bluuebunny/crossref_metadata_2025 huggingface dataset:
Soft tissue injuries of the hand
Authors: Stephens Paul , Dunn Roderick
Published: October 2018

Soft tissue injuries of the hand are common and may present variously to therapists, general practice, emergency departments, or surgeons. Simple injuries can be treated without specialist input, but the majority of hand trauma should be referred to dedicated hand surgery centres. Diagnostic error and delayed specialist treatment may lead to poor outcomes and long-term disability. This chapter provides a detailed overview for non-specialists, as well as an aide memoire for hand surgeons and hand therapists. It includes the principles of general wound care, the management of nail injuries, the treatment of extravasation and high-pressure injection injuries, and gunshot wounds. We describe different levels of upper limb amputation, as well as microvascular reconstruction (both replantation and revascularization). We also cover thermal injuries (burns and frostbite), trauma-induced cold sensitivity, and factitious injury.
Reconstruction
Authors: Sabapathay S. Raja , Dunn Roderick
Published: October 2018

The principles of upper limb reconstruction are to perform careful wound excision, fix the skeleton, reconstruct vessels, nerves, tendons, and bone as required (either immediate or delayed), and to obtain primary healing of the soft tissues with healthy vascularized tissue. This enables early movement—ideally, supervised by hand therapists—and generally results in a good outcome. In particular, delayed healing and immobility can lead to long-term morbidity. We provide a general overview of the principles of surgical incisions in the hand, wound care, and suturing, and discuss the use of skin grafts and flaps in the upper limb. We describe reconstruction of the different areas of the upper limb, along with detailed sections on digital and thumb reconstruction.
Skin conditions
Authors: Sierakowski Adam , Dunn Roderick
Published: October 2018

This chapter provides an overview of skin conditions affecting the hand, including nail pathology, benign and malignant skin tumours, and Dupuytren’s disease (DD). Although distortion of the nail occurs most commonly after trauma, nail changes may indicate other systemic causes (e.g. psoriasis), and may occasionally be due to underlying malignancy. Hands are exposed to sunlight and other occupational hazards (chemicals, radiation), and are vulnerable to skin cancer, most commonly squamous cell carcinoma. DD is often familial, commoner in men, and can affect the feet (plantar fibromatosis) and penis (Peyronie’s disease). Discreet areas of DD are now treatable by collagenase injection. Surgery is still indicated to restore function, either by fasciectomy (excision of DD) or dermofasciectomy (fasciectomy plus full thickness skin graft) where skin is involved or there is a secondary skin defect following fasciectomy. Patients should be counselled realistically about the post-operative recovery to full function, and that DD is not curable by surgery.
Osteoarthritis of the hand
Authors: Rust Philippa , Birks Meg , Warwick David
Published: October 2018

The small joints of the hand are vulnerable to osteoarthritis, usually spontaneous but sometimes following trauma or infection. Nodular arthritis and arthritis in the thumb CMC has a benign natural history and most might get a little stiff but pain usually settles and function is good. Precipitous surgical intervention is inappropriate; time, reassurance, occupational therapy, splints, analgesics, and occasionally steroids should always be tried. The choice of surgical treatment depends on the functional needs of the joint—the little and ring fingers need flexibility for grip whereas the index and thumb require stability for pinch. Options include fusion (e.g. thumb metacarpophalangeal joint), excision arthroplasty (e.g. thumb base) and joint replacement (e.g. finger metacarpophalangeal joint)
Nerves
Authors: Crick Alexandra , Warwick David , Dunn Roderick
Published: October 2018

Examination of the nerves of the upper limb and localization of nerve lesions is mysterious to the unfamiliar. This chapter provides a scheme for the neuroanatomy of the upper limb, and for examination and investigation of nerve pathology including a section on neurophysiology. We discuss nerve injury, including pathophysiology and recovery. We describe common compression neuropathies affecting the median, ulnar, and radial nerves, and the brachial plexus lesions including thoracic outlet syndrome. Common tendon transfers are discussed for reconstruction following peripheral nerve injury or other loss of peripheral nerve function, and also for spinal injury at different levels.
Tumours
Authors: Lamyman Michael , Dunn Roderick
Published: October 2018

Hand tumours occur in a spectrum from common benign conditions (such as ganglions) and rare, aggressive metastatic sarcoma. We present a clear account of benign and malignant soft tissue and bone tumours affecting the hand and upper limb, including diagnostic features, useful investigations, and classifications. Treatment plans are discussed, with some operative details for the different types of ganglia.
Growth and nutritional requirements
Authors: Puntis John
Published: October 2018

Energy intake must equal energy expenditure to maintain body weight. For children to grow, energy intake must be greater than energy expenditure. Basal metabolic rate is the amount of energy needed to maintain normal physiological function. Nutrient requirements at different ages are widely available.
Nutritional assessment
Authors: Puntis John
Published: October 2018

Routine assessment of nutritional status should be part of normal practice when seeing any patient. The purpose is to document objective nutritional parameters (e.g. anthropometry), identify nutritional deficiencies, and establish nutritional needs. Protein–energy malnutrition has many adverse consequences including growth failure (identified by reference to standard growth charts). Worldwide, malnutrition contributes to a third of deaths in children under 5 years of age, and one in nine people don’t have enough food to lead an active and healthy life. In developed countries, malnutrition complicates both acute and chronic illness with negative effects on outcomes. In clinical practice, a useful approach to nutritional assessment is to consider three elements: ‘what you are’ (i.e. body habitus—underweight for height; short for age; etc.), ‘what you can do’ (functional activity), and ‘what you eat’ (current nutritional intake).
Breastfeeding
Authors: Puntis John
Published: October 2018

Breastfeeding has many benefits to both mother and infant and the World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months of life. Correct positioning of the baby at the breast and social and emotional support for the mother are among other factors that are important to successful breastfeeding. The ‘Baby Friendly’ initiative sets out ten steps to successful breastfeeding and encourages maternity hospitals to implement these and become accredited. The WHO ‘International Code of Marketing of Breast Milk Substitutes’ gives clear guidance on acceptable practices to formula manufacturers so that breastfeeding is not undermined. ‘Tongue tie’ has increasingly become regarded as a cause of maternal pain and difficulty latching on during breastfeeds. However, estimates of prevalence show huge variation and there is no agreed standard method of assessment. In addition, the risks of frenotomy need to be balanced against any possible benefit.
Formula and complementary feeding
Authors: Puntis John
Published: October 2018

Some mothers are unable, or choose not, to breastfeed; bottle-feeding carries certain risks that can be minimized by following simple rules. Formula must satisfy all the nutritional needs of an infant and recommendations for the composition of infant formula have been adopted in the Codex Alimentarius. The two main types of formula differ in protein composition (whey or casein predominant). Follow-on formula are designed for infants from 6–12 months of age. Soy protein is an alternative to cow milk protein, but because of its high phytoestrogen content, should not be used before 6 months. Unmodified cow’s milk as the main drink before 12 months of age is associated with iron deficiency. ‘Complementary feeding’ embraces all solid and liquid feeds other than breast milk and infant formula. There is considerable international variation in practice with regard to introduction of complementary feeds, but in general this should not be before 17 weeks, and not after 26 weeks.
The premature newborn
Authors: Puntis John
Published: October 2018

Infants born at 24 weeks’ gestation now have a 40% chance of survival, rising to 80% at 26 weeks. Many have difficulty tolerating enteral feeds because of gastrointestinal immaturity; during this time parenteral nutrition is commonly given. Undernutrition in the early weeks of life may have lasting effects on developmental outcomes and increase the risk of certain chronic diseases in adult life (e.g. hypertension, cardiovascular disease, diabetes). Breast milk appears to confer some protection against necrotizing enterocolitis and be good for brain development. There has been a resurgence of investment in milk banks so that donor milk from nursing mothers in the community can be processed and given to preterm infants whose mothers cannot provide sufficient milk of their own. When breast milk is unavailable, preterm formula should be used, and following discharge from hospital (when many infants are showing a growth deficit), a nutrient-enriched formula can be given.
Growth faltering (failure to thrive)
Authors: Puntis John
Published: October 2018

Growth faltering or ‘failure to thrive’ is a descriptive term implying failure not only of growth, but also impairment of other aspects of a child’s well-being. Weight crossing down over two major centiles is often taken as an indication for referral to a paediatrician. In the absence of specific symptoms or physical findings (other than poor growth) an underlying illness is unlikely. Few investigations may be needed, and should be guided by symptoms and any clinical findings. Coeliac disease and occasionally Crohn’s disease may present as growth faltering in the absence of symptoms. For some children, multidisciplinary assessment is appropriate; home visits at meal times can be particularly instructive.
Micronutrients and minerals
Authors: Puntis John
Published: October 2018

The term ‘micronutrients’ includes two main classes of nutrient substances required in the diet in very small amounts: the essential organic micronutrients (vitamins) and the essential inorganic micronutrients (trace elements). The clinical effects of individual vitamin and trace element deficiencies are described, with emphasis on vitamin D. Children with restricted diets, malabsorption and maldigestion are particularly at risk.
Nutrition support teams
Authors: Batra Akshay , Puntis John
Published: October 2018

The chapter discusses the role of nutritional support teams in identification, prevention, and management of malnutrition in children.
Enteral nutritional support
Authors: Batra Akshay , Puntis John
Published: October 2018

This chapter discusses assessment, management, and monitoring of children on enteral nutritional support. It is a practical guide to types of enteral feeding tubes and different formulations of feeds, including a blenderized diet used to provide nutrition.
Refeeding syndrome
Authors: Batra Akshay , Puntis John
Published: October 2018

Malnutrition is a problem in children with chronic illnesses. Aggressive nutritional rehabilitation can put them at risk of refeeding syndrome. This chapter highlights the risk factors and management of refeeding syndrome.
Parenteral nutrition
Authors: Batra Akshay , Puntis John
Published: October 2018

The chapter provides practical tips on management of children requiring parenteral nutrition including monitoring while on parenteral nutrition. It also discusses management of common complications such as catheter-related bloodstream infections and intestinal failure-associated liver disease.
Eating disorders
Authors: Puntis John
Published: October 2018

Anorexia nervosa, bulimia nervosa and binge eating disorder, and avoidant–restrictive food intake disorder are the main categories of eating disorder. They are associated with impairment of physical health and social, emotional, and cognitive development; outcomes are poor if untreated. Ten times more girls are affected than boys. The primary aim of management is to establish regular meals and snacks spread throughout the day. Severely malnourished children are at risk of refeeding syndrome and require expert care (outlined in the published guideline ‘Junior MARSIPAN’).
Carbohydrate intolerance
Authors: Puntis John
Published: October 2018

Symptoms such as watery diarrhoea, wind, and abdominal cramps should raise the possibility of carbohydrate intolerance. Lactose maldigestion is the most common cause and can be transient, after gastroenteritis, or in some populations is genetically determined with increasing age. Congenital sucrase–isomaltase deficiency (CSID) is underdiagnosed but amenable to treatment with dietary modification and oral enzyme replacement. Glucose–galactose malabsorption presents with watery diarrhoea from the time of first feeds. Investigations include sugar chromatography (when available), breath hydrogen testing, mucosal enzyme assay, and gene testing for CSID.
Obesity
Authors: Puntis John
Published: October 2018

Obesity is the most common nutritional disorder affecting children in the developed world. The marked increase in prevalence is linked to environmental and behavioural changes; children’s energy expenditure has undoubtedly decreased. Obese children often become obese adults; children from lower socioeconomic groups are more likely to be obese. Obesity is a risk factor for ischaemic heart disease, hypertension, stroke, type 2 diabetes, depression, and certain cancers. There is no proven preventive strategy but limiting time in front of computer and TV screens appears important. Obese children are relatively tall; the combination of obesity with short stature suggests underlying disease (e.g. hypothyroidism; Cushing’s syndrome should be considered). Treatment should be considered if body mass index is greater than the 98th centile and the family are willing to make the necessary lifestyle changes. Drug and surgical treatments have a role in a small number of children, but should always be used on a background of a behavioural weight management programme.
Gastrointestinal manifestations of cystic fibrosis
Authors: Beattie Mark
Published: October 2018

This chapter discusses the gastrointestinal manifestations of cystic fibrosis. This includes sections on pancreatic insufficiency and gut disease. Management of gut symptoms are discussed in detail (cystic fibrosis related and non-cystic fibrosis related) offering a practical approach for the reader.
Nutritional management of cystic fibrosis
Authors: Heather Nicky
Published: October 2018

This chapter covers the nutritional management of cystic fibrosis. This includes discussion of the risk factors for malnutrition, assessment of nutritional status, assessment of nutritional requirements, and practical management. The chapter includes a section on pancreatic enzyme replacement therapy.
Cystic fibrosis-associated liver disease
Authors: Kyrana Eirini , Dhawan Anil
Published: October 2018

The chapter on cystic fibrosis-associated liver disease discusses the pathophysiology and clinical features of this condition. In addition it covers diagnosis, including liver biopsy, transient elastography, the role of endoscopy and magnetic resonance retrograde cholangiopancreatography, and then discusses management including the role of transplantation.
Gastro-oesophageal reflux
Authors: Batra Akshay , Beattie Mark
Published: October 2018

Gastro-oesophageal reflux is a common problem in infancy and needs to be differentiated from gastro-oesophageal reflux disease. The chapter discusses the epidemiology, clinical features, role of investigations in gastro-oesophageal reflux disease and treatment options available.
Gastrointestinal polyposis
Authors: Beattie Mark
Published: October 2018

This chapter discusses the gastrointestinal polyposis syndromes that can present in childhood. This includes juvenile polyps, juvenile polyposis, Peutz–Jeghers syndrome, Cowden syndrome, Bannayan–Riley–Ruvalcaba syndrome, familial adenomatous polyposis coli, Gardener syndrome, Turcot syndrome, hyperplastic polyps, and inflammatory polyps.
Intractable diarrhoea of infancy
Authors: Wiskin Anthony , Beattie Mark
Published: October 2018

This chapter discusses chronic diarrhoea with onset in the first few weeks/months of life (intractable diarrhoea of Infancy). Multiple conditions are discussed including the pathophysiology, clinical features, and management.
Acute abdominal pain
Authors: Beattie Mark , Stanton Mike
Published: October 2018

This chapter discusses the assessment, differential diagnosis of acute abdominal pain. Appendicitis and intussusception are discussed in detail.
Recurrent abdominal pain
Authors: Tighe Mark , Beattie Mark
Published: October 2018

Recurrent abdominal pain occurs in 10–15% of school-aged children and is a frequent presenting complaint in general practice and general paediatric and paediatric gastroenterology clinics. Patients often have vague symptoms and investigation usually results in a low yield of organic disease. Treatment strategies are varied and often subjective with limited evidence upon which to base them. This chapter includes a general overview, classification, discussion of the complex and multifactorial aetiology, therapeutic approach, and outcome. It discusses a recommended clinical approach for the management of complex cases.
Chronic constipation
Authors: Beattie Mark
Published: October 2018

Chronic functional constipation is a common problem in childhood. Without early treatment, the condition is likely to impact all aspects of the child’s life, including education and psychological well-being as well as physical growth and development. The key to successful management is early diagnosis and prompt treatment with an emphasis on practical management strategies with multidisciplinary support where needed. Conventional treatment relies on patient education, behavioural modification, and drugs. This chapter discusses the epidemiology, clinical assessment, indications for further investigation, management including behavioural strategies, and drug treatment.
Perianal disorders
Authors: Batra Akshay , Beattie Mark
Published: October 2018

This chapter describes the conditions affecting the perianal region and their management.
The pancreas
Authors: Grammatikopoulos Tassos
Published: October 2018

The chapter on the pancreas includes some basic facts in regards to anatomy and physiology, but then goes on to focus on the diagnosis and management of pancreatitis, hereditary pancreatitis, and autoimmune pancreatitis. It covers the recent advances in genetics, nutritional management, interventional diagnostic or therapeutic procedures, and recommended treatment regimens.
Liver function tests
Authors: Kyrana Eirini
Published: October 2018

The chapter on liver function tests covers the main liver function tests used in everyday practice when assessing liver dysfunction and gives an overview of their significance.
Liver biopsy
Authors: Martin Lily
Published: October 2018

The chapter on liver biopsy in children includes the indications and contraindications of this procedure. It describes the various techniques used, as well as the pre- and post-procedure management and the common complications.
Neonatal jaundice
Authors: Kyrana Eirini , Tan Nancy
Published: October 2018

The chapter on neonatal jaundice covers the pathophysiology of jaundice with an extensive differential for unconjugated and conjugated jaundice. It includes suggested investigations and management, as well as more detailed information on idiopathic neonatal hepatitis.
Alpha-1 antitrypsin deficiency
Authors: Hadzic Dino
Published: October 2018

The chapter on alpha-1 antitrypsin deficiency describes the genetics and the pathogenesis of this disorder as well as the clinical features of the homozygous PiZ alpha-1 antitrypsin deficiency and its management.
Alagille syndrome
Authors: Baker Alastair
Published: October 2018

The chapter on Alagille syndrome covers the genetics and pathogenesis as well as the features and clinical presentation of this syndrome. It also discusses the complications as well as the suggested medical and surgical management for this condition.
Familial and inherited intrahepatic cholestatic syndromes
Authors: Baker Alastair
Published: October 2018

The chapter on familial and intrahepatic cholestatic syndromes covers the nomenclature and current changes in this group of disorders as well as their pathophysiology, classification, clinical features, and current management.
Non-alcoholic fatty liver disease
Authors: Fitzpatrick Emer
Published: October 2018

The chapter on non-alcoholic fatty liver disease includes the risk factors for this ever-increasing condition, the pathophysiology, as well as the differential of hepatic steatosis. Finally it includes the most current principles of its management.
Hepatitis C
Authors: Bansal Sanjay
Published: October 2018

The chapter on hepatitis C discusses the epidemiology, risk of transmission, and the clinical features of this infection. It explains the serology and then gives an update of treatment recommendations for children with interferon as well as directly acting antiviral agents.
Complications of chronic liver disease
Authors: Shanmugam Naresh P , Basude Dharam
Published: October 2018

The chapter on complications of chronic liver disease gives an overview of the definition, pathophysiology, diagnosis, and management of the various complications that accompany chronic liver disease. It includes among others, malnutrition and growth failure, hepatic encephalopathy, hepatopulmonary syndrome, hepatorenal syndrome, portal hypertension, and spontaneous bacterial peritonitis.
Nutritional management of liver disease
Authors: Mancell Sara , Kamat Deepa
Published: October 2018

The chapter on nutrition and liver disease describes the pathophysiology of the malnutrition that frequently accompanies chronic liver disease in children and then discusses the suggested management as well as ways of nutritional assessment and monitoring of the children. There is also a section of specific suggestions for various conditions such as biliary atresia, Alagille syndrome, Wilson disease, non-alcoholic fatty liver disease, as well as an overview of the various special feeds and supplements used in these conditions.
Acute liver failure
Authors: Shanmugam Naresh P , Bansal Sanjay
Published: October 2018

The chapter on acute liver failure includes the definition, aetiology, and management of this condition. It discusses the frequently associated complications (neurological, haemodynamic, coagulopathy, infectious, and metabolic) and its prognosis, as well as the role of liver transplantation and liver support systems in its management.
Portal hypertension
Authors: Grammatikopoulos Tassos
Published: October 2018

The chapter on portal hypertension includes the definition and pathophysiology of this condition. It presents the currently accepted classification of varices, the associated clinical features, and subsequently discusses the medical, endoscopic, and surgical management of portal hypertension. Prediction tools are also discussed as well as the management of acute variceal bleeding.
Deconstructing the Interview
Authors: Harding Duncan
Published: October 2018

The professional interview is a charged psychological encounter and hurdle, necessary for all of us to traverse in order to move on in our lives and careers. The interviewer is the gatekeeper who holds the keys to our brighter future. This book is a detailed examination of the interview experience and our role as the interviewee within it. This book does not consider the content required for any given interview; instead, it looks in detail at the interview processes and performance from a psychological perspective in order to be the best we can be. Deconstructing the Interview teaches a way of mindfully connecting with the interview space, operating externally in the room, and guiding our answers and performance with situational awareness and an enhanced understanding of the psychological factors at play. As well as communication skills, both verbal and non-verbal, this book considers in detail our interface with the external world around us; to improve and refine our interview skills, and to operate in the room as our true authentic selves. Here we accept and embrace anxiety as an essential part of this process, and we choose to be ‘mindfully anxious’. This book breaks down the interview stage and its players from a psychological perspective, and helps the reader build interview skills from the ground up. This is a new and novel approach in helping the reader prepare for the interview process, and builds on the author’s previous book in this series (Deconstructing the OSCE, 2014, OUP).
The road ahead
Authors: Harding Duncan
Published: October 2018

Deconstructing the Interview is a book aimed primarily at health practitioners, in all levels of training, but is also designed to be useful for anyone doing a job interview. This chapter introduces some of the concepts considered in this book, and explains the layout of the book as a whole. The chapter discusses clinical interviews along with some of the skills that will be developed to give the best interview performance. It introduces the modular dynamic skillset: how to refine our innate skills and how to process our content skills. It sets out a new perspective for candidates: one of change for the better.
Ground zero
Authors: Harding Duncan
Published: October 2018

This chapter begins the journey into our psychological processes, and it starts by considering who we are, what brought us to this point, and why we are here. This is our ground zero, and this chapter will begin our processes of psychological dissection and reconstruction. This chapter considers what it means to be a good candidate from the point of view of the interviewee and the interviewer, while at the same time being authentic. It will also explore what it means to be, and the importance of being, self-aware, as well as discussing our core internal state, and being mindfully anxious.
Being connected
Authors: Harding Duncan
Published: October 2018

Being connected to the interview process as a whole, and the interviewer in particular, is essential. This chapter considers our empathy and discusses ways of utilizing this in the interview as an applied skill. The chapter thinks about the emotional weight driving our connection with the interviewer, and the value of pitching that emotion at the right level. It also considers the importance of our speech, body language, and facial expression, taking a detailed look at each. This chapter includes an exercise to help develop key empathic skills, skills which can be used to maximize our performance during the interview.
A psychological arsenal
Authors: Harding Duncan
Published: October 2018

This chapter works through different aspects of a psychological skillset in the interview. It starts with psychological optimization, discussing what that is and the importance of being able to use it as an interview tool. The chapter moves onto an explanation about the psychological technique of reality checking and how this can help in situations where we may be overwhelmed by extreme anxiety. It then discusses the value of being calm in chaos. The chapter revisits mindfulness and how to achieve a state of mindfulness with a helpful exercise that can be practised throughout the day. It then looks at the concept of operating externally and considers the different kinds of potential psychological identifications at play in the interview.
Communication skills
Authors: Harding Duncan
Published: October 2018

This chapter considers our communication skills in the interview and describes techniques to help communicate effectively with the interviewer. It starts by looking at the psychological context of communication, and then moves onto verbal communication, considering the way content is delivered in its conciseness, tone, and volume. It discusses depth and breadth of content and how to hint at a broader level of understanding in the interview without straying from the question. Our non-verbal communication and expression reflects our core underlying state and this theme is explored by considering body language and facial expression, appropriate language, signposting, and summarizing. The chapter discusses the illusion of structure and includes an exercise to improve our dissemination, accuracy, and fluency of speech. The chapter finishes by learning how to listen and thinking about what makes an expert communicator.
Reviewing and refining
Authors: Harding Duncan
Published: October 2018

This is the final chapter in part two of this book, and it aims to pull the psychological learning together in a pragmatic way. It considers practice and processes of our psychological skills, i.e. in order to achieve more we must accept our vulnerability and realize we are not infallible. These psychological skills should be considered as a passive skillset, with rehearsal becoming second nature, underpinning the interview performance. The chapter reiterates the utmost importance of being present in the interview room and discusses the advantage of being an actor. It finishes by reflecting on our intricate psychological construction, built over the preceding chapters in this book.
Skills toolkit 3: Wild cards
Authors: Harding Duncan
Published: October 2018

This chapter considers some generic psychological strategies for dealing with unknown elements in the interview, the wild cards. The wild card allows the interviewer to see how a candidate goes about solving a problem that has not been pre-prepared, and how the journey of the problem-solving process might be more important to the interviewer than arriving at the answer. The chapter discusses facing the unknown and considers a way of reacting and adapting in the interview. It uses an exercise to develop a method to deal with a wild card in the interview, and then considers how to discover your edge in this process. Finally, the chapter discusses the importance of endings and closure after a wild card scenario.
Skills toolkit 4: The non-technical expert
Authors: Harding Duncan
Published: October 2018

This chapter considers non-technical skills as they pertain to the interview. It starts by discussing the importance of soft skills in the interview: our presence, attitude and professionalism, the way we process and react, our overall manner, and how these can fall away when we are stressed and pushed into a survival mode. The chapter then explores the following soft skills in further detail, looking at each in turn: eye contact and touch, warmth and professionalism, empathy and distance, confidence and humility, and then body language and the non-verbal. The chapter considers being a friend and colleague to the interviewer, and finally it discusses the importance of our insight and our capacity for change in this interview process.
Generic approach 1: Modular, dynamic skills
Authors: Harding Duncan
Published: October 2018

This chapter considers a generic approach to the interview on the basis that such an approach offers a better performance and also improves our ability to learn from mistakes for the benefit of future interview attempts. The chapter starts with discussing a modular dynamic skillset, the advantage of breaking things down psychologically and packaging those skills in order to transfer them to any given situation. It looks at how this might be applied in the interview and works through an exercise to increase our flexibility of thought as an active, applied psychological process. Finally, the chapter then works to develop a way of reading the interviewer themselves in the room.
Generic approach 2: Generic templates
Authors: Harding Duncan
Published: October 2018

This chapter continues to consider a generic approach in the interview, and describes a generic template that can be applied to any answer to questions in the interview. It details the steps in this template, and each of these steps is examined in turn. The focal problem looks at what is actually being asked by the interviewer and how the answer should be moulded to be relevant to the interview. Casting a wider net involves checking for cues from the interviewer that you are going in the correct direction for the given task. Moving forwards shows the interviewer that you are working through the task in a structured way, leading up to a careful resolution before showing your cards, and once sure of the final answer, delivering the finished question.
Basic MR physics
Authors: Kozerke Sebastian , Boubertakh Redha , Miquel Marc
Published: October 2018

In magnetic resonance, the properties of protons in tissue giving rise to so-called magnetic moments are exploited. The sum of many magnetic moments yields what is referred to as net magnetization, which can be seen as similar to the magnetization a bar magnet produces. The relation and interaction between magnetic moments, net magnetization, the static magnetic field, and radiofrequency fields are discussed. It is shown that radiofrequency excitation can be used to manipulate the net magnetization, such that it can be detected using radiofrequency antennae or coils. Upon excitation, the net magnetization will recover back to its equilibrium orientation with tissue-specific time constants for the transverse and longitudinal components, which, in turn, are important sources of image contrast in cardiac imaging. The discussion concludes with a foray into susceptibility and chemical shift effects resulting from different molecular environments in which protons can reside and which provide additional image contrast mechanisms.
Motion compensation
Authors: Kozerke Sebastian , Boubertakh Redha , Miquel Marc
Published: October 2018

This chapter introduces the different methods used to synchronize pulse sequences with both cardiac and respiratory motions, to suppress motion-related blurring and image artefacts. A single frame or a series of images (cine imaging) can be acquired at different time points (cardiac phases) throughout the cardiac cycle by detecting the patient’s heart rate, usually by using an electrocardiogram (ECG) or, in case of poor ECG signals, a pulse oximeter signal. Fast single-shot and segmented k-space acquisition techniques are introduced, and for segmented cine imaging, both prospective and retrospective gating techniques are described. To suppress breathing motion artefacts, acquisitions use respiratory motion techniques. For short acquisition durations, breath-holding is the easiest method to stop the patient’s breathing during data collection. However, for long scans, respiratory gating or respiratory navigated techniques can be used. The principles of these techniques and their applications are presented.
MR angiography
Authors: Kozerke Sebastian , Boubertakh Redha , Miquel Marc
Published: October 2018

The appearance of blood on magnetic resonance (MR) images is directly linked to its flowing nature. The contrast mechanism relies on the time-of-flight mechanism. In spin echo sequences, the excited blood flows out before the echo is created, resulting in black blood images, whereas in gradient echo images, the rapid succession of radiofrequency pulses saturates stationary signals, while fresh blood continuously flows in, leading to bright blood images. This phenomenon can be exploited to create inflow or time-of-flight angiography. It is also possible to encode the movement by using gradients that create phase differences between stationary and moving tissues. This technique, known as phase contrast angiography, can be used to image the venous and arterial phases separately. It also forms the basics of blood flow quantification. Finally, it is possible to use gadolinium-based agents to acquire contrast-enhanced angiographies.
MRI set-up and safety
Authors: Luechinger Roger , Sommer Torsten
Published: October 2018

Magnetic resonance imaging (MRI) is a safe diagnostic tool, with several hundred millions of safe diagnostic studies performed to date. However, there have been at least 15 published cases of patient deaths associated with MRI scanning: ten patients with implanted pacemakers, two patients with an insulin pump, one patient with a neurostimulator, one patient with an aneurysm clip, and one child killed by an oxygen tank. Additionally, hundreds of cases of severe burns or injuries due to ferromagnetic projectiles have also been reported. The main sources of all these risks are the electromagnetic fields of the MRI scanner used to create the images.
Morphology
Authors: Baksi A John , Desai Milind Y , Mohiaddin Raad H
Published: October 2018

Cardiovascular magnetic resonance (CMR) allows a detailed assessment of cardiac morphology in health and disease, facilitated by its high spatial resolution, large field of view, diverse soft tissue contrast, and the ability to characterize tissue composition. CMR images can be acquired in standard views, and their systematic analysis allows an appreciation of normal cardiovascular morphology (the form and structural relationships of the heart and vessels) and provides a frame of reference for comparison and quantification and detection of pathology. Understanding morphology in relation to function is fundamental to determining whether the images acquired by CMR represent normal or abnormal findings. This chapter describes the CMR methods most commonly used for morphological assessment of the heart and vasculature and describes normal cardiovascular morphology and the characteristic features of the principal cardiac structures.
Global and regional cardiac function
Authors: Maceira Alicia M , Young Alistair A
Published: October 2018

Cardiovascular magnetic resonance is currently the most accurate and reproducible method for the measurement of biventricular global and regional systolic function, as well as diastolic and atrial function. Regional wall motion can be visually evaluated and quantified with tissue tagging or feature tracking analysis techniques. Wall motion analysis is usually performed at rest but can also be done with low-dose and high-dose dobutamine. Segmental strain is best measured with tissue tagging or displacement-encoded phase contrast imaging. Current analysis software enables the measurement of ventricular volumes throughout the cardiac cycle, and assessment of left and right ventricular diastolic function can be done by evaluating the time–flow curve, derived from the volume–time curve obtained in the volumetric analysis. Although contrast between flowing blood and the myocardium in cardiac cine images is typically excellent, the precise placement of the contours is reader-dependent and training is highly recommended due to the subjective nature of contour placement.
Mapping techniques
Authors: Ferreira Vanessa M , Messroghli Daniel
Published: October 2018

Parametric mapping provides quantitative information on changes in magnetic properties of the heart, which reflect alterations in myocardial tissue composition and their environment. These magnetic properties include T1 (spin-lattice), T2 (spin–spin), and T2* relaxation times. The basic principle of mapping techniques is that each tissue type has a normal range for these parameters, deviation from which may indicate disease or a change in physiology. The two principal outputs derived from T1 mapping are native T1 values and extracellular volume fraction (ECV). Native T1 represents a composite signal from the intra- and extracellular components of the myocardium. ECV quantification is derived from native and post-contrast T1 values of the myocardium and blood, using an extracellular contrast agent, and the haematocrit. It permits assessment of the interstitial space as a surrogate marker for diffuse myocardial fibrosis or other aetiologies of ECV expansion. T2 and native T1 are increased by the accumulation of free water content in the myocardium. T2*-mapping is used to detect myocardial iron loading, as T2* (but also T1) is shortened by paramagnetic molecules such as iron and oxygen. Parametric mapping may detect subclinical or diffuse myocardial processes not accessible to conventional CMR methods, and has relevant applications in a wide range of cardiac diseases. With increasing evidence of clinical utility, parametric mapping techniques are expected to become important diagnostic and prognostic tools in myocardial tissue characterization.
Coronary imaging
Authors: Prieto Claudia , Botnar René M , Sakuma Hajime , Ishida Masaki , Makowski Marcus R
Published: October 2018

Due to its high soft tissue contrast, high spatial resolution, and lack of ionizing radiation, cardiovascular magnetic resonance (CMR) is a promising imaging modality for non-invasive imaging of the coronary arteries. However, because of the high spatial resolution and large coverage required for visualization of the coronary arteries, scan times are relatively long. This can result in imaging artefacts from cardiac and respiratory motion. Usually, coronary CMR is therefore performed with respiratory and cardiac compensation methods. CMR has shown promising results for the detection of coronary stenosis, when compared against invasive and computed tomography coronary angiography, but in clinical practice, CMR is more often used to define the course of anomalous coronary arteries and for the detection and tracking of coronary artery aneurysms. CMR also allows imaging of the coronary vessel wall and coronary plaque imaging, as well as the detection of coronary thrombus. These emerging methods may have a future role in risk stratification of patients with known or suspected coronary artery disease.
Acute ischaemic heart disease
Authors: Thiele Holger , Bettencourt Nuno , Salerno Michael , Dall’Armellina Erica
Published: October 2018

Cardiovascular magnetic resonance (CMR) plays an increasing role in the non-invasive assessment of acute coronary syndromes (ACS) and related conditions. CMR allows reliable assessment of contractile function, detailed visualization of myocardial infarction, and detection and quantification of the area at ischaemic risk, microvascular obstruction, and myocardial haemorrhage. CMR is used in research that furthers the understanding of the pathophysiology of ACS, in clinical practice to differentiate ACS from other diagnoses such as myocarditis, to detect and follow up complications of myocardial infarction (MI) such as aneurysm formation, and to risk-stratify patients with acute MI. As a result, the role of CMR in acute presentations of ischaemic heart disease continues to expand and is increasingly recognized in international practice guidelines.
Cardiac involvement in systemic diseases and secondary cardiomyopathies
Authors: Patel Amit , Miszalski-Jamka Tomasz , Mavrogeni Sophie , Schulz-Menger Jeanette
Published: October 2018

Cardiovascular magnetic resonance (CMR) is an important tool for the evaluation of patients with systemic diseases and secondary cardiomyopathies such as sarcoidosis, systemic lupus erythematosus, the vasculitides, rheumatoid arthritis, the muscular dystrophies, and several others. Although the clinical manifestation of these systemic disorders can be variable, it is increasingly evident that a significant amount of cardiovascular involvement can exist prior to the development of obvious functional abnormalities such as a decrease in left ventricular ejection fraction. Because CMR can evaluate many aspects of heart disease such as cardiac structure and function, including, but not limited to, myocardial perfusion, fibrosis, and inflammation, these previously difficult-to-identify cardiac abnormalities associated with systemic diseases and secondary cardiomyopathies can readily be identified, even in the absence of abnormalities on other non-invasive tests. The basic time-efficient protocol includes assessment of function and focal fibrosis applying late gadolinium enhancement. Reversible changes can be detected by oedema imaging. Recent developments allow quantification of subtle changes using parametric mapping. Improved detection of heart disease in these patients allows for earlier initiation of medical therapy and may identify those at highest risk for developing complications such as heart failure, significant arrhythmias, and other potentially life-threatening problems. This chapter reviews the role of CMR in the evaluation and management of these disorders.
Pericardial disease
Authors: Kwon Deborah , She Helen , Frank Herbert , Sykora Teresa
Published: October 2018

Pericardial disease is associated with significant morbidity and mortality. While important therapeutic advances over the past decades have improved outcomes in patients with ischaemic and non-ischaemic cardiomyopathies, considerably less progress has been made in pericardial disease. Cardiovascular magnetic resonance is an important imaging modality for the diagnostic workup of pericardial disease. It allows assessment of pericardial anatomy, determining the impact of pericardial disease on ventricular function, the presence of constrictive physiology, the degree of pericardial inflammation, and associated myocardial and thoracic pathology. These findings contribute importantly to determining appropriate medical and surgical therapy in patients with pericardial disease.
Valve disease
Authors: Cavalcante Joao , Knobelsdorff Florian von , Myerson Saul
Published: October 2018

Although echocardiography remains the primary imaging modality for valvular heart disease (VHD) diagnosis, cardiac magnetic resonance (CMR) has gained much interest in this field over the last few years. CMR allows for three-dimensional imaging of the cardiovascular system, using a large field of view, and reconstruction in any given plane. Its capability to quantify flow allows for accurate measurement of regurgitation, cardiac shunt volumes/ratios, and differential flow volumes (e.g. left and right pulmonary arteries). In addition, CMR provides insights into the aetiology/mechanism of VHD, the precise quantification of VHD severity, and the evaluation of myocardial response (function, remodelling, and fibrosis). This chapter discusses several CMR techniques for evaluation of patients with VHD. Important tips and pitfalls in the image acquisition and post-processing analysis will be also discussed, providing the users the necessary framework for its clinical application.
Epidemiology and classification
Authors: Basso Cristina , Buser Peter T , Rizzo Stefania , Lombardi Massimo , Thiene Gaetano
Published: October 2018

Cardiac masses include tumours, thrombi, vegetations, calcific lesions, and other very rare conditions. Cardiac tumours include benign tumours and tumour-like lesions, malignant tumours, and pericardial tumours. The estimated prevalence for primary cardiac tumours is 1:2.000 and for secondary tumours 1:100 autopsies. The incidence of cardiac metastases ranges from 2.3% to 18.3% of patients with extra-cardiac malignancies. About 10% of primary cardiac tumours are malignant and 90% benign. The majority of primary benign cardiac tumours are myxomas, followed by papillary fibroelastomas. Undifferentiated pleomorphic sarcomas are the most common primary malignant cardiac tumours, followed by angiosarcoma and leiomyosarcoma.