bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychosocial Issues Related to Liquid Biopsy for ctDNA in Individuals at Normal and Elevated Risk
Authors: Hamilton Jada G. , Watsula-Morley Amanda , Latham Alicia
Published: February 2021

The use of a liquid biopsy through analysis of circulating tumor DNA, or ctDNA, has received much attention as a potential diagnostic and prognostic tool in oncology. This chapter provides an overview of the medical application of liquid biopsy for ctDNA in individuals at normal and elevated risk of cancer. We discuss the psychosocial implications of ctDNA assays, including the incidental discovery of germline variants, the possibility of increased anxiety and uncertainty, and the potential for negative impact on quality of life. We conclude that although ctDNA shows great promise in improving disease outcomes among patients affected by cancer, further research is needed to establish the clinical validity and clinical utility of ctDNA assays. Additionally, psychosocial outcomes should be included in the balance of risks and benefits of these tests.
The Engaged Patient
Authors: Golant Mitch , Zaleta Alexandra K. , Ash-Lee Susan , Buzaglo Joanne S. , Stein Kevin , Saxton M. Claire , Donziger Marcia , Thiboldeaux Kim , Bohannon Linda
Published: February 2021

Patient engagement is ever more essential to developing innovative strategies that shape how comprehensive, integrated medical care is delivered to cancer patients and their families. With over 300 licensed professionals across the network, Cancer Support Community (CSC) is the largest nonprofit employer of psychosocial oncology mental health professionals in the United States. Through decades of working with cancer patients, families, and caregivers, CSC has developed a portfolio of evidence-informed programs that engage patients around their most pressing concerns—unwanted aloneness, loss of control, and lack of hope. CSC’s facilities, which provide support groups, education, exercise and nutrition classes, children’s programs, and social activities, are available at no cost for families. These services are replicated on CSC’s helpline and digital platforms. This chapter highlights a comprehensive integrated model of developing and delivering evidence-informed psychosocial programs and services in the community. The chapter also reviews CSC patient-centered research projects including (1) the Cancer Experience Registry®, an online observational study of cancer patients, survivors, and informal caregivers to identify and quantify their psychosocial experiences; (2) CancerSupportSource®, a reliable, valid, multidimensional distress screening program for patients and caregivers; and (3) Open To Options®, a shared decision-making program that helps patients prepare a highly personalized list of questions, concerns, and goals to share with their doctor. The extent to which the psychosocial oncology community can integrate care across healthcare systems, by leveraging new technologies, behavioral and implementation science principles, and community-based services, will determine its success in meeting the needs of cancer patients.
Addressing the Needs of Children When a Parent Has Cancer
Authors: Moore Cynthia W. , Dent Greer J. , Rauch Paula K.
Published: February 2021

This chapter reviews key issues of concern for parents with cancer, recognizing that addressing these parenting concerns as part of routine cancer treatment has the potential to alleviate an important source of patient distress. Research literature on the impact of parental cancer on children’s adjustment, and factors associated with better coping, is briefly reviewed. Practical suggestions are made for promoting open communication between parents and children about the parent’s illness and for supporting day-to-day family functioning, particularly when a parent’s prognosis is poor and survival time may be much shorter than hoped. Tables summarize child concerns common to each developmental stage and options for supports at each stage, communication strategies, and suggestions for preparing children for separations and hospital visits.
Neurobiology of Sleep and Wakefulness
Authors: Chopra Amit , Patel Rikinkumar S. , Das Piyush
Published: February 2021

Over the last century, multiple advancements in the field of neuroscience have furthered our understanding of the complex phenomenon of sleep and wakefulness in humans. As outlined in this chapter, electrophysiological markers broadly differentiate between the sleep and wakefulness states, which are essentially regulated by intricate neural networks and neurotransmitter systems in conjunction with circadian, homeostatic, allostatic, and other factors. Alterations of normal mechanisms regulating sleep and wakefulness not only have clinical implications in terms of understanding the genesis of sleep–wake disturbances in primary sleep-wake and psychiatric disorders but also offer the opportunity for development of effective therapeutic interventions.
Sleep and Cognition
Authors: Roshchupkina Lilia , Peigneux Philippe
Published: February 2021

How does sleep affect our brain functioning, and what happens when we do not receive our necessary “portion” of sleep? It is a well-known fact that sleep is essential for restoration of body and mind efficiency, while a lack of appropriate sleep adversely impacts mood, motor functions, and cognition, eventually affecting the quality of everyday life. Recent studies highlighted links between the amount of sleep disturbance and the severity of deterioration in some cognitive functions. Moreover, clinical observations indicate that sleep disturbances might be one of the earliest signs of neurodegenerative disorders, including early Alzheimer’s disease and dementia. This chapter briefly reviews the relationships between sleep and cognition, and consider the evidence suggesting that sleep deprivation and sleep disorders are associated with poor cognitive functioning and, in clinical population, with cognitive decline.
Hypersomnolence Disorders
Authors: Alhifzi Sulaiman , Zaki Nevin , Almeneesier Aljohara S. , BaHammam Ahmed S.
Published: February 2021

Despite varied classification systems, hypersomnolence disorders (or central disorders of hypersomnolence) are a group of disorders with a common symptom of excessive daytime sleepiness. In addition to a thorough clinical interview and examination, the assessment of hypersomnolence may require clinical investigations such as polysomnography and the multiple sleep latency test. This chapter examines the disorders of hypersomnolence with an emphasis on their clinical features and treatment strategies. The authors discuss the four main types of hypersomnolence disorders, narcolepsy type 1, narcolepsy type 2, idiopathic hypersomnia and Kleine–Levin syndrome, as well as hypersomnia due to a medical disorder, medication, or substance use; a psychiatric disorder; and insufficient sleep syndrome. It also discusses the relationships between hypersomnolence and psychiatric disorders.
Circadian Rhythm Sleep Disorders
Authors: Brown Gregory M. , Pandi-Perumal Seithikurippu R. , Cardinali Daniel P.
Published: February 2021

Circadian rhythm sleep disorders (CRSDs) cause disturbances in sleep and wakefulness due to a misalignment between the timing of the body’s intrinsic circadian clock and environmental light and social activity cycles. This chapter reviews these disorders with an emphasis on their neural pathways, genetic mechanisms, and regulatory factors. The authors discuss the relationship of CSRDs to physical and mental health, the treatment of CRSDs with circadian rhythm adjustment techniques, and the relationship of CSRDs to psychiatric disorders, along with potential chronobiologic treatments of psychiatric disorders. The chapter specifically addresses delayed sleep phase disorder, advanced sleep phase disorder, non-24-hour sleep–wake rhythm disorder, irregular sleep–wake disorder, shift work disorder, and chronobiology and psychiatric disorders. Melatonin and bright light therapy are covered.
Breathing-Related Sleep Disorders
Authors: BaHammam Ahmed S. , Alhifzi Sulaiman , Aleissi Salih
Published: February 2021

Breathing-related sleep disorders (BRSD) encompass obstructive sleep apnea (OSA), central sleep apnea, and hypoventilation disorders. Risk factors for BRSD include obesity, metabolic dysfunction, smoking, use of respiratory depressant medications (like opiates and benzodiazepines), and alcohol consumption, all of which are highly prevalent among patients with psychiatric disorders. BRSDs are associated with substantial morbidity, disturbed quality of life, and worse prognosis of comorbid psychiatric disorders. Therefore, it is essential for psychiatric care providers to have the clinical skills to recognize BRSDs. Recent studies suggest that the prevalence rates of OSA in psychiatric patients are higher than the general population. Moreover, BRSD’s share common symptoms and risk-factors with psychiatric disorders. A comprehensive clinical approach including a thorough sleep history and examination along with the use of validated screening questionnaires like the STOP-BANG questionnaire, particularly for at-risk patients, is effective in identifying BRSD.
Trauma- and Stressor-Related Disorders
Authors: Brownlow Janeese A. , Miller Katherine E. , Gehrman Philip R. , Ross Richard J.
Published: February 2021

Trauma- and stressor-related disorders (TSRD) are disabling psychiatric disorders that have distinct diagnostic criteria; however, some share commonly endorsed symptoms including disturbed sleep. This chapter provides a comprehensive description of sleep–wake disturbances common in TSRD and summarizes the evidence for empirically supported psychotherapeutic and pharmacological treatments for these sleep disturbances. There are few controlled studies of the applicability of currently available sleep-focused interventions to the management of disturbed sleep in TSRD. However, there is evidence supporting the efficacy of some psychotherapeutic and pharmacological treatments for the sleep disturbances in TSRD. Future investigations should include randomized clinical trials that combine treatments focused on sleep with treatments effective in managing other symptoms of TSRD.
Substance Use Disorders
Authors: Sinha Shirshendu , Kolla Bhanu Prakash , Mansukhani Meghna P.
Published: February 2021

Sleep disturbances although highly prevalent conditions in patients with substance use disorders, they are underreported, underrecognized, underdiagnosed, and often untreated. Alcohol and various drugs of abuse interfere with the initiation and maintenance of sleep. The sleep disturbances can be experienced during active substance use including intoxication as well as during early recovery. Literature also indicates insomnia is a risk factor for substance abuse. Thus sleep disturbances can play a major role in initiating and maintaining substance use and increase the risk of relapse. This review describes the existing literature on the bidirectional relationships between sleep disturbances and substance use disorders in the context of alcohol, cannabis, opioid, and cocaine use disorders. Evidence with regards the type and severity of the sleep disruption, its time course, relationship to relapse, and treatment options when available are discussed. Specific treatment strategies focused on individual substance-related sleep disturbances will improve global outcome in substance use disorders and sleep and enhance the quality of life of the patients.
Delirium
Authors: Hatta Kotaro
Published: February 2021

The fundamental concept of delirium is altered consciousness and its fluctuation. Sleep–wake cycle disturbance is one of the common clinical features of delirium. Evidence suggests that disturbed sleep plays a key role in pathogenesis of delirium and restoration of sleep–wake cycle provides a clinical opportunity for prevention of delirium. It is essential to evaluate clinical factors such as medical illnesses, psychiatric disorders, substance use disorders, medication side effects, and environmental factors leading to sleep disturbance in delirium. In addition, multicomponent nonpharmacologic delirium prevention interventions are effective in reducing delirium incidence and preventing falls, with trend toward decreasing length of stay, but nonsignificant reductions in mortality. Approaches to regulating functions of melatonin or orexin on sleep–wake cycle lead to pharmacological interventions, and preventive effects of melatonin receptor agonists and an orexin receptor antagonist on delirium have been shown. This evidence suggests importance of treating sleep–wake cycle disturbance to prevent delirium. More research is warranted to develop comprehensive clinical strategies, targeting sleep disturbance to predict, prevent and treat delirium.
Neurocognitive Disorders
Authors: Gossard Thomas , Louis Erik K. St.
Published: February 2021

Recent evidence for a strong bidirectional relationship between sleep and neurocognitive disorders has emerged. A key function of sleep in brain health is drainage of metabolites and toxins such as beta-amyloid that accumulate with continued wakefulness, making insufficient sleep, and sleep disorders possible contributors toward development of neurodegeneration. Sleep disturbances are frequent in patients with dementia and neurocognitive disorders, including poor sleep efficiency and architecture, sleep disordered breathing, sleep-related limb movements, and parasomnias. This chapter highlights current DSM-5 classifications for the major and mild neurocognitive disorders, including Alzheimer’s and Lewy body diseases and the related prodromal states of amnestic and nonamnestic mild cognitive impairment; less common neurodegenerative dementias are also reviewed. Diagnostic and therapeutic approaches to key sleep comorbidities in patients with neurocognitive disorders including insomnia, hypersomnia, sleep-disordered breathing, nocturnal movements, and parasomnias are also discussed.
Intramuscular Progesterone for the Prevention of Recurrent Preterm Birth
Authors: Oliver Emily A. , Roman-Camargo Amanda
Published: February 2021

Women with a history of spontaneous preterm birth have an increased risk of recurrent preterm birth. In this randomized placebo-controlled trial funded by the National Institute of Child Health and Human Development, patients between 16 and 20 weeks of gestation with a history of spontaneous preterm birth were administered intramuscular 17 alpha-hydroxyprogesterone caproate (17P) or placebo, weekly until 36 weeks of gestation. Treatment with 17P significantly reduced the rate of preterm birth (36.3% vs. 54.9%, p <0.001). Rates of necrotizing enterocolitis, intraventricular hemorrhage, and need for supplemental oxygen were all significantly decreased in the 17P group. In women with a history of spontaneous preterm birth, weekly 17P decreases the rate of recurrent preterm birth.
Planned Cesarean Section Versus Planned Vaginal Birth for Breech Presentation at Term
Authors: Morrison Samantha , Ehrenberg Hugh
Published: February 2021

The Term Breech Trial was an international randomized control trial to compare a policy of planned cesarean delivery versus planned vaginal delivery for the singleton term breech fetus. The primary outcome was a composite of perinatal and neonatal mortality and neonatal morbidity. Secondary outcomes were serious maternal morbidity or mortality. The odds of the primary outcome were significantly lower for the planned cesarean section group than for the planned vaginal birth group. This risk reduction was greatest at centers located in industrialized countries with overall low perinatal mortality rates. There were no significant differences in maternal outcomes. The article reviews this hallmark trial and places its findings in context within the current landscape of obstetrics.
Convergence Neuroscience of Meditative Mind–Body Therapies for Mental Health
Authors: Laird Kelsey T , Jain Felipe A. , Lavretsky Helen
Published: February 2021

Mind–body therapies that include meditation (e.g., mindfulness-based therapies, transcendental meditation, mantra meditation, and yoga) have demonstrated efficacy for enhancing mental health in a range of clinical and healthy populations. Of the forms of meditation, empirical research has most commonly focused on mindfulness-based approaches. Existing evidence suggests that, on average, both meditative movement (e.g., yoga) and multicomponent mindfulness-based interventions (e.g., mindfulness-based cognitive therapy and mindfulness-based relapse prevention) appear at least as effective as other active treatments for disorders such as major depression and substance use disorder. Results of studies with healthy adults suggest that multicomponent interventions such as mindfulness-based stress reduction have potential to increase empathy, self-control, self-compassion, relationship quality, and spirituality as well as decrease rumination. Translational neuroscience of mind–body therapies has also begun to evaluate the neurobiological mechanisms by which meditative therapies enhance resilience to mental health disorders, and several promising mechanistic domains (neural, hormonal, immune, cellular, and cardiovascular) have been identified. Directions for future research and implications for clinical practice are discussed.
An Introduction to Antidepressant Pharmacomicrobiomics and Implications in Depression
Authors: Brown Lisa , Cockburn Chelsea , Eyre Harris A.
Published: February 2021

Major depressive disorder (MDD) is a leading cause of disability worldwide, and over half of patients do not achieve symptom remission following an initial antidepressant course. Despite rigorous research, our understanding of the pathophysiology of MDD and response to MDD treatments is limited. An emerging field of interest in psychiatry is that of the interaction of mental illness and the microbiome. This new field also allows for the study of the effect of the microbiome on treatment response, or pharmacomicrobiomics (PMx). PMx, in addition to other tools like pharmacogenetics and pharmacoepigenetics, has the potential to inform treatment selection for individuals suffering from MDD and truly personalizing care for the disorder. Here, we discuss the current evidence for PMx as well as a potential future roadmap.
Surgical Technique
Authors: Heiser Clemens , Ulrich Sommer J.
Published: February 2021

This chapter serves as a practical guide for standard surgical techniques in upper airway stimulation. The major topics covered in this chapter are device implantation, operative device programming, and guidelines for anesthesia. Upper airway stimulation surgery can be technically demanding, particularly in the portions of the procedure involving nerve dissection and cuff positioning as well as placement of the respiratory sensor. Attention to detail during these aspects of surgery is critical in achieving good patient outcomes. Cuff positioning can be guided by proper use of observing the impact of intraoperative nerve stimulation on the tongue musculature as well as the use of nerve integrity monitoring.
Trial designs, including observational to interventional
Authors: Richard Edo
Published: February 2021

Observational studies have taught us a lot about the origin of neurological and neuropsychiatric diseases. This chapter describes how we can translate this knowledge into action. Before engaging in a large RCT, several steps have to be taken. First, the potential for a treatment effect has to be compelling. The target population in the RCT has to resemble the population in which observational studies described an association. Second, the outcome of an RCT has to be chosen, and has to have clinical relevance or at least have the potential of clinical relevance in the future. Third, the right study design has to be decided on. Each research question will require a specific study design with accompanying sample size calculation. Lastly, specific ethical considerations have to be taken into account when designing and executing an intervention study. This chapter presents an overview of these issues.
Idiopathic Parkinson’s disease and classification of parkinsonisms
Authors: Gallo Valentina , Chen Honglei , Pearce Neil
Published: February 2021

This chapter discusses Parkinson's disease (PD). PD is primarily characterized by motor symptoms; these include bradykinesia with rigidity and/or rest tremor according to the latest diagnostic criteria. Dr James Parkinson noted that the disease came on gradually, beginning in the hands and arms before moving through the rest of the body, and observed the weariness, inconvenience, and anguish it provoked in its victims. Nowadays, an increasingly more prominent role is being given to non-motor symptoms of PD; efforts are accordingly being made to produce a reclassification of clinical subtypes. Parkinsonism is principally divided into primary and secondary types. While potential causes of secondary parkinsonism should always be investigated and, when possible, treated, primary parkinsonism embraces a number of neurodegenerative disorders of multifactorial origin. The most common type of primary parkinsonism is PD. Another group of degenerative disorders is labelled atypical parkinsonism. The designation ‘atypical’ mainly refers to the poor levodopa response and the early manifestation of additional clinical features such as ophthalmoparesis, dysautonomia, apraxia, or dementia. Finally, the differential diagnosis of parkinsonism also encompasses a wide range of rare hereditary degenerative disorders that should be taken into account if the clinical presentation is not typical.
Posterior cortical atrophy
Authors: Yong Keir XX , Crutch SJ , Schott JM
Published: February 2021

Posterior cortical atrophy (PCA) is a neurodegenerative syndrome most commonly caused by Alzheimer’s disease (AD). PCA is a sporadic disorder, typically with onset between the ages of 50 and 65. The most prominent features of PCA are the early, progressive loss of vision and other posterior functions, in contrast to relatively preserved episodic memory function, while the radiological profile of PCA involves pronounced atrophy predominantly affecting parietal, occipital, and occipitotemporal cortices. Here we review literature relating to the characterization of PCA based on behavioural, neuroimaging, and pathological data. Estimates of the incidence and prevalence of PCA are considered, along with emerging evidence of genetic risk factors for PCA. Questions remain on the terminology surrounding PCA, such as its classification at a syndromic or disease level and the extent and heterogeneity of the PCA phenotype. Such issues, in addition to the sometimes profound divergence in clinical presentation between PCA and typical AD, have particular implications for management, and the design and implementation of future studies.
Detecting dementia early in populations
Authors: Borenstein Amy R
Published: February 2021

Clinical dementia is the result of the synergistic interaction between: (1) the lifelong accumulation of brain pathologies, which can be only neurodegenerative or combined additively with vascular pathology, and (2) brain reserve, both structural and cognitive. These two sets of risk factors are independent of one another, but interact to determine risk; thus it is important to take into account both types when determining individual risk. Over time, different diagnostic criteria for Alzheimer’s disease (AD) and mild cognitive impairment (MCI) have emerged. We discuss different methods for detecting dementia and AD in diverse populations.
Small vessel disease
Authors: Doubal Fergus N , Poggesi Anna , Pantoni Leonardo , Wardlaw Joanna M
Published: February 2021

‘Small vessel disease’ describes a combination of neuroradiological and clinical features that are due to an intrinsic disorder of the small cerebral arterioles, capillaries, and venules in varying proportions. It is very common, usually sporadic, although rare monogenic forms are well described. The commonest presentations are with stroke or cognitive impairment. The cause of the small vessel abnormalities in the sporadic form is not well understood and the brain damage is generally attributed to ischaemia secondary to the vessel abnormality. However, evidence for altered microvessel function and blood brain barrier failure is accumulating. The commonest risk factors are increasing age, hypertension, smoking, and diabetes, but environmental and lifestyle factors are also important although poorly understood. Whether the imaging features or incidence of small vessel-related stroke or dementia vary by world region is unknown. We review current knowledge on presentation, aetiology, incidence, and prevalence of sporadic small vessel disease.
Migraine
Authors: Vieira Julio R , Lipton Richard B
Published: February 2021

This chapter examines migraine. The incidence of migraine varies depending on multiple aspects, including age, sex, and the presence of aura. At an earlier age (younger than age ten), migraine initially affects more boys than girls, with migraine with aura (MA) occurring at a younger age than migraine without aura (MO). Later in life, when puberty starts, this relationship changes and it becomes more common in women than men. Migraine aura are focal neurological symptoms that typically occur prior to the onset of a headache due to a phenomenon called cortical spreading depression. The prevalence of migraine with aura vary between visual, sensory, or motor symptoms. It can also present as diplopia, slurred speech, aphasia, dizziness, vertigo, and hemiparesis. Moreover, the prevalence of migraine varies according to headache frequency. The chapter then looks at chronic migraine and menstrual migraine. It also explores several comorbidities associated with migraine, including many neurologic, medical, and psychiatric conditions.
The clinical spectrum of neurodegenerative disease
Authors: Saunders Stina , Muniz-Terrera Graciela , Russ Tom C , Ritchie Craig W , Ritchie Karen
Published: February 2021

Mild cognitive impairment (MCI) is a term applied to people who have memory problems that do not impact on daily function. It is assumed that earlier identification of neurodegenerative disease will lead to earlier treatment which may be more effective and which could modify the trajectory of decline. Because of shortcomings in disease identification and modification, MCI has previously been (inaccurately) viewed as a categorical entity. Instead, this chapter examines MCI as part of the clinical spectrum of neurodegenerative disease. We explore how the concept of MCI has evolved over time, where the historical roots of the condition lie, and elaborate on the challenges surrounding the status of MCI in current clinical practice. We argue that the condition needs to be formulated more accurately, incorporating genetic background, individual risk factors over the whole life-course, and, crucially, longitudinal assessment.
Epilepsy
Authors: Beghi Ettore , Giussani Giorgia , Tomson Torbjorn
Published: February 2021

Epilepsy is a chronic neurological disease affecting both sexes and all ages with worldwide distribution and peaks in children and the elderly. The pooled incidence of epilepsy is 61.4/100,000/year, with peaks in LMICs; the point prevalence is 6.4/1000 and the lifetime prevalence 7.6/1000. A documented aetiology is present in about one-half of cases. The overall prognosis is mostly favourable, with 55–68% of cases achieving prolonged seizure remission. Mortality ranges from 1 to 8 per 100,000/year, with a standardized mortality ratio of 1.3–6.0. Since 1990, a significant decrease of persisting disability and premature mortality has been observed, while age-standardized prevalence remained stable. Despite the decrease in the burden, epilepsy is still an important cause of disability and mortality. Future epidemiological studies will be affected by the new definition (now including people with a single seizure at high risk of recurrence) and the classification of seizures and epilepsy.
Neuropathies
Authors: Beghi Ettore , Giussani Giorgia , Poloni Marco
Published: February 2021

Peripheral neuropathies are most frequently a complication of a variety of acute and chronic diseases and injuries, including diseases of the roots, plexuses, and peripheral nerves in various combinations, and are categorized as symmetric polyneuropathies, mononeuropathies, multifocal neuropathies, and radiculopathies. This chapter illustrates data about peripheral neuropathies in the general population and in selected cohorts at risk: diabetic neuropathy (present in 66% of insulin-dependent and 59% of non-insulin-dependent diabetic individuals), acute and chronic inflammatory (2–16% of all polyneuropathies in hospital-based studies), paraneoplastic, infectious (Mycobacterium leprae, HIV, predominant in resource-poor countries), toxic and iatrogenic (antibacterial, antiparasitic, cardiovascular and chemotherapeutic agents), due to entrapment (carpal tunnel syndrome), and inherited (Charcot-Marie-Tooth, familial amyloidotic polyneuropathy, hereditary motor/sensory neuropathies). The actual burden of peripheral neuropathies is unknown because incidence and prevalence are preferably calculated in patients with the underlying cause and for the variability and low validity and reliability of the diagnostic criteria.
The neuroepidemiology of human prion disease
Authors: Urwin Patrick JM , Molesworth Anna M
Published: February 2021

Human prion diseases comprise a number of rare and fatal neurodegenerative conditions that result from the accumulation in the central nervous system of an abnormal form of a naturally occurring protein, called the prion protein. The diseases occur in genetic, sporadic, and acquired forms: genetic disease is associated with mutations in the prion protein gene (PRNP); sporadic disease is thought to result from a spontaneous protein misfolding event; acquired disease results from transmission of infection from an animal or another human. The potential transmissibility of the prion in any of these forms, either in disease states or during the incubation period, has implications for public health. Here we focus on Creutzfeldt-Jakob Disease (CJD), including variant Creutzfeldt-Jakob Disease (vCJD), although we will also discuss other forms of human prion disease.
Traumatic brain and spinal cord injury
Authors: Theadom Alice , Jones Kelly M
Published: February 2021

Incidence of traumatic brain injury and spinal cord injury ranges between 45–790 per 100,000 and 1–6 per 100,000 respectively, with mortality rates ranging between 1–35%. The epidemiological evidence on traumatic brain (TBI) and spinal cord injuries (SCI) including definitions, injury classifications, and international reports of prevalence, are presented. Mortality figures, mechanisms of injury, risk factors, personal and societal costs, and acute and long-term outcomes are also reviewed. The influence of definitions, inclusion criteria, and recruitment sources on estimates and the need for standardization of epidemiological methods is also considered. Population groups most at risk of sustaining traumatic brain or spinal cord injuries are identified as well as highlighting those at increased risk of poor outcomes in the longer term. Traumatic brain and spinal cord injuries are explored separately, before briefly exploring the evidence of concurrent traumatic brain and spinal cord injury.
Research and methodologic opportunities and challenges conducting research among US military personnel
Authors: Scher Ann I , Niebuhr David W , Singer Darrell
Published: February 2021

This chapter explores the opportunities and challenges in conducting epidemiologic research among US military personnel. The US military represents a unique opportunity for neurological and neuropsychiatric epidemiology. Comprised of a subset of the US population, military service members represent an open cohort who are exposed to a variety of occupational, physical, and psychological environments. While pre-accession socioeconomic status of individual military service members may vary, once in service, employment benefits and social support, including healthcare, are highly standardized. These attributes offer both strengths and constraints when conducting epidemiologic research among the military. Challenges (or possibly opportunities) associated with studying military populations include demographics, the ‘healthy warrior’ effect, and access. Meanwhile, opportunities include capture of medical encounter data in a standardized way as well as the size of the population, which makes it feasible to study relatively rare conditions. Indeed, the economic and ethnic diversity of the US military enhances the ability to study population subgroups. While the military population is predominantly young men, this is also a strength as young men are often under-represented in civilian population studies.
Plaque rupture and erosion
Authors: Mori Hiroyoshi , Torii Sho , Virmani Renu
Published: February 2021

Despite improvement in the treatment, prevention, and risk factor management of atherosclerosis, the most frequent cause of death globally remains coronary artery disease. Therefore, it is essential to understand the underlying mechanisms involved in the manifestation of acute coronary syndromes, sudden cardiac death, or stable ischaemic heart disease. Coronary atherothrombosis is the main underlying cause of acute coronary syndromes. This chapter discusses the two most frequent causes of atherothrombosis, that is, plaque rupture and plaque erosion, in patients presenting with acute myocardial infarction or sudden coronary death, including differences in the incidence, aetiology, morphological features, and risk factors that lead to plaque rupture and erosion.
Storage solutions for vein grafts
Authors: Vu Minh Quan , Noly Pierre-Emmanuel , Ali Walid Ben , Perrault Louis P.
Published: February 2021

Even though total arterial revascularization is increasingly used, saphenous vein grafts are still the most commonly used conduits for coronary arterial bypass grafting worldwide. Every surgeon should keep in mind that a vascular graft is living tissue with active metabolism, analogous to a solid organ for transplant, and should understand the impact of the choice of the storage solution. Unfortunately, the choice of the storage solution is usually not the result of a thoughtful review of alternatives and evidence but is a function of habit, convenience, and availability. The ideal storage solution should preserve and restore endothelial functional after harvesting. Much effort has been invested in finding ways to avoid or prevent endothelial lesions during harvesting and storage, as well as delaying vein graft dilatation after coronary arterial bypass grafting. After a brief reminder of the vein graft failure pathophysiology, this chapter discusses storage conditions using the existing graft storage solutions and their influence on endothelial function and graft patency. The use of external stenting for vein grafts is addressed elsewhere.
Acute emergency situations
Authors: East Lorna , Creed Fiona , Spiers Christine
Published: February 2021

An essential part of nursing in an acute care area is to be fully prepared to deal promptly and effectively with any acute emergency situation. More acutely ill patients are being cared for within ward environments, which place an ever-increasing need for staff to be competent and confident in the care and management of those at risk of cardiac arrest. The importance of a multidisciplinary and coordinated response to acute emergencies is explored in this chapter which focuses on using evidence-based resuscitation procedures. Early identification of peri-arrest arrhythmias and the management of patient in cardiac arrest to maximize patient survival are the cornerstones of this chapter. There is also brief discussion of the utility of cardiac pacing and cardioversion and the management of the patient with anaphylaxis.
The collapsed neonate
Authors: Lillie Jon , Tibby Shane
Published: February 2021

Babies under one month of age in respiratory and/or cardiovascular failure can present a significant diagnostic and management challenge. This chapter describes the important initial management steps for a collapsed neonate, exploring, in particular, some uncertainties around the use of oxygen therapy when considering congenital cardiac disease in this patient group. The causes of neonatal collapse are discussed—cardiac, infective, bleeding/trauma, and metabolic/endocrine/seizures—focusing on the assessment, investigations, and specific management of each of the major diagnoses. This chapter includes a diagnostic algorithm for inherited metabolic disorders with neonatal presentation, as well as helpful hints to differentiate among the common underlying causes for neonatal collapse.
Cardiac arrest
Authors: Lautz Andrew J. , Morgan Ryan W. , Nadkarni Vinay M.
Published: February 2021

High-quality cardiopulmonary resuscitation (CPR) with targeted post-arrest management have resulted in dramatic improvements in survival with favourable neurological outcome from in-hospital paediatric cardiac arrest over the past two decades. High-quality CPR focuses on five key components: (1) chest compression depth of at least one-third of the anterior–posterior chest diameter; (2) chest compression rate between 100 and 120 compressions per minute; (3) limitation of interruptions in chest compressions; (4) full chest recoil between compressions; and (5) avoidance of overventilation. Quantitative capnography with a target end-tidal CO2 of at least 20 mmHg and invasive arterial blood pressure monitoring targeting a diastolic blood pressure of at least 25 mmHg in infants and 30 mmHg in children during chest compressions are promising markers of effective CPR. Post-arrest management should target normoxia, normocarbia, normotension for age, and normoglycaemia with active targeted temperature management to prevent hyperthermia and surveillance for and aggressive treatment of seizures.
Acute liver failure
Authors: Jones Andrew , Deep Akash
Published: February 2021

The work-up and management of patients with acute liver failure in paediatric critical care are often challenging. This chapter takes the readers through definitions, grading of severity, and diagnostic work-up of acute liver failure in children. General principles underlying the management of acute liver failure, including immediate resuscitation and retrieval; organ support, including renal replacement therapy; and the management of complications, including bleeding, are discussed. In particular, this chapter focuses on neuromonitoring and neuroprotection strategies in children with hepatic encephalopathy as a complication. The role of liver transplantation in fulminant liver failure and a brief overview of complications are also discussed.
Ethical, legal, and end-of-life decision-making
Authors: Ray Samiran , Fine-Goulden Miriam R. , Brierley Joe
Published: February 2021

All of those working in paediatric intensive care will be faced with difficult decisions and will be looking after children at the end of their lives. Chapter 12 addresses the principles of medical ethics. It explains the assessment of ‘Gillick’ competence and obtaining consent from children, when to consider treatment limitation and involve the palliative care team, and, in some cases, where legal advice should be sought. Brainstem death is defined, and guidance is provided on how to perform brainstem death tests, including the use of ancillary tests and specific requirements for children under the age of 2 months. The chapter discusses end-of-life care in the Paediatric Intensive Care Unit, including organ donation in children. The final scenario explores the role of the intensivist in resource allocation decision-making and intensive care triage.
Status epilepticus in the Paediatric Intensive Care Unit
Authors: Wang Justin Q.Y. , Krishnan Hari
Published: February 2021

This chapter covers pertinent issues around the management of children with status epilepticus within and outside of specialist centres. A detailed overview of the work-up of a child in status epilepticus is presented. Additionally, the potential management of patients with refractory status epilepticus and super-refractory status epilepticus is evaluated. Furthermore, the chapter focuses on strategies to aid decision-making related to the practical challenges paediatric intensivists face, such as the suitability of extubating patients at the referring hospital, the decision to transfer patients to specialist centres for ongoing management, the role of neuroimaging, and about use of quantitative electroencephalogram (EEG) as a continuous neuromonitoring modality.
Safeguarding children in the Paediatric Intensive Care Unit
Authors: Jerrom Thomas D. , Ramnarayan Padmanabhan
Published: February 2021

Chapter 16 addresses the duties of medical professionals in safeguarding children. It covers the major types of child abuse and known risk factors. This chapter takes the readers through the assessment and management of a child suspected of having suffered non-accidental injury (NAI), including non-accidental brain injury. The features of specific subtypes of NAI are discussed, including ‘shaken baby syndrome’, spinal trauma, abdominal injuries, sexual abuse, and fabricated or induced illness. This chapter recommends a helpful list of investigations for suspected NAI. In addition, this chapter also addresses issues such as documentation, report-writing, and the role of the medic in court.
Person- and relationship-centred dementia care
Authors: Keady John , Nolan Mike
Published: February 2021

Dementia is a global issue experienced on an individual and relational level. This chapter traces the emergence of both person-centred care and relationship-centred care, with the latter approach expressed through the Senses Framework. The Framework outlines the theoretical development and practical application of the Senses [security, belonging, continuity, purpose, achievement, significance] and highlights the importance of staff, carer, and [in this chapter] person with dementia all working together. This chapter describes the application of the Senses Framework to a recent practice development study set in a care home for people with dementia and shows how the study used a combination of the Senses and life story work to create an ‘enriched’ environment. The chapter concludes with a discussion about how the Senses can be used to facilitate an early diagnosis of dementia and to help people with dementia and their families to engage with a life ‘outside the front door’, termed ‘The Neighbourhood Space’.
Psychological treatments
Authors: Wilkinson Philip , Laidlaw Ken
Published: February 2021

This introductory chapter provides a summary of the range of psychological treatments used with older people, and the main clinical applications of each treatment. It reviews possible barriers to uptake of psychological treatment by older people and how these barriers may be overcome. It provides an overview of the range of efficacious psychological treatments for older people with consideration of indication, access, and adaptation, and then discusses different modes of delivering treatment, including collaborative care models. It then reviews the modification of psychological treatments for working with people experiencing cognitive impairment and it briefly covers the approaches to working in dementia care.
Principles of service provision in old age psychiatry
Authors: Dening Tom , George Kuruvilla
Published: February 2021

Globally increasing numbers of older people bring both challenges and opportunities for old age psychiatry services. This chapter outlines the history, underlying principles, and policy context for contemporary mental health services for older people. It discusses components of services, including community health teams, memory assessment services, consultation-liaison psychiatry, and in-patient mental health care, as well as newer types of service, such as crisis teams and outreach to care homes. Other recent developments include various models of case management and emphasis on post-diagnostic support. Equally important are issues of equality and access, and the chapter covers several key areas, such as age, gender, sexual orientation, religion and spirituality, and rurality. Major challenges to old age psychiatry come from limited resources and non-recognition of the distinct needs of older adults, as well as the demands of the growing older population, advances in science and technology, and the need to attract talented psychiatrists into this field.
Memory assessment services
Authors: Banerjee Sube , Farina Nicolas
Published: February 2021

First developed in the 1970s and 1980s to help facilitate research, memory clinics have evolved into Memory Services, focused on delivering early diagnosis and intervention for people with dementia. Compared to traditional community mental health services, their focus is on early diagnosis in itself, rather than the management of complex problems in dementia. The increasing awareness of dementia has led to the development of many more memory services, encouraged by governments around the world. There is good evidence for the clinical and cost effectiveness of early diagnosis and intervention of dementia and memory services aim to achieve this. This chapter considers who memory services are for and what they should aim to achieve. A good memory service makes the diagnosis well, explains the diagnosis well, and provides the immediate care, support, and treatment that is needed by the person with dementia and their carers.
The experience of dementia
Authors: Oliver Keith , Doxford Hilary , Lafortune Louise , Brayne Carol , Hennell June , Dening Tom
Published: February 2021

This chapter consists of four sections that consider various aspects of the journey through dementia. The first two parts (by Keith Oliver and Hilary Doxford) describe the early stages of dementia, the process of getting a diagnosis, and the challenges of living well with dementia. The third section (Louise Lafortune and Carol Brayne) discusses the tensions between ‘early’ and ‘timely’ diagnosis, and also the issues that arise from having biomarkers that potentially enable us to diagnose conditions like Alzheimer’s disease before a person has any concerns or symptoms. At the moment, there is little evidence that people stand to benefit greatly in a diagnosis before the emergence of clinical symptoms. June Hennell concludes the chapter by describing her journey as a carer and adjusting to life after bereavement. The chapter thus provides a balanced and authentic view of how people respond to the impact of diagnosis and life afterwards.
The Lewy body dementias
Authors: Rongve Arvid , Aarsland Dag
Published: February 2021

Dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD) belong to the α‎-synucleinopathies, a family of diseases pathologically characterized by aggregation of α‎-synuclein in Lewy bodies in the brain. This chapter presents the epidemiological data for both conditions including new data on MCI. It reviews clinical diagnostic criteria and considers the different neuropathology staging systems for DLB and PDD and the most important genetic findings. It describes biomarkers in DLB and PDD with particular focus on imaging techniques like CIT-SPECT and MRI. It presents in detail important clinical symptoms in both conditions and discusses the most important clinical differential diagnoses. Finally, it examines pharmacological and non- pharmacological treatment of different symptoms in both conditions, with particular emphasis on the choline esterase inhibitors and antipsychotic medications, and presents new data on memantine.
The experience of depression
Authors: et Dening
Published: February 2021

The majority of chapters in this book demonstrate clinical aspects of various aspects of old age psychiatry. These accounts tend to focus only on the viewpoints of the healthcare professionals involved in the investigation, diagnosis, and management of the condition. This chapter is different, and provides a first-person account of an anonymous author and his experience of having episodes of depression. The author describes the course of the condition at various times in his life and the various ways in which it has affected him at various stages. This chapter also describes his experiences of treatment and contact with professionals.