bluuebunny/crossref_metadata_2025 huggingface dataset:
Myasthenia Gravis
Authors: Hawkes Maximiliano A. , Wijdicks Eelco F. M.
Published: August 2019

Myasthenia gravis (MG) is a well-characterized B-cell–mediated disease caused by autoantibodies against targets located in the postsynaptic end plate of the neuromuscular junction. Fluctuating weakness and fatigability are clinical hallmarks of this disease. MG can be divided into subgroups based on the age at onset, serum antibodies, and thymic tumor, and different clinical courses can be anticipated with each. This chapter describes general concepts about MG, focusing on the triage, work-up, and management of severe myasthenic exacerbation (crisis).
Rhabdomyolysis and Toxic Myopathies
Authors: Kao Justin C. , Milone Margherita
Published: August 2019

Myopathies in patients in the intensive care unit are comparatively rare and often are due to critical illness (rhabdomyolysis, critical illness myopathy). Rhabdomyolysis is commonly a consequence of continuous muscle activity, such as in status epilepticus and serotonin syndrome. Toxic myopathies are caused by drug exposure. Recognition and management of these 2 major myopathies are discussed.
Myopathy and Neuropathy Acquired in the Intensive Care Unit
Authors: Dhawan Priya S. , Tracy Jennifer A.
Published: August 2019

Acquired weakness in critically ill patients is common, affecting between one-third to one-half of patients in the intensive care unit (ICU). Exposure to simultaneous stressors such as metabolic derangements, fluid and electrolyte shifts, infection, catabolic stress, and medications put patients in the ICU at risk for damage to both nerve and skeletal muscle with substantial and often lasting morbidity. Critical illness polyneuropathy is a length-dependent, axonal peripheral neuropathy occurring in patients in the ICU and unrelated to the primary illness. Critical illness myopathy is an ICU-associated muscle disorder occurring independently of denervation and uniquely identified by electrophysiologic and histologic characteristics.
Neoplastic Meningitis
Authors: Porter Alyx B.
Published: August 2019

Neoplastic meningitis (NM), also known as carcinomatous meningitis or leptomeningeal metastases, is usually a late-stage complication of cancer. This complication occurs in approximately 5% of patients with cancer, but the incidence in autopsy studies is 3 times higher. Cases of NM are increasing because of increased use of advanced imaging techniques. Breast, lung, and melanoma are the most common solid tumor malignancies leading to this complication, and leukemia and lymphoma are the most common hematologic malignancies. (NM may present as the initial presentation of cancer).
Radiation Therapy
Authors: Keole Sameer R.
Published: August 2019

Radiation oncology is the specialty of medicine in which ionizing radiation is used to treat both malignant and benign conditions. The term radiation therapy (RT) is used, in part, as a differentiator from diagnostic radiation. In radiation oncology, treatment is provided with a team-based approach by physicians, nurses, physicists, dosimetrists, and radiation therapists. Dosimetrists perform the initial planning and mapping of the radiation fields. Radiation therapists deliver the treatment with external beam radiation therapy machines.
Intensive Care After Craniotomy
Authors: Gassie Kelly , Bradley Belinda G. , Wharen Robert E. , Kim Betty Y. S.
Published: August 2019

Technologic advances and a better understanding of the pathophysiologic basis of neurologic diseases have greatly improved the care of critically ill patients after neurosurgical procedures. Risk factors for the development of adverse events have been identified, and early identification and treatment of complications are essential. This chapter provides an overview of the initial evaluation of patients for intensive care unit admission after intracranial procedures, general care of those patients, and specific management strategies for early detection and treatment of complications.
Fluoroscopy: Principles and Safety
Authors: Sella David M. , Sturchio Glenn M. , Schueler Beth A.
Published: August 2019

Fluoroscopy is a valuable tool that can be used in critically ill patients. Detrimental effects on a patient physiologically and on hospital resources from unnecessary transport can be minimized with bedside procedures performed by an appropriately trained team. Operators must understand the basics of fluoroscopic imaging systems, radiation dose, and the ways in which exposure can be limited to both patients and personnel to avoid undesirable effects.
Basics of Airway and Oxygen Delivery Devices
Authors: Murray Andrew W.
Published: August 2019

One of the greatest responsibilities in managing an airway is to maintain a continuously patent airway. Any loss of patency of the patient’s airway is critical, and if the ability to provide ventilatation is lost, brain damage can rapidly develop potentially lead to brain death. The definition of difficult airway is not standardized in the anesthesiology literature, but it has been described as the situation when “a conventionally trained anesthesiologist experiences difficulty with facemask ventilation of the upper airway, difficulty with tracheal intubation, or both”
Noninvasive Positive Pressure Ventilation
Authors: Hampton Karen W.
Published: August 2019

Noninvasive positive pressure ventilation, also called noninvasive ventilation (NIV), is delivered through a noninvasive device, such as a full-face mask. Unlike the systems for invasive ventilation, which is delivered through an endotracheal or tracheostomy tube, the NIV delivery system is not a closed system, and so it leaks. The size of the leak affects the tidal volume delivered and the ability of the patient to trigger the machine into inspiration or cycle the machine into expiration. The acceptable leak for most systems is less than 35% of the peak inspiratory flow (leakage may be expressed as a percentage or as liters per minute).
Tracheostomy
Authors: Ghorab Saba , Lott David G.
Published: August 2019

Tracheostomy is a procedure where a conduit is created between the skin and the trachea. Tracheostomy is one of the most frequent procedures undertaken in critically ill patients. Each year, approximately 10% of critical care patients in the United States require a tracheostomy, most often for prolonged mechanical ventilation.
Electrocardiographic Monitoring
Authors: Parikh Pragnesh P. , Venkatachalam K. L.
Published: August 2019

Continuous electrocardiographic (ECG) monitoring is almost universal in patients in intensive care units, and 12-lead ECG is a frequently performed investigation. Both have the ability to detect many cardiac disturbances and the cardiac consequences of other conditions. Understanding the acquisition of the tracing, having a systematic approach to interpretation, and having the ability to differentiate concerning findings from nonconcerning ones and from artifacts are key skills for the intensivist.
Hemodynamic Monitoring
Authors: Callisen Hannelisa E. , Libricz Stacy L. , Sen Ayan
Published: August 2019

In the critically ill patient, ensuring adequate oxygen delivery with sufficient perfusion pressure is vital. Basic physical examination remains the most invaluable and simplistic form of hemodynamic assessment, but technologic evolution has allowed for substantial advancement in monitoring techniques.

This chapter reviews the most common hemodynamic monitoring devices and techniques and focuses on the invasiveness, advantages, limitations, and technical aspects of each.
Pulmonary Artery Catheterization
Authors: Lowman Philip E.
Published: August 2019

For years, the pulmonary artery catheter (PAC, better known as Swan-Ganz catheter) has been used largely to estimate and optimize hemodynamics according to the wedge pressure of the pulmonary artery. Its use dramatically declined after reports of complications and increased costs without benefit to patients. In the absence of reliable noninvasive devices, the catheter is used in severe cases and in cardiac surgery intensive care units.
Thoracentesis and Chest Tubes
Authors: Beamer Staci E.
Published: August 2019

The pleural cavity is a negative-pressure airtight space that serves as the interface between the lung and the chest wall. Fluid is produced normally by the parietal pleura and absorbed by the visceral pleura as a result of difference in capillary pressure. The fluid is subsequently absorbed by the pleural lymphatics and ultimately into the thoracic duct. Disruption of the pleural space can result in a pneumothorax (air) or a pleural effusion (fluid). Pleural effusions can be caused by blood (hemothorax), infection (parapneumoic effusion or empyema), chyle (chylothorax), malignancy, inflammatory conditions, or imbalances in hydrostatic and oncotic pressures. Both types of pleural processes alter the negative pressure of the thorax. The resulting positive pressure causes partial or complete lung collapse and respiratory symptoms. Thoracentesis and chest tube placement are essential procedures for both diagnosis and treatment of pleural conditions.
Interventional Radiology Procedures
Authors: Oklu Rahmi
Published: August 2019

Most patients in an intensive care unit are critically ill, hemodynamically unstable, and have multiple comorbidities. Interventional radiology procedures can offer therapeutic options for these patients and avoid the risks associated with invasive surgery and general anesthesia.
Lumbar Puncture
Authors: Smith Christina C.
Published: August 2019

Lumbar puncture (LP) is used in the diagnosis of neurologic disorders such as central nervous system (CNS) infections, subarachnoid hemorrhage, CNS malignancies, and demyelinating diseases. Although LP is relatively safe, patients may have minor or major complications, including headache (10%-30% risk), bleeding (2%), severe radiculopathy (15%), and nerve damage (1%). Infection after a diagnostic lumbar puncture is exceedingly rare (the risk is increased with spinal anesthesia but infection is highly uncommon).
Intraventricular Drug Administration
Authors: Horn William W. , Brown Benjamin L.
Published: August 2019

The blood-brain barrier prevents many medications from reaching brain tissue, and the intraventricular (IVT) route can be a useful alternative in appropriate situations. The administration of medications through extraventricular drains requires expertise. Permanently placed catheters such as Ommaya reservoirs can also be used for medication administration. These devices should be handled according to the manufacturer’s recommendations to avoid damaging them. Many hospitals have practice protocols.Herein we provide some guidelines.
Essentials of Cranial Neuroimaging
Authors: Lindell E. Paul
Published: August 2019

Critically ill patients may have a wide array of neuroimaging abnormalities, including ischemic stroke, intracranial hemorrhage (ICH), and anoxic or hypoxic brain injury. Recognition of common and life-threatening patterns is essential to proper treatment. Critically ill patients are in an unstable condition, so moving them to a computed tomographic (CT) or magnetic resonance imaging (MRI) suite presents logistic and safety challenges that involve nursing care, transport of the ventilator and other intravenous tubing, and vasopressor medications. CT has a faster acquisition time than MRI and is more commonly used to obtain emergent neuroimaging data, such as massive stroke or intracranial structural information.
Sedation and Analgesia
Authors: Sanz Juan G. Ripoll , Diaz-Gomez Jose L.
Published: August 2019

Although sedatives and analgesics differ in pharmacologic properties, both produce sedation. Opioids are the most commonly used and most effective analgesics. However the two should be clearly separated. Sedatives should be considered the primary choice for sedation in the intensive care units and opioids are preferred for pain management after major surgery periprocedural use to avoid pain in a conscious patients, patients with poly trauma particarly major fractures, or patients who are known to chronically use these agents and may withdraw quickly with major consequences for management.
Antibiotics, Antivirals, and Antifungals
Authors: Aviles David A. Sotello , Hellinger Walter C.
Published: August 2019

Antimicrobial therapy should not be initiated before infection with a susceptible pathogen is suspected or confirmed or before appropriate diagnostic specimens, including those for cultures, are collected. Recognizing indications for antibiotic administration and appropriately selecting antimicrobial agents based on clinical and microbiologic findings is required. Distinguishing between empiric prescribing, when infection syndromes and pathogens are suspected, and therapeutic prescribing, when infection syndromes are confirmed and pathogens identified, is critically important. Working knowledge of antimicrobial drug dosing, adjustment of dosing for renal or hepatic insufficiency, drug-drug interactions, and antimicrobial allergies or intolerances is required, and ready access to and liberal use of reference guides help ensure good patient care.
Palliative and End-of-Life Care in the Intensive Care Unit
Authors: Robinson Maisha T.
Published: August 2019

Palliative medicine is the specialty that focuses on improving the quality of life for patients and families when the patients have serious or advanced medical conditions. The approach to care is patient centered and goal oriented. It can be performed at any stage of illness with or without a palliative medicine consultative service. All clinicians, including intensive care unit (ICU) physicians, who care for patients with serious or advanced illnesses should be able to provide adequate palliative care.
Brain Death
Authors: Wijdicks Eelco F. M.
Published: August 2019

The fundamental neurologic principle that all brainstem function must have irreversibly ceased—in the overwhelming proportion, but not exclusively from massive damage to both cerebral hemisphere—must be understood before brain death testing proceeds. Brain death is a non- functioning destroyed (“dead”) brain with absent breathing and no circulation if support is not provided.
Physician Communication
Authors: Schraeder Terry L.
Published: August 2019

Physician Communication: Connecting with Patients, Peers, and the Public presents the current world of physician communications, from face-to-face and digital communications to public speaking and traditional media. The book explores methods and explains guidelines of exceptional physician communication. Physician–patient communication is, after all, human-to-human communication; establishing a bond and listening are just two of the essential elements in building trust and understanding—the foundations of communication. But today there is much we need to learn when it comes to facilitating the exchange of information, providing psychosocial support, ensuring shared decision-making, translating complex information, resolving controversies with sound science, and the myriad of goals we have as physician communicators with patients, peers, and the public. While most of our communication is with patients, we increasingly find ourselves communicating with family members, caregivers, students, residents, colleagues, patient advocates, researchers, insurance agencies, bosses, board members, the public, and even at times journalists. What we are communicating, where we are communicating, and with whom we are communicating are continually changing and expanding—and with ever more electronic technologies available to us, from electronic medical records and emails to online forums, video conferencing, and other high-tech systems. All of this makes how well we communicate as physicians even more important to our success in today’s healthcare environment.
Face-to-Face Communication
Authors: Schraeder Terry L.
Published: August 2019

On any given day, seeing many different patients with a myriad of different problems can bring up various challenging discussions and situations. The physician’s ability to make a human connection to each patient will always improve communication and ultimately care—knowing that each conversation may be as diverse and varied as the patients themselves. Can physicians learn how to take care of patients and at the same time always have a respectful, positive, and therapeutic interaction together? Can physicians provide excellent care despite the time limitations they are under and the computer screen in front of them? Is it possible to make sure patients are happy with their care and with their doctors? Are there natural physician communicators? This chapter will show physicians how to deepen their connection to patients and enhance their own and their patients’ experiences by improving their communication and interpersonal skills. Physicians’ success at face-to-face communications with patients is highly dependent on understanding their patients and the intricacies and nuances of clinical communication. Despite the ever-increased mechanization, the increased strains of healthcare, and the computer-driven clinical sphere, physicians still work in a very personal intimate setting with humans who may be experiencing profound life moments. Physicians need to have humility, patience, respect, and compassion with both their patients and themselves in order to learn how to limit the negative influences that hinder their abilities to connect and care for patients.
Digital Communication
Authors: Schraeder Terry L.
Published: August 2019

There are few aspects of society, including clinical medicine, still untouched by digital communication and the Internet. It would seem that the important and intimate conversations in a doctor’s office or at the bedside should be one of the last refuges to provide private and exclusive face-to-face discourse between two humans, free of the distraction and distance of the computer. But that is changing. From computers in the exam room to electronic medical records, to email exchanges with patients and medical apps, computers are ever present in the delivery of healthcare. Of course, information technology has revolutionized medicine, and the advantages for patients and physicians are numerous. Through patient portals, patients can now look at their lab results, learn more about their diagnosis, and ask relevant questions; physicians can respond quickly to emailed questions; and patients can inform themselves about surgery by watching online videos. Apps monitor physiological data points; robots deliver medications and perform surgery; and artificial intelligence plays a bigger role in the analysis of complex healthcare data. Many physicians have jumped on board with social media, where they can have a variety of professional and personal interactions. It seems that those in medicine have readily adapted to the electronic universe. But how has it affected physicians’ behavior, expectations for access and processing of information, and most important, relationships with their patients? This chapter explores those topics and takes a closer look at the different ways in which medical professionals are communicating and interacting in the digital universe.
Preoperative Evaluation of Neurosurgical Patients
Authors: Munshi Aditya , Merli Geno
Published: August 2019

All patients undergoing noncardiac surgery are exposed to a risk of adverse surgical, anesthesia, and medical complications. Unlike procedural risk, the medical risks are often modifiable, and therefore stratification of patient medical risk prior to surgery forms the basis of reducing postoperative morbidity, mortality, and length of hospital stay. Patients undergoing neurosurgical procedures pose several unique challenges and require special focus. This patient subgroup also carries a high risk for thrombotic events from immobilization and interruption of pharmacological prophylaxis. Cardiovascular events occurring in the postoperative period are the primary focus of risk assessment in noncardiac surgery, and this is also true for neurosurgical procedures, many of which are performed emergently or urgently. The authors discuss cardiovascular risk stratification based on a patient’s functional status, exercise capacity, and prior cardiac history. They review risk assessment scales to aid decision-making and how to select patients for further testing. Bleeding complications can be devastating and are of great concern in neurosurgery; the chapter discusses assessment of bleeding risk using an approach that combines basic laboratory testing with a thorough history and physical exam. The authors address the risk of thromboembolic events in neurosurgery patients and provide recommendations for preoperative assessment and postoperative prophylaxis. This chapter covers a broad approach from the point of view of a hospitalist physician evaluating a patient preoperatively, including a review of current guidelines, recommendations, and future directions on risk stratification for cardiac, thrombotic, and bleeding complications.
Role of Hospital Medicine in Management of Intracranial Brain Tumors
Authors: Ye Donald Y. , Theofanis Thana , Garzon-Muvdi Tomas , Evans James J.
Published: August 2019

Intracranial tumors reflect a broad range of benign and malignant processes that are often managed by neurosurgeons and medical oncologists. Patients presenting with new brain tumors will undergo biopsies or resection for tissue diagnosis and resolution of neurological symptoms. These patients have significant perioperative risk factors that must be addressed to ensure the best possible outcomes. Hospitalists play a pivotal role in identifying these risk factors and offering management strategies prior to the development of an operative plan. This chapter provides insight into the range of preoperative considerations and postoperative complications that a hospitalist may face when managing brain tumor patients.
Antiepileptic Medication Use in Neurosurgical Patients
Authors: Margiotta Megan , Ambrose Timothy
Published: August 2019

When caring for neurosurgical patients, many will either be started on a new antiepileptic medication or will be continued on a regimen that had been started prior to hospitalization. Because of this, it is important for a hospitalist to be familiar with the potential risks and benefits of these medications, even though they may be initiated by a neurosurgeon or neurologist. This chapter discusses several common antiepileptic drugs and their uses in the inpatient setting. This is not intended to be an exhaustive discussion; as of this writing, there are at least 27 unique antiepileptic medications available in the United States alone, with more being studied and produced.
Management of Bleeding Disorders in the Neurosurgical Patient
Authors: Gannamani Vedavyas , Rizk Sanaa
Published: August 2019

Postoperative patients are carefully monitored for bleeding due to its potential to result in dire situations, including death. Patients undergoing neurological surgeries are at heightened risk of morbidity and mortality from postsurgical bleeding due to compact neuroanatomical spaces and flow-sensitive organs. Hospitalists are regularly involved in the management of neurosurgery patients for preoperative risk assessment and medical co-management and must therefore have a good understanding of the predisposing factors that identify at-risk patients to avoid or minimize postoperative bleeding. The major factors to consider while assessing the risk of postoperative bleeding can be broadly divided into surgical and patient-related (nonsurgical). Patients on antiplatelet or anticoagulant agents pose a special management challenge in the perioperative period because interruption of these medications can increase the risk of cardiovascular or thromboembolic events postoperatively. This chapter outlines the general principles of perioperative management of bleeding disorders and postsurgical bleeding in neurosurgery patients admitted for elective or emergent surgeries. Management of patients primarily admitted for intracranial hemorrhage, spinal cord hematoma, or trauma will be discussed separately. This chapter also discusses interventions and therapies to reduce chances of perioperative bleeding in those with patient-related risk factors and reviews current practice guidelines on perioperative adjustment of anticoagulant or antiplatelet agents in patients undergoing neurosurgery.
Fever in the Neurosurgical Patient
Authors: Akram Rakhshanda , Benjamin Crystal , Mwamuka Linda , Belden Katherine A.
Published: August 2019

Postoperative fever falls under the category of nosocomial fever, not incubating at the time of surgery. Early postoperative fever is more likely to be a part of the cytokine-mediated physiologic response to surgery and does not always need an infectious workup. Other important noninfectious causes of postoperative fever in neurosurgical patients include dysautonomia and central fever, which are often diagnoses of exclusion after infectious etiologies have been ruled out. Infections in neurosurgical patients can be secondary to the surgical procedure, such as postoperative meningitis, cerebrospinal fluid shunt and drain infections, cranial or spinal epidural abscess, and osteomyelitis and surgical site infections. Other hospital-associated infections, such as nosocomial pneumonia, sinusitis, diarrhea, urinary tract infections, bloodstream infections, and acalculous cholecystitis, are other important causes to be considered as part of the infectious workup. Hyperthermia-induced brain injury is a significant concern in neurosurgical patient population. Therefore, careful management of fever in this patient population is imperative to improve patient outcomes and decrease the cost of medical care.
Diagnosis and Management of Sodium Disorders in the Neurosurgical Patient
Authors: Edwards Jesse , Sharma Sharad , Gulati Rakesh
Published: August 2019

Sodium disorders are the most common electrolyte abnormality among hospitalized patients and even more common in the neurosurgical patient population. Timely diagnosis and careful correction of serum sodium is an essential skill for the neurosurgical hospitalist and may greatly mitigate the risk of significant harm to the patient. Water dysregulation is the primary feature of sodium abnormalities and may manifest as hyponatremia due to syndrome of inappropriate antidiuretic hormone (SIADH) secretion or hypernatremia due to central diabetes insipidus (DI). Therapy for the correction of serum sodium must take into consideration the etiology of dysregulation, unique risks associated with different neurologic pathologies, and the risk of osmotic fluid shift associated with fluctuations in serum sodium. Rapidly correcting sodium levels may lead to a variety of unintended sequelae, including osmotic demyelinating syndrome (ODS), cerebral edema, seizure, pulmonary edema, and death. Since neurosurgical patients are at elevated risk for severe morbidity due to osmotic fluid shift, it is crucial that neurosurgical hospitalists have a firm understanding of water and sodium pathophysiology, expertise in the diagnosis and treatment of sodium abnormalities, and nuanced appreciation for the risks and features unique to neurosurgical diseases. This chapter outlines the most common etiologies of sodium disorders in the neurosurgical patient population and offers recommendations for their diagnosis and treatment. Hyponatremia due to hypovolemia, cerebral salt wasting (CSW), SIADH, and adrenal insufficiency (AI) will be highlighted first, followed by hypernatremia due to free water deficit in the setting of central DI and inadequate oral fluid intake.
Management of Pressure Injuries in Neurosurgical Patients
Authors: Daniel Rene , Abai Babak
Published: August 2019

Wound management is an important component of the care for neurosurgical patients. Improper wound management can lead to patient suffering, morbidity, increased length of stay, readmission, increased cost of care, and, in some cases, infection, sepsis, and mortality. The neurosurgeons manage the neurosurgical wounds. In contrast, pressure wounds are usually managed by a team led by the hospitalist. In this chapter, the authors outline the standards of care for management of pressure injuries prior to, during, and after neurosurgery procedures. The focus will be on the role of the hospitalist in this process. The crucial role of the collaboration among hospitalists, nursing staff, neurosurgeons, wound specialists, and general surgeons will be highlighted. The authors emphasize the role of evidence-based management in this process and propose an algorithm for the care of these wounds based on current understanding. Finally, the areas of needed research to achieve the best level of care are explored.
Perioperative Optimization of Pain Control in Patients Undergoing Spinal Surgery Using Multimodal Analgesia
Authors: Mei Newton , Sharan Ashwini D.
Published: August 2019

Inadequate pain control in patients with spinal pathology and after spine surgery not only places the patient at risk for a myriad of complications, but it also depletes healthcare resources. To be able to optimize pain relief in spine patients, the healthcare provider needs to understand the complexity of the underlying pain and be well versed in the medications that have been shown through research to provide significant analgesic relief. Multimodal analgesia (MMA) has gained popularity in recent years for its ability to synergistically treat pain using a variety of biochemical pathways, and its use has been applied across a variety of surgical procedures. In spine patients, evidence has identified gabapentinoids, NSAIDs, acetaminophen, ketamine, neuraxial anesthesia, and local anesthesia to be effective analgesic agents that should be considered for inclusion in MMA to manage pain in spine patients. As the literature continues to evolve, new agents such as dexamethasone and methadone may be added to the spine MMA repertoire. Furthermore, MMA should be customized to fit the patient, taking into account the patient’s age, medical comorbidities, allergies, and possible interactions with other prior medications. This general overview highlights the medications that should be incorporated in a spine patient’s MMA and recommends a basic algorithmic approach to developing a MMA to treat spine patients.
Reading Film
Authors: Servitje Lorenzo
Published: August 2019

Films reflect and influence values, practices, and the cultural contexts in which they are produced and consumed. In terms of health humanities, reading film allows us to investigate how we “see” certain types of bodies, illnesses, and medical practices, revealing tensions, contradictions, and assumptions about health that have become cultural myths—naturalized narratives or beliefs that illustrate a common cultural ideal. Reading film as a research method for health humanities requires attention to narrative and filmic elements at both the level of individual scenes and the film as a whole. Reading film provides a unique way to understand the broader social impacts of medicine and develops a visual literacy to interrogate how health and medicine shape and are shaped by a given cultural moment.
Art History
Authors: Conaty Siobhan M.
Published: August 2019

Art history and the health sciences are disciplines that are uniquely positioned to enrich each other. Traditionally, careful observation of anatomy led to more realistic art, while anatomic drawings allowed medical practitioners to learn about the human body. Art history and health practices share a relationship bound by the need to both observe and understand the particularities of a given text, body, or object in light of environment and context. This chapter introduces a system of inquiry for scholars in health humanities using the art history methods of close looking, art in context, formal analysis, and critical thinking. Such methods are critical in any situation where one is expected to interpret, understand, and construct meaning from a text, object, body, or image. These skills are valuable and practical tools necessary for all fields of study in order to negotiate and interpret the images that dominate our modern world.
Archives
Authors: Clark Claire D.
Published: August 2019

Archives are a source of inspiration for health humanities scholars who focus on finding lessons from historical figures or excavating the voices of patients who have historically been silenced. Sound archival research in health humanities may achieve the dual objectives of illuminating individual patient experiences and the power dynamics that shape the healthcare system as a whole. Conducting archival research involves preparing for and visiting the archive, and organizing and synthesizing your material. This chapter draws on research for the book The Recovery Revolution, a social and cultural history of addiction treatment, to illustrate the strengths and weaknesses of archival research methods. Archival research can be challenging because of a lack of patient-centered source material and the influence of biases and hindsight on researchers' interpretations of evidence. An awareness of the contingencies inherent in historical research can improve the rigor of researchers' syntheses of archival material.
Age Studies and Disability Studies
Authors: Lamb Erin Gentry , Garden Rebecca
Published: August 2019

Age and disability studies explore the meaning, nature, and consequences of embodied difference—of age and/or disability—within society. While distinct fields, these areas of study have some methodologies in common and share the same impetus: to counter prejudice—ageism and/or ableism—and to explain the origins and mechanisms of such prejudice in the interests of reducing or eliminating it. Both fields examine how aging and disability are represented within popular culture and the consequences of these representations in terms of constraining lived experiences through the promotion of stereotypes and stigma and the presentation of limited narrative identities. Through a reading of two graphic novels, this chapter will introduce some of the key methodological approaches these fields have in common and will demonstrate the value—for health humanities in particular—of thinking through the lenses of both fields simultaneously.
Digital Health Humanities
Authors: Ostherr Kirsten
Published: August 2019

Digital health humanities is an emerging research method that blends critical analysis with the use of computational tools to explore research questions related to digital information and communication technologies (ICTs) in healthcare. As a method that draws from and extends the fields of digital humanities and health humanities, digital health humanities employs digital tools to conduct health humanities research focusing on ICTs as objects of inquiry within the domain of health. Through analysis of the social and technical features of digital health technologies, this method emphasizes engagement with patients, caregivers, and other research participants that use the technologies under investigation. This chapter explains how to identify research problems suitable for exploration and intervention using digital tools, gather data on the need for and appropriateness of a digital health design intervention for a specific problem or patient population, and assess the necessary social and technical features of digital ecosystems.
Autoethnography
Authors: Richards Rose
Published: August 2019

In autoethnography, one researches the hidden experiences of only one person—the researcher—in order to provide a unique perspective on a group that can be understood by insiders and outsiders alike. Autoethnography is well-suited for exploring concerns about the individual’s identity or life experience. This method can be challenging, however, because it demands hard emotional work and unsettles one’s assumptions about life issues. This chapter describes different audiences and foci of autoethnography within health humanities and then explains the steps for doing autoethnography: choosing autoethnography as a process of inquiry, journaling with memory techniques, using keepsakes and other memory aids, revisiting your memories alongside nonpersonal data, assessing your own identity and positioning, literature search and review, and analyzing your ideas through writing and rewriting. This process is demonstrated through the author’s experiences of life-long chronic kidney disease, dialysis, and transplantation.
Community Dialogues
Authors: Determeyer Peggy L. , Crowder Jerome W.
Published: August 2019

Community dialogues provide a method of determining viewpoints and values for representative populations and also offer a means for educating and empowering participants on the topic being discussed. Dialogue participants take the information that is gleaned from the research and use it to make changes that will affect their families and broader community members. In the conduct of dialogues, research becomes a two-way street: researchers and participants both gather information, with the former collecting data about values and beliefs about a topic and the latter acquiring knowledge regarding a topic to deliver to their communities and serve as a catalyst for further conversation and change. The technique is particularly well-suited for complex topics where some education is needed about the different perspectives being researched. The researchers go beyond the normal data-gathering and analyzing functions to assist participants in identifying potential avenues for implementing policy changes.
Interviews
Authors: Klugman Craig M.
Published: August 2019

Interviewing is a means of engaging an individual in dialogue to reflect upon and share his or her life experience. For health humanities, this method accesses the lived reality of patients and healthcare providers. Asking people to share their personal narratives can allow for emic—from the subject’s perspective—and etic—from the researcher’s point of view—interpretation. Health humanities interviews consist of six steps: define the research question, design the interview, apply for Institutional Review Board approval, conduct the interviews, analyze the data, and distribute the findings. This chapter examines best practices for conducting interview studies including format (structured, unstructured, semi-structured), question type (closed- or open-ended), sampling (convenience, snowball), and notetaking. The author uses a study on collecting death histories to demonstrate this process and how to apply narrative, thematic, and frequency analyses.
Fiction Writing
Authors: Saffran Lise
Published: August 2019

Fiction writing is a method that uses imagination and narrative to collect information about potential sources of bias—assumptions, stereotypes, misconceptions—that one group might have toward another or toward a specific kind of behavior. This fiction writing method involves leading participants through a series of prompts designed to encourage deep engagement with a narrative and with perspective taking. The steps involved are (1) identifying an area/topic/relationship, (2) anchoring the situation/topic to a character, (3) rounding out the character, (4) constructing a scene featuring the character, (5) analyzing the results, and (6) disseminating the findings. Researchers can combine fiction writing with assessments of empathy for an imagined character or attitudes about attribution for health behaviors. Research themes include how individual characteristics are emphasized in explaining health behaviors. Understanding the relationships among narrative, empathy, and attribution has implications for how services are designed and delivered, as well as for health policies.
Epidemiology
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

Epidemiology is the study of the frequency and distribution of disease, and of the causes, associations, and effects of those diseases. It allows us to think of how these aspects of a condition apply to whole populations. In rehabilitation, this can help with planning of rehabilitation services at international, national, regional, and local levels; identifying deficits in service provision to assist in advocacy and to highlight where change may be needed; comparing services in different areas in order to explore different models of practice; and identifying future trends. This chapter contains useful definitions and describes methods for collecting epidemiological data and factors that are affected for people with disabilities (participation, activities, cost of living, rehabilitation needs, etc.), covering the basics of epidemiology in rehabilitation medicine.
Rehabilitation team
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

This chapter describes the requirement for a team in the treatment of an individual who has undergone a disabling event. A disabling event impacts the way a person manages across many domains of life (e.g. physical, psychological, and so on) but also on how they and others see their place in society. Providing a rationale for the benefits of working in a team, the chapter covers the definition and composition of an effective rehabilitation multidisciplinary team, including how to develop a successful team culture, communication, leadership, and meetings. Cautions on how to proceed when a team goes wrong are also discussed.
Cognition and behaviour
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

This chapter provides a general overview of cognition, and relevant models of information processing to facilitate decision-making and acting with regard to rehabilitation medicine. Perceptual disorders are discussed, and factors that may cause them to arise are covered. Attention is also described, including key terminology, and memory structure and forms are covered. High-level cognitive processes are described, and then applied to rehabilitation approaches (both remedial and compensatory). General background to behaviour, learning theory, management, and treatment approaches are all discussed, including cognitive behavioural therapy. Finally, pharmaceutical management to modify behaviour is covered.
Spasticity and contractures
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

This chapter discusses spasticity, a positive feature of disruption of the upper motor neuron pathways following acquired brain injury. After defining spasticity, it covers the prevalence and impact on limb function, methods of measurement (to monitor the outcomes of rehabilitation), goal setting, and management. Physical interventions by the physiotherapist and occupational therapist are described (as well as interventions to manage paresis and develop motor control), and pharmacological interventions (such as oral and intrathecal medications, and injectables) and their use in both treatment and management are discussed. The case for surgical intervention is also made for certain cases.
Chronic pain
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

This chapter defines the difference between acute and chronic pain, as well as the epidemiology of chronic pain (including why prevalence rates vary widely in the literature). Nociceptive pain and neurogenic pain are both defined, alongside a summary of the mechanisms of common pain syndromes. Examination of the patient with pain is described, including ways of taking a history in those who are unable to give a complete or coherent account. Measurement of pain, management strategies, and pharmaceutical interventions are all covered, and a defence of multidisciplinary pain management programmes is included. Finally, specific chronic pain conditions are defined, and recommendations for management are highlighted.
Neurogenic bladder and bowel
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

This chapter discusses continence. Bladder and bowel anatomy and physiology are complex, with continence being dependent on both intact anatomical structures and normal peripheral, autonomic, and central nervous system function. This chapter focuses on continence and incontinence, but with an emphasis towards the neurological substrates. Starting with the physiological considerations of normal bladder and bowel function, urinary incontinence is defined. The separate categories are then described, and pathophysiologies of bladder and bowel disorders are explained. Management of urinary problems are defined, including surgical interventions. Bowel incontinence is described, with common contributors (anatomical, neurology, and stool consistency) and management strategies outlined.
Injections in rehabilitation medicine
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

Injection-based interventions are a useful addition to the rehabilitation physician’s practice. These can occur in either inpatient or outpatient settings and be for musculoskeletal (e.g. joint/soft tissue injections) or neurological conditions (such as antispasticity injections and nerve blocks). Local steroid injection is a well-proven and effective treatment for focal pain and inflammation, and this chapter covers commonly used steroid injections, as well as different agents and procedures with their indications (including botulinum toxin injection). It provides a guide to the use of appropriate general injection techniques and includes tables showing the dose and duration of action of commonly used steroids and local anaesthetics for injections.
Cardiac rehabilitation
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

This chapter covers cardiac rehabilitation and secondary prevention, including the long-term programme of medical evaluation, exercise, risk factor modification, education, and counselling to limit the physiological and psychological effects of cardiac illness. The chapter opens with a definition of cardiac rehabilitation. The epidemiology of cardiac disease is then covered, and core components of a cardiac rehabilitation programme are described. Assessment, education, risk factor management, and risk factor stratification are all covered, and the benefits and risks involved in cardiac rehabilitation are discussed. The chapter ends with a discussion about maintaining long-term behaviour change in those patients referred to cardiac rehabilitation and prevention.
Respiratory issues in rehabilitation
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

Respiratory aspects of rehabilitation fall into two broad and overlapping categories. One is that of pulmonary rehabilitation which traditionally has focused on exercise, behaviour change, and educational-based intervention for those with chronic lung disease, predominantly chronic obstructive pulmonary disease, but its efficacy has since been proven in other chronic respiratory conditions (e.g. asthma, interstitial lung disease, cystic fibrosis, bronchiectasis, lung transplantation, and pulmonary hypertension). The other is rehabilitation in the context of neurogenic respiratory impairment, which is relevant to persons with both degenerative and monophasic-onset neurological conditions. These categories are overlapping as techniques from one may have relevance to the other. This chapter describes these aspects, investigations, and interventions.
Mobility and gait
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

Mobility is a function of everyday life that allows us the freedom to move between places for work, social events, and activities of daily living. Reduction in mobility leads to activity limitations and participation restrictions, may increase dependence on others, and adversely affects the quality of life of the person, carers, and family. This chapter covers the anatomy and physiology of mobility and the gait cycle, then the effect of pathology on the gait. Assessing and examining mobility is covered in the context of planning rehabilitation programmes. Gait analysis, including three-dimensional computerized biomechanical assessment, is explained. Interventions and goals in gait rehabilitation are outlined, and avoidance and reduction of falls is also explained.