bluuebunny/crossref_metadata_2025 huggingface dataset:
Airway
Authors: Hosie H , Morton N S
Published: October 2023

As noted in Section 3 the early warning signs of airway obstruction are clinical, especially when the patient is breathing spontaneously. Monitors become more important as more invasive techniques are used to maintain the airway, so that in the intubated patient whose ventilation is being controlled, monitors give vital early warning signs.
Drugs
Authors: Morton N S
Published: October 2023

An adverse drug reaction is any drug effect that is not beneficial to the patient. Some reactions depend on the dose of drug given and are an extension of the drug’s properties. This type of reaction is common, for example morphine produces dose-related depression of breathing. Other adverse reactions are not related to the dose given and are unpredictable and relatively rare, for example anaphylactic shock, malignant hyperthermia.
Equipment
Authors: Morton N S
Published: October 2023

Most operating theatres are connected to a back up power generator electricity supply to cover the possibility of failure of the usual mains supply. This generator system is regularly checked but there is the remote chance that it could also fail. In this situation, theatre lighting, monitoring equipment and ventilators may fail. The safest option is to take over ventilation by hand using portable oxygen and a self-inflating bag and try to get a battery powered patient monitor pack attached. The surgery should be stopped until the situation is clarified and then completed if possible as quickly as is safe. The anaesthetist will give specific instructions on how the assistant should help.
Genitourinary Surgery
Authors: Morton N S
Published: October 2023

Patients with renal failure presenting for surgery raise particular problems. Patients are often anaemic and may have significant abnormalities of their body chemistry and fluid compartments. Particular care is required in the patient in renal failure presenting for a surgical procedure to establish vascular access for dialysis as these patients may be in cardiac failure from fluid overload and may have a high serum potassium which predisposes to abnormal heart rhythms. Many drugs used in anaesthesia are excreted from the body via the kidneys and so care is needed with doses of agents such as muscle relaxants and opioids, particularly if given in repeated doses.
Acute Medicine Algorithms
Authors: Singer Mervyn , Webb Andrew R
Published: October 2023

Acute Medicine Algorithms is an essential pocket reference for everyone in the intensive care unit. It takes a unique approach to the management of acutely ill patients - with a straightforward decision-tree format which provides unequivocal guidelines for acute medical conditions. It includes 70 algorithms - either problem orientated or related to specific conditions - together with complementary notes and references. The book provides junior doctors and SHO's in the ITU with an invaluable aid to learning and revising the management of acute medical care and provides experienced physicians with a thought-provoking digest of current practices and procedures. Acute Medicine Algorithms continues the tremendous success of the highly-acclaimed Critical Care Algorithms from the same author team. All those involved in acute medical care will find this book an indispensable clinical tool that will prove an invaluable reference in day-to-day practice and as a revision and discussion text.
Whole-body scintigraphy
Authors: Schaeffer Juergen , Floege, Juergen , Koch Karl M
Published: October 2023

Accurate and early diagnosis of 132-microglobulin amyloidosis (Al32m) is essential for the individual patient in order to rule out other causes of symptoms, and because of potential serious complications of progressive Al32m such as hip fractures. Reliable diagnosis is also important for the understanding of the pathogenesis, and also, it is hoped, for the development of strategies to prevent or at least delay the progression of Al32m.
Description, localization, and progression of β2- microglobulin dialysis-related amyloid deposition
Authors: Athanasou N A
Published: October 2023

Beta2-microglobulin (132m) amyloid deposition is now recognized as one of the most serious complications of long-term haemodialysis. Its most prominent clinical manifestations are the carpal tunnel syndrome, joint swelling, erosive arthropathy, haemarthrosis, and cystic lesions within bone. The pathological features of dialysis amyloid deposition in joints can be related to the radiological and clinical pattern of amyloid arthropathy. Systemic amyloid deposition also occurs in patients on long-term haemodialysis treatment. In both cases, the pathological consequences of dialysis amyloid deposition depend largely on the duration of haemodialysis and the site of amyloid deposition (Table 8.1).
Accidents and Emergencies in Children
Authors: Morton Rosemary J , Phillips Barbara M
Published: October 2023

The second edition of this book includes a revised section on paediatric resuscitation summarizing the main guidelines. The section on major trauma has been extended to follow the Advanced Paediatric Life support guidelines. The book will continue to provide an essential practical reference for all junior doctors and nurses working in an A & E department.
The endometrial vascular bed
Authors: Rogers Peter
Published: October 2023

In searching for a paradigm upon which to base an understanding of the structure and function of the endometrial vascular bed, it is not inappropriate to consider the relative evolutionary histories of both the vascular system and the endometrium. Primitive invertebrate and vertebrate vascular systems first appeared some 500 million years ago. Since that time the vascular system has evolved into a complex organ playing central roles in a number of functions critical to the survival of the organism, including oxygen transport, nutrition, excretion, fluid balance, homeostasis, and immune defence. By contrast, placental mammals and the first primates appeared about 60–70 million years ago, and it is from this time onwards that a functional endometrium has developed.
The role of hysterectomy for menorrhagia
Authors: Petrucco Oswald M
Published: October 2023

Disorders of menstruation resulting in excessive menstrual loss, or menorrhagia, affect up to 20 per cent of otherwise healthy women. At a rate of 20-30 per 1000 these women will seek the help of primary care physicians and when referred to gynaecologists they will represent up to 12 per cent of all gynaecological consultations (Bradlow et al. 1992). The health care costs of abnormal menstruation and associated anaemia, when related to loss of productivity in the work force and home and utilization of medical services, are considerable even before expenditure is considered for investigating and treating this disorder. Medication prescribed for women suffering from menorrhagia for 1993 in England and Wales resulted in 821 700 prescriptions at a cost of £7 176 596. In the same year 128 000 diagnostic procedures and 73 000 hysterectomies were performed for the management of menorrhagia (Nuffield Institute for Health 1995).
Surgical treatment of submucous fibroids
Authors: Donnez Jacques , Nisolle Michelle , Gillerot Stephane , Bassil Salim , Polet Roland , Smets Mireille
Published: October 2023

Dysfunctional uterine bleeding and fibroids are the major reasons for hysterectomy in women over 40 years of age. Since 1985, gonadotrophin releasing hormone (GnRH) agonists have been recognized as a possible medical management for these conditions (Maheux et al. 1985). Nevertheless, because of the bone loss induced by the hypoestrogenic state, this therapy must be considered as either a temporary medical approach before endoscopic surgery, or as a long-term therapy combined with ‘add-back’ therapy (Friedman et al. 1988; Maheux et al. 1991).
Contraceptive steroids and endometrial morphology
Authors: Okon Moses A , Li T C , Dockery Peter
Published: October 2023

The effect of the contraceptive pill on endometrial histology depends on the factors discussed above. The endometrium of women taking combined oral contraceptives may sometimes show early secretory activity in the glands but secretory changes typical of the mid and late luteal phase are lacking. During the last week of the cycle the glands become atrophic, small, and tubular with a lining of flattened cuboidal epithelium.
Thecase for community-based maternity care
Authors: Young Gavin
Published: October 2023

Why do I propose that maternity care be based in the community? I believe that is where it belongs and that it is in the interests of most women and their families that maternity care is based within their community.
Latest views on antenatal care programmes
Authors: Tucker Janet , Hall Marion
Published: October 2023

In defining the aims of antenatal care two main elements are repeated in health service literature: clinical monitoring of the pregnancy with appropriate intervention, and psychosocial support for the woman and her family. For example, James (1995) says that antenatal care should achieve the following:
The prevention and treatment of illness in pregnancy
Authors: White David , Griffiths Frances , O’Neill, Patrick , Jackson Ann
Published: October 2023

The invitation to contribute a chapter with the above title came as something of a surprise. We have worked together in a primary health care team for the last eight years providing general medical and maternity care with access to GP intrapartum care in a nearby GP/consultant delivery suite, but apart from AJ, who is a midwife, we have no special interest in maternity care. Having said that, the practice has been involved in education and research for many years, with one former partner responsible for numerous publications, including an audit of maternity care spanning 26 years (Marsh and Channing 1985a; 1985b; 1989).
New born babies and how to treat them
Authors: Watkin Sara , Henson Cath
Published: October 2023

Ninety-three per cent of newborn babies are born at term and of these between 95% and 99% are in good condition. They require no resuscitation and have no abnormalities on routine baby check and biochemical screening. Caring for the newborn demands the skills and expertise of working in partnership with parents.
Introduction
Authors: Lindesay J , Morris J C
Published: October 2023

Specialist services for patients with memory disorders have a relatively short history and have tended to develop separately from other provision for people with dementia, such as psychogeriatric services. One increasingly popular service model, the memory clinic, has its origins in the United States, where they were first established in the mid-1970s with the aim of providing an outpatient diagnostic, treatment, and advice service for individuals with milder forms of dementia. Their genesis was to a great extent a response to the unmet needs of families of dementing individuals, who were frustrated by the apparent reluctance of many physicians to diagnose dementia in patients who lacked insight into their cognitive difficulties and who appeared superficially normal by virtue of preserved social skills and competence for basic activities of daily living. Despite this interest in dementia, they were called ‘memory clinics’ in order to focus attention on memory impairment as an important early sign of the disorder, and to get around the problem that dementia was often not recognized by the patients’ doctors. It was also thought that the idea of a ‘dementia clinic’ would be unattractive and stigmatizing, and might discourage referrals (Fraser 1992). These clinics enabled interested and experienced specialists from various disciplines to collaborate in the diagnosis, management, and research into what, at that time, was an under-appreciated group of disorders. In the two decades since the first clinics were set up, their numbers have steadily grown in the United States and elsewhere; a survey carried out in 1993 in the British Isles identified 20 memory clinics active at that time (Wright and Lindesay 1995). The experience of these specialist memory disorders services has contributed significantly to the greater awareness of the problems associated with mild dementia, and so to the development of community-based services for patients and caregivers. These services have also been important in combating therapeutic nihilism and in promoting the concept of dementia (notably Alzheimer’s disease) as a treatable disorder.
Electrical burns
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Electrical burns are always deep. Clothing may ignite, causing a thermal burn. Fasciotomy of severely burned muscle may release myoglobin into the circulation and produce renal fail¬ ure. IVFR to ensure supranormal urine output.
Extensor tendons 1 —mallet finger
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Make sure that the PIPJ is free to move in the splint. Skin care is difficult to maintain. Make sure that the patient does not remove the splint and bend the finger. The splint can be removed to wash and dry the finger, but the finger must be supported on a flat surface while the splint is off.
Extensor tendons 2 —division of extensor tendon over proximal phalanx (boutonniere deformity)
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Commonly missed injury. Tell patient to return if finger starts to flex at the PIPJ and he cannot straighten it fully. Then refer to hand clinic. May be an open or a closed injury causing a division of the central slip of the extensor tendon: Closed injury, following a sudden forced flexionrugby injury Open injury-knife/glass.
Intercarpal ligament disruption: lunate dislocation and scapho-lunate dissociation
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Pain and swelling are often severe, X-rays may look relatively normal. Median nerve may be involved by direct contusion or later swelling. May need acute decompression of the median nerve. Look for concomitant injuries from this high-energy trauma-CMC dislocation, radio/ulnar dislocation, elbow dislocation, radial head fracture.
Epiphyseal
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

The physis is weaker than the ligaments and so is liable to injury. Beware missing a type V injury, as it may lead to deformity with growth. These are sometimes described as fractures and some¬ times as fracture dislocations.
Pulp space infection
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Beware of unusual looking or chronic infections. Consider osteomyelitis, foreign body, or squamous cell carcinoma. Deep infection of the soft tissues of the fingertip usually due to Staph. aureus or coliforms.
The presentation and diagnosis of domestic violence
Authors: Heath Iona
Published: October 2023

That was my life. Getting hit, waiting to get hit, recovering; forgetting. Starting all over again. General practice has enormous potential to offer help to women enduring domestic violence.2 The general practice surgery is freely accessible to all and there is no stigma attached to a visit to the general practitioner, the practice nurse or the health visitor, as there might be for a visit to the police domestic violence unit or the offices of the local social services department. Despite this, many general practitioners and other primary health care professionals have been slow to exploit the potential of their situation.
An Evolutionary View
Authors: Greaves Mel
Published: October 2023

What then is cancer? The answer you may get depends on what you want to know and how you pose the question. Some of the most vivid and moving descriptions of cancer have come from patients who happen to be writers or journalists.7 These accounts portray what cancer is, in terms of personal impact, uncertainty, and pain: an insider’s story. If, on the other hand, you are looking for details of different cancers, gene mutations or of hazards to avoid, tests to take, or available treatments and averaged outcomes, then these data are available in your library or on internet web sites. This information contributes to the overall picture but does not in itself constitute either an explanation of why we get cancer or an adequate prescription for what makes a cancer. I’m aiming for something different.
How should we live?
Authors: Lomas Peter
Published: October 2023

There has never been a shortage of people ready to tell others how to live. Sometimes such advice comes from someone who is regarded as having particular knowledge in a certain field of operations, and, if luck holds, the advice will be helpful. But what of advice that is of a more general nature? In most of daily living this comes from relatives, friends, and the man-in the-street, that is, those who cannot be expected to know the answers any better than we ourselves, whose opinions may be unsought and unwelcome, yet to whom we might gratefully tum when in distress. By contrast, there are the prophets and sages, those who, for one reason or another, have acquired a reputation for wisdom. Most of them are dead; and it is a brave, stupid, or foolhardy person who will readily stand up in the market-place and claim to be wise. Yet, in effect, this is what the psychotherapist is called upon to do.
The boy who bowed to the King
Authors: Ewin Jeannette
Published: October 2023

The memorial service for Hugh Macdonald Sinclair was held at the University of Oxford in the Magdalen College Chapel on 13 October 1990. As sounds of the choir filtered from the stone building along the gardens and paths of the College, aproned butlers and kitchen staff rushed heavy trays from the kitchen pantries and cellars across the ancient yard to the President’s residential quarters. The day was warm for the time of year. The staff gossiped as they worked, recalling evenings when Sinclair generously entertained them at dinner in the College; with good food, fine wine, port, and cigars. Always the best from Hugh Sinclair. He was rarely demanding, unlike many Fellows, and he frequently took time to speak with the chefs, butlers, and cleaners alike. He had been a ‘gent’. Tall, softly spoken, balding, and bespectacled. Perhaps shy, some said, but always charming.
Lady Place: progress, and a blunder
Authors: Ewin Jeannette
Published: October 2023

Hugh had no money of his own, and was forced to convince his mother to finance the purchase of Lady Place. She would need to sell Gransden, but they could continue to count on her rental income from Barming House. Surely she would enjoy this place: Sutton Courtenay was a picturesque English village. Anglican and Catholic churches were close at hand, as was a fast train to London and a well-known golf course, Frilford Links. The market town of Abingdon, about 3 miles from Lady Place, provided reasonable shopping, and the open fields of the property were convenient for meets of both the Old Berkshire and South Oxfordshire Foxhounds. On a pragmatic level (always of vital importance to his mother), if the two cottages on the property were rented, and the gardens and pasture were put to good use, Lady Place could generate enough cash to help maintain it.
War
Authors: Ewin Jeannette
Published: October 2023

On 1 September 1939, the British Prime Minister, Neville Chamberlain, demanded that Germany cease its invasion of Poland or face a declaration of war: the ultimatum was repeated on the following day. These efforts proved futile, and on 3 September, at 11.30 a.m., the people of the United Kingdom were told hostilities had begun. British ships in the Western approaches and elsewhere were set upon by U-boats, and at 9.30 that night the passenger liner Athenia was torpedoed with the loss of 112 lives. On hearing the news, Hugh unburdened himself in a letter to his mother. He thanked her for the care and kindness she had shown him, recalled the good times they had enjoyed together, and said he loved her. He admitted that he had been ‘dreadfully tired’ at times, and confessed to two bad breakdowns through overwork. If he had been unkind to her, he wrote, it was due to exhaustion, and never the lack of love. After placing the finished letter and a copy of his will in a small brown envelope, Hugh sealed shut the flap with red wax.
Nissen huts and honours received
Authors: Ewin Jeannette
Published: October 2023

It was 1947: Princess Elizabeth Alexandra Mary, the elder daughter of King George VI, married her third cousin, Philip, the Duke of Edinburgh; Captain Chuck Yeager flew the Bell X-1 rocket plane at supersonic speed; and India gained her independence from British rule. Perhaps telling more of the time, the fashion house of Dior enjoyed instant success when it introduced the long and swirling skirts of the New Look, flaunting the extravagant use of fabric in the face of lingering rationing.
Clinical effectiveness and evidence-based practice
Authors: Maslin Anna M
Published: October 2023

Even if an argument is forcefully made for a woman with breast cancer having the right to information which will enable her to exercise her autonomy if she so wishes by being involved in the decision-making process, how likely will it be that accurate, clinically effective, individualized information will be available for her? This section aims to briefly review the position in relation to breast cancer.
Cardiovascular Risk Factors in Chronic Renal Failure
Authors: Wheeler David C , Baigent Colin
Published: October 2023

Prevalence of cardiovascular disease in chronic renal failure Cardiovascular disease is now the leading cause of mortality among patients with chronic renal failure in Europe, the United States, and other developed countries. Approximately 60% of deaths among US dialysis patients can be attributed collectively to myocardial infarction, cardiac arrest, stroke, and ‘other cardiac causes’ (Table 1.1). Some international variation may exist, although qualitatively similar patterns have been reported in Europe.At all ages, the absolute mortality rates among dialysis patients are substantially higher than in the general population (Fig. 1.1).
Mortality and cardiovascular risk factors influencing survival in end-stage renal failure
Authors: Foley Robert N , Parfrey Patrick S
Published: October 2023

Pericarditis and pericardial effusion were common manifestations of terminal uremia before renal replacement therapies became available. The availability of chronic hemodialysis led to an almost miraculous change in that the inexorable progression to death associated with the uremic syndrome was stalled. It became rapidly apparent, however, that the reprieve was temporary, and that the survival of dialysis patients was still at least an order of magnitude shorter than in a general population sample of similar age.
Oxidative stress and cardiovascular disease in end-stage renal failure
Authors: Descamps-Latscha Béatrice , Khoa Thao Nguyen , Witko-Sarsat Véronique , Massy Ziad A , Drüeke Tilman L B
Published: October 2023

Atherosclerotic vascular disease remains the most frequent complication in uremic patients undergoing maintenance hemodialysis, accounting for approximately half of the deaths in these patients.1-4 Although the prevalence of cardiovascular-related deaths in the end-stage renal failure (ESRF) population is highest in the elderly (approximately 150 cardiovascular related deaths per 1000 patient-years at risk), it is still substantial (40 cardiovascular deaths per 1000 patient-years at risk) in the age group 20-40 years. Thus, as a percentage of total deaths, cardiovascular deaths are approximately equivalent across all age groups. Interestingly, the high prevalence of atherosclerotic cardiovascular complications also found in uremic patients not yet on dialysis suggests that uremia-related factors per se can con tribute to the genesis of atherosclerotic vascular lesions.
Congestive heart failure and its management in end-stage renal failure
Authors: Casserly Liam F , Givertz Michael M
Published: October 2023

Despite advances in the fields of dialysis and renal transplantation, morbidity and mortality remain high in patients with end-stage renal failure (ESRF). Although an overall reduction in crude death rate has been reported in the United States ESRF population since 1988, cardiovascular disease remains the most common cause of mortality. Cardiac arrest and acute myocardial infarction account for the majority of cardiac deaths, but congestive heart failure (CHF) contributes significantly to all other cardiovascular mortality.
Cardiac drugs
Authors: Jennings Kevin
Published: October 2023

Caution: calculating the correct dosage of parenteral agents pre scribed according to patient weight is difficult and liable to error. Do use the wall charts or pocket aids provided by manufacturers for this purpose.

Inotropic agents should be avoided in patients with obstructive valve disease or with hypertrophic cardiomyopathy: they may result in a deleterious increase in the pressure gradient.
The clinical approach to assessing patients with early onset dementia
Authors: Nestor Peter , Hodges John R
Published: October 2023

The clinical assessment of patients with suspected dementia should, ideally, be multidisciplinary. Neurology, neuropsychology, and psychiatry each have an important role to play in the diagnostic process. Whether one chooses to offer these in a joint assessment clinic or as series of separate consultations will probably depend more on practical than clinical expediencies. Each has its own advantages and disadvantages; our approach, which we have found particularly rewarding, is the joint assessment clinic in which complex referrals are seen by all three arms of the team on the same day (the Cambridge Memory Clinic is described in detail elsewhere: see Berrios and Hodges 2000).
Neuropsychiatric assessment
Authors: Cummings Jeffrey L , Chung Julia A
Published: October 2023

Neuropsychiatric symptoms, including affective disturbances, personality changes, and psychosis, are common and important in the assessment and treatment of patients with early onset dementia. Early recognition is essential in formulating the differential diagnosis and providing effective interventions that may reduce morbidity and mortality. Single item and multidimensional tools can assist the clinician in evaluating initial symptomatology and monitoring clinical changes.
Drug interventions in dementia
Authors: Rahman Shibley , Sahakian Barbara J , Gregory Carol A
Published: October 2023

There is now considerable optimism in the treatment of the presenile dementias. However, with this optimism has been the growing realization that therapeutic strategies in dementia should have very specific aims — to delay the progress of the disorder that is causing a progressive decline, to treat a range of emergent cognitive deficits, to ameliorate associated behavioural and affective disturbances, thereby reducing the consequences of functional disability and improving quality of life, and to address fully the needs of the caregiver. Whilst it remains the case that affective and behavioural symptoms of dementia, such as depression, difficult behaviour, and agitation, also often respond to interventions which are non-pharmacological in nature — e.g. trying to avoid circumstances which trigger behavioural outbursts, developing proper care environments, and teaching behavioural management to family members and nurses, these ‘symptoms often respond to therapeutic strategies aimed primarily at cognitive symptomatology.
Definitions, epidemiology, and models of fatigue in the general population and in cancer
Authors: Hotopf Matthew
Published: October 2023

Fatigue is a universal experience and a common symptom. Most people experiencing fatigue do not see it as anything unusual, but instead put it down to the toils of normal life (David et al. 1990). In some individuals fatigue can become chronic and disabling. Fatigue is rated by patients as an especially alarming and difficult symptom, whereas doctors—who are perhaps aware of its non-specific nature—tend to underestimate its importance (Dohrenwend and Crandell 1970).
Mechanisms and models of fatigue associated with cancer and its treatment: evidence from preclinical and clinical studies
Authors: Andrews Paul , Morrow Gary , Hickok Jane , Roscoe Joseph , Stone Paddy
Published: October 2023

Defining non-exercise-induced fatigue in humans and identifying its correlates in other animals is one of the most difficult aspects of studying this widespread clinical problem. In humans an operational definition is ‘a subjective state of overwhelming, sustained exhaustion and decreased capacity for physical and mental work that is not relieved by rest’ (Piper et al. 1989; Piper 1992). Additionally, in contrast to exercise-induced fatigue, that which accompanies cancer and its treatment has a sustained duration of weeks, months, or even years.
Becker muscular dystrophy
Authors: Visser Marianne de , Hoogerwaard Edo M
Published: October 2023

Becker strongly believed that the newly discovered muscular dystrophy was allelic to DMD. For many years Duchenne type and Becker type of muscular dystrophy were considered to be distinct genetic entities. In 1983, Kingston et al. with molecular genetic evidence, showed that both disorders segregate with the same Xp21 chromosomal region and that DMD and Becker type muscular dystrophy (BMD) most likely were allelic disorders, possibly caused by mutations in the same gene. With the discovery of the dystrophin gene and its product, the dystrophin protein, Becker eventually proved to be
Oculopharyngeal muscular dystrophy: the muscular dystrophies
Authors: Brais Bernard , Tomè Fernando M S
Published: October 2023

In 1915, Taylor of Boston reported the familial association of eyelid ptosis and dysphagia in a family of French—Canadian descent (Taylor 1915). The more common autosomal dominant (MIM 164300) form of Oculopharyngeal muscular dystrophy (OPMD) became a distinct muscular dystrophy in 1962 (Victor et al. 1962).
Managed counselling in primary care
Authors: Foster Joan
Published: October 2023

The keyword in the tide of this ch.spier is 'managed’: it concept which litis no! been part of the culture of counselling in the past. This chapter will look at the growth of Lonrisellitip in the XI IS and lhe changes that have taken place with the introduction of1 the new XUS’ since April 1999. The particular areas of equity of provision and clinical governance will be discussed. These have had major implications for primary care counsellors in many areas. One of the results will be more a widespread introduction of managed counselling services. What this means in concrete terms will be explored, from both a management and counselling perspective. The consequences in terms of both gains and Josses will also be addressed.
Counselling research and evaluation
Authors: Rowland Nancy , Goss Stephen
Published: October 2023

As an emerging; professional "roup, counsellors, especially those who work in primary or secondary care, are taxed with questions about the utility of the work they do. Does counselling work? What interventions work best for which patients? Are counsellors providing a safe and effective service? Further questions focus on the cost of counselling. How much does it cost? Is counselling cost-effective? Is it good value for money? I low does it compare in terms of cost and effectiveness with other interventions designed to alleviate mental health problems in primary care? These questiotts about effectiveness and cost-effectiveness are framed in the context of current health serr ice policy, with its emphasis on quality of care, evidence-based practice and cost-cftcctive services.
Evidence and risk: the sociology of health care grappling with knowledge and uncertainty
Authors: Bellaby Paul
Published: October 2023

Evidence-based health care is iconoclastic. It seeks to shake professionals from paradigms of practice that are not proved to be of benefit to patients or that carry unacceptable risks. For example, in the inter-war and post-war period it was common to remove tonsils and adenoids in young children who presented with tonsillitis. That practice would probably have been swept away by evidence-based health care because the benefits were unproved. An instance before the First World War of what evidence-based health care would now consider an unacceptable risk was the use of highly toxic mercury in the treatment of syphilis. In retrospect these clinical practices seem mere fashions of the day. In its place, evidence-based health care seems designed to make medicine an applied science, no longer an art or craft founded on experience.
Outcomes
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Outcomes and measurement are closely related one to another, so closely related in fact that taking them as separate sections requires some explanation. There are several dictionary definitions for outcome: ‘the issue; consequence; result’. The result of a trial or review is not necessarily the issue that interests us. Robert Macnamara once said, in another context, that we must stop making what is measurable important, and find ways to make the important measurable. Gertrude Stein is supposed to have said in the 1920 that for a difference to be a difference it has to make a difference. Once we take messages like this on board, then what we might regard as an outcome may be completely different from the result of a trial, or what the researchers have actually measured. We need to think differently
Being sure of a result
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

This section could better be described as ‘bullshit detection’. It aims to draw together ideas about bias and error from preceding sections and use them with examples of how systematic reviews can mislead. This is more important than most of us realise. Entire countries have changed medical policy on the basis of flawed research. An uncritical acceptance of results of systematic reviews and meta-analysis is almost as bad as not using them at all. Many of the sources we think of as being or aiming to be impeccable, like government agencies, academics or even the Cochrane Collaboration, produce reports that are just plain rubbish.
Paracetamol (acetaminophen) with codeine in acute postoperative pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Clinical bottom line. Paracetamol with codeine is an effective analgesic. The NNT for at least 50% pain relief with a single dose of paracetamol 1000 mg plus codeine 60 mg was 2.2 (1.7–3.9) based on information on 197 patients. Paracetamol 600/650 mg plus codeine 60 mg had an NNT of 4.2 (3.4–5.3) for at least 50% pain relief over 4–6 h in patients with moderate to severe pain compared with placebo based on information from 1136. Paracetamol plus codeine produced significantly more pain relief than paracetamol alone.
Diclofenac in postoperative Pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

For each trial the mean TOTPAR or SPID values for diclofenac and placebo groups were converted to the percent of maximum total pain relief based on the categorical pain scales (%maxTOTPAR or %maxSPID). These values were then converted to dichotomous information on the proportion, and then the number of patients, who achieved at least 50%maxTOTPAR. A NNT for at least 50% pain relief and the relative benefit of the treatment were then calculated.
Naproxen in postoperative Pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Clinical bottom line. Naproxen is an effective analgesic. A single dose of 550 mg naproxen sodium versus placebo had an NNT of 3.0 (2.2–4.8) for at least 50% pain relief over 4–6 h in patients with moderate or severe pain compared with placebo. This is more effective than a 1000 mg dose of paracetamol which has an NNT of 4.6 (3.9–5.4).Naproxen sodium 220 and 440 mg were also more effective than placebo. The most commonly reported adverse effects were nausea, vomiting, headache, gastric irritation, dizziness and somnolence. These were predominantly of mild to moderate severity.
Which migraine treatment strategy is most effective?
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

A number of strategies can be used to treat acute migraine attacks, each utilising some part of the evidence base. For instance, the initial attack could be treated with aspirin or simple analgesic, and if or when that fails, a triptan could be used. That is a step strategy within an attack. A different approach may be to try aspirin or simple analgesic for a few attacks. It will work for some, but for those for whom it does not work, a triptan may be an alternative treatment. That is a step strategy  across attacks, and is probably the strategy most likely to be used in the UK as it is probably seen as the cheapest.
Supplements and herbal Remedies
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Taking food supplements like vitamins or fish oil is now common, as is the use of herbal remedies. Many different types are freely available from pharmacies and health food shops, a big change in the last decade. For some of these there is efficacy, and folate supplementation up to about 400 _g daily is proven to yield benefit in reducing the incidence of cancer and heart disease. What this section seeks to do is examine the evidence for benefits for painful conditions. It will never be comprehensive, because new unsubstantiated treatments seem to emerge weekly. Buyers should beware.
Nilutamide plus orchidectomy for metastatic prostatic cancer
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Clinical bottom line. Nilutamide is associated with pain relief in patients who have undergone orchidectomy for prostatic cancer. Although nilutamide has an NNT of 7.5 (5–15) for any pain relief at six months compared with placebo, it remains to be established whether this is of clinical relevance. The most effective treatment for prostatic cancer with metastases is thought to be removal of the testicular and adrenal androgens. Orchidectomy and luteinizing hormone releasing hormone agonists (LHRH agonists) or oestrogens suppress testicular androgens. Antiandrogens such as nilutamide, flutamide or cyproterone acetate are used to suppress the effects of adrenal androgens.
Easy targets are not always the right ones
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

We know that the combinations work on different mechanisms to relieve pain. Yes, we could give the components separately, which would delight the purists who dislike combinations of drugs with different kinetics. But the convenience of just one medication to take is worthwhile, especially for elderly patients on many other drugs. We prescribe sustained release morphine formulations (at huge cost) because it is perceived as more convenient.
War-based hysteria—the military perspective
Authors: Palmer Ian P
Published: October 2023

Military interest in any medical subject is proportional to the effect the condition has on the fighting efficiency of that force. This chapter must be viewed in the context of armies existing to fight, not to go to hospital. Medical research on a battlefield is of low priority and difficult: researchers may die, records lost, and vagaries and variations in diagnostic practice and nomenclature are legion. Account must therefore be taken not only of hysteria but also its bedfellows malingering, somatization, war syndromes, and anxiety reactions for ‘medical disorders create complex problems, ones that have extended beyond questions of medical diagnosis and therapy to issues of social attitudes and policy’ (Feudtner 1993) and military societies are not exempt in this matter.
The origins of DSM and ICD criteria for conversion and somatization disorders
Authors: Cloninger C Robert
Published: October 2023

The first major practical problem facing a clinician evaluating a patient with unexplained neurological or other somatic complaints is diagnosis. Before initiating a responsible treatment plan a clinician must know how to recognize cases of hysterical conversion or somatization disorder in a way that is valid and reliable, so that any other physical and psychiatric disorder requiring treatment will not go unrecognized and untreated. If such cases can be reliably diagnosed—and they can (Guze, 1967; Yutzy et al. , 1995; Crimlisk et al. , 1998)—then the features that permit reliable differential diagnosis from other mental and physical disorders are the chief clues for understanding their underlying psychobiology and planning treatment. In this chapter, I will review the research and thinking that has led to the construction of modern diagnostic criteria for conversion and somatization disorders, and show how this provides a useful—in my opinion, essential—basis for diagnosis, aetiological research, and treatment planning.
Hypnosis and suggestion in the treatment of hysteria
Authors: Oakley David A
Published: October 2023

The various phenomena associated with hypnosis have been known for many centuries as relatively easily produced but powerful alterations in subjective experience. There has equally been a recognition of the close relationship between hypnotic phenomena and hysteria, as the quotation above testifies (see also Gauld, 1992; Mersky, 1995; Oakley, 1999a; Thornton, 1976). Historically, the fact that hypnotic procedures could induce symptoms similar to those seen in hysteria was discussed by Gilles de la Tourette (1887, 1891)and Babinski emphasized the link between hysteria and suggestibility (Babinski and Froment, 1918). The influential neurologist, Charcot, went further in his belief thatthough suggestion was important, hypnosis and hysteria were linked by a common underlying neurological condition (Charcot, 1886-90; see also Gauld, 1992; Kihlstrom, 1994).
Contraception
Authors: Szarewski Anne , Guillebaud John
Published: October 2023

Recent developments in methods of contraception have presented women with a wider range of options than ever before. At the same time, however, scare stories - particularly about the Pill - have spread anxiety and confusion. In this third edition of Contraception, Anne Szarewski and John Guillebaud assess all the evidence, including the new guidelines which were issued by the Committee of Safety of Medicines (CSM) in May 1999 following a review of the 1995 scare stories. They describe the latest methods, including new types of condoms, Persona, and Mirena, and cut through the conflicting information to give you the clearest and most reliable advice you will find anywhere. From reviews of previous editions: 'A model of clearly presented, unpatronising, up-to-the- minute information ... the current definitive book on the subject.' Vogue 'Excellent.' British Journal of Family Planning 'Essential reading for anyone thinking of changing their family planning method.' Woman 'this is the book to buy ... Written by expert gynaecologists... with textbook clarity, it's one of the most comprehensive guides around... an invaluable book.' Health and Fitness
Practical aspects of taking the combined pill
Authors: Szarewski Anne , Guillebaud John
Published: October 2023

However, as far as instructions go, many different leaflets exist, and they often contradict one another. Those produced by the manufacturers give different instructions from those of the Family Planning Association (FPA); and the latter may even differ among themselves, since the FPA leaflets have been brought up to date over the years. However, it is possible that old FPA pill leaflets are still in circulation. With so much varied and unreconcilable information about, it is not surprising that women are confused and mistakes occur.
Contraception at special times
Authors: Szarewski Anne , Guillebaud John
Published: October 2023

Breastfeeding in itself has a contraceptive effect, because the hormone which stimulates the production of milk also has the effect of inhibiting the ovaries. However, this is only consistently the case in full ‘demand’ breastfeeding, when the baby is fed very frequently both day and night. If you start to add water, other feeds, or train the baby to feed at regular, spaced intervals the contraceptive effect is greatly reduced. This is because the milk-stimulating hormone prolactin is only released when it is required, which is when feeding takes place. It does not remain in the bloodstream for very long, so as soon as you stop feeding its levels go down, and so does the effect on the ovaries.
The causes of delirium
Authors: Rolfson Darryl
Published: October 2023

Even for the experienced clinician, delirium in an older person can be a perplexing clinical challenge. The syndrome may develop insidiously, progress with periods of lucidity, and masquerade as a less acute cognitive syndrome. When recognized, the job has only just begun. Considering that the management of delirium is first and fore- most to ‘treat the underlying cause’; a sometimes exhaustive search then ensues to identify this. In fact, finding the causes of a delirious state becomes the central activity of a health-care provider who is interested in its resolution. Failure to address causation may reflect a serious uncertainty about the diagnosis, and will result in prolongation of the delirium and its consequences.
Educational issues
Authors: Ebner-Lyon Laurie , Brown Joy
Published: October 2023

The aim of this chapter is to discuss the central role of education in helping children with JIA and their families cope with a chronic disease. When a child is diagnosed with a chronic illness the entire family is affected in multiple ways. If family members are properly educated about the illness, it becomes possible for them to form a genuine partnership with the medical team to treat their child’s disease, allowing them to feel they have some control over the disease and its management. Knowledge about the disease becomes crucial when a parent is forced to balance the risks of the illness versus the risks of treatment. It is insufficient to expect families to “buy into” treatment because they are given a prescription.
Homer
Authors: Taplin Oliver
Published: October 2023

The early Greeks envisaged the world as encircled by the mighty freshwater river of Ocean, and held that all springs and streams derived from him. Ocean became their image for Homer: all poetry and eloquence derived from him as he surrounded and encompassed their thought-world. (Among the literary papyri found in Egypt those of The Poet, as he was known, outnumber all the other authors put together.) Alexander Pope, Homer’s greatest translator into English, found a different image: ‘our author’s work ... is like a copious nursery, which contains the seeds and first productions of every kind, out of which those who followed him have but selected some particular plants .. .’ Like all really great literature, it is fecund and inexhaustible, generous to all comers, and it may be cultivated in apparently limitless ways.
Lyric and Elegiac Poetry
Authors: Bowie Ewen
Published: October 2023

Only of hexameter poetry have we examples earlier than 700 BC. But many genres first known to us from the seventh century were certainly thriving long before-that century gives us our first elegiac, iambic, and melic poetry because by then writing was spreading, so that the works of celebrated poets could be re¬ corded as those of their predecessors could not. Of our genres only elegiac significantly exploited those formulaic phrases which both aided the composition and recitation of epic and contributed to its oral preservation. Furthermore much of our poetry was composed with particular audiences and occasions in view, so that incentives to preserve it orally were fewer.