bluuebunny/crossref_metadata_2025 huggingface dataset:
Students Exposed to Domestic Violence
Authors: Phifer Lisa Weed
Published: February 2020

An increasing number of children are exposed to domestic violence each year. Children in homes with violence may form unstable or unhealthy relationships with caregivers, resulting in lack of trust in others and difficulty regulating emotions. In the midst or aftermath of violence, children can have considerable struggle with forming and maintaining relationships with others, experience shame or grief, and may have lower self-esteem and difficulties with educational achievement. While symptoms of exposure to domestic violence are not always obvious or reported, educators with knowledge of trauma like exposure to violence can intervene and support students’ coping abilities and help foster positive relationships with others. In a nurturing classroom environment, educators can help build trust and positive problem-solving skills and provide a predictability that is often lacking in these students’ lives. Specific recommendations for educators and additional resources are included in this chapter to support students exposed to domestic violence.
Supporting Grieving Students
Authors: Schonfeld David , Demaria Thomas
Published: February 2020

The vast majority of children experience the death of someone close to them. Although common, such losses can have a significant and profound impact on children’s social and emotional development, as well as their academic functioning. Educators can play a critical role in helping children understand and cope with their loss, implement accommodations to ensure they make continued academic progress, and follow practical strategies to promote coping and minimize their distress. Advice is provided for school-employed mental health professionals on how to identify and support children who would benefit from additional services, how to respond to unique situations such as death due to suicide or in the context of a school crisis, and how to establish appropriate school policies such as approaches to commemoration and memorialization.
Students from Military Families
Authors: Pisano Mark C.
Published: February 2020

Military families face unique challenges during the various stages of the deployment cycle. The impacts of these challenges are felt by all members of the family and the children in particular. The social-emotional strains that children experience during a military parent deployment can negatively impact their emotional state as well as their school performance. The reintegration of the service member back into the family is typically stressful but more so when the service member has posttraumatic stress disorder or some other injury. Children respond to deployment stressors differently depending on their age. These responses are discussed along with strategies which are designed to help support the child and the family throughout the deployment. Strategies for the school setting as well as in the home are shared.
Students Affected by Interpersonal Violence
Authors: Nguyen-Feng Viann N. , Carroll Tim , King Lindsey
Published: February 2020

Interpersonal violence refers broadly to any actions between persons (i.e., interpersonal) that are hurtful or harmful (i.e., violence). Various forms of interpersonal violence (e.g., physical, emotional, sexual abuse; dating violence; bullying) are common among school-aged youth, and students may be both perpetrators and victims of interpersonal violence. The effects of interpersonal violence can impact various domains of functioning throughout one’s life, physically (e.g., increased risk of somatic symptoms) and emotionally (e.g., increased risk of depression, delinquent behavior). Cultural considerations of these effects warrant exploration. Further, schools represent a critical setting to monitor and address the impacts of interpersonal violence. The authors present both systems-level (e.g., Developmental Designs, Restorative Practices, Positive Behavioral Interventions and Supports) and student-level approaches to support students. They also provide a list of external resources and discussion questions.
Introduction to the Communication Approach
Authors: Wittenberg Elaine , Goldsmith Joy V. , Ragan Sandra L. , Ann Parnell Terri
Published: February 2020

The introduction to the volume emphasizes that communication between nurses and their patients and family members does not consist merely of disseminating information. Instead, nurses must view communication as the mutually beneficial creation of meaning and that the nurse and the patient/family collaboratively affect each other’s communication. Every message has two levels of meaning: the task level, usually conveyed by the words themselves, and the relationship level, generally conveyed by nonverbals. Nonverbal communication relays most of the meaning of a message and affects both the task (patient care) and the relationship (communication climate) between nurses and patients/families. For this reason, it is essential that verbal and nonverbal communication receive adequate attention. The six components of patient-centered communication include both task and relationship aspects of patient-centered care. The chapter ends with a brief description of the communication model that undergirds the entire book, the COMFORT model, which outlines palliative care communication.
O—Options
Authors: Wittenberg Elaine , Goldsmith Joy V. , Ragan Sandra L. , Ann Parnell Terri
Published: February 2020

Options are provisions of care that a nurse can provide, primarily through successfully created and shared messages. This chapter contends that patient and caregiver health literacy is co-created between providers, systems, and communities. This approach to health literacy moves from an information-based focus on health education with patients to the realization that knowledge does not equate with understanding and, importantly, understanding does not equate with behavior. Cultural and linguistic preferences cannot and should not be essentialized or assumed based on appearance, ethnicity, origin, or other individualized variables. Cultural humility moves beyond cultural competence to recognize each patient and their caregiver(s) as individuals. Communication accommodation theory (CAT) grounds the themes in this chapter and is a useful foundation as nurses consider all patients and families unique in their culture and health literacy needs. CAT includes three categories of accommodation that occur in all communication events. Convergence, the most successful path described in CAT, is characterized by alignment and adaptation in communication and relationship.
F—Family Caregivers
Authors: Wittenberg Elaine , Goldsmith Joy V. , Ragan Sandra L. , Ann Parnell Terri
Published: February 2020

Family is essential in navigating and delivering care for patients and is central to the success of a care plan. Nurses are information providers and communication facilitators, educating the patient/family about illness and procedures, challenging family members to consider the consequences of treatment, and encouraging awareness about a patient’s decline over time. Recognizing that family is significantly impacted when a loved one is seriously, chronically, or terminally ill can foster partnerships and bring supportive, clear communication to the family’s care experience. Learning about the family’s history, their background, the primary caregiver’s family role, and the needs of families are vital to patient- and family-centered nursing. Seeing the patient/family as one unit is vital to delivering palliative care. A family system and its pattern of communication precede any illness experience. That pattern of communication sets the stage for specific caregiver communication behaviors that impact patient care and outcomes.
R—Relating
Authors: Wittenberg Elaine , Goldsmith Joy V. , Ragan Sandra L. , Ann Parnell Terri
Published: February 2020

Relating is a chapter that unpacks the complex architecture of goals always at play for each of us. Because the true motives and goals of a patient are rarely fully understood or realized, the recommendation in this chapter is to attend to the relationship to facilitate the instrumental goals of palliative nursing. Throughout this chapter, authors examine the phenomenon of the patient/family acceptance of an illness status, as well as understanding patient/family perspectives on adjusting to new information. The authors examine the role of uncertainty and how it can impact goals of care discussions and, ultimately, decision-making. Relating to a patient/family creates the opportunity to learn about acceptability of a diagnosis/prognosis, fears associated with uncertainty, and the inevitable dissonance among personal goals in the face of serious illness. Multiple, conflicted, and unrealized goals are a reality that clinicians must navigate and that patients and families must face as they work together to acknowledge a changing life and identity.
Parent, Researcher, Advocate
Authors: Austin Joan K.
Published: February 2020

Epilepsy education and awareness are brought to the forefront in the following stories through innovative outreach, research, and marketing efforts.
Hidden Truths
Authors: Thompson-Dobkin Julie
Published: February 2020

This section emphasizes the empowerment of others through the arts, employment, camping, and the Americans with Disabilities Act.
The Intermission: My Story
Authors: Bender Joyce
Published: February 2020

This section emphasizes the empowerment of others through the arts, employment, camping, and the Americans with Disabilities Act.
Tremor
Authors: Shibasaki Hiroshi , Hallett Mark , Bhatia Kailash P. , Reich Stephen G. , Balint Bettina
Published: February 2020

Tremor is broadly classified into physiological tremor and pathological tremor. Depending on the clinical features and the predominant pattern of production, tremor is classified into resting tremor, postural tremor, and kinetic tremor. Tremor is associated with rhythmic contraction of agonist and antagonist muscles, either alternately or simultaneously. Tremor involving muscles in the resting condition is called resting tremor and is seen most commonly in Parkinson disease. Tremor involving muscles during isometric contraction is called postural tremor, and it is most commonly seen in essential tremor. Tremor involving muscles during intended movements (isotonic contraction) is called kinetic tremor, and it is most commonly seen in a lesion of the cerebellar efferent pathway.
Disorders of Increased Muscle Stiffness or Overactivity
Authors: Shibasaki Hiroshi , Hallett Mark , Bhatia Kailash P. , Reich Stephen G. , Balint Bettina
Published: February 2020

Increased muscle stiffness or overactivity (which differs from parkinsonian rigidity or dystonia) can be caused by a variety of disorders of central or peripheral nervous system origin and genetic, autoimmune, or infectious etiology. Increased muscle stiffness may be the cause of some joint movements, particularly when such stiffness is associated with stimulus sensitivity that causes involuntary movements. The conditions discussed in this chapter include stiff person syndrome, progressive encephalomyelitis with rigidity and myoclonus (PERM), acquired neuromyotonia (Isaacs syndrome), hereditary neuromyotonia, tetanus (which has an infectious etiology), Satoyoshi disease, neuromyotonia, and rippling muscle disease. Many of these cases are caused by decreased synaptic inhibition through an autoimmune mechanism.
Acute Concussion on the Field of Play
Authors: Hainline Brian , Gurin Lindsey J. , Torres Daniel M.
Published: February 2020

Concussions may develop in any sport as a result of contact with another player or with a structure in the sport environment, or from a fall. Any athlete with a suspected concussion on the field of play should be evaluated immediately, and should not be allowed to return to play if there is a suspected concussion. In any case of suspected concussion, serial evaluations should occur, and the athlete should receive instructions for concussion management and prompt follow-up. The SCAT5 and Child SCAT5 questionnaires are useful tools for clinicians to evaluate concussions, and the Concussion Recognition Tool 5 is a useful tool for non-clinicians to evaluate concussion.
Acute Concussion versus Second Impact Syndrome
Authors: Hainline Brian , Gurin Lindsey J. , Torres Daniel M.
Published: February 2020

Second impact syndrome is a rare condition thought to be a consequence of brain injury in someone who has not completely recovered from a prior brain injury. The inciting “second” impact may not seem severe, yet profound neurological deterioration may manifest almost immediately. The presumed pathophysiology is a breakdown in cerebral autoregulation, but a careful review of case reports indicates that this condition often coexists with brain hemorrhage. Second impact syndrome results in a rapid deterioration in neurologic function, and requires activation of emergency medical services and transport to a trauma center. In essence, second impact syndrome should be managed as a severe traumatic brain injury.
Return to Learn Following Concussion
Authors: Hainline Brian , Gurin Lindsey J. , Torres Daniel M.
Published: February 2020

Students who sustain a concussion may develop several symptoms that interfere with returning to school. Clinicians, students, parents, and teachers should all be part of a transparent return-to-learn plan that helps individuals navigate their recovery process. Most individuals can return to school with an informal, individualized management plan in place, but more formal plans should be developed for students with prolonged difficulties. Plans for such students are protected through the American with Disabilities Education Act. Those who have difficulty returning to school following concussion should also be re-evaluated medically to rule out comorbid or emerging neuropsychiatric conditions.
Managing Expectations Following Concussion
Authors: Hainline Brian , Gurin Lindsey J. , Torres Daniel M.
Published: February 2020

Individuals who sustain a concussion must understand that they may have various symptoms, that these should improve considerably within days, and that complete recovery is expected. However, a notable minority of individuals develop persistent symptoms following concussion, and such symptoms may be misconstrued. For example, some individuals who have sustained a concussion may become fearful that they will develop a progressive neurologic condition or even a brain degenerative disease. Such thinking can lead to maladaptations and comorbid psychiatric symptoms or disorders, which can prolong recovery from concussion. Thus, early education, empowerment, and management of expectations are important parts of concussion management.
Anxiety Following Concussion
Authors: Hainline Brian , Gurin Lindsey J. , Torres Daniel M.
Published: February 2020

Anxiety symptoms are common following concussion but do not indicate more severe brain injury. In the acute post-concussion state, it is common to feel irritable, more emotional, and to have difficulty falling asleep, which are non-specific symptoms commonly observed in anxiety disorders. Concussion injuries sometimes occur in a psychically charged environment, which may potentiate acute anxiety disorder or post-traumatic stress disorder. These disorders can then potentiate prolonged post-concussion persistent symptoms. It is important to differentiate between post-concussion anxiety symptoms and the development of an anxiety disorder. Nonpharmacologic and pharmacologic management, as needed, should address the specific anxiety manifestations.
Emotional Dysregulation Following Concussion
Authors: Hainline Brian , Gurin Lindsey J. , Torres Daniel M.
Published: February 2020

Emotional dysregulation is common after concussion, and is usually transient. Manifestations may include pathologic laughing and crying, affective lability, and irritability. It is important to recognize that emotional dysregulation can considerably impair quality of life and therefore should be recognized and managed appropriately. Prolonged emotional dysregulation following concussion can lead to persistent symptoms and the erroneous assumption that the individual has a more severe brain injury. Pharmacotherapy is often required for persistent pathologic laughing and crying, and nonpharmacologic strategies are usually effective for affective lability and irritability. It is important to differentiate emotional dysregulation from a more severe underlying brain injury.
Concussion and Vestibular Dysfunction
Authors: Hainline Brian , Gurin Lindsey J. , Torres Daniel M.
Published: February 2020

Vestibular dysfunction is common following concussion, and the development of severe dizziness is a predictor of prolonged post-concussion recovery. Vestibular dysfunction is also a clinical domain of concussion that benefits from domain-specific rehabilitation. Unfortunately, post-concussion patients with complaints of dizziness, or worsening vestibular symptoms with exercise, are too often advised to rest, and prolonged rest can worsen vestibular dysfunction. If vestibular dysfunction does manifest in an individual with concussion and is not addressed, it can lead to persistent post-concussive symptoms that may be misunderstood as a more severe brain injury or prolonged recovery from concussion.
Concussion and Oculomotor Dysfunction
Authors: Hainline Brian , Gurin Lindsey J. , Torres Daniel M.
Published: February 2020

Oculomotor dysfunction is common following concussion, but is too often not addressed. It is not surprising the oculomotor dysfunction is common following concussion because visual pathways comprise 50% of the brain. Post-concussion oculomotor dysfunction often manifests as convergence insufficiency, and failure to address it can result in prolonged post-concussive symptoms, including headache and dizziness, especially when attempting to read. A detailed oculomotor exam should be performed in all patients diagnosed with a concussion. Oculomotor rehabilitation is an emerging strategy that can be used early in the treatment of patients with post-concussion oculomotor dysfunction.
Women and Concussion
Authors: Hainline Brian , Gurin Lindsey J. , Torres Daniel M.
Published: February 2020

Most of the concussion literature is devoted to concussion and men, and this literature focuses primarily on American football and ice hockey. Yet women appear to be more prone to sport-related concussion than men, and may manifest with more concussion-like symptoms both at both baseline and post-concussion. There may be both endocrinologic and biomechanical reasons why women’s concussive symptoms are different from men’s, but this remains incompletely understood. There may also be sex-based and gender-based differences in how men and women experience and describe concussion. It is important to understand these distinctions when managing concussion in women.
Concussion and Cognitive Dysfunction
Authors: Hainline Brian , Gurin Lindsey J. , Torres Daniel M.
Published: February 2020

Cognitive complaints are common following concussion but generally resolve within the first week. When individuals present with persistent cognitive dysfunction following concussion, it is important to address all potential concussion-related issues that may interfere with cognition, including mood disorder, sleep disorder, vestibular and oculomotor dysfunction, pituitary dysfunction, and pain. Additionally, individuals with persistent cognitive dysfunction may develop secondary anxiety because of fears of permanent brain damage or a neurodegenerative disease. When individuals present with prolonged cognitive complaints following concussion, a referral to a sports neuropsychologist may help to differentiate primary cognitive impairment from other persistent symptoms that may interfere with cognition.
Hiding Concussion
Authors: Hainline Brian , Gurin Lindsey J. , Torres Daniel M.
Published: February 2020

Athletes and other individuals who sustain a concussion may try to hide their symptoms. There are many reasons for doing so, including a sense of invincibility, not wanting to let teammates down, or fearing that removal from play or work may jeopardize a position on a team. It is important to educate all stakeholders about the importance of not hiding concussions. Emerging evidence tells us that athletes who self-report concussion early return to play sooner than athletes who do not. Evidence-based education interventions are needed to positively shift the culture of concussion safety.
Legal and Insurance Concerns Following Concussion
Authors: Hainline Brian , Gurin Lindsey J. , Torres Daniel M.
Published: February 2020

When a concussion injury occurs in a workplace, employees may be required to use Workers’ Compensation insurance. There may be a limited pool of available clinicians who accept Workers’ Compensation insurance, which can delay proper concussion management. Further, workplace injuries may be associated with other musculoskeletal injuries; these other injuries may be managed first, thereby delaying appropriate concussion management. Concussion injuries may also lead to litigation, and being involved in a legal process has been associated with prolonged concussion symptoms. This of course must always be differentiated from brain injury, which should be appropriately compensated when negligence has occurred. For any patients who have suffered a concussion injury and who are in the Workers’ Compensation system or who are in the legal process, it is important to carefully document objective findings on the neurological exam.
Cognitive Dysfunction Following Concussion
Authors: Hainline Brian , Gurin Lindsey J. , Torres Daniel M.
Published: February 2020

Cognitive decline has been associated with a history of multiple concussions and repetitive head impact exposure. Cognitive decline may also result from hypopituitary dysfunction, undermanaged post-concussive symptoms, other mental health symptoms and disorders, medical conditions, and a genetic predisposition to neurodegeneration. Cognitive decline may be static or progressive. Any individual who presents with cognitive decline following a history of concussion should undergo a complete neuropsychiatric evaluation, and this should be coupled with a detailed medical and neurological exam to assess for all possible causes of impaired cognition. Neurodegeneration should not be assumed as a result of prior brain injury.
Chronic Traumatic Encephalopathy
Authors: Hainline Brian , Gurin Lindsey J. , Torres Daniel M.
Published: February 2020

Although a correlation has been noted between brain injury and chronic traumatic encephalopathy, a causal connection between the two has never been demonstrated. Chronic traumatic encephalopathy is a neurodegenerative condition similar to conditions such as Alzheimer’s disease and frontotemporal degeneration. Chronic traumatic encephalopathy can only be diagnosed post mortem, but attempts are underway to develop objective diagnostic tests in living individuals. When individuals who have a history of presumed head injury present with neuropsychiatric symptoms such as behavioral changes or cognitive decline, they should undergo a full neuropsychiatric workup and be managed appropriately for their symptoms.
A young person’s experience of chronic disease
Authors: Anonymous
Published: February 2020

This chapter is an anonymous account of one young person’s experience of receiving lifelong treatment for chronic disease. A trip to the hospital or to see the doctor for a single issue doesn’t require an advanced level of trust. A chronic condition requires the patient to develop a bond of trust with their care provider to make decisions that will maintain or, ideally, improve the condition. Vice versa, the care provider, be it doctor or nurse, needs to be able trust the patient to take on board their advice and be sure any medical plan will be followed, whether it is a set of exercises or a rigid treatment regime. This is a process that occurs over time and, with a chronic condition, time is something that can be afforded.
Bioinformatics
Authors: Chaudhry Afzal
Published: February 2020

Bioinformatics may be defined as ‘conceptualizing biology in terms of molecules and applying “informatics techniques” (e.g. applied mathematics, computer science and statistics) to understand and organize the information associated with these molecules, on a large scale’. Clinical bioinformatics may be defined as ‘the clinical application of bioinformatics-associated sciences and technologies to understand molecular mechanisms and potential therapies for human diseases’. If clinical bioinformatics is to deliver the integration of molecular and clinical data and thereby translate research knowledge into effective ‘personalized’ medicine, then two broad constituencies need to be supported. Clinicians at the point of care need to understand and integrate, perhaps via decision support mechanisms, entities such as genotype/phenotype correlations, biomarker discovery, and pharmacogenomics; while researchers require accurate, structured, and (ideally) coded clinical data, as well as biological reference data sets.
Humanitarian medicine
Authors: Kravitz Amy S.
Published: February 2020

Humanitarian medicine addresses the human consequence of crises such as conflict, disaster, or displacement, and serves to assist those whose lives and health are impacted by such events. It is practised in challenging settings where resources are limited and environments unstable, and requires a clinical skillset which is both near limitlessly broad and context specific. The humanitarian sector has expanded significantly during the last two decades as a result of climate-related crises and increasing complex humanitarian emergencies due to protracted and multifaceted conflicts. The picture today is evolving rapidly to address expanding humanitarian demands and a changing global sociopolitical reality.
Complementary and alternative medicine
Authors: Ernst Edzard
Published: February 2020

Complementary and alternative medicine can be defined as diagnosis, treatment, and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy, or by diversifying the conceptual frameworks of medicine. It is popular; hence doctors should know about it. The term covers a vast array of treatments and diagnostic techniques which have little in common except that they are not part of mainstream medicine. The most important modalities are acupuncture, phytotherapy, homeopathy, and spinal manipulation. In industrialized countries, typical users of complementary and alternative medicine are middle-aged, female, well-educated members of a high socioeconomic class. Indications range from chronic benign conditions where mainstream medicine does not offer a cure (e.g. back pain) to life-threatening diseases like cancer and AIDS.
The genomic basis of medicine
Authors: Stankiewicz Paweł , Lupski James R.
Published: February 2020

The first phase of the studies on genetic variation in humans has been focused on single nucleotide polymorphisms and common variation. The large number of single nucleotide polymorphisms identified has enabled successful genome-wide association studies for disease susceptibility risk of complex traits (e.g. diabetes and cancer), but for the most part has had limited practical applications in clinical medicine. This chapter examines the recent technological developments which have enabled a higher-resolution analysis of the human genome and its extensive submicroscopic structural variation, including copy-number variants. Copy-number variants involving dosage-sensitive genes result in several diseases and contribute to human diversity and evolution. An emerging group of genetic diseases have been described that result from DNA rearrangements (e.g. copy-number variants and other structural variations including copy-number neutral inversions and translocations), rather than from single nucleotide changes.
Ion channels and disease
Authors: Ashcroft Frances , Tammaro Paolo
Published: February 2020

Ion channels are membrane proteins that act as gated pathways for the movement of ions across cell membranes. They are found in both surface and intracellular membranes and play essential roles in the physiology of all cell types. An ever-increasing number of human diseases are now known to be caused by defects in ion channel function. To understand how ion channel defects give rise to disease, it is helpful to understand how the ion channel proteins work. This chapter therefore considers what is known of ion channel structure, explains the properties of the single ion channel, and shows how single-channel currents give rise to action potentials and synaptic potentials.
Allergy
Authors: Ewan Pamela
Published: February 2020

Allergy is common and becoming commoner: it now affects about one-third of the UK population. This is being driven by environmental changes, which are also leading to an increase in both the complexity and severity of the condition. In addition to the traditional allergic disorders—asthma, rhinitis, and eczema—multisystem allergic disease and reactivity to several allergens are now common; new allergies have appeared, including those due to foods, drugs, and diagnostic agents; and anaphylaxis is increasing. In contrast, new cases of latex allergy have become uncommon. Where possible, patients with significant allergy should be referred to an allergy specialist who can provide expertise not offered by—and complementary to—that of other specialties. Identifying and managing allergic causes of disease leads to reduction or resolution of its manifestations.
Epidemiology of cancer
Authors: Swerdlow Anthony , Peto Richard
Published: February 2020

The epidemiology of cancer is the investigation of the incidence and causes of the disease in people under different conditions of life. Such investigations have generally been the way in which reliable evidence about causal agents for cancer, and the magnitude of the risks from these agents, have been found. They have shown that any type of cancer that is common in one population is rare in some other, and that the differences between populations are mostly not genetic, but rather the consequences of behaviours and circumstances of life. In principle, cancers are largely preventable. The range of incidence rates between geographical and ethnic groups is more than 10-fold for each of the common cancers, and for some cancers is more than 100-fold. Large changes in rates of many tumours can occur in migrants compared with rates in their homeland and within populations over time, indicating the scope for prevention.
Systemic treatment and radiotherapy
Authors: Jena Rajesh , Harper Peter
Published: February 2020

Cancer therapy is underpinned by a detailed understanding of cancer biology and the complex interaction of tumour and host. Systemic therapies and radiation therapy are being used in many early stage cancers, with a ‘risk adaptive’ approach to maximize the likelihood of uncomplicated tumour cure, both as primary treatment and in the postoperative setting. Targeted therapies have changed the course of many common cancers. Patients with early stage disease benefit through enhanced cure rates, while rational treatment approaches to metastatic disease improve outlook for many patients. Where cancer therapies are given with curative intent, care must be taken to consider long-term toxicities. Systemic therapies may be associated with organ-specific late effects such as dose-dependent cardiac toxicity from anthracycline chemotherapy, lung fibrosis from bleomycin, and sensorineural hearing loss from vincristine. Radiation therapy also carries a risk of tissue damage, dependent on the dose and volume of tissue that is irradiated.
Ageing and clinical medicine
Authors: Steves Claire , Pendleton Neil
Published: February 2020

In 2017 there were, for the first time, more people older than 65 years than children under the age of 5 years. Despite the recent exponential increase in human lifespan, health-span has not kept pace, and variability between countries in healthy lifespan exceeds that of life expectancy. The increase in morbidity as people age is largely explained by loss of physiological reserve capacity in multiple systems simultaneously, which is termed frailty. Recent evidence suggests that different heritable (intrinsic factors) factors drive the ageing of different organ systems, but diverse systems share environmental (or extrinsic) drivers. Ageing is associated with macromolecular changes (molecular damage); changes in nutrient sensing, metabolism, and metabolic signalling; senescence in stem cells; altered intercellular communication, in particular changes associated with inflammaging; and changes in circadian rhythms and the hypothalamo-pituitary-adrenal axis.
Optimizing well-being into old age
Authors: Firth
Published: February 2020

Healthy ageing, well-being in later life, quality of life, and disability-free life are ideas that drive policy and practice in our ageing society. Their meanings overlap in sometimes confusing ways, but there is consensus that the postponement or containment of disability is a necessary but insufficient precondition of healthy ageing and the optimization of well-being in later life. Psychological factors like self-efficacy and sense of coherence also seem necessary for healthy ageing, but may be difficult to work with for many clinicians trained in a more medical model of healthy ageing. Primary promotion of healthy ageing through the avoidance of disability has had some success, especially through its impact on cardiovascular disease, but we have much to learn about influencing diet and physical activity across the life course for well-being in later life.
Supporting older peoples’ care in surgical and oncological services
Authors: Dhesi Jugdeep , Partridge Judith
Published: February 2020

The clinical profile of patients presenting for elective and emergency surgery and for oncological treatment is changing. Patients are now older and more complex with coexisting multimorbidity and geriatric syndromes. There is increasing recognition of the need to improve the effectiveness, efficiency, and the experience of patients in this vulnerable group. Achieving the best outcomes requires attention to asessment, quantification of risk, and proactive and responsive management among other aspects. Such wide-ranging interventions cannot be delivered by single specialties, but require collaboration across disciplines and specialties to ensure delivery of patient-centred services, relevant education, and training, and a research programme that aims to inform routine clinical practice.
Neurodegenerative disorders in older people
Authors: Hindle John
Published: February 2020

Neurodegenerative disorders are associated with a progressive loss of structure and function of neurones that leads to neuronal death. Their aetiology combines ageing, genetic susceptibility, and risk factors including environmental exposure, balanced against protective factors. They present with varying combinations of progressive cognitive, emotional, motor, autonomic and peripheral symptoms, and clinical signs. Neurodegenerative conditions are all likely to have a preclinical prodromal period, followed by slow initial decline during which there is clinical presentation, followed by a further steady decline and an eventual accelerated decline. The rate of progression of these disorders varies greatly, but they are all inevitably progressive, currently have no cure, and require symptomatic treatment.
Promotion of dignity in the life and death of older patients
Authors: Burns Eileen , Scampion Claire
Published: February 2020

Respect for the dignity of patients is a traditional part of medical codes. Dignified care is key to a holistic person-centred approach, with participation of the individual, communication, and respect. Nurses and doctors recognize lack of dignity in depersonalized care, treating the person as an object, humiliation, abuse, and invisibility.

Older people regard dignity as critically important in their care. This relates to issues around privacy, courteousness, respect for the individual, and consideration about choices related to care, and to respect for cultural or religious needs. Assuring dignity requires the sensitive addressing of basic needs and the promotion of inclusivity and participation, with recognition that even in the presence of some impairment of cognition, the wishes and views of the patient remain central to decision-making.
Pain management
Authors: Fallon Marie
Published: February 2020

Pain occurs in more than 50% of patients with advanced disease, interferes with daily functioning and quality of life, and is very often undertreated. Patients can find it difficult to articulate the character of their pains, but it is important to determine whether it is somatic, neuropathic, or visceral since this has important implications for management. For most patients with cancer pain, a three-step approach combining simple or opioid analgesia (depending on severity) along with an adjuvant analgesic (depending on cause) will result in good pain relief, but the challenge is to achieve good pain relief without unacceptable adverse effects.
Biology of pathogenic microorganisms
Authors: Maskell Duncan J. , Wood James L.N.
Published: February 2020

Microorganisms are present at most imaginable sites on the planet, and have evolved to occupy these ecological niches successfully. A host animal is simply another ecological niche to be occupied. This chapter describes how the ability to cause disease may in some cases be an accidental bystander event, or it may be the result of evolutionary processes that have led to specific mechanisms allowing the pathogen to exploit the rich source of nutrients present in the host, and then be transmitted to another fresh host. Pathogenicity often relies on a series of steps, with specific and often distinct mechanisms operating at each of them. Some types of pathogen must adapt to the host environment by altering gene expression, and most must retain the ability to be transmitted readily between hosts.
Infection in the immunocompromised host
Authors: Cohen Jon , Khatamzas Elham
Published: February 2020

The term ‘immunocompromised host’ embraces a group of overlapping conditions in which the ability to respond normally to an infective challenge is in some way impaired. This includes patients with underlying conditions such as protein–calorie malnutrition and diabetes, as well as organ transplant recipients, those with haematological malignancies and others receiving therapeutic immunosuppression, and patients with HIV infection. Many patients have multiple risk factors that increase the risk of opportunistic infection. A high level of awareness is essential for the management of patients who are immunocompromised; infections can progress very quickly, the early physical signs are often muted, and the microbiology can be confusing.
Respiratory tract viruses
Authors: Peiris Malik
Published: February 2020

Viral respiratory infections, including rhinovirus, coronavirus, adenovirus, respiratory syncytial virus, human metapneumovirus, parainfluenza viruses, and influenza viruses, are a substantial cause of morbidity worldwide. Transmission occurs through direct contact, contaminated fomites, and large airborne droplets, with long-range transmission by small particle aerosols reported in at least some instances of influenza and severe acute respiratory syndrome. Clinical syndromes affect the upper and/or lower respiratory tract, including coryza, pharyngitis, croup, bronchiolitis, and pneumonia. Each syndrome can potentially be caused by several viruses, and each respiratory virus can be associated with different clinical syndromes. Measles is a major cause of lower respiratory tract infections and fatality in tropical countries.
Arenaviruses
Authors: ter Meulen Jan H.
Published: February 2020

Arenaviruses are zoonotic RNA viruses that are distributed worldwide and are adapted to various rodent genera. Some are highly pathogenic and cause haemorrhagic fevers that are endemic in restricted regions of a few countries. Humans are thought to become infected mainly through inhalation of aerosolized rodent urine or dust particles to which infectious urine has dried, or by ingestion of contaminated foodstuff: prevention therefore depends on rodent control and avoidance of contact with rodents, their excreta, and nesting materials. Because arenaviruses cause diseases that start insidiously and therapy is life-saving, they should be considered in all patients with fever of unknown origin and a history of possible exposure in the well-known endemic areas.
Filoviruses
Authors: ter Meulen Jan H.
Published: February 2020

Filoviruses are large RNA viruses, of which Ebola virus and Marburg virus cause the most severe forms of viral haemorrhagic fever and have been best-studied because of fear of their misuse as bioterrorism agents. These are zoonotic viruses with reservoirs, most likely fruit-eating bats, in the rainforests of tropical Africa, where they cause sporadic infections and outbreaks among great apes and humans. The primary mode of transmission of Ebola virus to humans often involves contact of hunters with dead animals that serve as amplifying hosts, especially gorillas, chimpanzees, and forest antelopes, whose meat is consumed as ‘bush meat’. Contact with bats has been implicated for both Marburg and Ebola virus. However, the viruses are highly infectious and are transmitted from the index case and subsequently from person to person by all body fluids, including sweat, respiratory droplets, and semen. The viruses can persist in convalescent patients for many months.
HTLV-1, HTLV-2, and associated diseases
Authors: Verdonck Kristien , Gotuzzo Eduardo
Published: February 2020

Human T-cell leukaemia virus (HTLV)-1 and HTLV-2 belong to the genus Deltaretrovirus of the family Retroviridae. They only infect humans, produce a lifelong infection, and can be transmitted from mother to child, through sexual intercourse, and via cellular blood components and organ transplantation. Both viruses are present in all continents and have a heterogeneous distribution. HTLV-1-endemic foci (general population prevalence >1%) are found in Japan, the Caribbean, South America, Africa, and Australo-Melanesia. There are endemic foci of HTLV-2 among native Amerindians and Central African populations. HTLV-1 and 2 also occur among people who inject drugs. It is unclear why some infected people develop associated diseases while others remain asymptomatic.
Pneumococcal infections
Authors: Scott Anthony
Published: February 2020

Streptococcus pneumoniae is an encapsulated Gram-positive bacterium that lives almost exclusively in the human nasopharynx. Each pneumococcus expresses one of more than 90 immunologically distinguishable capsular polysaccharides that are the principal target of systemic human immunity and define its serotype. Pneumococci are transmitted through contact with infected nasal secretions or by airborne dissemination, and most preschool children carry them in their nasopharynx. The risk of acquisition is increased by contact with other children, crowded environments, and cold weather. The incidence of pneumococcal disease is highest in young children and elderly people, and also increased in males, certain indigenous populations, smokers, alcoholics, and patients with chronic medical illnesses or immune susceptibility, including HIV infection, sickle cell disease, and splenectomy.
Haemophilus influenzae
Authors: Robinson Esther
Published: February 2020

Haemophilus influenzae is a Gram-negative bacillus that is an exclusively human pathogen and commensal. There are six capsular serotypes (a–f), of which type b (Hib) is a major cause of childhood infectious disease. Transmission occurs by close bodily contact, the main source being other children. Carriage of the organism may be followed by disease in susceptible individuals. In infants, Hib causes symptoms ranging from a mild non-specific febrile illness (occult bacteraemia) to fully blown sepsis with meningitis, epiglottitis, pneumonia, septic arthritis, or cellulitis. Non-typeable H. influenzae are common nasopharyngeal commensals and cause otitis media and conjunctivitis in children. In adults, non-typeable H. influenzae cause exacerbations of chronic bronchitis, sinusitis, and pneumonia. Other Haemophilus species, including H. parainfluenzae, are common commensals and rare causes of infective endocarditis and other sepsis.
Melioidosis and glanders
Authors: Peacock Sharon J.
Published: February 2020

Melioidosis is a serious infection caused by the soil-dwelling Gram-negative bacillus Burkholderia pseudomallei. It is most commonly reported in north-east Thailand and northern Australia, but is increasingly recognized around the world. Infection is predominantly acquired through bacterial inoculation, often related to occupation, and mostly affects adults between the fourth and sixth decade who have risk factors such as diabetes mellitus and renal impairment. Clinical features are very varied, ranging from a septicaemic illness (the most common presentation), often associated with concomitant pneumonia (50%) and other features including hepatic and splenic abscesses, to a chronic illness characterized by fever, weight loss, and wasting. Aside from supportive care and drainage of collections of pus, treatment requires prolonged antimicrobial therapy, with a parenteral phase of 10 to 14 days (ceftazidime or a carbapenem) followed by oral therapy for 12 to 20 weeks (trimethoprim-sulfamethoxazole).
Francisella tularensis infection
Authors: Oyston Petra C.F.
Published: February 2020

Fransicella tularensis is a small Gram-negative coccobacillus that circulates in small rodents, rabbits, and hares, most frequently in Scandinavia, northern North America, Japan, and Russia. Clinical presentation depends on the route of infection. Most commonly this follows the bite of an infected arthropod vector, resulting in ulceroglandular tularaemia. The most acute and life-threatening disease, respiratory or pneumonic tularaemia, arises following inhalation of infectious aerosols or dusts. The organism is highly fastidious, requiring rich media for isolation and specialized reagents for positive identification; most cases are diagnosed serologically. Treatment is with supportive care and antibiotics (usually ciprofloxacin, doxycycline, or gentamicin). There is no vaccine.
Tetanus
Authors: Thwaites C. Louise , Yen Lam Minh
Published: February 2020

Clostridium tetani is a Gram-positive spore-forming anaerobic bacillus able to infect and cause disease in both humans and animals. The bacterium is highly sensitive to oxygen but can survive in the environment as an extremely resistant metabolically inactive spore. Under suitable anaerobic conditions the spore germinates and the bacteria multiply, releasing a highly potent neurotoxin, tetanus toxin, which is responsible for the clinical features of tetanus. Tetanus is a disease characterized by muscle spasms caused by a toxin produced by Clostridium tetani. Without treatment mortality is high due to muscle spasms which prevent respiration or due cardiovascular system instability secondary to autonomic nervous system dysfunction. Tetanus is prevented by good wound hygiene and/or vaccination and, although rare in developed countries, the disease remains a significant problem in many countries where facilities for treatment are often poor and mortality remains high.