bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychiatric Aspects of Pain Management in Palliative Care
Authors: Key R. Garrett , Breitbart William S.
Published: January 2023

Pain is one of the most prevalent and impairing symptoms in the realm of palliative care. Although opioids remain at the center of most pain management strategies, it is critical to employ adjuvant analgesics effectively and to understand the impact of psychosocial variables on a person’s overall pain experience. Many psychotropics can be employed as analgesics and also leveraged for secondary benefits to sleep, nausea, appetite, depression, anxiety, and fatigue. A number of promising nonpharmacologic approaches to pain also exist. Practitioners with a clear picture of physiologic and psychosocial components of the pain experience will be able to optimally manage pain and help their patients enjoy the best possible quality of life.
Dignity Therapy
Authors: Mari Schoppee Tasha , Max Chochinov Harvey
Published: January 2023

Despite significant advancement in medical interventions, patients often struggle with not feeling valued or worthy. While loss of dignity can be a significant struggle for patients nearing death, the concept of “death with dignity” has become entwined with euthanasia and physician-assisted suicide. This chapter has documented the state of the science regarding efforts to define dignity based on patient perspectives and the development of dignity therapy. A literature search was implemented in four databases (PubMed, CINAHL, PsychINFO, and Academic Search Premier) using the terms “Dignity Therapy” and “Chochinov.” Also, articles were identified from bibliographies of the initial evidence set, and additional references known to the authors of this chapter were included. Extensive review of the dignity therapy literature was synthesized to identify the populations of application, common findings, and areas of opportunity for future research. Sixty-seven articles were identified for inclusion in this review. Evidence has demonstrated dignity therapy to have application across various cultures, ages, and diagnoses; high satisfaction with patients and families; and ability to increase sense of meaning, purpose, and will to live. Areas for future research of dignity therapy include use with marginalized peoples, impact on family caregivers, implementation with diverse cultural groups, comparison of dignity therapy to other psychotherapeutic models, and exploration of the mechanisms of impact.
Managing Cancer and Living Meaningfully (CALM) Therapy
Authors: Malfitano Carmine , Hales Sarah , Rodin Gary
Published: January 2023

Managing cancer and living meaningfully (CALM) is a brief, semi-structured individual and couple-based intervention designed to alleviate distress and promote well-being in individuals living with advanced cancer. CALM emerged from a longitudinal program of research and the theoretical traditions of relational, attachment, and existential theory. Through a therapeutic process that supports affect regulation, attachment security, and reflective functioning, CALM addresses four content domains: symptom management and communication with healthcare providers; changes in self and relations with close others; spiritual well-being, sense of meaning and purpose; and preparing for the future, sustaining hope, and facing mortality. Caregivers are invited to participate to provide an additional perspective and help address strains and strengths in the spousal relationship, the impact of the illness on the family, and planning for the future. Qualitative research demonstrates that CALM provides the experience of a safe place to explore fears, feel more fully seen in human terms, and face the challenges and threats of advancing disease. Quantitative research demonstrates that CALM is effective in reducing and preventing depressive symptoms, alleviating death anxiety, and facilitating communication of patients with healthcare providers, preparation for the end of life, and clarification of feelings and values. Healthcare providers from multiple disciplines in more than 20 countries have been successfully trained in CALM through didactic and experiential workshops and ongoing supervision. The semi-structured nature of CALM has allowed its adaptation and delivery in diverse cultural and clinical contexts.
Mindfulness-Based Interventions
Authors: Carlson Linda E. , Moran Chelsea , Baydoun Mohamad
Published: January 2023

For palliative care recipients, the psycho-emotional impacts of facing chronic progressive disease and end of life are significant, encompassing feelings such as fear, regret, anger, resentment, and depression. Informal caregivers and healthcare providers (HCPs) are also impacted by the psychological stress of managing patients requiring palliative and end-of-life care and, subsequently, the adverse effect that heightened distress has on their own health and patient quality of care. Over the past two decades, a growing number of studies have shown that mindfulness-based interventions (MBIs) can be a feasible, acceptable, and effective approach to reduce distress among patients in palliative care, their informal caregivers, and HCPs. By bringing one’s focused attention to experiences occurring in the present moment with an open, kind, and accepting attitude, MBIs may improve the quality of life of patients in palliative and end-of-life care, promoting stress reduction and pain and symptom management. MBIs may also be useful in addressing psychosocial issues faced by informal caregivers and HCPs to improve their well-being. Given their potential benefits, MBIs should be further explored by the healthcare community as adjuncts to conventional palliative care.
Acceptance and Commitment Therapy
Authors: Hulbert-Williams Nicholas J. , Hulbert-Williams Lee
Published: January 2023

Acceptance and commitment therapy (ACT) is a type of psychological intervention that differs from some more dominant therapeutic approaches, such as cognitive behavior therapy in fundamental ways. Encompassing a number of third-wave psychological intervention components—including acceptance, mindfulness, and values-driven processes—ACT increases psychological flexibility which may, in turn, improve well-being outcomes. This chapter includes a detailed description of ACT and an account of how and why it might be especially suitable for people affected by life-limiting illness, drawing on both theory and the authors’ applied work with this client group. Though the overall evidence base for ACT is gaining strength, there are few studies which robustly test the benefits of integrating ACT into palliative care. Most of the work published to date focuses solely on those with advanced cancer and has not progressed beyond small-scale pilot and feasibility studies. This lack of evidence might be a fundamental barrier to widespread implementation of ACT despite its promising strengths and qualitatively reported acceptability.
Grief Interventions in Palliative Care
Authors: Lichtenthal Wendy G. , Roberts Kailey E. , Rogers Madeline , Fadalla Carol , Rosa William E. , Neimeyer Robert A.
Published: January 2023

Family members of patients receiving palliative care for life-limiting illness face grief both before and after the patient’s death. While many will adapt, others will develop mental health challenges that may benefit from psychosocial intervention to support them in their grief. This chapter provides an overview of grief interventions in palliative care, with a focus on intervention for family members (i.e., those individuals who are close to the patient). Interventions can be delivered before the patient dies to address pre-death grief and reduce risk for negative bereavement outcomes, immediately following the patient’s death to support continuity of care, and in the long term to treat bereavement-related mental disorders. Additional information is provided on supporting palliative care clinicians who are impacted by the multiple patient losses that inherently come with their work. The chapter concludes with recommendations for future research on grief interventions in palliative care.
Pain medicine and the medicalization of chronic pain
Authors: Sullivan Mark D. , Ballantyne Jane C.
Published: January 2023

This chapter examines how the ideal of managing complex chronic pain on a rehabilitation model was gradually eroded, particularly in the United States, as healthcare itself became increasingly focused on rapid results and short-term outcomes. Multidisciplinary management became hard to sustain, chronic pain management fell increasingly to primary care, and primary care became increasingly stressed by the burden of looking after intractable chronic conditions. The lure of opioids drew patients and their physicians into prescribing that promised much relief, but ultimately increased the burden of care. The framing of pain as a medical problem opened the floodgates for abuse of patients’ suffering based on profiteering and the offering of false hopes. Once the limitations of long-term opioid therapy became clear, the medical community turned back to the earlier recognition that over-reliance on medical solutions for chronic pain leaves the patient out of the recovery.
Carer, Partner, and Family-Centered Support
Authors: Mitchell Hannah-Rose , Applebaum Allison J. , Zaider Talia
Published: January 2023

The psychosocial experiences inherent to oncology and palliative care extend beyond the individual with cancer to the family members and friends tasked with serving them unpaid care (“caregivers”), and to the entire family system. Not only can cancer present distress directly to the patient, caregiver, and family, it can also disrupt relationships and family functioning. This chapter highlights how psycho-oncology and palliative care are optimized when families are considered, and clinicians take flexible, culturally sensitive approaches to identifying the individuals whom the patients wish to be involved in their units of care through the end-of-life phase. Guidance for routine and ongoing assessment of individual (e.g., burnout and subclinical/clinical psychiatric symptoms) and relational concerns (e.g., challenges in roles, communication, conflict, boundaries, and intimacy) is provided. Evidence-based treatments to support caregivers, couples, and families coping with cancer and receiving palliative care, which can be delivered at individual, dyadic, or group levels are also highlighted. Family-centered support throughout the care continuum and the palliative care phase is ever so more important given ongoing shifts to outpatient and home-based care. This chapter offers tools to encourage family participation and collaboration, while identifying and addressing the needs related to and consequences of caregiving and coping with cancer in each unique family system.
Community-Based Group Intervention to Reduce Fear of Falling and Activity Restriction
Authors: Schmid Arlene A.
Published: January 2023

Fear of falling is common in older adults and may lead to activity restriction. In the A Matter of Balance study, a standardized group intervention, focused on promoting activity by reducing fear of falling and addressing self-efficacy, was compared to a social contact control condition. Assessments were completed at baseline, 6 weeks, 6 months, and 12 months. Individuals randomized to the intervention reported increased “intended activity” and greater mobility control compared to those in the control condition. Improvements were enhanced for individuals considered compliant (completed five or more sessions); they demonstrated significantly greater falls efficacy, perceived falls management, and mobility control compared to the control group. Effects diminished over time, indicating a potential need for booster sessions.
Combined Occupational Therapy and Medical Approach to Fall Prevention
Authors: Niemiec Stacey L. Schepens , Wagas Rafael
Published: January 2023

Despite falls being a common reason older adults present to the emergency room, current practice lacks systematic assessment processes to determine cause, consequence, and prevention of falls in this population. A randomized controlled trial was undertaken to compare a combined medical and occupational therapy interdisciplinary approach to assessment and referral (n = 184) versus usual care (n = 213). Outcomes were analyzed at 4, 8, and 12 months. Cumulative number of falls was significantly lower in the intervention group (183) versus the control group (510; p = 0.0002) at 1-year follow-up. The intervention group demonstrated reduced risk of falling (odds ratio 0.39; 95% confidence interval 0.23–0.66), reduced risk of recurrent falls (0.33; 0.16–0.68), and reduced likelihood to return to hospital (0.61; 0.35–1.05). The control group had a more significant decline in function (p < 0.00001). The study concluded that the medical–occupational therapy interdisciplinary approach to assessment and referral reduces falls risk and slows functional decline.
Effectiveness of Assistive Technology and Environmental Interventions in Maintaining Independence and Reducing Home Care Costs for the Frail Elderly
Authors: Arthanat Sajay
Published: January 2023

This randomized controlled study examined the effects of assistive technology (AT) and environmental interventions (EIs) on functional independence and home healthcare costs of older adults with chronic health conditions. The sample included 104 older adults, with 52 individuals randomized to an AT-EI intervention and 52 who received standard home care. Following a comprehensive functional assessment and home evaluation, older adults in the treatment group received personalized AT-EI intervention. After 18 months, both treatment and control groups demonstrated declines on instrumental activities of daily living, functional independence, cognition, mobility, and social integration. However, the decline was significant for the control group on all outcome measures, with the declines far more significant than those of the treatment group on pain, physical independence, and occupation. The control group also reported significantly higher healthcare costs during the follow-up period. Findings suggested that a comprehensive AT and EI intervention can slow functional declines of at-risk older adults and minimize their healthcare costs.
Community Aging in Place, Advancing Better Living for Elders (CAPABLE)
Authors: Fields Beth
Published: January 2023

An interprofessional team, including occupational therapy, nursing, and a handy worker has the potential to support the growing aging population’s desire to age in place. The study included a pilot randomized controlled trial comparing the Community Aging in Place, Advancing Better Living for Elders (CAPABLE) intervention to an active control group consisting of reminiscence and sedentary activities in 40 low-income, community-dwelling, disabled older adults (65 years or older). Performance of activities of daily living (ADLs) and instrumental ADLs (IADLs), health-related quality of life, and falls efficacy were measured at baseline and 6 months after the pilot trial completion. Moderate to strong effect sizes favoring CAPABLE were found for ADL and IADL performance, quality of life, and falls efficacy. This study provides support for the person-centered, team-based CAPABLE intervention to reduce disability and increase quality of life of community-dwelling older adults.
Occupational Therapy for Independent-Living Older Adults
Authors: Schepens Niemiec Stacey L. , Lee Elissa S. , Pyatak Elizabeth A.
Published: January 2023

Occupational therapy (OT) has the potential to mitigate against the health risks associated with older adulthood but traditionally has been applied only after catastrophic health events. The Well Elderly study included a randomized controlled trial comparing preventive OT services to non-professionally led social activity and a non-treatment control condition in 361 independent-living, multiethnic older adults (60+ years old). Physical, social, and mental health outcomes were measured at baseline, 9 months (intervention end), and 15 months. Results showed significant benefits for the OT group in overall health, functional status, and life satisfaction compared with both control conditions. The social activity control group did not differ significantly in outcomes compared with the non-treatment control. This study provides support for preventive OT service provision to promote the health and well-being of independent-living older adults, above and beyond mere participation in group-based social activities.
Occupational Therapy for Patients with Parkinson’s Disease
Authors: Takahashi Kayoko
Published: January 2023

The chapter “Occupational Therapy for Patients with Parkinson’s Disease” describes a randomized controlled trial on the efficacy of occupational therapy for patients with Parkinson’s disease who are living at home. A 10-week intervention was individualized to match the needs of both the patients and their caregivers, and it focused on strategies to improve the performance of daily activities. Self-management strategies were taught to both the patients and their caregivers to facilitate future problem-solving. The results showed that the intervention effectively increased occupational performance and satisfaction with meaningful daily activities in persons with Parkinson’s disease. The beneficial effects were sustained in the long term.
Occupation-Based Interventions for Addictive Disorders
Authors: Aguilar Carlos Juarez
Published: January 2023

Addictive disorders often impact an individual’s ability to engage in meaningful occupations in a way that is desirable and beneficial to them. When comparing the use of didactic interventions such as cognitive-behavioral therapy with occupation-based interventions, this systematic review suggests that there is a small but significant improvement in outcomes in people receiving occupation-based interventions as treatment. Leisure, work, and social participation were the areas of occupation that this study found to be the primary focus of occupation-based interventions. Common occupation-based interventions identified in this review included, but were not limited to, yoga, music and songwriting, exercise, biking, and lyrical analysis. The accessible, low-cost, and non-invasive nature of these interventions suggests they can be easily integrated into a client’s treatment plan and daily living. Implementing these types of interventions for their small but significant improvement in outcomes is worth exploring across different settings.
An Adapted Model of Constraint-Induced Movement Therapy for Young Children with Hemiplegic Cerebral Palsy
Authors: Chang Megan C. , Anvarizadeh Arameh
Published: January 2023

The chapter “An Adapted Model of Constraint-Induced Movement Therapy for Young Children with Hemiplegic Cerebral Palsy” describes a study examining the effects of a modified constraint-induced movement therapy on children between 18 months and 4 years of age who were diagnosed with hemiplegic cerebral palsy. The results showed that the 6-month modified constraint-induced movement therapy significantly improved voluntary hand use on the affected hand after 2 months of treatment with 2 hours of use daily. The chapter also provides information about related research evaluating the modified constraint-induced movement therapy among children with cerebral palsy and presents a case study applying the study’s findings to clinical practice.
Evaluating Playfulness in Children
Authors: Ausderau Karla K. , Chatman Candace
Published: January 2023

The purpose of this study was to examine the reliability and validity of the Test of Playfulness (ToP) with children with physical disabilities and no known cognitive limitations, compare their scores with those of able-bodied peers, and examine patterns of difference in test items. Data from all of the children in the normative data set meeting inclusion criteria (n = 25) were paired with those from able-bodied children matched on gender and age. Data were gathered during two 15-minute videotaped free-play sessions. Rasch analysis revealed 100% rater reliability, and 88% of the children with physical disabilities conformed to playfulness patterns represented in the normative data. Mean ToP scores did not differ between groups. Based on the study results, the ToP is a highly reliable assessment for children with physical disabilities. However, person-response validity did not achieve 95%. Further investigation is needed to determine ToP validity for children with physical disabilities and environmental influences on playfulness.
Occupational Therapy and Adult Cancer Rehabilitation
Authors: Morikawa Stacey , Amanat Yasaman
Published: January 2023

The articles “Systematic Review of Occupational Therapy and Adult Cancer Rehabilitation,” part 1 and part 2, examine the evidence of the effectiveness of occupational therapy interventions on adults with cancer. The systematic review highlights the importance of interventions including physical activity, symptom management, multidisciplinary rehabilitation programs, and interventions targeting psychosocial concerns, sexuality, and return to work. Strong evidence indicates that physical exercise is safe and beneficial for most cancer survivors, most notably to address cancer-related fatigue. Strong evidence supports the benefit of multidisciplinary rehabilitation for cancer survivors as well as the benefit of psychosocial intervention in reducing anxiety and depression. Moderate evidence supports the effectiveness of interventions on sexuality and return to work; however, further research in this area is needed. This systematic review provides support for occupational therapy intervention in addressing the activity and participation needs of adult cancer survivors.
Cognitive Orientation to Daily Occupational Performance’s (CO-OP’s) Effectiveness in the Subacute Stroke Population
Authors: Peterson Kelsey
Published: January 2023

The “Combined Cognitive-Strategy and Task-Specific Training Improve Transfer to Untrained Activities in Subacute Stroke: An Exploratory Randomized Controlled Trial” article analyzed the effect of the Cognitive Orientation to Daily Occupational Performance (CO-OP) approach against regular outpatient occupational therapy (OT) on improving participants’ occupational performance and participation post-stroke. It employed an exploratory, randomized controlled trial at two outpatient OT clinics in Canada and the United States. Outcomes were measured using the Canadian Occupational Performance Measure, the Performance Quality Rating Scale (PQRS), the Community Participation Index, the Stroke Impact Scale, and the Self-Efficacy Gauge. Twenty-six participants were evaluated. At post-intervention, CO-OP over usual care had a medium effect size for PQRS trained activities and a large effect for PQRS untrained activities. At 3-month follow-up, CO-OP over usual care had large effect sizes for PQRS trained and untrained activities and medium effect sizes for change in participation via the Community Participation Index and self-efficacy.
Giving and Receiving Feedback
Authors: Veach Patricia McCarthy
Published: January 2023

This chapter identifies feedback as one of the most frequent, valued, and consequential clinical supervision activities. It discusses the functions of feedback in supervision, including the importance of feedback for evaluating student performance, the supervision relationship, and supervision processes. It describes primary types of feedback (positive and corrective; immediate and distal), includes descriptions of the characteristics of effective feedback, and identifies common challenges to giving and receiving feedback. The chapter includes specific strategies and models for promoting effective feedback interactions between supervisors and students along with illustrative examples. Learning activities encourage self-reflection about feedback characteristics and challenges, and they provide stimulus material to practice feedback skills.
Rivaroxaban With or Without Aspirin in Patients with Stable Peripheral or Carotid Artery Disease
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in the management of patients with atherosclerotic vascular disease. The Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial assessed the role of rivaroxaban in decreasing major adverse cardiovascular events. The COMPASS trial demonstrated better efficacy for a combination of low-dose rivaroxaban and aspirin than aspirin alone or rivaroxaban alone. This chapter describes the basics of the study, including funding, study location, who was studied, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and concludes with a relevant clinical case.
Rivaroxaban in Peripheral Artery Disease After Revascularization (VOYAGER)
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in the management of patients with atherosclerotic vascular disease following revascularization. The Rivaroxaban in Peripheral Artery Disease After Revascularization (VOYAGER) trial assessed the role of a combination of low-dose rivaroxaban and aspirin in decreasing major adverse cardiovascular and limb events. The VOYAGER trial demonstrated better efficacy for a combination of low-dose rivaroxaban and aspirin than aspirin alone. This chapter describes the basics of the study, including funding, study location, who was studied, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Analysis of Pooled Data from the Randomized Controlled Trials of Endarterectomy for Symptomatic Carotid Stenosis
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery assessing whether carotid endarterectomy improved outcomes compared to medical management in symptomatic carotid artery disease. The analysis of pooled data from the randomized controlled trials of endarterectomy for symptomatic carotid stenosis demonstrated benefit with surgery for patients with 50% to 69% symptomatic stenosis, and the procedure was found to be highly beneficial for those with 70% symptomatic stenosis or greater. This chapter describes the basics of the study, including funding, study locations, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticisms and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Endovascular Repair Compared with Surveillance for Patients with Small Abdominal Aortic Aneurysms
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery assessing whether early elective endovascular repair for small abdominal aortic aneurysms was beneficial compared to surveillance. The Positive Impact of Endovascular Options for Treating Aneurysms Early (PIVOTAL) trial demonstrated that early endovascular repair does not provide a survival advantage in patients with small abdominal aortic aneurysms. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Renal Artery Aneurysms
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery reporting on the natural history and surgical outcomes of renal artery aneurysms. The observational study of a 35-year clinical experience from a single center demonstrated that surgical therapy of renal artery aneurysms in properly selected patients provides excellent long-term clinical outcomes. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Supervised Exercise Versus Primary Stenting for Claudication Resulting from Aortoiliac Peripheral Artery Disease
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery assessing whether primary stenting improved walking distance compared to supervised exercise in patients with intermittent claudication. The Claudication: Exercise Versus Endoluminal Revascularization (CLEVER) trial demonstrated that supervised exercise results in superior treadmill walking performance compared with primary stenting. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Pharmacomechanical Catheter-Directed Thrombolysis for Deep Vein Thrombosis
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery assessing whether additional pharmacomechanical catheter-directed thrombolysis reduced the risk of post-thrombotic syndrome in patients with acute proximal deep vein thrombosis. The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial demonstrated that additional pharmacomechanical thrombolysis did not result in a lower risk of the post-thrombotic syndrome. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
2-Year Results of a Multicenter Randomized Controlled Trial Comparing Mechanochemical Endovenous Ablation to Radiofrequency Ablation in the Treatment of Primary Great Saphenous Vein Incompetence
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery that compared the outcomes of mechanochemical endovenous ablation (MOCA) and radiofrequency ablation of primary varicose veins. This randomized controlled trial, the MARADONA trial, demonstrated a higher rate of anatomic failures with MOCA, but similar clinical outcomes were observed at 2 years. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Bladder stone management
Authors: Allen Siân , Smith Daron
Published: January 2023

Bladder stone formation is a diagnosis that dates to antiquity but which is now uncommon, accounting for 5% of urinary tract stones. While the diagnosis can be seen across the whole range of urological conditions, patients with bladder outlet obstruction, intravesical foreign bodies, and those with neobladders are the most commonly at risk. As for upper tract urolithiasis, stone volume is the key factor in determining the best treatment for bladder stones, which also depends on the ease of urethral access and whether the patient has their native bladder or a neobladder. Treating the underlying cause (such as benign prostatic enlargement or the presence of intravesical mesh/surgical clips) also needs to be considered to minimize the risk of recurrent stone formation. Accordingly, the surgical strategy should be bespoke for the individual patient, particularly in more complex situations—‘Bladder stone management’ discusses these with a number of case illustrations.
Oncocytoma
Authors: Deytrikh Andrew , Reall Georgina , Lenton James , Browning Anthony
Published: January 2023

This case discusses the diagnosis, management, and prospect of surveillance for renal oncocytomas. Diagnostic adjuncts such as computed tomography and percutaneous biopsy with histology aim to differentiate these benign renal lesions from the more sinister renal cell carcinomas, particularly chromophobe subtype. There are a number of considerations with each of these diagnostic modalities which contribute to the difficulty of classifying these lesions as benign oncocytomas with certainty. The mainstay of management is still active surgical intervention, which should be nephron-sparing when possible, although surveillance of the lesion is the preferred option for some. Surveillance programmes and triggers to move from active monitoring to surgery are poorly defined and currently largely based on local protocols. Review of cross-sectional imaging prior to renal surgery may reveal important vascular anomalies, including left-sided inferior vena cava as described.
Non-muscle-invasive bladder cancer
Authors: Conroy Samantha , Noon Aidan P.
Published: January 2023

This case presentation depicts the frequent challenges faced by urologists in managing high-risk non-muscle-invasive bladder cancer in a frail, elderly, comorbid cohort of patients. It explores the complex interplay of factors considered during the investigation, risk stratification, and management of an 82-year-old gentleman presenting with a non-muscle-invasive tumour of the highest-risk category. It focuses and expands upon current recommended bladder-preserving therapies, as well as highlighting the need for and future of novel, second-line bladder-preserving management options in high-risk non-muscle-invasive bladder cancer.
Progression of high-grade non-muscle-invasive bladder cancer
Authors: Neal Naomi L. , Bryant Richard J. , Protheroe Andrew
Published: January 2023

High-grade non-muscle-invasive transitional cell carcinoma of the bladder is a potentially aggressive form of bladder cancer, with a high rate of progression to muscle-invasive disease and/or metastasis. Options for management of high-grade non-muscle-invasive bladder cancer include bladder preservation strategies such as treatment with intravesical bacillus Calmette–Guérin instillation therapy followed by careful surveillance, or immediate radical cystectomy. This case aims to focus on these options, along with the potential for the development of metastatic disease in this condition, and the options for subsequent medical oncology management. After a prolonged period of time where there were relatively limited available chemotherapy options for patients with metastatic bladder cancer, recent immunotherapy options have become available for treatment, potentially improving outcomes for patients.
Metastatic renal cancer
Authors: Neves Joana B. , Tran Maxine G. B. , Bex Axel
Published: January 2023

This case describes a young previously fit male diagnosed with a large but localized epithelioid angiomyolipoma, a rare variant of angiomyolipoma. Epitheloid angiomyoliponas are classified as benign tumours, but are known to potentially behave aggressively and one year after surgical excision, the patient developed metastatic disease. The case discusses the challenges faced with the management of large, localised renal tumours, and the difficulty in managing rare manifestations of metastatic disease when there is a paucity of clinical trial data. The discussion offers real-life comparison to what is currently recommended in international guidelines for the management of metastatic, mostly clear cell renal cell carcinoma.
Genitourinary prolapse
Authors: Krishnaswamy Priyanka H. , Jha Swati
Published: January 2023

Pelvic organ prolapse is an increasing problem in the ageing population. Although not life-threatening, it can impose a significant burden of social and physical restrictions of activities, impact on psychological well-being, and decrease overall quality of life. In this case, an example of a woman with pelvic organ prolapse is discussed, including defining what pelvic organ prolapse is, and how and why it occurs. Classification, symptoms, and signs on examination including various management options, conservative and surgical, are also discussed. Urinary incontinence is covered elsewhere in this book and is beyond the scope of this case.
Urethral diverticulum
Authors: Ranasinghe Anudini , Greenwell Tamsin , Ockrim Jeremy
Published: January 2023

Urethral diverticula are rare entities and their diagnosis can be challenging and often delayed. The symptom complex can be hugely variable, and diagnosis is mostly dependent on imaging. Fine-slice magnetic resonance imaging has become the modality of choice to gain anatomical information, and (video) urodynamics is useful in assessing bladder and outlet function. Once a diagnosis is made, most opt for surgical excision for symptom resolution and the small, but significant risk (1–9%) of malignancy arising in the urethral diverticulum. Diverticulum size, position, and configuration (simple, partial, or complete horseshoe configurations) are important in surgical planning. In experienced hands, even the most complex diverticula can be approached ventrally through an anterior vaginal incision. The authors opt for Martius fat pad interposition in most patients as this has been shown to reduce the risk of urethrovaginal fistula formation and preserves the plane for future anti-incontinence surgery if required.
Male factor infertility: management of the azoospermic patient
Authors: Young Matthew , Kayes Oliver
Published: January 2023

Male factor infertility (MFI) plays an important role in up to 50% of cases where couples struggle to conceive naturally. It is essential that the male partner is accurately assessed by a specialist in MFI to identify potential causes and to guide the couple regarding treatment options for natural or assisted conception. This case explores the systematic approach to assessing men referred with subfertility. It expands on the importance of taking a detailed clinical history and performing a focused examination alongside interpreting mandatory laboratory investigations in order to establish a diagnosis. The contemporary evidence relevant to this case is discussed, while considering all treatment options available to similar couples in order to achieve a pregnancy. The case ends with a discussion regarding the future developments and controversial topics within the field of male factor infertility.
Priapism
Authors: Ellul Thomas , Bullock Nicholas , Younis Ayman
Published: January 2023

Priapism is a rare condition, with an estimated incidence of 5.34 per 100,000 men in the US. It is subdivided into ischaemic, non-ischaemic, and stuttering priapism. Ischaemic priapism is the commonest type and is a urological emergency. A case is presented of recurrent ischaemic priapism secondary to illicit drug use and the different treatment options available. The management of priapism is mainly to resolve pain in the short term and to maintain erectile function in the long term. The treatment of priapism depends on its onset and type, and an algorithm for each type is detailed in the main body of this case. Awareness of basic management of priapism and early discussion with a specialist centre is vital to minimize the risk of irreversible consequences such as corporal fibrosis, subsequent penile shortening, and erectile dysfunction.
Black hole discs and spheres in galactic nuclei – exploring the landscape of vector resonant relaxation equilibria
Authors: Máthé Gergely , Szölgyén Ákos , Kocsis Bence
Published: January 2023

Vector resonant relaxation (VRR) is known to be the fastest gravitational process that shapes the geometry of stellar orbits in nuclear star clusters. This leads to the realignment of the orbital planes on the corresponding VRR time-scale tVRR of a few million years, while the eccentricity e and semimajor axis a of the individual orbits are approximately conserved. The distribution of orbital inclinations reaches an internal equilibrium characterized by two conserved quantities, the total potential energy among stellar orbits, Etot, and the total angular momentum, Ltot. On time-scales longer than tVRR, the eccentricities and semimajor axes change slowly, and the distribution of orbital inclinations are expected to evolve through a series of VRR equilibria. Using a Monte Carlo Markov Chain method, we determine the equilibrium distribution of orbital inclinations in the microcanonical ensemble with fixed Etot and Ltot for isolated nuclear star clusters with a power-law distribution of a, e, and m, where m is the stellar mass. We explore the possible equilibria for nine representative Etot–Ltot pairs that cover the possible parameter space. For all cases, the equilibria show anisotropic mass segregation, where the distribution of more massive objects is more flattened than that for lighter objects. Given that stellar black holes are more massive than the average main-sequence stars, these findings suggest that black holes reside in disc-like structures within nuclear star clusters for a wide range of initial conditions.
Modelling populations of kilonovae
Authors: Setzer Christian N , Peiris Hiranya V , Korobkin Oleg , Rosswog Stephan
Published: January 2023

The 2017 detection of a kilonova coincident with gravitational-wave emission has identified neutron star mergers as the major source of the heaviest elements and dramatically constrained alternative theories of gravity. Observing a population of such sources has the potential to transform cosmology, nuclear physics, and astrophysics. However, with only one confident multi-messenger detection currently available, modelling the diversity of signals expected from such a population requires improved theoretical understanding. In particular, models that are quick to evaluate and are calibrated with more detailed multi-physics simulations are needed to design observational strategies for kilonovae detection and to obtain rapid-response interpretations of new observations. We use grey-opacity models to construct populations of kilonovae, spanning ejecta parameters predicted by numerical simulations. Our modelling focuses on wavelengths relevant for upcoming optical surveys, such as the Rubin Observatory Legacy Survey of Space and Time (LSST). In these simulations, we implement heating rates that are based on nuclear reaction network calculations. We create a Gaussian-process emulator for kilonova grey opacities, calibrated with detailed radiative transfer simulations. Using recent fits to numerical relativity simulations, we predict how the ejecta parameters from binary neutron star (BNS) mergers shape the population of kilonovae, accounting for the viewing-angle dependence. Our simulated population of BNS mergers produce peak i-band absolute magnitudes of −20 ≤ Mi ≤ −11. A comparison with detailed radiative transfer calculations indicates that further improvements are needed to accurately reproduce spectral shapes over the full light curve evolution.
Sources, Aesthetics, and Performance in Rădulescu’s Piano Sonatas
Authors: Pace Ian
Published: January 2023

This chapter constitutes a form of analysis, both based upon the scores and coming out of and reflecting back upon practice, from one who has regularly performed Horaţiu Rădulescu’s six piano sonatas for almost two decades. The chapter considers the sonatas from various angles—their titles, musical borrowings, textures, harmonic language, form (especially the use of sonata form), use of mensuration canons—and considers the implications for touch, rhythm, tempo, rhetoric, rubato, virtuosity, while also adding observations on how particular approaches to various of these parameters can affect the projection of various possible conceptions of the work. Focusing in particular upon the Third and Sixth Sonatas, the chapter also situates these relatively late works in the context of the composer’s wider aesthetic developed since the late 1960s, and considers his use of Byzantine chant and consequent implied musical provenance in the context of the cultural and political milieu in which he grew up, in communist Romania. It also compares his use of Romanian melodies, most of which were collected by Béla Bartók, with the older composer’s own settings of some of the same melodies. It draws upon, but modifies, the analytical strategies developed for engaging with the works’ harmonic language developed by Bob Gilmore, while arguing for a greater consideration of linear progression. Rejecting a prescriptive approach to the relationship between analysis and performance, the chapter elucidates some of the range of creative but intelligent possibilities available for interpreting these works.
Confucianism and Education
Authors: Walton Linda
Published: January 2023

Education is integral to Confucianism. Beginning with compilation of the Analects by Confucius’s students recording their teacher’s sayings, the teacher-student (or master-disciple) relationship has been central to the transmission of Confucian teachings. After the development of formal schooling by the state, Confucian education was also closely aligned with government. Recruitment, training, and selection of government officials was dominated by Confucianism, inspiring the civil service examination system and determining its content. Yet Confucian values were also deeply rooted in the family. Children learned the core values of filial piety (xiao 孝) and gender roles through both the study of texts and ritual practices in the setting of family life. Despite harsh rejection of Confucianism in the course of twentieth-century revolutions, Confucian education experienced a resurgence in the twenty-first century in both public and private realms as a means to restore connections with Chinese cultural identity and to achieve a “harmonious society” (hexie shehui 和諧社會).
The Construction of Confucianism in Europe and the Americas
Authors: Jensen Lionel M.
Published: January 2023

This is an essay in global intellectual history told through the figure of Confucius and the manifold figurations of “Confucianism.” It reflects on the conditions and consequences of the naming of Kong Fuzi 孔夫子/Confucius and the energetic early modern transmission of the moral sayings that came to be—and remain—known as Confucianism. In the course of attending to the wider economic, intellectual, religious, social, and technical changes of 1550–1870, the chapter presents the premodern and early modern circulation of ideas embedded in the cargo of hundreds of vessels calling at ports like Goa, Malacca, Macao, and on into the European humanist enterprise of philology, which is at the root of the modern humanities. The concept of “Confucius and sayings” then circulated further into the Americas, being taken up as part of the global font of wisdom drawn on as new nations attempted to generate their own institutional and ideological foundations for a new order of the world (novus ordro seclorum).
The Construction of Confucianism in East Asia
Authors: Zufferey Nicolas
Published: January 2023

Confucianism has largely been a Western construction. In ancient Chinese, the closest match to “Confucians” was ru, “literati” or “classicists” but the term is not a perfect equivalent. Thus the subject of this chapter will be the construction of the ru rather than the construction of Confucianism. The chapter will outline the history of the ru from their emergence in antiquity to later developments; however, it will focus on the formative stage, namely pre-imperial times and the Qin and Han dynasties. In conclusion, the status and identity of Confucianism in the “Sinosphere” (Korea, Japan, and Vietnam) will be briefly described.