bluuebunny/crossref_metadata_2025 huggingface dataset:
The use of spectroscopic techniques in the study of DNA stability
Authors: SantaLucia John Jr
Published: November 2020

Accurate determination of nucleic acid thermodynamics has become increasingly important in understanding biological function as well as applications in biotechnology and pharmaceuticals. Knowledge of the thermodynamics of DNA hybridization and secondary structure formation is necessary for understanding DNA replication fidelity (1), mismatch repair efficiency (2) and the mechanism of DNA triplet repeat diseases (3). In addition, RNA folding thermodynamics are an important aspect of understanding ribozyme catalysis, as well as understanding the regulation of protein expression, mRNA stability and the mechanism of protein synthesis by the ribosome (4). With the genome sequencing era upon us (5), it will increasingly become important to predict the folding and hybridization thermodynamics of DNA and RNA, so that accurate diagnostic tests for genetic and infectious diseases can be developed. Thus, there is a need to develop a database of accurate thermodynamic parameters for different nucleic acid folding motifs (4). This chapter describes practical aspects of the application of UV absorbance temperature profiles to determine the thermodynamics of nucleic acid structural transitions. Protocols and practical advice are presented for issues not normally addressed in the primary literature but that are crucial for the determination of reliable thermodynamics, such as sequence design, sample preparation, choice of buffer, protocols for determining strand concentrations and mixing strands, design of microvolume cuvettes and cell holder, instrumental requirements, data analysis methods, and sources of error. References to the primary literature and reviews are also provided where appropriate.
Using Evidence for Decision Making
Authors: Leufer Thérèse , Cleary-Holdforth Joanne
Published: November 2020

By now, you have read lots of information on the principles of decision making and why this is so important for you in your nursing practice. It will be invaluable to you as you progress in your nursing career to know how to make decisions in and about nursing practice, including knowing: ● when to make these decisions; ● when decisive action is required; ● when to call a doctor; ● when to withhold a particular medication; and ● when to recommend an alternative nursing intervention. It is equally imperative that you understand why you are making the decisions that you are making and where you might go to find the information that you need to underpin these decisions. The Nursing and Midwifery Council (NMC), in its Standards for Pre-Registration Nurse Education (2010), specifies clearly the competencies that are required upon completion of a nursing programme for entry to the NMC professional register. In its competency framework, four key areas (‘domains’) are identified, one of which is ‘Nursing practice and decision making’, demonstrating unequivocally the emphasis and importance that the NMC places on the role of the qualified nurse in decision making. This domain statement is presented in Box 3.1. Specific requirements relating to this domain can be found in Parts 2 and 3 of this book. In addition, the NMC stipulates, in relation to specific knowledge and skills, that ‘all nurses must apply knowledge and skills based on the best available evidence indicative of safe nursing practice’ (NMC 2010). It also offers guidance to programme providers on the ‘Essential Skills Clusters’ (NMC 2010)—that is, additional sets of skills (‘clusters’ of skills set around specific areas of nursing practice) required to be attained by student nurses at specific points during their programme. The Essential Skills Cluster that is relevant to the use of evidence to underpin practice decisions is the ‘Organisational aspects of care’. Within this cluster, there are a number of descriptors listed that are related to this area, as listed in Table 3.1.
Professional Values and Decision Making
Authors: Chadwick Ruth
Published: November 2020

This is the first chapter in the part of the book exploring each of the four domains comprising the Nursing and Midwifery Council (NMC) Standards for Pre-Registration Nursing Education (NMC 2010) in which the student nurse in the United Kingdom has to demonstrate attainment of the specific competencies to achieve registration as a nurse. In keeping with the overall aims of the book, the aim of this chapter is to help you to develop your decision-making skills in the domain of ‘professional values’. It will offer real-life case studies to illustrate key issues and how you, as a student, can learn to make effective decisions in your journey to becoming a registered nurse. Because this book is written by registered nurses, many of whom work in education, you will probably not be very surprised to learn that we think your decision to become a nurse could be one of the best decisions that you have made to date—but do you really understand what lies before you? Before you begin to be concerned about the ‘right-ness’ of your decision to become a nurse, it is important to remember that there are many individuals who are there to help you on your professional journey, including your personal tutors, mentors and other practitioners in practice, lecturers, other students, and most importantly the patients and clients for whom you will be caring and with whom you will be working. In addition, you will have friends and family who offer a different kind of support to you, as well as those organizations that can offer professional support to you as a student nurse and subsequently to you as a qualified nurse. This chapter also intends to help you to appreciate the significance of the NMC’s Guidance on Professional Conduct for Nursing and Midwifery Students (NMC 2011) as you embark on your professional and personal journey to become a registered practitioner who is able to demonstrate the required standards of conduct, performance, and ethics, as expressed in The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives (NMC 2008).
Unstable Endings
Authors: Wothers Peter
Published: November 2020

In 1896, Henri Becquerel (1852–1908) had discovered, by chance, the phenomenon of radioactivity, after he found that uranium salts left on top of covered photographic plates produced an image on the plates when they were later developed. Soon afterwards, thorium was also found to be radioactive. In 1898 Marie Curie (née Sklodovska) realized that certain minerals were more ‘radioactive’ (a term she first introduced) than could be rationalized by the amount of uranium or thorium that they contained. She guessed that they might contain trace amounts of an even more radioactive element, and during the long purification process, she eventually realized that two such elements were present. The naming of the first of these, discovered in July 1898, is described by her daughter Eve Curie in her biography of her mother: . . . ‘You will have to name it,’ Pierre said to his young wife, in the same tone as if it were a question of choosing a name for little Irène [their first daughter]. The one-time Mlle Sklodovska reflected in silence for a moment. Then, her heart turning toward her own country which had been erased from the map of the world, she wondered vaguely if the scientific event would be published in Russia, Germany and Austria—the oppressor countries—and answered timidly: ‘Could we call it “polonium”?’ . . . Marie Curie named the element after her homeland, Poland, but the country did not exist as a separate entity at that time, and her choice was something of a political statement. The second element discovered by Marie and Pierre Curie was found to be millions of times more radioactive than uranium. This element they called ‘radium’ because of its intense radioactivity. Over three and a half years later, when they finally isolated a tenth of a gram of purified radium salts from tonnes of pitchblende ore, the Curies were delighted to find that the substance was spontaneously luminous. After the discovery that uranium and thorium were radioactive, in September 1899, Ernest Rutherford (1871–1937) made a further discovery: ‘In addition to this ordinary radiation, I have found that thorium compounds continuously emit radio-active particles of some kind, which retain their radio-active powers for several minutes.
Epidemiological and Geographical Considerations
Authors: Colbert Dom
Published: November 2020

It is useful to have a good knowledge of geography and to have at least a globe or atlas in the clinic so that the patient can point out a planned itinerary. Appropriate internet facilities must be available so that information on local diseases, current outbreaks, and required immunizations can be accessed speedily.
Earth Matters
Authors: Bardgett Richard
Published: November 2020

For much of history, soil has played a major, and often central, role in the lives of humans. Entire societies have risen, and collapsed, through the management or mismanagement of soil; farmers and gardeners worldwide nurture their soil to provide their plants with water, nutrients, and protection from pests and diseases; major battles have been aborted or stalled by the condition of soil; murder trials have been solved with evidence from the soil; and, for most of us, our ultimate fate is the soil. In this book Richard Bardgett discusses soil and the many, and sometimes surprising, ways that humanity has depended on it throughout history, and still does today. Analysing the role soil plays in our own lives, despite increasing urbanization, and in the biogeochemical cycles that allow the planet to function effectively, Bardgett considers how superior soil management could combat global issues such as climate change, food shortages, and the extinction of species. Looking to the future, Bardgett argues that it is vital for the future of humanity for governments worldwide to halt soil degradation, and to put in place policies for the future sustainable management of soils.
Soil and Biodiversity
Authors: Bardgett Richard
Published: November 2020

One of the most striking things about soil is that it harbours a remarkable diversity of life. A handful of soil from any well-kept garden, forest, or agricultural field, can contain literally billions of individual organisms and thousands of species. In some cases, as much as 10 per cent of the soil’s total weight could be alive, although in most cases it will be 1–5 per cent. The bulk of these organisms are microorganisms, which aren’t visible to the naked eye: the bacteria, fungi, and algae. But the soil is also home to many animals, including microscopic nematodes and protozoa, and large faunas such as springtails, earthworms, spiders, and even moles. The diversity of all these organisms is vast, with some scientists estimating that soils probably contain as much as one-quarter of the living diversity on Earth. The importance of soil organisms for soil fertility has long been known. The philosopher Aristotle (384–322 BC) referred to earthworms as ‘the intestines of the earth’, and Cleopatra (69–30 BC), the last pharaoh of Egypt, declared them to be sacred because of their contribution to Egyptian agriculture. Darwin detailed the importance of earthworms for soil fertility in his last book, published in 1881. He commented: . . . It may be doubted whether there are many other animals which have played so important a part in the history of the world as have these lowly organized creatures. . . . Also, the benefits of leguminous plants for soil fertility and crop growth have been known since Roman times. But it wasn’t until the late nineteenth century that it was discovered that nitrogen fixation is down to microscopic bacteria (Rhizobium) that live in small modules in roots. Around the same time, it was also discovered that bacteria that live freely in soil, outside plant roots, also fix nitrogen from the atmosphere and boost nitrogen supply to soil.
Perinatal depression across the world: Prevalence, risk factors, and detection in primary care
Authors: O’Hara Michael W. , Segre Lisa S.
Published: November 2020

This chapter, like the entire volume, is dedicated to the memory of Channi Kumar. I first met Channi in August 1984 in Oakland, California, at the biennial meeting of the Marcé Society, hosted by James Hamilton. I had already been impressed by Channi’s research but knew him only through his published work. In person, the man did not disappoint. He was elegant and kind, a man who treated everyone with respect. Over the years, my affection and admiration for Channi grew through many stimulating discussions and delightful social occasions. Even our last series of meetings focused on a new, exciting initiative of Channi’s: the ‘Transcultural Study,’ which he envisioned as a way to harmonize the detection, assessment, and treatment of perinatal mood disorders, across western Europe and even the United States, Asia, and Africa. Through experiences like these, Channi made my life richer, personally and professionally; and I greatly miss him as a mentor and a friend, and feel privileged, along with my colleague Lisa Segre, to contribute a small piece to honor this great psychiatrist and humanitarian. Michael W. O’Hara Perinatal depression is a significant mental health problem that afflicts women around the world at a time when they are highly vulnerable—pregnant or managing a new infant. In one form or another, perinatal depression has been recognized for thousands of years; however, only in the past 50 years has there been a sustained focus on the non-psychotic mental illnesses experienced by some during pregnancy and the postpartum period. The literature of the 1960s contains only a few papers with the words postpartum depression, postnatal depression, or perinatal depression. Not until the 1970s did these terms come into common use. Indeed, a search for at least one of these terms on the PsycNET database (from entries catalogued between 1884 and 9 September 2012) revealed the vast majority (2,743 or 75%) of 3,651 papers, books, and book chapters on perinatal depression were published after 2000. These findings show how work in the field of perinatal mental illness has expanded exponentially.
Mother- and father-to-infant emotional involvement
Authors: Figueiredo Bárbara
Published: November 2020

A mother’s specific emotional and hormonal state after childbirth ensures her emotional involvement and adequate parental behaviour. Soon after delivery, or even in late pregnancy, the mother’s emotional state—in particular, an increased sensitivity—becomes fully adapted to the identification and satisfaction of the infant’s physical and psychological needs. Winnicott (1956, 1960) was perhaps one of the first authors to point out the presence of a particular emotional state in recently delivered mothers—‘primary maternal preoccupation’, referring to the mother’s correct identification and immediate satisfaction of the infant’s physical and psychological needs. Winnicott (1990) later defined and described four main tasks to be fulfilled in the maternal role, including the emotional involvement with the child, which he termed ‘holding’. Holding tasks are: (1) to provide protection and care to the child, (2) to take into account the child’s limitations and dependency status, (3) to provide the necessary care for the child’s growth and development, and (4) to love the child. In the meantime, Yalom et al. (1968) and Pitt (1973) both described the ‘postpartum/maternity blues—a transient state of emotional dysphoria, emerging within a few hours to 2 weeks after childbirth, in about 50 to 70% of puerperal women, and characterized by intermittent mild fatigue, tearfulness, worry, difficulty in thinking, and sleep disturbances. Progesterone and oestrogen levels, which gradually increase during pregnancy, fall suddenly after delivery, returning to prepregnancy levels in just 3 days. This rapid decline, the most severe threat to a women’s hormonal and emotional balance, has been proposed as the main cause of postpartum/maternity blues (e.g. Pitt 1973; Yalomand et al. 1968). The mother’s behavioural sensitivity to such a drop in reproductive hormones was later associated with higher reactivity to the infant’s stimuli and greater proximity with the neonate (e.g. Barrett and Fleming 2011; Carter 2005; Fleming et al. 1997; Miller and Rukstalis 1999), and was proposed as serving the function of eliciting mother-to-infant involvement, to ensure that the infant receives the required care to survive (e.g. Carter 2005; Figueiredo 2003; Pedersen 1997). The evolutionary point of view had its clearest proponent in John Bowlby (1969/1982, 1980) who proposed the presence of a behavioural system (that is, an organized set of behaviours) in parents—the ‘caregiving system’, to guarantee the proximity and protection of the child.
Essential Dental Public Health
Authors: Daly Blánaid , Batchelor Paul , Treasure Elizabeth , Watt Richard
Published: November 2020

Public health is a key concern of modern dental practitioners as they continue to play a vital role in the health of populations across the world. The second edition of Essential Dental Public Health identifies the links between clinical practice and public health with a strong emphasis on evidence-based medicine. Fully revised and updated for a second edition, this textbook is split into four parts covering all the need-to-know aspects of the subject: the principles of dental public health, oral epidemiology, prevention and oral health promotion, and the governance and organization of health services. Essential Dental Public Health is an ideal introduction to the field for dentistry undergraduates, as well as being a helpful reference for postgraduates and practitioners.
The structure of the NHS in the UK
Authors: Daly Blánaid , Batchelor Paul , Treasure Elizabeth , Watt Richard
Published: November 2020

The National Health Service was created at the end of the Second World War. Its structure has remained relatively stable until the 1970s. Since then, politicians have continued to reform it at an ever-increasing rate and, in 2012, the biggest change to the English NHS structure was implemented (Reynolds and McKee 2012). The question as to why the reforms are being undertaken is crucial. Growing demands, changing epidemiology, better understanding of the determinants of health, and evolving societal values have all influenced the process. Perhaps most crucial is the latter. It is probably more appropriate to describe the current NHS as four differing NHS care systems that are coterminous with the legislative bodies that exist within the UK, namely England, Northern Ireland, Scotland, and Wales. Not only are the planning arrangements becoming more divergent, but also the philosophical approach underpinning each system is beginning to follow very different paths. The NHS has almost never taken a typical theoretical planning approach but rather has evolved due to the wide range of factors and influences involved. These include the changing power of health care professions, the need to ration services, adoption of economic theory (market forces and the internal market), and, not least, changing governments with differing political stances. The importance of understanding the history of the service and the lessons of the past are that they inform the present and can provide an indication of how the future may look. This chapter outlines the major influences on the NHS since its inception, describes the major problems currently faced by the NHS, and provides an overview of the ways in which clinical services are currently delivered. It will not give a detailed description of the structure of the health service, not least as by the time the book is published a new structure will exist. The current structure of the health service in each of the four countries of the UK will be available on this book’s website, and updated as changes occur.
Defining issues
Authors: Harding Dennis
Published: November 2020

The universality of human mortality is the commonest of truisms, but the prospect of mortality evidently has weighed differently on different societies over the course of human history, from the oppressive burden of the later Middle Ages to the more relaxed live-for-the-present-ism of the current generation. The disposal of the dead is at basis a hygienic necessity that is recognized in all but the most socially disrupted circumstances, but the manner of disposal may reveal attitudes of society towards death and the concept of afterlife, or the role of the dead in the continuing life of the community. Even in our contemporary secular society, relatives of the victims of murder or abduction or of death in foreign parts crave the recovery of bodies for due burial, without which they apparently cannot ‘achieve closure’, a condition of grace that might have been considered essential to the dead, but which evidently matters equally to the bereaved. The discipline of archaeology is methodologically disposed to distort the reality of the past in that it seeks to recognize ordered patterns where in reality diversity and apparent irrationality must have been inherent. The keystone of Childe’s approach, the identification of archaeological cultures, was dependent upon recurrence of diagnostic types in association, which would permit the comparison of one cultural assemblage with another in time or space. Even in processual and post-processual approaches the essence is to reduce the ever-burgeoning data-base to some semblance of order, without which it is impossible for interpretation to proceed, other than intuitively, empathically, or experientially, that is, based upon imaginative reconstruction rather than being inferred, however inadequately, from archaeological data. The consequence of this process of classification has been to emphasize certain outstanding classes of data, like long barrows, stone circles, or hillforts, as typical of their period or region, at the expense of a subtler analysis of the many possible variations of settlement or burial sites that are detectable, even from the surviving archaeological record. In recent years there has been a significant shift in archaeological approaches to burial data.
Urinalysis
Authors: Lovegrove Jane
Published: November 2020

Urinalysis simply means analysis of urine. It is an easily performed investigation that can detect a wide variety of abnormalities within a few minutes at low cost. Urinalysis is an investigation which all nurses should be competent to perform and is identified by the NMC (2007) as being an example of an essential skill nurse students should be competent to perform before entering their branch programme. Urinalysis may be performed in a wide variety of clinical settings. It should be performed on every patient entering the acute care setting. Additionally, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD (2009), stresses the need for urinalysis to be performed on all emergency admissions to an acute hospital. It may also be performed in outpatient and general practice clinics, and community areas. To obtain the most accurate information from the test, students need to know how to obtain and assess a sample of urine and be aware of factors that may influence the reliability of the investigation. Urine may be tested in three different ways. ● Macroscopic urinalysis, ● Microscopic urinalysis, ● Chemical analysis. Macroscopic and chemical analysis are the investigations performed in the clinical setting which may be tested by OSCE. Microscopic investigation requires samples to be sent to a laboratory. Macroscopic analysis is the analysis of the urine by the naked eye. Chemical analysis may be performed by use of a plastic diagnostic reagent strip or ‘dipstick’ which contains small pads of chemicals which react to substances that may be found in urine. For purposes of testing urine at random, clients are asked to urinate into a clean but not sterile dry container with no precautions regarding contamination. In females in particular this may result in samples being contaminated by vaginal fluids, such as blood or mucus. Due to the risk of contamination a mid-stream specimen of urine may be required if an abnormality is found in a random sample. A mid-stream specimen requires cleaning of the external urethral meatus prior to urination, passing the first half of the bladder contents into the lavatory, and passing the second part of the urine flow into a sterile container.
Clinical Pharmacology for Prescribing
Authors: Emmett Stevan R. , Hill Nicola , Dajas-Bailador Federico
Published: November 2020

Clinical Pharmacology for Prescribing explains how drugs work and why they should be prescribed for common medical conditions. Linking disease processes to pharmacological interventions, this guide gives a sound basis for evidence based prescribing. Written for medical students, trainee doctors and non-medical prescribers, it addresses all aspects of practical pharmacology, explaining drug classes, their mechanisms and effects on the body. Ultimately its focus is on clinical use, so that safe prescribing decisions are based on sound understanding of science - why and how drugs work to treat common conditions. Every chapter provides clear linkages between pathophysiology of disease and drug mechanisms, highlighted in original illustrations that bring together drug mechanisms, pathways and their place in medical management. Unwanted effects, drug interactions and prescribing warnings are emphasised to help the reader become aware of critical issues in prescribing. This resource also addresses how to prescribe for vulnerable patient groups and provokes deep understanding for patient safety. Written by a Practicing Pharmaceutical Physician with a D.Phil in Pharmacology, an Assistant Professor with the Faculty of Medicine and Health Sciences and a Senior hospital-based Clinical Pharmacist. The textbook has been extensively reviewed by practicing clinicians such that this new resource exemplifies the skills and knowledge needed for practical, legal and safe clinical prescribing.
Respiratory Medicine
Authors: Emmett Stevan R. , Hill Nicola , Dajas-Bailador Federico
Published: November 2020

Asthma is a reversible chronic airways condition character­ized by airway obstruction, bronchial hyperresponsiveness and chronic inflammation. Exposure to triggers causes an inflammatory cascade and symptoms, such as wheeze, dyspnoea, and cough. It is the most common medical condition in children, affecting 1 in 10 to varying degree. Peaks in prevalence occur at 10 and 59 years of age, with a tendency towards those of an atopic (hypersensitive al­lergic/ genetic predisposition) nature. In asthma, there is a swing in balance between two opposing T- helper (Th) cell populations towards persistent and excessive T- helper cell type 2 (Th2) dominated immune responses. Th1 cells are involved in response to infection, while Th2 cells are responsible for cytokine production (e.g. IL- 4, IL- 5, IL- 6, IL- 9, and IL- 13) that are involved in allergic reaction, which may explain the overproduction of IgE, the presence of eosinophils and airway hyperresponsiveness. In the case of inhaled allergens, lung- based dendritic antigen- presenting cells ultimately stimulate Th2 cell pro­duction from naive Th0 cells (Figure 3.1). Aspirin and other NSAIDs can also initiate asthma symptoms, although this appears to be non- IgE dependant. Other dominant cells seen in asthma include mast cells and eosinophils. Mast cells, when activated by inhaled antigen, release bronchoconstrictive factors like histamine, cysteinyl-leukotrienes, prostaglandin D2, and eosinophil chemotactic factor. Mast cells in the airway may be sensitive to osmotic changes, thus account for exercise- induced asthma. The production of IL- 5 from activated Th2 and mast cells causes differentiation of eosinophils, which then migrate to the lung tissue, where they adhere to surface proteins like vascular- cell adhesion molecule 1 (VCAM- 1) and intercellular adhesion molecule 1 (ICAM- 1). Upon activation, these release pro- inflammatory cytokines like leukotrienes and granule proteins, which injure airway tissues. Additionally, eosinophil life is prolonged by the presence of IL- 4 and granulocyte- macrophage colony-stimulating factor (GM- CSF). Collectively, the persistence and presence of eosinophils may potentiate chronic in­flammatory changes and this correlates closely with the clinical severity of disease. The overall cellular balance shift (Th2 dominance, mast cells, and eosinophils) and presence of an in­flammatory stimulus results in bronchoconstriction (mainly via IgE- dependant release of mediators from mast cells constricting smooth muscle cells), airway oe­dema (through inflammation, mucus hypersecretion, and smooth muscle hypertrophy and hyperplasia), and airway hyperresponsiveness (through inflammation, dysfunc­tional neuroregulation, and structural changes).
Neurology
Authors: Emmett Stevan R. , Hill Nicola , Dajas-Bailador Federico
Published: November 2020

Cerebrovascular disease encompasses all disorders that temporarily or permanently affect the way oxygen and glucose are delivered to the brain via cerebral blood ves­sels. Stroke is a sudden focal event that leads to neuro­logical deficit, because of disturbed circulation. Ischaemic strokes account for around 80% of total numbers and are caused by inadequate blood flow secondary to occlusion by an atheroma, embolus, or less commonly, severe local vasospasm. The remaining 20% are haemorrhagic strokes that occur because of a bleed through ruptured vessels and may be defined by their location. Historically, symptomatology in stroke exceeds 24 hours and where symptoms resolve before this, i.e. a tran­sient vessel occlusion, is termed a transient ischaemic at­tack (TIA). More recently, however, a TIA has been defined by the American Heart Association and American Stroke Association (AHA/ ASA) as a ‘transient episode of neuro­logic dysfunction caused by focal brain, spinal cord or ret­inal ischaemia without acute infarction’. TIAs occur more commonly in men, increasing with age and affecting 35 per 100 000 people. It is also associated with an increased risk of stroke. Stroke is a major health burden in the UK, with an an­nual incidence in excess of 150 000, accounting for ap­proximately 40 000 deaths/ year. Furthermore, there are approximately 1.2 million people in the UK living with the effects of a stroke. Modification of risk factors, rapid clinical diagnosis, and efficient early intervention is essential in re­ducing incidence and improving outcomes (see Figure 9.1). Ischaemic stroke, the most common form of cerebrovas­cular disease, results mainly from the enlargement or rup­ture of an atheromatous plaque, or from an embolus that travels from the systemic arterial system into the CNS vasculature. The subsequent reduction in oxygenated blood flow by 20– 30% deprives brain tissues, normally completely dependent on aerobic metabolism, of glucose and oxygen. At a cellular level the resultant anaerobic conditions trigger the ischaemic cascade, so that cells ultimately undergo apoptosis and die. Persistent ischaemia lasting more than 1 hour leads to local tissue necrosis, neuro-inflammation, and oedema. Prior to cellular apoptosis, the normally maintained electrochemical gradient across the cell membrane is disrupted, such that intracellular Ca2+, Na+, and Cl- levels rise uncontrollably, bringing with it an inflow of water causing neurons and glia to swell.
Understanding Bone Conditions
Authors: Sutcliffe Anne , Swift Cameron
Published: November 2020

The aim of this chapter is to provide nurses with the knowledge to be able to assess, manage, and care for people with bone conditions in an evidence-based and person-centred way. Bone conditions (a major category of musculoskeletal conditions) cover a wide spectrum of diseases, some of which may be considered mild and self-limiting, while others may have a significant impact upon the individual’s quality of life and ability to function. It is estimated that up to 30% of all GP consultations are about musculoskeletal complaints; many are age-associated, and population ageing will continue to increase this demand (Oliver, 2009). The chapter will focus on osteoporosis, hip fracture (perhaps the most serious and costly consequence of osteoporosis or osteopaenia), Paget’s disease, and osteoarthritis, respectively. The chapter will provide a broad overview of these common conditions, enabling a proactive approach to patient care within a multidisciplinary context, whether in the primary or secondary care setting. The nursing management of the symptoms and common health problems associated with bone conditions can be found in several Part 2 chapters, and these are highlighted throughout the chapter. Osteoporosis has been defined as:...A progressive systemic skeletal disease characterised by low bone mass and micro-architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. (WHO, 1994)…The World Health Organization (WHO) has recommended a clinical definition of osteoporosis based on a bone mineral density (BMD) measurement of the spine or hip, expressed in standard deviation (SD) units called T scores. Using this definition, an individual is classified as having osteoporosis if his or her T score is ≤–2.5 SD at the spine or hip (WHO, 1994). It is estimated that osteoporosis occurs in approximately 3 million people in the UK, resulting in more than 230,000 fractures per annum, the most frequent being hip, vertebral body, and forearm fractures. In total, 75,000 hip fractures occur annually (British Orthopaedic Association, 2007), with the average age of incidence being 84 and 83 in men and women, respectively (National Hip Fracture Database, 2010).
Understanding Renal Disorders
Authors: Ugboma Debra , Willis Helen
Published: November 2020

The aim of this chapter is to provide nurses with the knowledge to be able to assess, manage, and care for people with the renal disorders chronic kidney disease (CKD) and acute kidney injury (AKI) in an evidence-based and person-centred way. In recent years, AKI has replaced the term ‘acute renal failure’. The chapter will provide a comprehensive overview of the causes, risk factors, and impact of CKD and AKI, before exploring best practice to deliver care, as well as to prevent further progression of these conditions. Nursing assessments and priorities are highlighted throughout, and further nursing management of some of the symptoms and common health problems associated with CKD and AKI can be found in Chapters 6, 9, 15, and 19, respectively. Chronic kidney disease (CKD) is the gradual and usually permanent loss of some kidney function over time (Department of Health, 2007). In CKD, the damage and decline in renal function usually occurs over years, and in early stages can go undetected (Department of Health, 2005a). CKD has rapidly moved up the healthcare agenda in recent years, primarily because of the links with cardiovascular risk, and with a shift in focus away from the treatment of established renal failure towards the detection and prevention of CKD in primary care (O’Donohue, 2009). Glomerular filtration rate (GFR) is an indicator of renal function and is the rate at which blood flows through, and is ‘filtered’ by, the kidney; a normal GFR is approximately 125 ml/min. CKD is classified into five stages according to an estimated glomerular filtration rate (eGFR) and, in the milder stages, further evidence of renal damage such as proteinuria and haematuria. This classification holds regardless of the underlying cause of kidney damage. The understanding of GFR is pivotal to caring for patients with renal disorders. Monitoring, management, and referral of the patient in the earlier stages of CKD became much clearer following the publication of the National Clinical Guidelines for the Management of Adults with Chronic Kidney Disease in Primary and Secondary Care (NICE, 2008a). Many people with stage 3 CKD, unless they have proteinuria, diabetes, or other comorbidity such as cardiovascular disease, have a good prognosis and can be managed in primary care (Andrews, 2008).
Managing End-of-Life Care
Authors: Albarran John W , Hills Marika
Published: November 2020

This chapter addresses the fundamental nursing role of managing end-of-life care. Death is as fundamental a part of life as living, and while caring for a dying patient and their family is demanding, complex, and emotionally exhausting, it can also be a gratifying and privileged experience for nurses. Specifically, nurses have a centre-stage role in leading and informing care delivery at the end of life. Care will typically embrace assessing the needs of the patient and family, providing symptom relief and comfort care, and providing cultural and spiritual support. Additionally, caring functions should also extend following death to caring for the deceased in a dignified manner and supporting the newly bereaved, demonstrating genuine concern, compassion, and effective communication skills (Hills and Albarran, 2010a; Maben et al., 2010). To examine the key themes and challenges of practice, it is important to understand the political, professional and societal influences, and contextual nature of death and dying in the UK. At present, there is neither a clear nor universally accepted definition of end-of-life care, but it is generally understood to be the care of a person who is identified as having failing health and who is in a progressive state of decline (Shipman et al., 2008). Establishing the last phase of a patient’s life can be a difficult and complex process, and this might occur:…● after the diagnosis of a life-limiting condition; ● during the transition or deterioration of a chronic disease illness; ● when there is an increasing frailty combined with greater dependence on care provision, particularly in the older adult; ● following a sudden infective episode, cardiac event, or a life-threatening accident….The last phase of end-of-life care is referred to as the dying phase. Consideration of the end-of-life care needs of people with chronic terminal conditions should begin at diagnosis, and must embrace after-death care and family support. Over the past century, progress and advancement in disease management, together with improvements in living standards, have resulted in changes to the national death profile, with currently two-thirds of the 0.5 million annual deaths in the UK occurring in people over 75 years of age.
Managing Hydration
Authors: Ugboma Debra , Cowen Michelle
Published: November 2020

This chapter addresses the fundamental nursing role of managing hydration. Water is a basic nutrient and is essential to sustaining human life. In the developed world, we often take for granted the basic commodity of clean and plentiful water, but in other parts of the world water can have a profound effect on human health, in both the reduction and the transmission of disease (World Health Organization, 2011). For health, body water and electrolytes must be maintained within a limited range of tolerances. For nurses working in acute or primary care settings anywhere in the world, it is important to have a clear understanding of fluid and electrolyte homeostasis to assess haemodynamic status, to anticipate and recognize deterioration in status, and to implement appropriate corrective interventions. Developing knowledge and associated skills around this topic will be facilitated by reflecting upon your clinical experiences as a student or as a qualified nurse, and your ability to link theory and practice. Your basic foundation of knowledge should include an understanding of how fluid is gained and lost from the body, the distribution of water between different compartments within the body, the processes by which fluid and electrolytes move between the intracellular and extracellular environments (Pocock and Richards, 2009; Cowen and Ugboma, 2011), and knowledge of the different types of intravenous replacement fluid (Endacott et al., 2009: 249舑73). Equally important is an insight into the use of criteria such as clinical/outcome indicators and benchmarking, what to use on what occasions, and how to use such tools to your best advantage. Armed with this knowledge, you will be well equipped to assess each patient’s needs and to make clinical decisions about the most appropriate evidence-based nursing interventions to be used. The state of water balance within the body is principally maintained by the osmoreceptors in the hypothalamus. These are best described as ‘sensors’ that detect the osmolarity (concentration) of the blood to stimulate or suppress the thirst mechanism, as well as regulate the amount of antidiuretic hormone (ADH) released by the posterior pituitary gland. When a person is becoming dehydrated, the thirst centre will be stimulated and usually he or she will seek fluid to rehydrate him or herself.
Managing Hygiene
Authors: Voegeli David
Published: November 2020

This chapter addresses the fundamental nursing role in managing hygiene. The ability to maintain personal and oral hygiene forms some of the activities of living that everyone undertakes every day, but which are often taken for granted until a deterioration in a person’s physical or mental state, such as illness or ageing, prevents individuals from meeting these needs independently. Being able to assess the need for nursing intervention accurately, and to deliver appropriate evidence-based care, requires considerable skill. It draws on many of the core competencies of professional nursing, such as observation, communication, and clinical decision-making. Therefore it is inappropriate that, in a majority of care settings, these activities are often delegated by the registered nurse to those with the least experience. It is important to remember that, registered nurses retain professional accountability for the quality and effectiveness of the interventions provided or delegated to the patients under their care. Increasingly, this fundamental aspect of care is viewed as an overall indicator of the quality of the care provided. Assisting individuals to maintain their personal hygiene needs promotes comfort, safety, well-being, and dignity, and also plays an important part in the prevention of infection. It is also an important aspect of many religions, such as the ritual washing performed by Muslims before prayer. Indeed Young (1991) suggested that cleanliness is a basic human right rather than a luxury. There has been criticism over the past decade that aspects of nursing care relating to the maintenance of patient hygiene have become neglected, and the Healthcare Commission (2007) reported that 30% of complaints received against UK hospitals related to issues of personal care and dignity, including:…● patients being left in soiled clothing or bedding; ● hygiene needs not being met (patients not being washed or mouthcare given); ● hair and nails not being cared for….In response to these criticisms, both the Nursing and Midwifery Council (NMC) and the Department of Health (DH) worked to improve the quality of personal care provided by nurses.
Managing Medicines
Authors: Baileff Anne , Davis Jan
Published: November 2020

The management of medicines is a fundamental component of contemporary nursing care and a pervasive form of therapeutic intervention in healthcare (Medicines Partnership, 2002). In this chapter, we will focus on the skills and underpinning knowledge that you need to enable you to undertake an in-depth assessment of an individual’s use of medication, and how you can work in partnership with him or her to optimize safe, effective use, regardless of care setting. We will not address factors associated with the scheduled administration of medicines undertaken (for example, during the traditional ward drug round), although the principles articulated in this chapter are transferable. Likewise, the principles of good medicine management are also applicable to all of the chapters in this book on core conditions and health needs. Medicines are used to promote health, and to prevent, control, and treat disease. However, they are potent substances. All have side effects, and many interact adversely, not only with other medicines, but also with common fruit, vegetables, and food products. Ethnicity, race, age, weight, and gender can also affect an individual’s response to a specific medicine. Public access to medicines has increased hugely in the past decade, and prescriptive authority is no longer the sole right of medical practitioners. Nurses, pharmacists, physiotherapists, podiatrists, optometrists, and radiographers are now all able to prescribe a wide range of drugs. Patient group directions enable nurses and other health professionals to supply and administer drugs to patients without referral to a doctor, and medicines are increasingly available without prescription to purchase over the counter from a number of retail outlets and over the Internet. At the outset, it is clearly important to understand what we mean by ‘medicines management’; you will then appreciate the extent of your responsibilities and the skills that you need for competent practice. Medicines management is a complex subject and there have been several attempts to define it. The Audit Commission (2001: 5) defines it as:…the entire way that medicines are selected, procured, delivered, prescribed, administered and reviewed to optimise the contribution that medicines make to producing informed and desired outcomes of patient care….
Jaw cysts and odontogenic tumours
Authors: Robinson Max , Hunter Keith , Pemberton Michael , Sloan Philip
Published: November 2020

Odontogenic cysts and tumours arise from inclusion of tooth-forming epithelium and mesenchyme in the jaw bones during development. Cysts also arise from non-odontogenic epithelium trapped during fusions or from vestigial structures. In addition, bone cysts that can arise at other skeletal sites may also occur in the jaws. Odontogenic cysts and tumours may be classified according to their putative developmental origins and biology. The classification of jaw cysts is shown in Fig. 6.1. Odontomes are hamartomatous develop­mental lesions of the tooth-forming tissues. Odontogenic tumours are uncommon and are usually benign. Ameloblastoma is the most com­mon odontogenic tumour and is described in detail. The other odon­togenic tumours are rare and only the principal features are presented. Very rare congenital lesions of possible odontogenic origin are men­tioned in the final section. A cyst may be defined as pathological cavity lined by epithelium with fluid or semi-fluid contents. However, clinically, the term encompasses a broader range of benign fluid-filled lesions, some of which do not possess an epithelial lining. The preferred definition is, therefore, ‘a pathological cavity having fluid or semi-fluid contents that has not been created by the accumulation of pus’. Cysts are commonly encountered in clinical dentistry and are generally detected on radiographs or as expansions of the jaws. Most cysts have a radiolucent appearance and are well circumscribed, often with a corticated outline. At least 90% of jaw cysts are of odontogenic origin. The clinico-pathological features of jaw cysts are summarized in Table 6.1. The incidence of the four most common jaw cysts are provided in Table 6.2. The epithelial lining of odontogenic cysts originates from residues of the tooth-forming organ. • Epithelial rests of Serres are remnants of the dental lamina and are thought to give rise to the odontogenic keratocyst, lateral periodon­tal, and gingival cysts. • Reduced enamel epithelium is derived from the enamel organ and covers the fully formed crown of the unerupted tooth. The dentiger­ous (follicular) and eruption cysts originate from this tissue, as do the mandibular buccal and paradental cysts. • Epithelial rests of Malassez form by fragmentation of Hertwig’s epi­thelial root sheath that maps out the developing tooth root. Radicular cysts originate from these residues.