bluuebunny/crossref_metadata_2025 huggingface dataset:
Nerve blocks-simple injections, epidurals, spinals, and more complex blocks
Authors: Breivik Harald
Published: October 2023

The skillful practice of diagnostic and ‘prognostic’ local anaesthetic nerve blocks, followed by selective neurolytic blocks with ethanol or phenol, was the basis for the pioneering anaesthesiologists’ involvement in relief of ‘intractable’ pain (Bonica 1953; Swerdlow 1983). During the last three decades knowledge of the pharmacology and toxicology of opioid analgesics has improved. At the same time development and availability of more effective forms of administration of opioid analgesic drugs has also contributed to improved medical management of severe cancer pain (Twycross 1994).
Selected surgical approaches
Authors: Dunn Geoffrey
Published: October 2023

Diagnosis and treatment of pain is an appropriate reason for referral to a general surgeon at any time in the course of a malignant disease. The surgeon has many tasks in the palliation of cancer including: staging of disease, control of disease, control of pain and symptoms, reconstruction, and rehabilitation. The preparation of the patient for possible surgical intervention begins with the referring physician. The chances of a helpful surgical encounter are enhanced by offering realistic expectations before the referral is made. This requires knowledge on the part of the non-surgeon concerning prerequisites and principles of surgical intervention. The surgeon has a valuable opportunity to assess non-physical components of ‘total pain’ (Saunders and Sykes 1993).
Spinal cord stimulation
Authors: Budd Keith
Published: October 2023

The ‘gate theory’ of Melzack and Wall (1965) has had an astonishing effect upon research into pain and its treatment. The precision of its formulation enables scientists to design experiments to test its predictions and clinicians to devise new forms of pain relieving therapy. Many scientific experiments supported the concept of a spinal gate. Clinical work gave rise to transcutaneous neural and spinal cord stimulation and offered an intriguing scientific basis for some forms of acupuncture. The relationship of therapeutic spinal cord stimulation (SCS) to the gating mechanisms remains unclear at present even though it was the gate control theory that inspired its inception. The first patient to receive SCS was successfully treated for cancer-related pain. However, since that time, the response of nociceptive pain to SCS has not always been as successful.
Radiotherapy
Authors: Makin Wendy P
Published: October 2023

Radiotherapy can achieve pain relief by directly influencing the disease process. Intensive or ‘radical’ treatment may be given with the intention of eradicating cancer completely and thereby curing the patient. If successful, there is resolution of pain and other symptoms associated with the presence of tumour. Radiotherapy also has an important role in palliation, especially for metastatic disease. Although the patient cannot be cured, treatment to symptomatic tumour sites may contribute considerably to quality of life without necessarily influencing survival. Such palliative treatments account for up to half of the workload of a radiotherapy department, and many of these are given to help pain. The aim of this chapter is to provide the non-radiotherapist with an understanding of the principles of treatment, what can be achieved and what it entails for the patient, to help clinical decisions concerning pain management.
Health considerations
Authors: McDonald F , Ireland A J
Published: October 2023

In the determination of an orthodontic treatment plan, health, and in particular dental health, is a most important consideration. Along with improved oral function and improved aesthetics, health gain is one of the three principal reasons for performing orthodontic treatment. An assessment of dental health in terms of past history, and present and possible future status therefore needs to be made as part of the diagnostic process. Each presenting malocclusion can usually be treated in different ways but whatever the chosen treatment plan, it is important that health is improved, not compromised, as a result of the orthodontic treatment. Health considerations will therefore assist in the setting of realistic treatment objectives and thus help determine the most appropriate treatment plan for a particular patient. Important health considerations are dental caries, periodontal disease, prevention of traumatic injury, and psychosocial well-being. These will now be considered in more detail.
Evidence based practice
Authors: McDonald F , Ireland A J
Published: October 2023

In both medicine and dentistry many of the available treatments in use by clinicians are based on personal training, clinical experience, the authoritative views of colleagues, or as a result of research findings. Such a varied background can lead to slow acceptance of new and effective treatment modalities by clinicians as a whole, and, equally, outdated and ineffective treatments may only slowly be discarded. The purpose of an evidence based approach to dentistry.
Pharmacology
Authors: Leung Wai-Ching
Published: October 2023

Compared with younger adults, the elderlya have a higher incidence of drug interactions b have a faster rate of renal drug clearance c generally require a larger dose of drugs d have a faster rate of drug metabolism e have a higher incidence of drug side-effects.
Psychiatry
Authors: Leung Wai-Ching
Published: October 2023

Which of the following statements about delusions is/are true? a they are always false b they may be caused by a lack of education c they may disappear if evidence to the contrary is explained to the person d they may be caused by unusual cultural upbringing e they cannot be shared by others who live with the person.
Public health and health services
Authors: Leung Wai-Ching
Published: October 2023

Which of the following is/are examples of primary prevention? a use of condoms to prevent pregnancy b immunization against measles, mumps and rubella c amniocentesis to detect Down’s syndrome d adding fluoride to drinking water to prevent dental cariese improved diabetic control.
Problem solving
Authors: Leung Wai-Ching
Published: October 2023

A GP was called out at midnight to visit a 24 year old man with a one day history of increasing shortness of breath and wheezing. He was known to suffer from asthma since childhood and had been maintained on regular salbutamol and steroid inhaler. His usual peak flow had been 550 litre/min. On examination, his pulse was 120 beats/min and his respiratory rate was 50 beats/min. His respiration was very shallow. He had very quiet breath sounds, but no wheeze was detected on auscultation. His peak flow was 120 litre/min.
Pharmacology of drugs, gases, and vapours used during general anaesthesia
Authors: Illingworth Karen A , Simpson Karen H , Swales Sue
Published: October 2023

Intravenous anaesthetic induction agents must be given slowly and in reduced doses to shocked or elderly patients to avoid profound cardiorespiratory depression. Etomidate has less effect on the cardiovascular system than barbiturates or propofol and may be the drug of choice when cardiovascular stability is needed. Nitrous oxide should be avoided if there is air in body cavities, for example a pneumothorax, (unless a chest drain is in situ), air embolus, or intracranial air. Volatile anaesthesia increases cerebral blood flow and should be avoided if intracranial pressure is elevated. The use of naloxone to reverse the effects of opioids at the end of anaesthesia is not recommended.
Common problems in airway and ventilation management
Authors: Illingworth Karen A , Simpson Karen H , Swales Sue
Published: October 2023

Any patient with depressed consciousness is at risk of airway obstruction, ventilatory depression, and aspiration of gastric contents. Airway or breathing problems may cause hypoxaemia. Adequate oxygenation is essential. Asthma may be fatal if the severity is underestimated or treatment is inadequate. Respiratory arrest in children may be due to infection, poisoning, trauma, or inhalation of a foreign body.
Nerve blocks of the lower limb
Authors: Illingworth Karen A , Simpson Karen H , Swales Sue
Published: October 2023

Anaesthesia and analgesia of the lower limb if combined with a femoral or 3 in 1 block (see p. 343). The pain of hip, tibial, or femoral shaft fracture may be treated by combined sciatic and femoral nerve blocks. Posterior and anterior approaches to the sciatic nerve are described. In the A & E setting, when the block is used during the management of trauma, the anterior approach is preferable, as it can be performed with the patient supine. The posterior approach requires that the patient is turned laterally.
Pyrimidine antimetabolites
Authors: Milano Gerard , Schellens Jan H M
Published: October 2023

Antimetabolites have structural similarities with intermediates of normal metabolism and they interact with the synthesis of RNA and DNA precursors.In the majority of cases antimetabolites are enzyme substrates and act by inhibiting enzymes which are essential for RNA and DNA synthesis. Alternatively, antimetabolites may be cytotoxic because of their incorporation into nucleic acids; this is well characterized
Alkylating agents
Authors: Boddy Alan V
Published: October 2023

Alkylating agents were among the first drugs to be used to treat malignant disease and form a major component of many regimens employed against both haematological and solid tumours. Their common mechanism of action is the formation of covalent adducts with the nucleotides of DNA. Subsequent processing or repair of these lesions leads to single- or double-strand breaks in the DNA and subsequently to cell death.
Cognitive Effects of Typical Antipsychotic Treatment: Another Look
Authors: Blyler Crystal R , Gold James M
Published: October 2023

The introduction of several new ‘atypical’or new generation antipsychotic compounds in the last decade represents a major advance in schizophrenia therapeutics. Evidence suggests that some of these compounds, particularly clozapine, may be differentially effective for a significant percentage of treatment-resistant patients, and the presence of fewer undesirable side effects relative to traditional antipsychotics may enhance treatment compliance (Kane et al., 1988; Buchanan et al., 1998). These drugs, therefore, may be superior antipsychotics, both because of true differential efficacy and because increased compliance with treatment reduces the relapse risk associated with medication discontinuation. Far less clear, however, is whether these newer compounds are more than better antipsychotics, i.e. the data are much less compelling regarding whether these compounds are truly differentially effective in the treatment of the cognitive impairments that are characteristic of schizophrenia (Buchanan et al., 1994). In light of evidence that cognitive deficits are critically important mediators of functional disability (Green, 1996), the establishment of whether these newer compounds truly act as cognitive enhancers rather than being simply better antipsychotics is necessary. In formulating the issue in this way, we do not mean to in any way diminish the importance of antipsychotic effects. Clearly, such effects are crucial in the clinical management of the illness. If the goal of treatment is to have a major impact on long-term functional outcome, however, the problem of cognitive impairment remains a major hurdle in the evaluation of the broad scope of drug efficacy.
The Pathology Of Bladder Cancer
Authors: Johansson Sonny L , Cohen Samuel M
Published: October 2023

Tumours of the lower urinary tract comprise approximately 10% of all male cancers and less than half of that figure in females. The incidence has been rising and over 50 000 new cases are diagnosed annually in the United States. In Sweden, 23% more cases were diagnosed in 1994 compared with 1983 (1). In Europe and the United States more than 90% of the tumours are of urothelial (transitional cell) origin. Transitional cell is a misnomer, but because it is so widely used in the literature and in clinical practice it can be used synonymously with urothelial, a term which we prefer. Approximately 5% of bladder tumours are squamous cell carcinomas (SCCs) and 1% adenocarcinomas, the remainder comprising uncommon variants of bladder carcinoma and various sarcomas such as rhabdomyosarcoma and leiomyosarcoma (2) (Table 6.1).
The Biology Of Bladder Cancer
Authors: Stadler Walter M , Brendler Charles B
Published: October 2023

Bladder cancer is predicted to develop in 54 500 Americans in 1997 and lead to 11 700 deaths in the same year (1). The death rate from this disease has slowly been declining over the last 2 decades, probably due to improvements in the diagnosis and therapy of localized disease (2). None the less, for certain sub¬ groups the risk of developing progressive muscle invasive disease is significant and approximately one-half of these patients will go on to develop metastatic disease (3). Furthermore, the treatment options available for metastatic bladder cancer are woefully limited, and less than 5% of patients with metastatic disease who are treated with the standard methotrexate, vinblastine, adriamycin, and cisplatin (MVAC) chemotherapy regimen are longterm survivors (4,5). There thus continues to be a need for better diagnosis of localized disease, better prognostic and predictive markers of future disease activity, and better treatment options for those who develop metastatic disease. These improvements will likely arise directly from some of the new knowledge regarding the biology of bladder oncogenesis that has been elucidated over the last several years.
Systemic Chemotherapy Of Muscle-Invasive Bladder Cancer
Authors: Sternberg Cora N , Calabró Fabio , Marini Luca , Scavina Paola
Published: October 2023

Bladder cancer is the fifth most common cancer in men and the seventh in women, with 52 900 cases in the United States in 1996 and 11 700 deaths (1,2). The male to female occurrence is 3: 1. It is, primarily a disease of the elderly, with 80% of cases in the 50–79 year age group, and a peak incidence in the seventh decade. The majority of patients are diagnosed at an early, treatable stage. At initial presentation 75% of bladder tumours are superficial, limited to the mucosa, submucosa, or lamina propria. Recurrence after initial treatment for superficial tumours is discovered in 50–80% of patients. Progression to muscle-invasive disease occurs in 10–25%. For patients with muscle-invasive bladder cancers, there is a 50% risk of distant metastases. It is important to identify those tumours that are biologically aggressive and that have the potential to result in mortality. For patients with metastatic disease progress continues to be made with the development of new chemotherapeutic regimens.
Gene Therapy Of Bladder Cancer
Authors: Freund Christian T F , Lerner Seth P
Published: October 2023

Gene therapy is a novel treatment approach based on direct genetic modification of gene expression in somatic cells to treat both acquired and inherited diseases (1). Gene therapy is also referred to as ‘molecular medicine’ because it attempts to correct or eliminate the specific molecular reason for disease on a cellular level rather than to treat its symptoms in an overall and non-specific manner (2). Gene therapy applies the principles we have learned from studying disease on a molecular level and integrates techniques derived from molecular biology, genetics, and virology to form a new treatment modality. Gene therapy is a new form of pharmacology, and we are in the earliest stages of drug development. In this chapter we present a rationale for applying gene therapy to the treatment of bladder cancer, give a brief introduction to the complex field of vector systems for delivery of genes, and review the abundant preclinical data providing proof of principle in bladder cancer cell lines and animal models. The first human clinical phase I trials are currently under way and will provide the basis for establishing the safe and effective application of gene therapy to human bladder cancer.
Alternative Urinary Reservoirs And Conduits: State Of The Science
Authors: Desgrandchamps Francois , Griffith Donald P
Published: October 2023

Bladder augmentation or bladder replacement is required in some patients with malignancies or other advanced pathological problems. Conduits and reservoirs constructed from reconstituted autologous large and small intestine have worked reasonably well for the past 75+ years. A robust literature thoroughly documents the advantages, disadvantages, and limitations of the many variations of intestinal alternatives. Common to all intestinal alternatives is a need for: (i) a general anaesthetic; (ii) a major operation with attendant stress, morbidity, and convalescence; (iii) significant expense; and (iv) significant recurrent medical problems in managing the conduit or reservoir. Despite the successful use of bowel many investigators have dreamed and worked toward other alternatives.
Mental fatigue and cognitive dysfunction
Authors: Meyers Christina A
Published: October 2023

Fatigue is the most widespread adverse symptom related to cancer and cancer therapy (Cleeland 2000). Although there is growing awareness of the prevalence of cancer-related fatigue, there is very little scientific literature about the aetiology and natural history of this debilitating symptom, unlike other illnesses with associated fatigue such as multiple sclerosis and lupus erythematosus. Fatigue can be physical (e.g. associated with muscle weakness or lack of stamina), mental (including poor concentration and lack of motivation), or both. Fatigue can have adverse effects on cognitive function and mood.
Medical management and treatment of muscular dystrophy
Authors: Manzur Adnan Y
Published: October 2023

The last decade has seen major advances in the understanding of the molecular genetics and pathogenesis of the muscular dystrophies (Dubowitz 1998; Emery 1997; 1998), and this in turn has raised expectations of a curative treatment. This is not yet available and symptomatic and palliative treatment is essential to enhance the patient2019s quality of life. Physical therapy for prevention of contractures and promotion of ambulation is the mainstay of treatment. Judicious surgical intervention may improve or stabilize motor function in carefully selected patients. Early detection and treatment of function and quality of life. The early detection and treatment of cardiac and respiratory complications, so crucial to improve survival, is covered in Chapters 11 and 13.
Surgical management of muscular dystrophy
Authors: Merlini Luciano , Forst Jürgen
Published: October 2023

Proper management can only be achieved if the natural history of the disease is precisely known. This principle pertains to all diseases, particularly neuromuscular disorders. In Duchenne muscular dystrophy (DMD), strength is near normal in the early stages; a rapid downhill progression follows with loss of the ability to walk, respiratory involvement, and eventual cardiac failure. We have subdivided orthopedic treatment in DMD according to the stage of the disease; early lower limb surgery, combined limb surgery and orthosis in the late stage of walking ability, and spinal surgery for scoliosis. In addition, two other orthopedic interventions are mentioned: scapular fixation in facioscapulohumeral muscular dystrophy (FSH) and neck hyperextension correction in rigid spine syndrome.
Must (should) all ESRD patients be treated?
Authors: Friedman Eli A
Published: October 2023

Allocation, defined as ‘the action of apportioning or assigning to a special person or purpose’ (Oxford English Dictionary, 1971) has as synonyms: appropriation, ration, allotment, distribution, quota, and share. In terms of treatment for end-stage renal dis ease (ESRD) it is evident that throughout the world rationing (allotment, quotas) of ESRD treatment are realities forced by financial limitation. As shown in Fig. 4.1, there are sharp national differences in the rate of treatment for ESRD depending on the income of individual countries (United States Renal Data System, 1999).
Equity and patient autonomy in dialysis
Authors: Levinsky Norman G
Published: October 2023

Which patients with end-stage renal disease (ESRD) should receive chronic dialysis? Perhaps the question is better formulated as: Should any patients with ESRD who want the therapy not receive dialysis? This chapter explores these questions with respect to a number of patient criteria: age, comorbidities, terminal illnesses, persistent vegetative state, diminished mental status, non-compliance, and destructive behavior. Broader issues of societal allocation of resources for costly ESRD programs in nations at various economic levels are discussed in several other chapters.
Allocation of kidneys for transplantation
Authors: Sells Robert A
Published: October 2023

There is general agreement that for the great majority of persons with end-stage renal failure, a kidney transplant is preferable to chronic dialysis. With the progressive expansion in the number of patients suitable for transplantation over the past several decades, the demand for kidney transplants has increased. Even though there is evidence that a significant number of suitable dialysis patients may not be referred for kidney transplantation (Tilney, 1998), the gap between supply and demand has in creased relentlessly since the late 1980s.
Criteria for primary implant selection in total hip arthroplasty: a North American perspective
Authors: Bourne Robert B
Published: October 2023

Total hip arthroplasty (THA) has been one of the most significant medical breakthroughs of the twentieth century, revolutionizing the care of patients with end-stage arthritic conditions of their hip joints. HJ Comparative clinical research has revealed that THAs, both cemented and cement less, are among the most cost-effective medical or surgical interventions utilized, are cost saving, and are durable for up to 20 or more years following implantation (Fig. 7.1).
Criteria for implant selection in revision total hip arthroplasty: a European perspective
Authors: Wagner H , Wagner M
Published: October 2023

If the bone in the old prosthesis bed is still in relatively good condition and the patient is elderly, a new prosthesis can be fixed at the old site with bone cement. This is a simple operative technique, although cement fixation of a replacement prosthesis is less stable than in primary implantation because of the smooth inner surface of the medullary cavity, so that a shorter lifespan may be expected.
Background-behavioural and psychological symptoms in dementia
Authors: Ballard Clive , O’Brien John , James Ian , Swann Alan
Published: October 2023

Dementia is a syndrome characterized by cognitive and non-cognitive symptoms. Traditionally it is the cognitive impairments which have been the main focus of attention, although over the last 15 years the importance of non-cognitive symptoms has become increasingly recognized. Their pronounced and diverse impact is discussed in the relevant chapters dealing with the respective individual symptoms. There are several clinically distinct categories of frequent and troublesome non-cognitive symptoms.
Identification and measurement of behavioural and psychological symptoms in dementia
Authors: Ballard Clive , O’Brien John , James Ian , Swann Alan
Published: October 2023

There are two key questions: (i) Why do we need standardized rating scales? and (ii) Why can scales that have been developed to measure mood and psychosis in the absence of cognitive impairment not serve the same purpose in the assessment of behavioural and psychological symptoms in dementia (BPSD)? The first question is best addressed by comparing some of the studies that evaluated the prevalence of BPSD from case-note reviews or clinical interviews with those that utilized a standardized schedule.
Other behavioural and psychological symptoms in dementia
Authors: Ballard Clive , O’Brien John , James Ian , Swann Alan
Published: October 2023

There are almost as many types of behavioural and psychological symptoms in dementia (BPSD) as there are people with dementia. Although, for convenience and to facilitate treatment, they are usually grouped into clusters, some defy classification. For every problem, a better understanding is facilitated by a detailed description and evaluation; an approach which is far more helpful than trying to label a unique symptom ‘artificially’.
The person and the environment
Authors: Ballard Clive , O’Brien John , James Ian , Swann Alan
Published: October 2023

This chapter focuses mainly on the care of the person with dementia within institutional environments. While these settings are equipped to deal with problem behaviours, the environments are often associated with high levels of ill-being (Kitwood 1997). For example, Novaco (1993) claims that institutional settings are often conducive to the displaying of challenging behaviour. He argues that these environments tend to limit satisfaction and are intrinsically constraining, leading to frequent incidences of aggression and distress. Clegg (1993), describing parallel settings with people with learning difficulties, suggests that institutional environments foster lives of ‘social emptiness’.
Managing carers’ psychological needs
Authors: Ballard Clive , O’Brien John , James Ian , Swann Alan
Published: October 2023

Caregivers looking after a person with dementia are often highly stressed, and frequently experience clinically significant depression. Behavioural and psycho logical symptoms in dementia (BPSD) are a major trigger of both increased burden and depression amongst caregivers (Donaldson et al. 1997). BPSD also accelerate admission to institutional care (Steele et al. 1990), probably largely as a result of the additional strain that they place upon caregivers. Treatment issues, such as developing more effective management strategies for the spectrum of BPSD symptoms, and specific treatment interventions for caregivers are of prime importance.
Management of other behavioural and psychological symptoms in dementia
Authors: Ballard Clive , O’Brien John , James Ian , Swann Alan
Published: October 2023

As for all behavioural and psychological symptoms in dementia (BPSD), it is important to consider the management sieve (Chapter 3): is the problem severe enough and persistent enough to need intervention? If so can an augmentation of the support package or environment, or a specific psychological intervention, resolve or substantially improve the situation? If conservative measures and non pharmacological interventions have not been successful, is the problem severe enough to merit a trial of pharmacotherapy? For most of the BPSD considered in this chapter, there is very little evidence pertaining to treatment intervention, other than some notable trials of non-pharmacological approaches for the treatment of abnormal vocalizations. The potential side effects and consequences of drug interventions, particularly with neuroleptic agents, have been highlighted elsewhere (Chapter 15), but are particularly important when considering the absence of any adequate clinical trials.
An integrated treatment approach
Authors: Ballard Clive , O’Brien John , James Ian , Swann Alan
Published: October 2023

The main aim of this chapter is to synthesize an approach to the management of behavioural and psychological symptoms in dementia (BPSD) using the principles and guidelines discussed in detail in the preceding chapters. From the outset, one must acknowledge the scanty evidence base for this integrated model: most of it comes from experience in clinical practice. It is a potentially risky venture to com bine different paradigms in an all-encompassing integrated whole. It can be particularly problematic to combine an essentially psychosocial model as a cause for aggressive behaviour and, at the same time, equate the same behavioural problems with changes in neurotransmitter functioning. However, as clinicians, we strongly believe that these models are not mutually exclusive and that a careful, judicious combination of approaches can act synergistically.
Evidence-based medicine for professionals
Authors: Gray JA Muir
Published: October 2023

Ludwig Wittgenstein was a very able medical laborntory technician, working in Newcastle General Hospital during the Second World War, and in addition was one of the twentieth century’s most influential philosophers. His contribution in his latter, better-known, job was to linguistic philosophy and although his text is often dense and difficult, his basic messages were, and are, simple and clear. Words, he said, are simply tools, and most causes of dis¬ agreement arise from the fact that those who were arguing were using the same term with different meanings. For Wittgenstein, what can be said is the same as what can be thought, as the famous aphorism from his key work the Tractatus says, ‘the limits of my language are the limits of my world’ (Wittgenstein 1922). He also pointed out that words, as they become more widespread in their use, pick up many different meanings and may eventually cause more confusion than clarity. All these observations relate to the term “evidence-based medicine’ since it was first introduced five years ago.
Risk communication—making evidence part of patient choices
Authors: Edwards Adrian , Bastian Hilda
Published: October 2023

This chapter examines the importance of discussing risk information when making choices about treatment or care that are informed or supported by evidence. The sharing of risk information is one of the key competences in involving patients in choices (Chapter 8, Elwyn and Charles). The content of ‘effective’ information and the context in which discussions are most effective are described. However, we discuss also that risk information is highly susceptible to errors of interpretation by professionals and patients and the danger of manipulation. This chapter summarizes the existing literature on these issues, and describes how steps can be made to ensure that the information of most value to patients can be presented and discussed, and in an accurate and balanced way.
Assessment of the Injured Athlete
Authors: Smith Aynsley M , Hartman Angela D , Detling Nicole J
Published: October 2023

The number of reported athletic injuries has increased > as a consequence of more people becoming involved in sports and improved methods of detecting and diagnosing injuries. The fact that athletes are participating in sports at younger ages, thus identifying themselves as athletes early in Jife, makes both acute and chronic injury more devastating. Frequently, athletes of all ages have their dreams and goals interrupted by injury.
Coping Strategies
Authors: Miller Gretchen A Kerr ,Patricia S
Published: October 2023

We know intuitively that there are tremendous individual differences in the way people appraise and cope with life stressors. One only needs to consider Holocaust survivors to appreciate the human potential to overcome extraordinary levels of stress. And yet, others suffer deleterious consequences with relatively minor stressors. Physicians speak freely of the influence of patients’ attitudes, particularly optimism and pessimism, on the course of illness.
Creating an Environment for Recovery
Authors: Taylor Adrian , Marlow Caroline
Published: October 2023

We know a great deal about adherence levels to fitness and exercise pro grams, and adoption and maintenance of a wide range of health-promoting behaviors. There is relatively less evidence about how good athletes are at adhering to a program of rehabilitation following a sports injury. However, the few studies that have examined this show that adherence rates may vary considerably depending on the setting, medical history, severity of the injury, stage of season, importance attached to (or level of) sports participation, and many other factors. Perhaps the most critical factor though is whether the rehabilitation program is to take place independently at home or in a super vised facility. Evidence suggests that adherence may be considerably higher in a supervised setting or in sporting cultures which are supportive of the recovering athlete.
Steroid injection for shoulder and elbow disorders
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Clinical bottom line. There is currently insufficient evidence to provide a definitive answer on the efficacy of steroid injections. Existing data suggest no compelling evidence. Steroid injections should not be used to alleviate pain associated with shoulder disorders until the effectiveness of this treatment can be demonstrated. Shoulder disorders are often caused by periarticular soft tissue impairment, with a minority originating from neurological or generalised musculoskeletal conditions, neoplasms or referred pain from the neck or from internal organs. Based on Dutch data, of all newly presented episodes, 23% resolve within one month, 51% within six months and 59% within one year.
Cognitive behaviour therapy and behaviour therapy for chronic pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Inclusion criteria were randomised clinical trial which assessed cognitive behaviour therapy or behaviour therapy in the treatment of chronic pain. MEDLINE, PsychLit, Embase and Social Science Citation Index were searched, using a combination of MeSH terms and relevant keywords, for trials which assessed cognitive behaviour therapy or behaviour therapy for the treatment of chronic pain. Bibliographies of retrieved reports and reviews were checked for additional citations. The Oxford Pain Relief Database was also searched. Papers were read by each reviewer. Authors were contacted for additional information if this was lacking from the individual studies. Information was pooled in a meta-analysis and effect size was calculated using Hedge’s g. Corrections for small sample size were made. When mean or standard deviations were not presented other available statistics were used to determine the effect size.
Homeopathy
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Homeopathy became popular in the 19th century, based on the idea that preparations of substances that, when given to healthy people, produced symptoms similar to those of the disease being treated. ‘Like cures like’ is one assumption. Another is that homeopathic remedies become stronger when diluted and accompanied by vigorous shaking. The greater the dilution, the greater the strength, therefore, even to the point where it is unlikely that even a single molecule of the original substance still exists in the final dilution.
Other complementary or alternative therapies for pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Clinical bottom line. Trials are of insufficient quality to draw a clear conclusion. It is not clear whether physiotherapy is better than other conservative treatments, or whether it is better than no treatment. It is not possible to establish which types of exercises are the most effective. Physiotherapy is widely used for back complaints, usually exercise therapy given alone or in combination with other treatments (e.g. massage, heat, traction, ultrasound or short wave diathermy). A systematic review [1] found 16 trials in which control groups were active/no intervention/placebo and the main outcomes pain and mobility.
The epidemiology of delirium
Authors: Lindesay James , Rockwood, Kenneth , Rolfson Darryl
Published: October 2023

The purposes of epidemiological research are to describe and define disorders; to pro- vide prevalence and incidence rates to inform service development and evaluation; and to identify aetiological factors. To date, most epidemiological studies of delirium in old age have been carried out in medical and surgical in-patients, and have focused on esti- mating its prevalence and incidence in these settings, identifying significant risk fac- tors, and evaluating its impact upon outcomes. The picture that emerges from these studies is not a consistent one; in particular, the estimated prevalence and inci- dence rates vary considerably between studies. This is due to a number of conceptual and methodological issues that need to be borne in mind when interpreting these data: case definition, case finding, selection bias, and differences in the populations being studied.
Clinical skills in the evaluation of arthritis
Authors: Szer Ilona S
Published: October 2023

The aim of this chapter is to fully describe the physical findings in children with Juvenile Idiopathic Arthritis (JIA) and related conditions. Most children with rheumatic conditions have objective physical findings, especially in muscles and joints. Through careful examination and pattern recognition the physician can arrive at the correct diagnosis. The initial consultation visit sets the stage for the future care of the child. The physician should be unhurried and undisturbed. Therapy begins when the physician greets the patient at the doorstep and continues as the history is taken.
Acute and chronic infections of bones and joints
Authors: Kimura Yukiko
Published: October 2023

The aim of this chapter is to discuss all of the infectious conditions that may present with musculoskeletal manifestations and must be “ruled out” early in the evaluation of the child with arthritis. When a child presents with fever and a limp or limb pain, the first and most urgent diagnostic consideration should be that of a serious bacterial infection (see Part 1, Chapter 1.3, Algorithm 1.3.1, “The Child with Musculoskeletal Pain/Dysfunction and Fever”), rather than Juvenile Idiopathic Arthritis (JIA). Bacterial musculoskeletal infections such as osteomyelitis and septic arthritis, which occur commonly in children, can cause serious morbidity if not recognized, diagnosed, and treated promptly and appropriately.
Autoinflammatory diseases and distinct but rare rheumatic conditions
Authors: Li Suzanne C
Published: October 2023

The aim of this chapter is to describe a number of diseases occurring in children that may mimic JIA particularly Systemic Arthritis. These diseases are frequently hereditary and their genetic basis is becoming increasingly understood. In addition to rheumatic conditions, such as systemic lupus erythematosus, dermatomyositis, and vasculitis syndromes discussed in Chapter 1.6, there are a number of other systemic inflammatory conditions that can present with features suggestive of Systemic Arthritis. These include the periodic fever syndromes, sarcoidosis, CINCA/ NOMID, Blau syndrome, Caffey disease, and Goldbloom syndrome, all of which will be discussed in this chapter.
Oligoarthritis
Authors: Miller John J , Malleson Peter N
Published: October 2023

The aims of this chapter are to discuss the clinical features, investigations, immunopathology, and genetics of Oligoarthritis. Both Persistent Oligoarthritis (which remains oligoarticular throughout its disease course), and Extended Oligoarthritis (which becomes polyarticular), will be discussed in separate sections of the chapter. As uveitis is common in this form of JIA, this condition will also be discussed here.
Psychosocial aspects
Authors: Shaw Karen
Published: October 2023

Why some children and families with JIA cope well, and why others have social and emotional difficulties is discussed. How to recognize and address psychosocial problems so as to maximize the overall well- being, and minimize the disability of a child with JIA is explored. Despite the difficulties associated with Juvenile Idiopathic Arthritis (JIA), psychosocial dysfunction is not inevitable. The majority of families manage with considerable skill. They develop new competencies and for some, the presence of arthritis can even result in strengthened family ties. This said, living with JIA is not easy.
Adjunctive therapies
Authors: Klein-Gitelman Marisa
Published: October 2023

The aim of this chapter is to discuss therapies that are potentially important in managing the complications of JIA, including anaemia, growth failure, drug toxicity, and osteoporosis. Children with Juvenile Idiopathic Arthritis (JIA) may develop secondary medical problems as a result of the initial disease process itself and /or the medical therapy used to control arthritis. Adjunctive therapies are interventions that treat symptoms associated with the underlying illness or its treatment but do not specifically alter the disease course. This chapter examines the use of several adjunctive therapies in the treatment of children with chronic arthritis.
Surgical interventions
Authors: Hall Ann
Published: October 2023

The aim of this chapter is to discuss the role of surgical procedures in the management of JIA. Surgery has an established place in the management of juvenile idiopathic arthritis (JIA) although this role is diminishing because of improved medical management. However, a proportion of children will require surgery during the course of their illness. In one centre [1] 10% of all patients with JIA had at least one surgical procedure; 50% of these patients had Rheumatoid Factor positive Polyarthritis. First reports of surgery for JIA began to appear in the literature in the 1960s.
Greek Art and Architecture
Authors: Boardman John
Published: October 2023

The arts of the western world have been dominated by the art of the Greeks. Even the alternative arts of Celtic Europe or the Asian steppes were infiltrated by classical imagery. Although this record makes it easy for us to isolate those characteristics which distinguish Greek art from the arts of other cultures, contem¬porary or later, it has probably also made it the more difficult to assess on its own terms, to judge its role and the response of those for whom it was practised, and to value justly its profound innovations. And the attempt to define its characteristics may also do less than justice to that other remarkable phenomenon, the rapidity of its evolution from virtual abstraction to realism; while if its history is defined in such bald terms we may also miss other fundamental qualities-its unusual (for antiquity) subject¬ matter and its preoccupation with form and proportion.
The History of the Hellenistic Period
Authors: Price Simon
Published: October 2023

The Hellenistic period, the 300 years between the reigns of Alexander the Great of Macedon (336-323 BC) and Augustus, the first Roman Emperor (31 BC-AD 14), is often seen as an uninteresting and incoherent part of Greek history. Falling be¬ tween the two ‘central’ periods of classical Athens and Ciceronian or Augustan Rome, the period seems to be merely the melancholy story of the decline of the Greek city, subjected first to Alexander and his successors and then to the Romans.
Introduction
Authors: Fitzpatrick Sheila
Published: October 2023

This second edition of The Russian Revolution appears in the wake of dramatic events-the fall of the Communist regime and the dissolution of the Soviet Union at the end of 1991. Those events have had all sorts of consequences for historians of the Russian Revolution. In the first place, they have opened archives that were previously closed, brought forth memoirs that were hidden in drawers, and released a flood of new material of every kind. In the second place, they have changed the category of the Russian Revolution.
The Setting
Authors: Fitzpatrick Sheila
Published: October 2023

At the beginning of the twentieth century, Russia was one of the great powers of Europe. But it was a great power that was universally regarded as backward by comparison with Britain, Germany, and France. In economic terms, this meant that it had been late to emerge from feudalism (the peasants were freed from legal bondage to their lords or the state only in the 1860s) and late in industrializing.
The Armistice, September 1943
Authors: Morgan Philip
Published: October 2023

On the evening of 8 September 1943, Marshal Badoglio, the head of the government, announced the armistice in a radio broadcast to the Italian people and armed forces: The Italian government, acknowledging the impossibility of continuing the unequal struggle against the overwhelming power of our opponents, and with the aim of sparing the nation further and more serious harm, has requested an armistice from General Eisenhower, commander-in-chief of the Anglo-American allied forces. This request has been met. Consequently, all hostilities against Anglo-American forces by Italian forces, everywhere, must stop. Italian forces, however, will resist any eventual attacks coming from any other source.
Continuing the Wars, and the Second Fall of Mussolini, April 1945
Authors: Morgan Philip
Published: October 2023

In 1990, an Italian called Giuseppe Bonfanti, 66 years old, returned to Italy from Brazil, where he had emigrated after the war. The purpose of his visit was to kill another elderly man, 68-year-old Giuseppe Oppici. It was not a tidy killing. If it had happened forty-five years earlier, Bonfanti would undoubtedly have used his gun. As it was, he killed Oppici with a pickaxe in an alley in Salina, the birthplace of both men. The reason, and justifiation, for the killing was that in November 1944 Oppici was among a group of Fascists on a reprisal expedition who burned down the partisan Bonfanti’s house and slaughtered his livestock. ‘I came back just to kill him,’ said Bonfanti;’ finally I made him pay.
The Domination Of Pompeius
Authors: Syme Ronald
Published: October 2023

The Pompeii, a family of recent ennoblement, were of non-Latin stock, as the name so patently indicates, probably deriving their origin from Picenum, a region where they possessed large estates and wide influence.1 Cn. Pompeius Strabo, after shattering the Italian insurrection in Picenum, used his influence and his army for personal ends and played an ambiguous game when civil war broke out between Marius and Sulla. Brutal, corrupt and perfidious, Strabo was believed to have procured the assassinat10n of a consul. When he died of a natural but providential death the populace broke up his funeral. Strabo was a sinister character, ‘hated by heaven and by the nobility’, for good reasons. There were no words to describe Cn. Pompeius the son. After his father’s death, protected by influential politicians, he lay low, lurking no doubt in Picenum.
Toothpicks and Logos
Authors: Heskett John
Published: October 2023

This is a book that has needed to be written for years.' Victor Margolin, Editor, Design Issues John Heskett wants to transform the way we think about design by showing how integral it is to our daily lives, from the spoon we use to eat our breakfast cereal, the car we drive to work in, to the medical equipment used to save lives. Design combines 'need' and 'desire' in the form of a practical object that can also reflect the users identity and aspirations through its form and decoration. This concise guide to contemporary design goes beyond style and taste to look at how different cultures and individuals personalize objects. Heskett also reveals how simple objects, such as a toothpick, can have their design modified to suit the specific cultural behaviour in different countries. There are also fascinating insights into how major companies such as Nokia, Ford, and Sony approach design. Finally, we are shown an exciting vision of what design can offer us in the future and especially its role in humanising new technology.
Into The Twentieth Century And Beyond
Authors: Snow Stephanie J
Published: October 2023

Victorians poised on the brink of a new century considered any aesthesia as one of the best fruits of their times. In chloroform’ s jubilee year, the Duke of Cambridge opened a new operating theatre at St George’ s Hospital: nothing during the reign of Queen Victoria had made as much progress as medical and surgical science, he said. Four years later, the Victorian era ended with the death of the Queen in 1901, and a new reign began. About-to-be Edwardians, reading of the postponement of Edward’ s coronation on account of his suffering an abscess in the appendix, did not, perhaps, appreciate that had Victoria, rather than Edward suffered the same condition, matters may have been very different.