , Swales Sue
Published: October 2023

It is essential to follow the ABC of resuscitation: A clear and maintain the Airway ensure adequate Breathing ensure adequate Circulation. Use 100 per cent oxygen during resuscitation. When a cervical spine injury is suspected, use cervical spine control while maintaining the airway. Some patients will need total spinal immobilization. In epiglottitis, interference with the airway may cause total airway obstruction.
Other nerve blocks and field blocks
Authors: Illingworth Karen A , Simpson Karen H , Swales Sue
Published: October 2023

The supraorbital nerve leaves the orbit as two branches through two holes or notches on the superior orbital margin about 2.5 cm from the midline. It supplies the skin of the forehead, including adjacent scalp. The supratrochlear nerve leaves the orbit medial to the supraorbital nerve. It provides cutaneous sensation to the medial part of the forehead.
Topical anaesthesia
Authors: Illingworth Karen A , Simpson Karen H , Swales Sue
Published: October 2023

A thick layer of cream is applied to the proposed site(s) of injection. This is covered with an occlusive dressing and left for 1 hour with EMLA or 30 minutes with amethocaine. The procedure should commence within 30 minutes after the dressing has been removed.
The public perspective
Authors: Girling David J , Parmar Mahesh K B , Stenning Sally P , Stephens Richard J , Stewart Lesley A
Published: October 2023

Clinical trials are a special type of research involving human participants, sometimes with healthy volunteers, but often with patients who agree to participate in trials as part of their treatment and medical care. Trials therefore carry particular responsibilities both to ensure the welfare of their participants and to be publicly accountable. In the quest to design, conduct and report the results of the ‘perfect’ trial, we must not lose sight of the fact that the whole purpose of trials is ultimately to benefit patients and the community at large. Clinical trials cannot be done without patients, and success depends upon establishing effective partnerships between researchers, clinicians and patients.
Putting plans into practice
Authors: Girling David J , Parmar Mahesh K B , Stenning Sally P , Stephens Richard J , Stewart Lesley A
Published: October 2023

Some trials will be planned and conducted by an individual person, others as part of a programme of multi centre randomized trials by an established trials office. Setting up and conducting a single trial or a programme of trials is, however, a major and specialized activity which should only be undertaken by persons or groups with the necessary expertise and experience, whether or not they constitute an established long- standing group. Individuals conducting the trial should include, or have access to, the necessary statistical, medical, computing and data management expertise. Such expertise is essential and can be provided in a number of ways through the course of the trial. It is important to recognize, however, the need for continuity of personnel and for the non-clinical staff to be conversant with the medical issues.
Analysis
Authors: Girling David J , Parmar Mahesh K B , Stenning Sally P , Stephens Richard J , Stewart Lesley A
Published: October 2023

In this chapter we present the principles of, and approaches to, analysis. A central component of this chapter are the practical issues for the analysis of a typical randomized trial, which should give the practitioner guidance on many aspects of analysis. Within this section there is, in particular, guidance on the analysis and presentation of quality of life data. There is also a statistical methods section which outlines the methods available for different types of data. This section is brief and can be omitted without loss of continuity. The aim is to emphasize principles and limit the number of formulae and equations. For a more detailed technical presentation of these methods the reader is referred to more specialized books, such as Altman [1].
Systematic review and meta-analysis
Authors: Girling David J , Parmar Mahesh K B , Stenning Sally P , Stephens Richard J , Stewart Lesley A
Published: October 2023

It should be self-evident that healthcare decisions should be based on the best possible evidence; that effective treatments should be used whilst ineffective or harmful ones should not. Yet it is only relatively recently that the principles of evidence-based medicine have been explicitly discussed and gained widespread acceptance. There is an increasing awareness that the evidence for and against medical treatments must be evaluated properly and with appropriate scientific rigour. So far this book has set out the rationale for randomized controlled trials (RCTs) and described their role as main building blocks in clinical research. Undoubtedly, RCTs provide the most appropriate methods for the unbiased primary assessment of competing therapies. However, individual trials do not always provide the solutions that we seek and we need to look across trials at the totality of evidence. Consequently, there has been a vast increase in the number of systematic reviews and meta-analyses that have been undertaken in recent years [1] (Fig. 11.1).
Epipodophyllotoxins
Authors: McLeod Howard L
Published: October 2023

The podophyllotoxins have a long therapeutic history, with references as early as AD 900 to the use of the roots of wild chervil to treat cancer. Sandoz Pharmaceuticals synthesized nearly 600 derivatives of podophyllin in the 1950s and 1960s and identified two active compounds, etoposide and teniposide (Fig. 8.1) with a unique mechanism of action.1 Previous analogues had arrested cells in mitosis, but the new derivatives prevented proliferating cells from entering mitosis and reduced the mitotic index to zero. Subsequent studies identified topoisomerase II as a primary cellular target of epipodophyllotoxins.
Hypertension in end-stage renal failure
Authors: Ribstein Jean , Mourad Georges , Argiles Angel , Mimran Albert
Published: October 2023

Hypertension can cause or promote renal failure. In most cases, the process of renal deterioration is quite slow, and coronary or cerebrovascular events occur beforehand as indirect complications of the hypertensive process. In recent years, a decrease in cerebrovascular and coronary mortality has been observed in several (but not all) countries, whereas the prevalence of end-stage renal failure (ESRF), as well as congestive heart failure, has increased. The follow-up of large cohorts within a substantial number of years has indicated that hypertension is an independent risk factor for ESRF, particularly in African-Americans.
Diagnosis and management of ischaemic heart disease in end-stage renal failure
Authors: Chesser Alistair M S , Savage Tessa
Published: October 2023

Despite advances in dialysis and transplantation therapy, the prognosis of patients with end stage renal failure (ESRF) remains poor. Data from the United States Renal Data System reveal that the 5-year survival of all patients commencing dialysis is 29.4%. Of these deaths, 47.2% are of cardiac origin. Acute myocardial infarction is the cause of death in 10.5% of all ESRF patients, and ‘cardiac arrest’ the cause of death in 20.2%. The prognosis for diabetic patients is less good still. Twenty-seven per cent of diabetic patients commencing dialysis treatment fail to survive 1 year. Irrespective of transplantation status, 44.5% of all deaths in diabetic patients with ESRF are secondary to cardiac causes.
Management of peripheral arterial disease among end-stage renal failure patients
Authors: Koskas Fabien , Cluzel Philippe , Deray Gilbert , Petitelere Thierry , Barrou Benoît , Bitker Marc-Olivier , Kieffer Edouard
Published: October 2023

Peripheral arterial complications of end-stage renal failure (ESRF) are the non-coronary arterial lesions that occur because of ESRF or are worsened by its presence. The attribution of peripheral arterial lesions to ESRF alone is questionable compared with their representing the complication of well-defined vascular risk factors commonly present in ESRF patients, including diabetes mellitus and hypertension (HT). Although ESRF alone is able to induce arterial lesions, hints towards arterial lesions existing before the development of uremia should evolve more rapidly than among non-ESRF patients. This explains the importance of a steady arterial surveillance among ESRF patients using non-invasive methods. Preventive detection of arterial lesions through complete clinical examination, duplex scanning, and computed tomography (CT) scanning in selected cases offers a unique opportunity for earlier management of such lesions.
Specific cognitive enhancers
Authors: Friedman Joseph I
Published: October 2023

Although typical neuroleptics are effective in the management of positive symptoms associated with schizophrenia, they do not address the cognitive dysfunction (Cleghorn et al., 1990; Seidman et al., 1993; Verdoux et al., 1995). Most patients experience cognitive deficits despite having achieved remission of positive symptoms (Nuechterlein and Dawson, 1984; Bilder et al., 1992), Therefore, cognitive symptoms have emerged as an independent feature of schizophrenia that needs to be targeted for remediation independently of positive symptoms.
Immunotherapy Of Bladder Cancer
Authors: Hall David , Battin John , Nseyo Unyime O , Lamm Donald L
Published: October 2023

In the United States the incidence of bladder cancer increased 26% from 1956 to 1990, nevertheless mortality has declined by 8% following the introduction, of bacille Calmette-Guérin (BCG) immunotherapy and effective cisplatinum-based combination chemotherapy. Intravesical immunotherapy has reduced disease progression and may have contributed to observed decline in mortality. The antineoplastic effect of the live attenuated tuberculosis vaccine, BCG, was reported by Pearl in 1929. However, Morales, in 1976 was the first to report the results of intravesical BCG in the management of early stage bladder cancer. Many clinical investigations have demonstrated the superior benefit of intravesical BCG in the management of superficial bladder cancer, and currently BCG remains the gold standard by which treatments of aggressive superficial bladder cancer must be compared. This chapter contains highlights of the recent advances in intravesical immunotherapy of bladder cancer, summarizes the mechanisms of action of BCG, and reviews the important role of intravesical BCG immunotherapy as well as other immunotherapeutic agents in the therapy and prophylaxis of superficial transitional cell carcinoma (TCC) of the urinary bladder.
Novel Therapeutic Strategies For Bladder Cancer
Authors: Papamichael D M , Syrigos K N
Published: October 2023

The most widely employed chemotherapy programmes in the advanced as well as adjuvant disease setting are the M-VAC (methotrexate, vinblastine, adriamycin, cisplatin) (1) and CMV (cisplatin, methotrexate, vinblastine) (2) regimens. Their toxicities are predictable, with neutropenic fever and mucositis being the most serious (3). However, peripheral neuropathy, renal function impairment as well as diminished auditory acuity are also observed. In a number of trials the treatment-related mortality had been of the order of 3–4% (2,3). Although overall response rates achieved with combination chemotherapy regimens range from 50% to 70%, long-term survival figures are very disappointing; 10% of patients with metastatic disease and 20–30% of patients with nodal involvement at presentation, are expected to live long term (3–6). Patients with a poor performance status and visceral or bony metastatic disease tend to fare worse, with a median survival of 6 months.
How Your Back and Neck are Built and Work
Authors: Burn Loïc
Published: October 2023

Before discussing the huge and growing problem of back and neck pain it is essential to have some idea of how the whole system is built and works. We will show you what an extraordinarily complicated structure it is. This may help you to appreciate some of the problems clinicians face when trying to make an accurate diagnosis. We will also demonstrate how some positions put you at greater risk of developing pain, and how if specific neck structures are damaged, manipulation can be dangerous.
Your Neck And Back Pain Diagnosis
Authors: Burn Loïc
Published: October 2023

More than for any other medical problem, it is difficult to say what causes neck and back pain and also to define what exactly it is. On the other hand, the CSAG guidelines (see Chapter 1) include a system of case analysis to be used by doctors which greatly clarifies matters not only for them but also for you. This is particularly important with the existence of literally hundreds of confusing diagnostic labels. This chapter explores the issues and, hopefully, reassures you.
People Who May Help You
Authors: Burn Loïc
Published: October 2023

In this chapter we look at the different people who could treat your back or neck. In each case we try to answer some of the following questions: Many of the professions listed in this chapter have umbrella organizations (addresses of which are given in Appendix 3) to which any reputable practitioner will belong. They can advise you about the relevant complementary therapists in your area; your doctor will advise you about other orthodox practitioners that you may see. In addition, you can always contact the NBPA for information and advice.
Helpline Queries: Specific Questions And Answers
Authors: Burn Loïc
Published: October 2023

In the last chapter we considered the groups of problems that concern you most and how to set about tackling them. Here we discuss those specific back and neck questions that are most often asked. Some of the questions seek only further information; but in three quarters of cases advice is wanted. In a third of cases the problems are so individual that no book can give dogmatic answers. For example, with regard to surgery, each situation has to be assessed on its merits and you will have to rely essentially on your surgeon’s experience and judgement. On the other hand we can direct you to where you can find the information you need and indicate how you should approach the problem.
Fatigue in lay conceptualizations of health and illness
Authors: Krishnasamy Meinir , Field David
Published: October 2023

In Chapters 1 and 2 the incidence and prevalence of fatigue as a facet of the cancer experience has been clearly stated. Its complex, multidimensional nature has been explored and challenges inherent to its management will be alluded to in Chapter 12. Nevertheless, despite an acknowledgement of its multifaceted nature and its propensity to impact on numerous domains of quality of life (see Chapters 6 and 13) little has been written of lay conceptualizations of fatigue within the context of cancer and cancer treatment.
The experience of cancer-related fatigue
Authors: Armes Jo
Published: October 2023

Fatigue is a common complaint, experienced both in health and in illness, as indicated by Hotopf (see Chapter 1) and Krishnasamy and Field (see Chapter 5). Among cancer patients it has been identified as one of the most common symptoms experienced (Nail 2002), and over the last 15 years there has been a growing recognition of its deleterious impact on those affected.
Carers, caring, and cancer-related fatigue
Authors: Krishnasamy Meinir , Plant Hilary
Published: October 2023

Despite an acknowledgement of the prevalence of fatigue as a facet of the lives of individuals living with and caring for people with cancer (Zarit 1994; James 1998), little is known of the ways in which carers experience or articulate the physical and emotional dimensions of fatigue associated with their caring role. In addition, ways in which family members perceive and interpret fatigue as a manifestation of cancer, and its treatment, have largely been overlooked.
The experience of cancer-related fatigue in children, adolescents, and their families
Authors: Hockenberry Marilyn , Hinds Pamela , Barrera Patrick , Burleson Cindy , Gattuso Jami , Kline Nancy , Bottomley Sarah , Alcoser Patricia , O’Neill Jill Brace
Published: October 2023

Living with cancer may affect every aspect of a child’s or adolescent’s life, disrupting relationships with family members and friends and having a negative impact on a young person’s future development of important social skills (Green 1998; Weinblatt 1998).
The assessment and measurement of fatigue in people with cancer
Authors: Wu Horng-Shiuann , McSweeney Maryellen
Published: October 2023

Cancer-related fatigue (CRF) is a pervasive subjective experience that can affect all aspects of a person’s life. Assessment of CRF is the key to recognizing and managing this distressing symptom (Bender et al. 2002; Patrick et al. 2002; Ressel 2003). Research on the assessment and measurement of CRF has many encouraging aspects. These include the initial formulation and preliminary testing of a diagnosis of CRF within the framework of ICD-10 diagnoses and the development of Cancer-Related Fatigue Guidelines (Mock et al. 2003) that incorporate evidence-based fatigue assessment and evaluation.
The therapeutic effects of exercise on fatigue
Authors: Porock Davina , Fu Mei
Published: October 2023

Fatigue has been identified as the most distressing and prevalent cancer-related symptom in a variety of cancer populations.
Fukuyama congenital muscular dystrophy
Authors: Saito Kayoko , Kobayashi Makio
Published: October 2023

Fukuyama congenital muscular dystrophy was accepted as an entity by many Japanese investigators following this first report (Fukuyama et al. 1981; Kamoshita et al. 1975; Nonaka and Chou 1979), but not internationally as the prevalence of FCMD outside of Japan is extremely low. FCMD was first registered under the OMIM number 253800 in the 7th edition of McKusick ‘Mendelian Inheritance in Man2019 in 1986. Subsequently, it was included formally as an independent subtype of muscular dystrophy in the 10th revision of the Neurological Adaptation of the International
Emery—Dreifuss muscular dystrophy
Authors: Toniolo Daniela
Published: October 2023

Emery–Dreifuss musculardystrophy (EMD) is an inherited disorder characterized by early onset contractures, progressive weakness in humero-peroneal muscles, and cardiomyopathy with conduction block. The disease may have been described for the first time in 1902 (Cestan and Lejonne 1902). However, in 1966, Emery examined a large Virginian family affected with an X-linked muscular dystrophy (Emery and Dreifuss 1966) whose members had been reported earlier by Dreifuss and Hogan (1961) as having a possible benign form of Duchenne muscular dystrophy (DMD). and intellectual impairment (Emery 1989; Emery and Dreifuss 1966; Emery and Emery 1995). Similar symptoms were later described in other families and in 1979 Rowland suggested the term ‘Emery-Dreifuss muscular dystrophy (EMD)2019 for this distinctive disease (Rowland et al. 1979).
Distal muscular dystrophy
Authors: Udd Bjarne , Somer Hannu
Published: October 2023

Distal myopathy has prevailed as the main general term used for this group of primary myopathies. Since they are progressive and genetic disorders, the use of distal dystrophies as the collective term is also correct. In fact, much of the pathology in affected muscles shows findings compatible with dystrophic changes, including fibre necrosis, regeneration, splitting and replacement by fat and connective tissue. During the past decade distal myopathies have entered the new field of molecular genetic clarification. All major entities previously defined on clinical grounds have proved to be distinct categories also by molecular genetic resolution.
Counselling and young people
Authors: Turner Gillian , Mcsloy Joan
Published: October 2023

Young people present to primary care with a variety of issues for which counselling may be useful (Sawyer & Bowes 1999). However, young people may not attend primary care services because of concerns about lack of confidentiality, power and control.
Terminal illness
Authors: Poingdestre Dorothy
Published: October 2023

In this chapter I discuss the range of issues and feelings that are likely to be important in relation to care for those with a terminal illness (see also Spilling 1986; Buckman 2000; .Macleod 2000; Peberdy 2000), in an attempt to demonstrate the contribution which counselling can make to that care.
Key legal issues
Authors: Dickens Bernard M
Published: October 2023

Kidneys are paired in the human body, like lungs, to serve highly particularized and distinctive functions, but legal issues related to kidney function and replacement affect the entire body of legal regulation of human life. Legal issues extend beyond cradle to grave or ‘womb to tomb’ concerns, since they arise before individuals are conceived, and extend to posthumous use of their remains.
Genetics: Ethical issues in kidney disease
Authors: Kielstein Rita , Sass Hans-Martin
Published: October 2023

We are witnessing a revolution of Copernican dimension in medicine and health care, which is based on the rapid and enormous progress in molecular genetics. These revolutionary forces have already entered and soon will influence even more patient care, carrier typing and consultation, and molecular genetic and pharmacogenetic research in nephrology. The new understanding of the genetic origin of some disorders and of the genetic predisposition to many diseases and health disorders creates controversies in the ethical assessment of the new forms of information and intervention; this will be controversial for some time. (Sass, 1996).
Special issues in the care of children
Authors: Trachtman Howard , Grijnsztein Mark , Frank Rachel , Gauthier Bernard
Published: October 2023

Ethical conduct is mandatory in all medical disciplines and it must be exercised in all patients regardless of their underlying disease or their age. Therefore, it might appear superfluous to discuss ethical issues specifically in pediatric patients with renal dis ease. However, this entire volume reflects the fact that special ethical problems occur in the practice of nephrology. Some of these difficulties reflect the variable nature of medical progress in different areas, for example the development of renal transplantation, and the impact of political developments, for example the decision to reimburse the costs of end-stage renal disease (ESRD) therapy in many countries with national funds.
China
Authors: Li Lei-Shi , Yao Xiao-Dan
Published: October 2023

China has a long cultural history of more than 5000 years, and traditional medicine has been an important part of this ancient civilization. In the long run of medical practice, traditional Chinese medicine has developed a classic system of its own (‘ YIN YANG WU-XING’ theory), which is still widely accepted and practised among the vast population of China. In the practice of traditional medicine, ethical disciplines have been established and generally accepted. Confucianism and Buddhism exert prominent influence on medical practice as well as medical ethics. All these combine to form the unique aspect of Chinese medical ethics, which is distinctly different from that of the Western world.
Femoral neck fractures: epidemiology and results and controversies in treatment
Authors: Tsigaras Hany , MacDonald Steven J
Published: October 2023

Hip fractures are a major public health issue globally. The morbidity and mortality associated with these injuries exacts a significant economic and social cost to the patient, the health care provider, and the community.’ Hip fracture is a universal problem with an escalating incidence.2 As longevity continues to increase, the proportion of the population at greatest risk, the elderly, grows.
Criteria for implant selection in revision total hip arthroplasty: a North American perspective
Authors: Rorabeck David A Parker,Cecil H
Published: October 2023

Total hip arthroplasty (IBA) has become one of the most successful and cost-effective orthopaedic interventions.1 However, despite improved long-term results, the large number of arthroplasties performed has predictably led to an increased number of revision procedures which make up a significant proportion of all THA surgery (60).
Bearing surfaces in total hip replacements: state of the art and future development
Authors: McKellop Harry A
Published: October 2023

To understand and compare the wear performance of bearing materials, it is convenient to define some key terms relating to the tribology of artificial joints. For joint replacements, it is most meaningful to define wear as the removalof material from the bearing surfaces in the form of wear particles, since the intensity of the biological reaction is a function of the rate of release of this debris.
Depression and burden in dementia carers: the role of behavioural and psychological symptoms
Authors: Ballard Clive , O’Brien John , James Ian , Swann Alan
Published: October 2023

The majority of people with dementia live in the community, usually supported by one main informal carer giver, on whom the greatest share of responsibility falls. Indeed, the day-to-day rigours of caregiving are extremely demanding, a point made very well in the publication The 36 Hour Day (Mace and Rabins 1981). Caregivers have important mental health needs in their own right, their well-being has a key impact upon the quality of life of the person that they are looking after and they represent the cornerstone of any community care package, without whom institutional care would become necessary for many more dementia sufferers.
Pharmacotherapy of depression
Authors: Ballard Clive , O’Brien John , James Ian , Swann Alan
Published: October 2023

The focus of this chapter will be on the pharmacological management of depression in dementia. Even when a clear diagnosis of clinically significant depression has been made, similar caveats outlined in the previous chapter apply with regard to the need for pharmacological treatment. Careful assessment needs to be made of the distress experienced by the patient and the care givers, the time for which the symptom has been present, and the duration and past history (treated or otherwise) of similar episodes. We saw in Chapter 4 that longitudinal assessment of depression occurring in the context of dementia reveals that only one in five patients experience depression lasting longer than 6 months.
Judgement and science
Authors: Downie R S , Macnaughton Jane , Randall Fiona
Published: October 2023

Any account of what makes a good doctor must have something to say on scientific medicine. The good doctor, whatever else he may be, must at least be some sort of scientist. Now, whereas it is impossible to dissent from this view, it is a much more complex view than might seem to be the case. There are two complexities. First, the assimilation of science by medicine is relevant in different ways to medicine; the impact of science in medical research is different from its impact on clinical practice. In this chapter, we are concerned with science and medical research, and in the next chapter, with science and clinical practice. Second, different sorts of activities count in medical opinion as scientific.
Judgement in public health
Authors: Downie R S , Macnaughton Jane , Randall Fiona
Published: October 2023

We have so far concentrated on the complex ways in which the evidence-base of medicine is modified by judgement in clinical practice. Thus, patient anecdotes and patient consent or refusal of given treatments affect the options available in a clinical situation. Moreover, the doctor’s scientific attitude is modified by his ability to interpret and to have insights about the individual patient. But, as distinct from clinical practice, there is another domain of medicine with its own distinctive evidence-base and its own need for judgements of a different sort—this is the domain of public health medicine, formerly called ‘community medicine’.
Measuring pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Pain is a personal experience which makes it difficult to define and measure. It includes both the sensory input and any modulation by physiological, psychological and environmental factors. Not surprisingly there are no objective measures – there is no way to measure pain directly by sampling blood or urine or by performing neurophysiological tests. Measurement of pain must therefore rely on recording the patient’s report. The assumption is often made that because the measurement is subjective it must be of little value. The reality is that if the measurements are done properly, remarkably sensitive and consistent results can be obtained. There are contexts, however, when it is not possible to measure pain at all, or when reports are likely to be unreliable. These include impaired consciousness, young children, psychiatric pathology, severe anxiety, unwillingness to co-operate, and inability to understand the measurements. Such problems are deliberately avoided in trials.
Size
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

One of the single most important factors we have to get to grips with when evaluating evidence is size. We all occasionally meet people who will maintain that a clinical trial in which a new treatment used in 10 patients is statistically better than placebo in 10 other patients is sufficient evidence to take that new treatment into clinical practice, but that is wrong. Even conventional statistical significance is not very convincing. We conventionally use a 5% significance level, meaning that only one time in 20 should a particular result occur by chance. Yet when we play monopoly we are hardly surprised if we throw a double-six, one chance in 36.
Analgesics for Dysmenorrhoea
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Clinical bottom line. NSAIDs are effective for treating dysmenorrhoea, with NNTs of 2–3 compared with placebo. They also reduce restriction on daily living and reduce absence from work or school. Dysmenorrhoea affects many women of reproductive age, and is a frequent cause of time lost from work or school as well as interfering with daily living. Treatment is usually with NSAIDs and minor analgesics.
Do NSAIDs inhibit bone healing?
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Clinical bottom line. The only evidence that NSAIDs inhibit bone healing comes from animal experiments (of unknown relevance), and in humans from a retrospective series using high doses of intramuscular ketorolac after spinal fusion, plus a small case control study looking at failure of fractured femurs to heal. NSAIDs are effective in reducing postoperative heterotopic bone formation, with an NNT of 3. NSAIDs do not affect risk of fracture in any significant way. Some orthopaedic centres do not allow the use of NSAIDs for postoperative analgesia after fractures or orthopaedic surgery because they are thought to interfere with bone healing. The purpose of this section is to examine the evidence we found for the effects of NSAIDs on bone healing.
Sumatriptan for acute Migraine
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Clinical bottom line. Oral sumatriptan 100 mg has been fully tested in thirteen randomised trials with about 3500 patients. The NNT for 2-h headache response was 3.3 (3.0–3.7). Oral sumatriptan 50 mg has been fully tested in six randomised trials with about 5500 patients. The NNT for 2-h headache response was 4.1 (3.4–5.2). Subcutaneous sumatriptan 6 mg has been fully tested in eight randomised trials with about 900 patients. The NNT for 2-h headache response was 2.0 (1.8–2.2). Intranasal sumatriptan 20 mg has been fully tested in six randomised trials with about 1500 patients.
Prophylaxis for migraine
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

People who have frequent migraines will sometimes need other approaches to treatment than just treatment of the acute attacks. This usually means a prophylactic treatment to try and reduce the number of acute attacks. The evidence on the efficacy of migraine prophylaxis is not extensive but is summarised here. Beta-blockers are competitive antagonists of adrenaline and noradrenaline at beta-adrenoceptors. Propranolol is the most commonly used of the beta-blockers, although timolol, metoprolol and nadolol are also used in migraine prophylaxis. However, there are a number of important side-effects associated with this class of drugs.
Health care and health
Authors: Dolan Paul , Olsen Jan Abel
Published: October 2023

This chapter considers what is meant by health care and health. It looks at what health care does for people, and at what the determinants of ill health are. The chapter is primarily an analytical one but it also highlights some stark inequalities in health care expenditure and health.
Equity-motivated responses to market failures
Authors: Dolan Paul , Olsen Jan Abel
Published: October 2023

There are many reasons why we care for other people’s health to the extent that we are willing to subsidize their use of health care. This chapter begins with an inquiry into altruism, before discussing various aspects of equity. Altruism is discussed through the eyes of ‘the individual as a consumer’, while equity is seen through the eyes of ‘the individual as a citizen’.
The epidemiology of hysterical conversion
Authors: Akagi Hiroko , House Allan
Published: October 2023

Clinical epidemiology is the study of illness in populations. One of its aims is to estimate the magnitude of the problem posed by a particular disorder—usually defined according to the disorder’s frequency and severity in the population. It may also provide clues as to the cause by identifying the characteristics—such as age, sex, socio-economic status, or exposure to risk factors—of those who have the disorder, or by highlighting variations in occurrence over time or between places. The third value of epidemiology is that it can assist in planning treatment trials , successful design of which relies on accurate knowledge of rates of occurrence (to plan recruitment) and of natural history (to estimate sample size).
Conversion, dissociation, or doxomorphic disorder
Authors: Merskey Harold
Published: October 2023

I should begin by explaining or apologizing for a new word: doxomorphic. I hope the importance of the word will be evident later, but for the moment I should simply state its origins. There is an existing word doxogenic which comes from the Greek doxa (opinion) and gennan (to produce) (Dorland 1974). I put this old word forward a few years ago (Merskey 1994) as a step in the neutralization of pejorative descriptions of hysteria, or as an alternative to more ambitious theories of hysteria. I offer doxomorphic as a word to describe symptoms which resemble those due to patients’ ideas. Doxomorphic, unlike doxogenic , does not state an aetiology.
Rehabilitation for hysterical conversion states
Authors: Wade Derick T
Published: October 2023

The management of patients whose neurological symptoms, signs, and disabilities do not have a satisfactory or adequate explanation in terms of an underlying disease or diagnosis has always been difficult for doctors. Such patients challenge doctors and health care professionals in many ways: scientifically (what is the explanation of this state in terms of anatomy and physiology?); practically (how can we help? how much investigation should we undertake?); and ethically (should we simply ignore and discharge such patients? how do health care professionals cope with the irritation they may arouse in themselves?). To many people such patients abuse society’s benefits, failing to follow accepted social rules that people can only exhibit illness behaviour and adopt the sick role when they have a medically legitimate disease (usually taken to mean a pathologically proven disease).
Education about delirium
Authors: Rockwood Kenneth
Published: October 2023

For many years articles were written and lectures given with a title such as: ‘the con- fusion about confusion’, or ‘delirium: a confusing matter’. The intent was to signal that the routine management of the delirious patient was poorly done and that education was an important remedy. After more than 20 years of experience with such presentations, however, I do not think that we can use the term ‘confusion’ in relation to delirium management any longer. The problem is so pervasive and so chronic that our failure to come to grips with delirium must be considered a form of dementia.
Looking into the mind
Authors: Tyrrell David , Fielder Michael
Published: October 2023

‘History is more or less bunk’, claimed Henry Ford, and maybe it is. Certainly, if we accept that it is written by the winners, then we must expect some distortion. But here we talk of politics. Other accounts going back over the centuries may be considered more reliable—and, perhaps, more inspiring. Philosophical writings from ancient Greece and onwards continue to guide our thoughts and inform our actions. And amongst these treasures of ancient learning there is much about man’s attempts to understand the workings of the human body, as we discovered in Chapter 1. But what about those obscure areas where the mind plays its part?
Acute inflammatory rheumatic syndromes
Authors: Szer Ilona S
Published: October 2023

The aim of this chapter is to describe the acute and usually self limited inflammatory conditions of children which are manifested by arthritis and must be ruled out before chronic rheumatic conditions, such as Juvenile Idiopathic Arthritis, may be considered. The differential diagnosis of childhood arthritis is extensive, as can be appreciated from algorithms found in Chapter 1.3. To date, over 110 distinct disorders that include arthritis have been identified. Some of these conditions have not yet been recognized in children and some have only been seen in children and not in adults.
Systemic Arthritis
Authors: Prieur Anne-Marie , Malleson, Peter N , Kimura Yukiko
Published: October 2023

The aim of this chapter is to discuss the clinical features, investigations, and epidemiology of Systemic Arthritis. The differing clinical courses of this disease and the impact on prognosis, as well as predictors of outcome, are discussed. In addition, there is a discussion of the chief diagnoses that are often confused with Systemic Arthritis. Systemic Arthritis is classified as belonging in the group of childhood rheumatic diseases gathered together under the umbrella term of Juvenile Idiopathic Arthritis (JIA) [1].
Rheumatoid Factor Positive Polyarthritis
Authors: Gardner-Medwin Janet
Published: October 2023

The aims of this chapter are to discuss the clinical features, investigations, and complications of Rheumatoid Factor (RF) Positive Polyarthritis, which is similar to but is somewhat distinct from rheumatoid arthritis in adults. This chapter also contains a discussion of RF, the presence of which is a requirement in the diagnosis of RF Positive Polyarthritis. Rheumatoid Factor (RF) Positive Polyarthritis is the smallest category of Juvenile Idiopathic Arthritis (JIA), making up about 5% of cases. It is most common in teenage girls, and is associated with a poor prognosis.
Immunopathology of the joint in Juvenile Idiopathic Arthritis
Authors: Wedderburn Lucy R , Nistala, Kiran , Southwood Taunton R
Published: October 2023

The aim of this chapter is to describe the macroscopic pathology, histopathology, and immunopathology of the inflamed joint in Juvenile Idiopathic Arthritis (JIA). The pivotal and multifaceted role of the T cell in mediating inflammation and joint damage, as well as the complex and multifactorial nature of this process, will be discussed. The inflamed joint is central to the clinical manifestations of Juvenile Idiopathic Arthritis (JIA), and understanding the pathological alterations associated with this manifestation is essential to understanding the disease itself.