bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrative Nursing Management of Pain
Authors: Thompson Susan , Wagner Judy L.
Published: January 2019

Pain represents a significant challenge for clinicians as their patients seek relief from acute and chronic pain. This chapter reviews the current epidemic of patients with chronic pain, and the socioeconomic burden it imposes on individuals, families, communities, and healthcare systems. Definitions of pain and the complexity of pain management are discussed, along with an overview of the current efforts to address the worldwide opioid crisis. Nurses are uniquely positioned to comprehensively assess and treat pain in their patients. A review of an integrative and patient-centered nursing approach for assessing pain and finding the right therapy for the right situation is discussed. Also included in the chapter are practical examples and a case study, as well as ideas on how to incorporate a variety of integrative therapies into daily nursing practice, such as guided imagery, acupressure, aromatherapy, massage, and movement therapy.
Integrative Nursing Management of Cognitive Impairment
Authors: Williams Debbie , Koithan Mary
Published: January 2019

Cognitive impairment involves difficulty remembering, learning new things, concentrating, or making decisions that affect everyday life. Given the current demographics of the population, cognitive impairment will continue to be a significant symptom that integrative nurses will encounter in clinical practice. Intervention strategies can reduce the financial, social, physical, and emotional burden of cognitive impairment, and a whole-person/whole-systems approach to management can help patients and their families improve quality of life and functional status over the long term. Multimodal, individualized interventions based on the characteristics of the person’s underlying cause of cognitive impairment and the accompanying responses can improve success in reducing the negative effects of this symptom.
Nursing as an Integrative Healthcare Profession
Authors: Pool Natalie , Koithan Mary , Ringdahl Deborah
Published: January 2019

Nurses have traditionally provided care that is inherently integrative in nature, and they continue to utilize these approaches across contemporary healthcare settings. This chapter explores the state of nursing as an integrative healthcare profession. The American Nurses Association (ANA) has called for nursing to embrace an integrative approach to care, and a comparison of integrative nursing principles and values with the current version of the ANA’s Scope and Standards of Practice reveals significant congruency with several areas calling for increased alignment. Recognizing this alliance strongly suggests that integrative nursing is not a specialty practice and does not merit separate scope and standards statements or additional certification examinations. Additionally, an increasing number of professional organizations and state boards of nursing provide parameters for integrative nursing practice, including guidelines for the safe implementation of specific health promoting and healing modalities.
Integrative Nursing in Senior Living
Authors: Kirk Laura N. , Porter Rachel Trelstad , Quarberg Amy , Halcon Linda
Published: January 2019

The aging of the population, both nationally and globally, necessitates the development of innovative care models and living arrangements that will allow older adults to maintain health, function, engagement, and purpose even as they encounter increases in chronic disease and disability. Approximately 15% of adults ≥65 years of age in the United States reside in settings other than traditional community housing. The implementation of care practices guided by the principles of integrative nursing provides a unique and profound opportunity to enhance the quality of life of individuals within the senior living environment. Several case studies are presented, including the Hacienda in Arizona, The Waters Senior Living, and Woodbury Senior Living.
Prelicensure Education for Integrative Nursing
Authors: Miller Connie S. , Linck Raney
Published: January 2019

The time has come to return to our nursing roots and the wisdom of the past to transform not only what we teach, but also how we teach pre-licensure students. This chapter provides an overview of prelicensure educational pathways, including a review of current standards and regulations for entry-to-practice nursing programs. To transform curriculum so that programs reflect the values, concepts, and principles of integrative nursing, radical revision is not necessary, nor the ultimate goal. Adding content and skills is a misplaced focus and simply exacerbates the problem of content overload. The integrative nursing principles offer a fresh lens to examine the ways we currently approach role development and identity formation in our student nurses. The principles provide the perspective and guidance to bring us back to the core of nursing, creating classroom communities that can model what it means to be an integrative nurse.
Graduate Nursing Education for Integrative Nursing
Authors: Ringdahl Deborah
Published: January 2019

Graduate nursing education provides an opportunity to advance knowledge about integrative nursing and the effects of this approach to care on patient and systems outcomes. Graduate programs for advanced practice and their focus on organizational and systems leadership, quality improvement, interprofessional collaboration, and advanced practice align with professional competencies and provide the foundation for translating integrative nursing principles into clinical care. There is both a “reclaiming” of authentic nursing values and practice and “laying claim” to new and evolving models of health care. This chapter focuses on how concepts and principles of integrative nursing can inform innovative graduate nursing curriculum and transform advanced nursing practice. Examples of integrative nursing curricular opportunities are provided, and recommendations to increase and sustain education reform are presented.
Continuing Professional Development for Integrative Nursing
Authors: Koithan Mary , Pool Natalie
Published: January 2019

Nursing professional development (NPD) is defined as a career-long continuum of formal and informal educational activities that are informed by wide-ranging sources of evidence, including that from clinical or practice-based repositories as well as scientific and theoretical foundations. Several organizations support professional development opportunities in integrative nursing, including accreditation bodies, universities and schools of nursing, and independent professional education companies. This chapter presents opportunities for professional development, interprofessional education, and continuing education in integrative nursing as well as future trends in the field. An in-depth description of three exemplar programs that support ongoing professional development in integrative nursing as a way of highlighting the breadth and depth of opportunities for lifelong learning is presented.
Integrative Nursing in Turkey
Authors: Gözüm Sebahat , Platin Nurgün
Published: January 2019

This chapter focuses on past and current integrative practices in Turkey. Native practices have been embedded within Turkish culture for centuries as a part of the country’s heritage and history. Recently, the Ministry of Health approved a list of complementary therapies and standards to regulate practices in integrative medicine. In addition, the nursing discipline has come a long way in terms of research on integrative practices, from descriptive studies to randomized control group studies and projects at the doctorate level. However, in spite of research activities and the emergence of new courses in nursing curricula, the progress in implementing integrative therapies to clinical practice in Turkey has been very slow.
Integrative Nursing in Sweden
Authors: Jong Mats , Kristiansen Lisbeth , Jong Miek C. , Falkenberg Torkel
Published: January 2019

This chapter describes the existing “core” of caring/nursing in the Nordic tradition and how that can be merged with the concepts of integrative nursing to form a vision and strategy for the future. Terms such as integrative nursing are unfamiliar among nurses in Sweden, but the concepts of holistic care and healing have been taught for a long time and are well integrated in education and legislation. This chapter discusses possible barriers, such as the level of decision-making in Swedish healthcare as well as the role and attitude towards legislation in the light of the dominant biomedical paradigm. Further discussion explores how integrative nursing may serve as a bridge between the caring, nursing, and biomedical perspectives in its effort to identify and construct evidence from the basis and understanding of complex interventions and complex systems science. Practical steps for progression are identified and suggested.
Integrative Nursing in China
Authors: Liu Yilan , Ren Hairong
Published: January 2019

This chapter explores the application of integrative medicine and nursing within the framework of Traditional Chinese medicine (TCM). Concepts such as Qi and yin yang theory are discussed, TCM therapies such as moxibustion are also explored. What is now called integrative medicine and integrative nursing has existed within China for centuries and is not new; however, there are still challenges to advancing integrative nursing in China, including a nurse shortage and the lack of a defined set of principles of integrative nursing. This chapter discusses a vision and strategies for the development and sustainment of integrative nursing in China.
Florence Nightingale’s Legacy for the 21st Century: Global Activism, Advocacy, and Transformation
Authors: Beck Deva-Marie , Dossey Barbara Montgomery , Rushton Cynda Hylton
Published: January 2019

This chapter explores Florence Nightingale’s (1820–1910) legacy as global nursing, global healthcare, and global citizenship. Integrative nursing recognizes health as an ever-changing pattern of creative, adaptive relationships—across all dimensions of human experience and planetary health. Our integrative nursing lens acknowledges holistic and integral philosophies and principles of the fundamental unity within and between all beings and their environments. Today, integrative nurses are 21st-century Nightingales who carry forth her vision to achieve a healthier world together. Their deep personal and professional integrative nursing mission can continually transform their own lives, thus allowing all nurses to become effective advocates and catalysts for human health. They are change agents for global transformation across our lifetimes and to the generations who follow us.
Conclusion: Gazing with Soft Eyes: Envisioning a Responsive, Integrative Healthcare System
Authors: Koithan Mary
Published: January 2019

Integrative nursing offers a way to transform our beleaguered healthcare system, offering new solutions and paths to a system that is responsive, person-centered, relationship-based that is also affordable, and accessible. The principles of integrative nursing offer additional clarity about nursing’s role in the delivery of care across patient populations and clinical settings to promote health and wellbeing as well as serves as a call to action in the policy arena. Integrative nurses not only provide care that supports wholeness and healing but serve as activists that advocates for a hopeful and inclusive healthcare system.
Introduction
Authors: Svrakic Dragan M. , Divac-Jovanovic Mirjana
Published: January 2019

The term “fragmented personality” evokes the neuro-psychological essence of personality disorder (all variants), i.e., a suboptimal brain and mind integration within a person that leads to social maladaptation, together known as a personality disorder. Diagnostic aspects pivotal to the analysis of personality and its disorders are twofold. One aspect examines the level of mental functioning (a qualitative aspect of personality integration, i.e., “vertical” or in-depth diagnosis), while the second aspect is concerned with that individual’s habitual (mal)adaptive styles in relation to the environment (“horizontal diagnosis”). These two aspects provide answers to the three most important questions relevant to diagnosis and therapy: what (habitual patterns of behavior and relationships), how (characteristics of mental functioning), and why (factors in the development and maintenance of the observed patterns).
Psychotherapy of Personality Disorder
Authors: Svrakic Dragan M. , Divac-Jovanovic Mirjana
Published: January 2019

This chapter reviews the therapeutic process, strategies, and goals in psychotherapy of personality disorder that have been accepted by consensus. Psychotherapy can be thought of as environmental intervention that consistently trends in the right direction, proven capable of correcting the pathogenic impact of past environments or excessive neurobiology. The correction is both mental and structural. With personality disorder, psychotherapy must be transtheoretical, integrative, and eclectic in order to meet the uniquely multicausal and multidimensional nature of the syndrome. The chapter introduces Reconstructive Interpersonal Therapy (RIT), an integrative, transtheoretical psychotherapy of personality disorder drawing from psychoanalytic, cognitive, and humanist traditions. The RIT is presented in detail, with a comprehensive review of its basic principles and tools along with a number of practical tips in everyday therapeutic work. A detailed review of empirical studies of the efficacy and effectiveness of psychotherapy in personality disorder concludes the chapter.
A Puzzle About What the NVVRS “Projected Probability of Current PTSD” Measures
Authors: Dohrenwend Bruce P. , Murphy Eleanor , Yager Thomas J. , Wall Melanie M. , Hatch Stephani L.
Published: January 2019

This chapter asks and answers a critical question regarding the lack of difference in rates of NVVRS projected probability of PTSD in veterans who served in high and low combat periods of the Vietnam war. This chapter finds that the projected probability measure reflects symptoms of general distress more than it reflects symptoms of PTSD. If the previous NVVRS analyses had been able to use diagnoses of PTSD in the full sample, it is likely that they would have found differences in outcome between high and low combat periods of the war. After intensive study of the diagnosed onsets of, and current PTSD in, veterans in the NVVRS subsample who fought in four distinct periods of the war, this chapter concludes that the projected probability of current PTSD measure is a weak, if not misleading, measure of war-related PTSD.
Long-Term Impact of the War on Veterans’ Lives Nearly 40 Years After the War Ended
Authors: Dohrenwend Bruce P. , Yager Thomas J. , Wall Melanie M.
Published: January 2019

This chapter finds that the rate of war-related PTSD declined by about half in the years between the NVVRS and the Longitudinal Study. This furthered the previously reported decline of PTSD by almost half from its initial onset before the NVVRS was conducted. The chapter reports that most Vietnam veterans found value in their war experience, but they also put the war behind them after homecoming, suggesting successful transitions to civilian life. However, while readjustment to life after leaving Vietnam was satisfying and productive for most veterans, a minority believed that their wartime experiences still had a major negative effect on their current lives. Moreover, at the time of the Longitudinal Study, a small group of veterans (4%) suffered from current PTSD, and over three-quarters who had experienced PTSD onsets continued to experience one or more PTSD symptoms.
Medical Reasoning
Authors: Montgomery Erwin B.
Published: January 2019

Modern medicine is one of humankind’s greatest achievements. Yet medical errors and irreproducibility in biomedical research suggest something is amiss. Concerns have driven considerable and thoughtful critical analyses, but the apparent intransigence of these problems suggests a different perspective is needed. The perspective pursued in this book begins with the idea that the need for certainty in medical decision-making has been and remains the primary driving force in medical reasoning. Faced with the unique challenges of having to treat the individual patient, the great variety of manifestations across patients is daunting. Either there are as many different “diseases” as there are patients, or there is some economical set of principles and facts that can be combined to explain each patient’s disease. Modern allopathic medicine follows from the presumption that economical sets of principles and facts exist. The challenge is to discover those principles and facts and develop means to reason from them to the individual patient in a way that provides certainty. Medical reasoning implicitly evolved from variations of logical deduction and induction reflected in the hypothetico-deductive, pattern recognition, and intuitive approaches used in medicine today. However, these require the judicious use of logical fallacies that increase utility but at the cost of certainty. Similarly, medical research necessarily requires the judicious use of a variation on syllogistic deduction. Their necessary use creates risks for errors. Many problems in medical reasoning and research are the consequence of injudicious uses. This book is a critical and historical analysis of medical reasoning from this perspective.
Introduction
Authors: Montgomery Erwin B.
Published: January 2019

The critical and historical analysis of medical reasoning begins from the central importance of certainty in practice and research. The need for certainty manifests in preference for objective tests, particularly their overutilization, and evidence-based medicine used synonymously with randomized control trials. The variety of manifestations in each patient and each subject of research is a challenge to certainty. The response is a choice of epistemic perspectives. Either there are as many “diseases” as there are patients, or there is an economical set of diseases, defined by principles and facts, by which any patient can be understood. The latter suggests a type of logical deduction, and deductive logic is indeed the model. However, deduction, while providing certainty, does not generate new knowledge. Rather, derivative logical fallacies must be used that provide utility at the expense of certainty. Similarly, induction also is problematic. The implications of the conundrum and responses are introduced.
Epistemic Challenges and the Necessary Epistemic Responses
Authors: Montgomery Erwin B.
Published: January 2019

The practice of medicine is different from the practice of science, although some have argued that medicine must increasingly approximate science if progress in medicine is to be made. There is a myth that science medicine will eliminate uncertainty. Science can remain contingent and pending as individual patients demand action and medical decisions cannot be put in abeyance. Some extrapolate from this difference that science and medicine are fundamentally different, for example, maintaining a distinction between practical and scientific medicine. Yet medicine, practical or otherwise, still requires the use of logic and thus philosophical analysis. Indeed, on closer analysis, medical and scientific reasoning are not fundamentally different—only the consequences are different. Variations of logic to provide utility require an expanded sense of logic. However, with growing appreciation that most living biological systems are chaotic and complex, the logic used in medicine must continue to evolve.
A Calling to Be Better than Ourselves
Authors: Montgomery Erwin B.
Published: January 2019

It is difficult to name a profession with great authority with so little accountability compared to physicians who have finished supervised training. US Supreme Court justices have lifetime appointments and removal from office is exceedingly rare, nevertheless they are always under the public eye. Analyses demonstrate that the threat of malpractice is a poor tool at best to enforcing best practices. Attempts to establish peer review when used rarely address issues of medical reasoning. Furthermore, the physician shortage often leads to perhaps excessive tolerance for physicians’ actions. Accountability is a clinician’s ethical responsibility by virtue of the ethical principles of respect for autonomy, obligation to beneficence, avoidance of maleficence, and justice. These principles underlie the informed consent that is the basis of the clinician–patient relationship. In the end, it is only the personal commitment of the clinician to the patient that best guarantees that both will be served well.
Medical Negligence and Complaints
Authors: Ley Nigel Spencer , Sturgess Jane
Published: January 2019

Medicine is not a perfect science and doctors are not infallible. Throughout any medical career there will be cases of poor outcomes. Sometimes treatment may not work, sometimes the patient will be made worse, and sometimes a patient may die. The cause of a poor outcome may simply be the nature of the condition from which the patient is suffering. However, in some cases the cause may be mistakes by the treating clinicians. The purpose of this chapter is to consider the legal consequences of such mistakes. In English law where someone suffers an injury (physical or psychiatric) as a result of another person’s negligence, the injured person can bring a claim for compensation both for the injury itself and for any consequential financial loss. To prove negligence, a claimant needs to demonstrate there was a duty of care, that duty was breached, and they were injured as a consequence.
The Coroner
Authors: Cheney Belinda , Goddard Martin , Morris David S.
Published: January 2019

The coroner is an independent judicial officer, appointed by the local authority and responsible for investigating deaths in certain circumstances. The coroner investigates violent or unnatural death, deaths of unknown cause, and deaths that occurred in custody or otherwise in state detention. It is the coroner’s role to establish the identity of the deceased person, as well as how, when, and where they died. Neither a coroner nor a jury may express an opinion on any matters other than the four factual questions nor can any verdict be framed in such a way as to appear to determine any question of criminal or civil liability. No matter how justified, the coroner has no jurisdiction to investigate unless there is a statutory trigger and no duty to hold an inquest where the investigation has revealed a natural cause of death and there is no related and compelling reason to do so.
Medical Regulation
Authors: Curley Anna
Published: January 2019

Regulation of the medical profession is to ensure medicine is only practised by qualified individuals. Regulatory systems set and maintain standards of education and training, control entry into practice, and ensure competence of practising physicians. Medical regulators also identify and take action against incompetent, unethical, or immoral practices by physicians. In the UK, these regulatory roles are carried out by the General Medical Council (GMC). The Medical Act 1983 provides the statutory basis for the GMC’s overall functions. Its role in education has evolved significantly of late as it now holds responsibility for postgraduate medical education and training in the UK and is tasked with developing combined standards for undergraduate and postgraduate education. The GMC also governs medical revalidation, the purpose of which is to improve the safety, quality, and effective delivery of care for patients by bringing all doctors into a governed system that prioritizes professional development and accountability.
Healthcare Management
Authors: Roche William R.
Published: January 2019

Doctors are familiar with the professional regulation of their practice and behaviour through the General Medical Council and for their liabilities under civil law in the event that a patient comes to harm. The public outcry in response to a series of reports into healthcare failings and wrongdoing has led to legislation that criminalizes certain acts and omissions. Increased resort to judicial review has also produced a series of key judgments that have more sharply defined the duties and liabilities of those commissioning and providing healthcare. Medical managers need to be aware of the increased range of professional expectations of them as individuals and the statutory duties of healthcare commissioners and providers. This chapter will discuss issues in relation to this, such as rationing, corporate manslaughter, due diligence, duty of candour, intellectual property, exploiting commercial interests, and trainee liability.
Legal Basis for Prescribing
Authors: de Monteverde-Robb David
Published: January 2019

Drug prescribing is a multifaceted and technically complex process requiring careful judgement of the competing risks of harm and benefits of treatment. Good prescribing requires knowledge of your patient’s illness, comorbidities, and concurrent treatments. When prescribing, a doctor must be aware of a drug’s potential for toxicity, its metabolic or excretory pathway, its interactions, its cautions and contraindications, and its legal status. Since the enactment of the UK Human Medicines Regulations 2012, prescribing of medicines may be undertaken by any suitably qualified doctor, dentist, and various other groups recently given prescribing privileges. All groups have a duty to prescribe medicines within their area of competence and scope of practice, as failure to prescribe medicines safely is responsible for a significant amount of reported serious medication incidents. This chapter will review the law concerning prescribing, the liability imposed on suppliers, consent issues, non-standard prescribing, and the legal status of non-allopathic medicines.
Illness narratives in the workplace
Authors: von Kardorff Ernst
Published: January 2019

Why is there so little research on illness narratives in the workplace albeit the significant role of labour in society, the considerable increase of illnesses at work and high rates of sick-leave and early retirement? The importance of reconstructing illness narratives in the workplace for prevention, timely support, coping and staying at work is emphasized. It will further be shown how illness narratives are embedded in narrations on working conditions and return to work experiences. The mixed-method study focused on return to work trajectories of participants of vocational retraining. On this basis, this chapter discusses strategies of successful and failed arrangements in the workplace.
The ‘narrative spirit’
Authors: Jeoung Yeonok , Lucius-Hoene Gabriele , Ik Bak Yong
Published: January 2019

Recent studies in Korea show that doctors have suffered a severe loss of image among their patients, due to their authoritarian, unempathic, and unfriendly communication behaviour. These findings were confirmed by studies of their communication styles done with conversation analysis. Training courses for medical students in doctor–patient communication have become mandatory, but are short and to date have provided no significant change; the ethical foundations of doctors when dealing with patients remained untouched. This chapter explores how the humanistic concepts of narrative medicine and can provide better understanding between doctors and patients. This ‘narrative spirit’ resonates with traditional values of Buddhism and Confucianism that are deeply rooted in Korean culture. It discusses a training programme for doctors working with text analysis of narrative interviews of patients’ illness experiences and shows how using patients’ stories may evoke this ‘narrative spirit’ and combine traditional ethical values with modern medical education.
How to use illness narratives in medical education
Authors: Palant Alexander , Himmel Wolfgang
Published: January 2019

To be effective, (future) clinicians should gain an understanding of patients’ perspectives when it comes to having an illness. How patients experience their illness is best represented in illness narratives. Such illness narratives can be found on the website www.krankheitserfahrungen.de—the German version of the international DIPEx websites. This chapter discusses a pilot study of a teaching unit developed using website videos of illness narratives from patients with type 2 diabetes regarding weight loss. It discusses the aim of this pilot, which was to teach medical students to identify different subjective views of, and reactions towards, the pressure to give up a previous lifestyle. It investigates how, while students and the teacher appreciated the exercise and learned to better understand the patients’ perspective from illness narratives, the external conditions seem to be the main challenge for patients who need to implement lifestyle changes.
What’s in a name?
Authors: Holmberg Christine
Published: January 2019

There is a push in healthcare delivery for patients to base their treatment decisions on ‘evidence’ rather than ‘anecdotes’, a term used for individual experiences, and that devalues their epistemological grounding of an individual’s experiences in comparison to statistically-derived scientific knowledge. This chapter discusses how the profound differences between these different forms of knowledge can be teased out through the lens of phenomenological scholars and an investigation of experience and storytelling. It covers how treatment decisions are characterized by choices, of which one is not necessarily superior to another, but rather all are characterized by different risks and benefits, and that such treatment decisions work in the subjunctive mode and as such are inherently narratively structured. Healthcare decision making is about finding a plot. Thus, this chapter explores how helping patients to make ‘better’ decisions may necessitate presenting storylines in which future outcomes are envisioned that take both the intersubjective knowledge of the patient and the scientific knowledge of epidemiology into account.
Changes in authenticity
Authors: Miller Erez C. , Fleischmann Amos
Published: January 2019

The use of medications for attention deficit hyperactivity disorder (ADHD) has been strongly debated because medications may alter the individual’s sense of authenticity. This chapter examines online forums that include young people’s experiences with ADHD medications, their sense of control over medication use, and the drugs’ effects on their sense of authenticity. It discusses the analysis of four Internet forums dedicated to ADHD issues using an ethnographic-discursive approach, and demonstrates that the results suggest there are two types of competing narratives—those of the young people, who express doubts about taking medications due to their effect on various psychological characteristics and especially on their sense of authenticity, and those of professionals, who uphold the medical perspective that regardless of the medications’ effects they are still the best option for treating ADHD. It covers how the clash between these two competing narratives resonates a more general struggle of people with disabilities for their rights. Finally, it discusses how social media echoes the struggle between individuals with disabilities and the establishment’s view of ADHD as a medical condition which should be treated accordingly, even at the cost of losing the individual’s authenticity.
Epidemiological Studies: A Practical Guide
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

This volume provides a practical, hands on guide to the design, planning, conduct, analysis, and interpretation of epidemiological studies. The learning points are applicable to all human studies of health and disease that require the collection and analysis of data to answer questions on disease risk, health outcomes, and the effects of interventions in ‘real world’ populations. It summarizes the main study designs used in epidemiological from purely quantitative studies to assess incidence and prevalence, to the range of observational studies used in the modern practice of epidemiology. A substantial section is devoted to the practical aspects of conduct of epidemiological studies, balancing scientific quality with practicality: the latter covering issues such as costs and ethics. This book also provides a detailed menu of activities that takes the investigator through all the necessary steps following the collection of individual subject data through to generating the statistically robust results necessary to reach conclusions about the questions asked. It provides insights into how to use existing data (secondary data analysis) to answer epidemiological questions, an increasing activity in this era of ‘big data’. Similarly, with a growing epidemiological literature, with multiple studies seemingly addressing the same question, the volume explores how practically to synthesize the results of such multiple investigations and the role of meta-analysis. The book’s ultimate goal is to provide a practical toolkit to enable the successful completion of questions appropriate for applying epidemiological methods.
Which measure of disease occurrence?
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

A key aspect of epidemiology is about understanding and exploring variations in disease. In order to do so it is important that the same definitions of disease occurrence are used, no matter where a study is being conducted, and that the same approach to measurement is taken. The epidemiologist needs to be aware of which measure to use in specific circumstances. Measuring disease occurrence is the basic activity of epidemiology, and the following section provides the background to choosing the most appropriate measure(s) of disease occurrence for the aims of the study. The term ‘disease’ can also be taken in this context to describe any personal attribute. Thus, the concepts described in this chapter apply equally well to assessing the occurrence of a symptom, the development of a particular disability, or the frequency of a medical intervention.
Participation in epidemiology studies
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

There are two major reasons to maximize participation in an epidemiological study. Firstly, low participation can lead to bias and secondly, inadequate numbers recruited can limit the power of the study. All other things being equal, lower participation will increase the influence of non-response bias in a study. However, it should be noted that even in studies with high participation there exists a possibility of selection bias if non-participants are markedly different from participants in aspects that are key to the conditions being studied. There are several ways of boosting participation which should be embedded into the study design from the start, since chasing up to increase participation is resource-expensive.
Meta-analysis
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

The previous chapter has discussed how to gather and evaluate existing evidence from epidemiological studies. Here further consideration is given to summarizing the identified evidence in such a way that it can be used for decision-making, including approaches to control for chance and potential bias. Meta-analysis refers to the statistical analysis of results from individual studies for integrating the findings. There are other terms related to meta-analysis such as quantitative review, combined analysis, pooled analysis, or quantitative synthesis. Some of them use different methods, for example, meta-analysis of published data considers each study as a unit of analysis while individual patient data analysis includes the original data from each study on a participant level. This chapter describes how to numerically summarize data through performing a meta-analysis using data from a systematic review of epidemiological studies. It also considers possible bias, reporting guidelines, and statistical software available for meta-analysis.
The costs of an epidemiological study
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

Epidemiological studies can be very expensive, especially from large populations with multicentre recruitment. The researcher will need to ensure that there are adequate resources, allowing for the fact that things will not always go to plan, but making sure that the research is value for money. What is considered a reasonable cost will also depend on how strong the rationale is for conducting the study. Although in theory the study design influences the costs, in practice the resources available will often constrain the methodological choices. Costing an epidemiological study accurately at the start is vital. There are several ways to maximize the use of resources to ensure the study is efficient.
Seizures and Status Epilepticus
Authors: Reznik Michael E. , Claassen Jan
Published: January 2019

Seizures are common in the intensive care unit, both in patients with brain injury and those with other forms of critical illness. Many of these are nonconvulsive and have been increasingly recognized with the advent of continuous electroencephalography (EEG) monitoring. When seizures are prolonged or recur without a return to baseline, this is termed status epilepticus (SE)—a true medical emergency. Progression to refractory SE may occur quickly after onset, with a high potential for subsequent permanent neuronal damage. Successful management of SE therefore rests with early recognition and treatment, with a low threshold to begin anesthetic agents if seizures remain refractory to initial therapy. Meanwhile, a concurrent focus should be placed on airway, breathing, and circulation, as well as identifying the etiology of the seizures. Etiology is likely the best determinant of outcomes after SE (with outcomes worst for anoxic brain injury, followed by other newly acquired brain injury), while prolonged and refractory SE also portend a poorer prognosis.
Movement Disorder Emergencies and Movement Disorders in the ICU
Authors: Sandulescu Mihai C. , Burton Edward A.
Published: January 2019

Movement disorders include syndromes characterized by either slowness and paucity of voluntary movement (hypokinetic disorders) or involuntary movements (hyperkinetic disorders). Both types of movement disorder can present as a clinical emergency, where prompt diagnosis and treatment are necessary to avoid morbidity or mortality. This chapter reviews the most common hypokinetic and hyperkinetic movement disorder emergencies encountered in the hospital and intensive care unit, emphasizing diagnostic workup and practical management. Hypokinetic emergencies include neuroleptic malignant syndrome, parkinsonism-hyperpyrexia syndrome, acute parkinsonism, and psychosis in Parkinson’s disease. Hyperkinetic emergencies include hemiballismus-hemichorea, autoimmune orobuccolingual dyskinesia, serotonin syndrome, posthypoxic and other types of myoclonus, and acute dystonia. Diagnosis of these disorders is nearly always based on clinical evaluation; rapid recognition often results in effective treatment and a good prognosis for recovery. Consequently, familiarity with diagnosis and management of movement disorder emergencies is both important and useful.
Prognostication and Ethics
Authors: Hwang David Y. , White Douglas B.
Published: January 2019

This chapter provides an overview of prognostication and key topics in ethics as they relate to the practice of neurocritical care. Challenges with prognostication are summarized. Outcome prognostication tools for ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic brain injury are outlined along with a discussion of their limitations. Best practices for communicating prognosis are reviewed. Shared decision-making with surrogate decision-makers in intensive care units is discussed in detail, with attention to advance care planning documentation and resolution of situations in which clinicians may have conscientious objections to potentially inappropriate treatment.
Endosaccular Flow Disruption: A New Frontier in Endovascular Aneurysm Management
Authors: Dmytriw Adam A , Salem Mohamed M , Yang Victor X D , Krings Timo , Pereira Vitor M , Moore Justin M , Thomas Ajith J
Published: January 2019

Flow modification has caused a paradigm shift in the management of intracranial aneurysms. Since the FDA approval of the Pipeline Embolization Device (Medtronic, Dublin, Ireland) in 2011, it has grown to become the modality of choice for a range of carefully selected lesions, previously not amenable to conventional endovascular techniques. While the vast majority of flow-diverting stents operate from within the parent artery (ie, endoluminal stents), providing a scaffold for endothelial cells growth at the aneurysmal neck while inducing intra-aneurysmal thrombosis, a smaller subset of endosaccular flow disruptors act from within the lesions themselves. To date, these devices have been used mostly in Europe, while only utilized on a trial basis in North America. To the best of our knowledge, there has been no dedicated review of these devices. We therefore sought to present a comprehensive review of currently available endosaccular flow disruptors along with high-resolution schematics, presented with up-to-date available literature discussing their technical indications, procedural safety, and reported outcomes.
Epidemiology, Natural History, and Clinical Presentation of Large Vessel Ischemic Stroke
Authors: Rennert Robert C , Wali Arvin R , Steinberg Jeffrey A , Santiago-Dieppa David R , Olson Scott E , Pannell J Scott , Khalessi Alexander A
Published: January 2019

Large vessel occlusions (LVOs), variably defined as blockages of the proximal intracranial anterior and posterior circulation, account for approximately 24% to 46% of acute ischemic strokes. Commonly refractory to intravenous tissue plasminogen activator (tPA), LVOs place large cerebral territories at ischemic risk and cause high rates of morbidity and mortality without further treatment. Over the past few years, an abundance of high-quality data has demonstrated the efficacy of endovascular thrombectomy for improving clinical outcomes in patients with LVOs, transforming the treatment algorithm for affected patients. In this review, we discuss the epidemiology, pathophysiology, natural history, and clinical presentation of LVOs as a framework for understanding the recent clinical strides of the endovascular era.
Morality and the State
Authors: Moller Dan
Published: January 2019

This chapter argues that moral norms constrain the state. It rejects the idea that a group of people forming a polity can appeal to emergent norms that contravene the morality we accept at the interpersonal level. This means that the state may not do things to individuals that appropriately situated individuals may not do to each other. It also argues that we should ignore revisionist versions of utilitarianism when doing political philosophy. Revisionist utilitarianism may be true, but that truth would upend so much of what we believe that we are better off setting it aside in a book that is about political organization.
Direct Health Care Cost and Work Incapacity Related to Complex Regional Pain Syndrome in Switzerland: A Retrospective Analysis from 2008 to 2015
Authors: Scholz-Odermatt Stefan Markus , Luthi François , Wertli Maria Monika , Brunner Florian
Published: January 2019

Objective

First, to determine the number of accident-related complex regional pain syndrome (CRPS) cases from 2008 to 2015 and to identify factors associated with an increased risk for developing CRPS. Second, to analyze the duration of work incapacity and direct health care costs over follow-up periods of two and five years, respectively.

Design

Retrospective data analysis.

Setting

Database from the Statistical Service for the Swiss National Accident Insurances covering all accidents insured under the compulsory Swiss Accident Insurance Law.

Subjects

Subjects were registered after an accident between 2008 and 2015.

Methods

Cases were retrospectively retrieved from the Statistical Service for the Swiss National Accident Insurances. Cases were identified using the appropriate International Classification of Diseases, 10th Revision, codes.

Results

CRPS accounted for 0.15% of all accident cases. Age, female gender (odds ratio [OR] = 1.53, 95% confidence interval [CI] = 1.47–1.60), and fracture of the forearm (OR = 38, 95% CI = 35–42) were related to an increased risk of developing CRPS. Over five years, one CRPS case accumulated average insurance costs of $86,900 USD and treatment costs of $23,300 USD. Insurance costs were 19 times and treatment costs 13 times the average costs of accidents without CPRS. Within the first two years after the accident, the number of days lost at work was 20 times higher in patients with CRPS (330 ± 7 days) than in patients without CRPS (16.1 ± 0.1 days). Two-thirds of all CRPS cases developed long-term work incapacity of more than 90 days.

Conclusion

CRPS is a relatively rare condition but is associated with high direct health care costs and work incapacity.
Pharmacokinetics of Micafungin in Critically Ill Patients Receiving Continuous Venovenous Hemodialysis With High Cutoff Membranes
Authors: Tenorio-Cañamás Teresa , Grau Santiago , Luque Sonia , Fortún Jesús , Liaño Fernando , Roberts Jason A.
Published: January 2019

Background:

An optimal antifungal therapy for invasive candidiasis in critically ill patients is essential to reduce the high mortality rates. Acute kidney injury is common, and continuous renal replacement therapies are frequently used. Previous studies have demonstrated a lack of effect from different continuous renal replacement techniques on micafungin clearance. However, the use of high cutoff pore size membranes could potentially allow for the loss of albumin and alter micafungin pharmacokinetics. The objective was to explore the pharmacokinetics of micafungin in critically ill patients undergoing continuous venovenous high cutoff membrane hemodialysis (CVVHD-HCO).

Methods:

Prospective observational study performed in critically ill patients treated with 100 mg/d of micafungin and undergoing CVVHD-HCO. CVVHD-HCO sessions were performed using Prisma-Flex monitors and dialyzers with a membrane of polyarylethersulfone of 1.1-m2 surface area and 45-kDa pore size. Blood samples were collected from arterial prefilter, venous postfilter, and the drainage line ports at 0 (predose), 1, 4, 12, 24 hours after dose, and micafungin concentrations were determined using HPLC-UV.

Results:

Nine patients (55.6% male; age: 28–80 years) were included. Median (range) of micafungin concentrations in the effluent were <0.2 (<0.2–0.4) mg/L at low (predose) and 0.4 (<0.2–0.7) mg/L at high (1 h) concentrations. The extraction ratio was <12% at each time point. A 2-compartment model best described the time course of plasma concentrations, and body weight was the only covariate that improved the model.

Conclusions:

This is the first study demonstrating that CVVHD-HCO does not alter the pharmacokinetics of micafungin, and that standard doses of this antifungal can be used.