bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic factors for pulmonary metastasectomy in malignant melanoma: size matters
Authors: Viehof Jan , Livingstone Elisabeth , Loscha Elena , Stockhammer Paul , Bankfalvi Agnes , Plönes Till , Mardanzai Khaled , Zimmer Lisa , Sucker Antje , Schadendorf Dirk , Hegedüs Balazs , Aigner Clemens
Published: June 2019

OBJECTIVES

Pulmonary metastasectomy for malignant melanoma requires an individualized therapeutic decision. Due to recently developed novel treatment options, the prognosis of patients with melanoma has improved significantly. Validated prognostic factors that identify patients who are most likely to benefit from metastasectomy are urgently needed.

METHODS

We retrospectively reviewed all consecutive patients with melanoma undergoing complete pulmonary metastasectomy between January 2010 and December 2016. The impact of age, sex, extrapulmonary metastases, preoperative systemic therapy, number of metastases, laterality and largest diameter of metastasis on survival after metastasectomy was analysed.

RESULTS

A total of 29 male and 32 female patients were included in the study. The median follow-up time was 25.6 months. The mean number of resected metastases was 1.7 ± 1.1 (range 1–5). Ten patients had repetitive pulmonary metastasectomies. The median survival time was 31.3 months with a 2-year survival rate of 54%. Bilateral metastases or multiple nodules were not associated with a significantly decreased overall survival rate after metastasectomy. Shorter overall survival times were observed in male patients [hazard ratio (HR) 2.9, 95% confidence interval (CI) 1.42–5.92; P = 0.0035] and in patients with nodules larger than 2 cm (HR 3.18, 95% CI 1.45–6.98; P = 0.004). In multivariable analysis, both gender and tumour size remained significant independent prognostic factors.

CONCLUSIONS

Excellent overall survival rates after pulmonary metastasectomy for melanoma metastases were observed in patients with a metastatic diameter less than 2 cm and in female patients. In view of improved long-term outcome due to novel treatment options, the selection of patients for pulmonary metastasectomy based on prognostic factors will become increasingly important.
Feasibility and cardiac synchrony of permanent left bundle branch pacing through the interventricular septum
Authors: Hou Xiaofeng , Qian Zhiyong , Wang Yao , Qiu Yuanhao , Chen Xing , Jiang Hai , Jiang Zeyu , Wu Hongping , Zhao Zhongqiang , Zhou Weihua , Zou Jiangang
Published: June 2019

Aims

Left bundle branch pacing (LBBP) recently emerges as a novel pacing modality. We aimed to evaluate the feasibility and cardiac synchrony of permanent LBBP in bradycardia patients.

Methods and results

Left bundle branch pacing was successfully performed in 56 pacemaker-indicated patients with normal cardiac function. Left bundle branch pacing was achieved by penetrating the interventricular septum (IVS) into the left side sub-endocardium with the pacing lead. His-bundle pacing (HBP) was successfully performed in another 29 patients, 19 of whom had right ventricular septal pacing (RVSP) for backup pacing. The QRS duration, left ventricular (LV) activation time (LVAT), and mechanical synchrony using phase analysis of gated SPECT myocardial perfusion imaging were evaluated. Paced QRS duration in LBBP group was significantly shorter than that in RVSP group (117.8 ± 11.0 ms vs. 158.1 ± 11.1 ms, P < 0.0001) and wider than that in HBP group (99.7 ± 15.6 ms, P < 0.0001). Left bundle branch potential was recorded during procedure in 37 patients (67.3%). Left bundle branch pacing patients with potential had shorter LVAT than those without potential (73.1 ± 11.3 ms vs. 83.2 ± 16.8 ms, P = 0.03). Left bundle branch pacing patients with potential had similar LV mechanical synchrony to those in HBP group. R-wave amplitude and capture threshold of LBBP were 17.0 ± 6.7 mV and 0.5 ± 0.1 V, respectively at implant and remained stable during a mean follow-up of 4.5 months without lead-related complications.

Conclusion

Permanent LBBP through IVS is safe and feasible in bradycardia patients. Left bundle branch pacing could achieve favourable cardiac electrical and LV mechanical synchrony.
Oral anticoagulation in patients with atrial fibrillation and acute ischaemic stroke: design and baseline data of the prospective multicentre Berlin Atrial Fibrillation Registry
Authors: Haeusler Karl Georg , Tütüncü Serdar , Kunze Claudia , Schurig Johannes , Malsch Carolin , Harder Janek , Wiedmann Silke , Dimitrijeski Boris , Ebinger Martin , Hagemann Georg , Hamilton Frank , Honermann Martin , Jungehulsing Gerhard Jan , Kauert Andreas , Koennecke Hans-Christian , Leithner Christoph , Mackert Bruno-Marcel , Masuhr Florian , Nabavi Darius , Rocco Andrea , Schmehl Ingo , Schmitz Bettina , Sparenberg Paul , Stingele Robert , von Brevern Michael , Völzke Enrico , Dietzel Joanna , Heuschmann Peter U , Endres Matthias
Published: June 2019

Aims

The Berlin Atrial Fibrillation Registry was designed to analyse oral anticoagulation (OAC) prescription in patients with atrial fibrillation (AF) and acute ischaemic stroke.

Methods and results

This investigator-initiated prospective multicentre registry enrolled patients at all 16 stroke units located in Berlin, Germany. The ongoing telephone follow-up is conducted centrally and will cover 5 years per patient. Within 2014 and 2016, 1080 patients gave written informed consent and 1048 patients were available for analysis. Median age was 77 years [interquartile range (IQR) 72–83], 503 (48%) patients were female, and 254 (24%) had a transient ischaemic attack (TIA). Overall, 470 (62%) out of 757 patients with known AF and a (pre-stroke) CHA2DS2-VASc ≥ 1 were anticoagulated at the time of stroke. At hospital discharge, 847 (81.3%) of 1042 patients were anticoagulated. Thereof 710 (68.1%) received a non-vitamin K-dependent oral anticoagulant (NOAC) and 137 (13.1%) a vitamin K antagonist (VKA). Pre-stroke intake of a NOAC [odds ratio (OR) 15.6 (95% confidence interval, 95% CI 1.97–122)] or VKA [OR 0.04 (95% CI 0.02–0.09)], an index TIA [OR 0.56 (95% CI 0.34–0.94)] rather than stroke, heart failure [OR 0.49 (95% CI 0.26–0.93)], and endovascular thrombectomy at hospital admission [OR 12.9 (95% CI 1.59–104)] were associated with NOAC prescription at discharge. Patients’ age or AF type had no impact on OAC or NOAC use, respectively.

Conclusion

About 60% of all registry patients with known AF received OAC at the time of stroke or TIA. At hospital discharge, more than 80% of AF patients were anticoagulated and about 80% of those were prescribed a NOAC.
Linking biosynthetic and chemical space to accelerate microbial secondary metabolite discovery
Authors: Soldatou Sylvia , Eldjarn Grimur Hjorleifsson , Huerta-Uribe Alejandro , Rogers Simon , Duncan Katherine R
Published: June 2019

Secondary metabolites can be viewed as a chemical language, facilitating communication between microorganisms. From an ecological point of view, this metabolite exchange is in constant flux due to evolutionary and environmental pressures. From a biomedical perspective, the chemistry is unsurpassed for its antibiotic properties. Genome sequencing of microorganisms has revealed a large reservoir of Biosynthetic Gene Clusters (BGCs); however, linking these to the secondary metabolites they encode is currently a major bottleneck to chemical discovery. This linking of genes to metabolites with experimental validation will aid the elicitation of silent or cryptic (not expressed under normal laboratory conditions) BGCs. As a result, this will accelerate chemical dereplication, our understanding of gene transcription and provide a comprehensive resource for synthetic biology. This will ultimately provide an improved understanding of both the biosynthetic and chemical space. In recent years, integrating these complex metabolomic and genomic data sets has been achieved using a spectrum of manual and automated approaches. In this review, we cover examples of these approaches, while addressing current challenges and future directions in linking these data sets.
Technology, war and the state: past, present and future
Authors: Chin Warren
Published: June 2019

War made the state, and the state made war, but does this statement hold true today? Will it apply in the future? The consensus is that the absence of major war within the western world, post 1945, did cause the war–state relationship to change, but each became significantly less important to the other. This article argues that the relationship was closer and deeper than has been assumed. It proposes that the peculiar strategic conditions created by the nuclear age caused states to wage a ritualistic style of war, in which demonstration rather than the physical application of violence became increasingly important. Within this setting, the state drove the process of technological innovation in defence to its limits in an effort to demonstrate its military superiority. This massive peacetime investment in defence technology exerted a huge impact on the character of war, which led to new strategic forms. However, most importantly, the diffusion of military technology also affected the wider economy and society, leading to a form of internal power transition within states. The author speculates on how these elemental forces will play out in the future, what will happen to war and the state, and whether we will reach a point where war leads to the unmaking of the state.
Meat intake and risk of hepatocellular carcinoma in two large US prospective cohorts of women and men
Authors: Ma Yanan , Yang Wanshui , Li Tricia , Liu Yue , Simon Tracey G , Sui Jing , Wu Kana , Giovannucci Edward L , Chan Andrew T , Zhang Xuehong
Published: June 2019

Background

Epidemiological evidence on the associations between meat intake and risk of hepatocellular carcinoma (HCC) was limited and inconsistent.

Methods

We prospectively examined the association between consumption of meats and meat mutagens with HCC risk using data from the Nurses’ Health Study and the Health Professionals Follow-up Study. Cox proportional-hazards regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) after adjusting for known liver-cancer risk factors.

Results

During up to 32 years of follow-up, we documented 163 incident HCC cases. The HRs of HCC for the highest vs the lowest tertile intake levels were 1.84 (95% CI: 1.16–2.92, Ptrend = 0.04) for processed red meats and 0.61 (95% CI: 0.40–0.91, Ptrend = 0.02) for total white meats. There was a null association between unprocessed red meats and HCC risk (HR = 1.06, 95% CI: 0.68–1.63, Ptrend = 0.85). We found both poultry (HR = 0.60, 95% CI: 0.40–0.90, Ptrend = 0.01) and fish (HR = 0.70, 95% CI: 0.47–1.05, Ptrend = 0.10) were inversely associated with HCC risk. The HR for HCC risk was 0.79 (95% CI: 0.61–1.02) when 1 standard deviation of processed red meats was substituted with an equivalent amount of poultry or fish intake. We also found a suggestive positive association of intake of meat-derived mutagenicity or heterocyclic amines with risk of HCC.

Conclusions

Processed red meat intake might be associated with higher, whereas poultry or possibly fish intake might be associated with lower, risk of HCC. Replacing processed red meat with poultry or fish might be associated with reduced HCC risk.
Studying Parkinson’s disease using Caenorhabditis elegans models in microfluidic devices
Authors: Youssef Khaled , Tandon Anurag , Rezai Pouya
Published: June 2019

Parkinson’s disease (PD) is a progressive neurological disorder associated with the loss of dopaminergic neurons (DNs) in the substantia nigra and the widespread accumulation of α-synuclein (α-syn) protein, leading to motor impairments and eventual cognitive dysfunction. In-vitro cell cultures and in-vivo animal models have provided the opportunity to investigate the PD pathological hallmarks and identify different therapeutic compounds. However, PD pathogenesis and causes are still not well understood, and effective inhibitory drugs for PD are yet to be discovered. Biologically simple but pathologically relevant disease models and advanced screening technologies are needed to reveal the mechanisms underpinning protein aggregation and PD progression. For instance, Caenorhabditis elegans (C. elegans) offers many advantages for fundamental PD neurobehavioral studies including a simple, well-mapped, and accessible neuronal system, genetic homology to humans, body transparency and amenability to genetic manipulation. Several transgenic worm strains that exhibit multiple PD-related phenotypes have been developed to perform neuronal and behavioral assays and drug screening. However, in conventional worm-based assays, the commonly used techniques are equipment-intensive, slow and low in throughput. Over the past two decades, microfluidics technology has contributed significantly to automation and control of C. elegans assays. In this review, we focus on C. elegans PD models and the recent advancements in microfluidic platforms used for manipulation, handling and neurobehavioral screening of these models. Moreover, we highlight the potential of C. elegans to elucidate the in-vivo mechanisms of neuron-to-neuron protein transfer that may underlie spreading Lewy pathology in PD, and its suitability for in-vitro studies. Given the advantages of C. elegans and microfluidics technology, their integration has the potential to facilitate the investigation of disease pathology and discovery of potential chemical leads for PD.
Uterine and vaginal bacterial community diversity prior to artificial insemination between pregnant and nonpregnant postpartum cows1
Authors: Ault Taylor B , Clemmons Brooke A , Reese Sydney T , Dantas Felipe G , Franco Gessica A , Smith Tim P L , Edwards J Lannett , Myer Phillip R , Pohler Ky G
Published: June 2019

The present study evaluated the bovine vaginal and uterine bacterial community diversity and its relationship to fertility. Postpartum beef cows (n = 68) were synchronized beginning on day −21 and ending with timed artificial insemination (TAI) on day 0. Pregnancy was diagnosed 30 d after TAI. Uterine and vaginal flushes were collected on day −21, −9, and −2 for bacterial DNA extraction to sequence the V1 to V3 hypervariable regions of the 16S rRNA gene. Results indicated a decrease in the number of bacterial species over time in the uterus of resulting pregnant and nonpregnant beef cows (P < 0.0001). Principal coordinate analyses (PCoA) depicted clustering of samples, indicating closely related bacterial communities, by day in the uterus and vagina (P < 0.0001). At day −2, uterine samples from nonpregnant and pregnant animals clustered separately (P < 0.0001), with nonpregnant animal samples clustering tightly together. Overall, the current study suggests the shift in the reproductive bacterial communities’ diversity and phylogenetic relationship leading up to the time of breeding may contribute to successful pregnancy establishment.
Primary non-urothelial squamous cell carcinoma masquerading as a perforated gastric ulcer: a case report
Authors: Kaczynski Rachel E , Fegely Daniel , Nier Matthew , Valentin-Capeles Neysa , Battista Jackie
Published: June 2019

We present an 84-year-old female patient with a very rare form of primary non-urothelial squamous cell carcinoma of the bladder, found incidentally during emergency exploratory laparotomy for a perforated pre-pyloric gastric ulcer. The bladder tumor was positive for CK5/6, CK903, and thrombomodulin biomarkers, as well as for high-risk HPV (16, 18, and 31). Based on a literature review of non-urothelial bladder cancers, specifically non-bilharzial squamous cell carcinoma, we believe our patient had a very rare form of primary non-urothelial squamous cell carcinoma of the bladder. The presence of these tumor markers and the lack of clinical evidence to suggest another primary origin, such as anus, rectum, cervix, or uterus, support this conclusion. This case provides an interesting example of a very rare incidental finding during an emergent procedure.
Surgical strategy of urachal remnants in children
Authors: Tatekawa Yukihiro
Published: June 2019

A urachus is a vestigial tubular structure that connects the urinary bladder to the allantois during early embryonic development. Urachal remnants are classified as patent urachus, urachal sinus, urachal cyst, and urachal diverticulum. Ten patients with urachal remnants underwent surgery at our institution between 2015 and 2019. Six patients had a urachal sinus, and four had a urachal diverticulum. Two patients with urachal sinus underwent excision of the urachal remnant, from the umbilicus to the urinary bladder, using an umbilical approach. The other four patients with urachal sinus underwent laparoscopic surgery with excision of the urachal remnant, from the umbilicus to the urinary bladder. All patients with urachal diverticulum underwent open excision of the diverticulum through a Pfannenstiel incision. Pathologic examination of all urachal remnants showed no evidence of neoplasm and complete excision. All patients had an uneventful postoperative course and are doing well.
Measurement accuracy and uncertainty in plant biomechanics
Authors: Nelson Nathanael , Stubbs Christopher J , Larson Ryan , Cook Douglas D
Published: June 2019

All scientific measurements are affected to some degree by both systematic and random errors. The quantification of these errors supports correct interpretation of data, thus supporting scientific progress. Absence of information regarding reliability and accuracy can slow scientific progress, and can lead to a reproducibility crisis. Here we consider both measurement theory and plant biomechanics literature. Drawing from measurement theory literature, we review techniques for assessing both the accuracy and uncertainty of a measurement process. In our survey of plant biomechanics literature, we found that direct assessment of measurement accuracy and uncertainty is not yet common. The advantages and disadvantages of efforts to quantify measurement accuracy and uncertainty are discussed. We conclude with recommended best practices for improving the scientific rigor in plant biomechanics through attention to the issues of measurement accuracy and uncertainty.
Mechanical properties and structure–function trade-offs in secondary xylem of young roots and stems
Authors: Plavcová Lenka , Gallenmüller Friederike , Morris Hugh , Khatamirad Mohammad , Jansen Steven , Speck Thomas
Published: June 2019

Bending and torsional properties of young roots and stems were measured in nine woody angiosperms. The variation in mechanical parameters was correlated to wood anatomical traits and analysed with respect to the other two competing functions of xylem (namely storage and hydraulics). Compared with stems, roots exhibited five times greater flexibility in bending and two times greater flexibility in torsion. Lower values of structural bending and structural torsional moduli (Estr and Gstr, respectively) of roots compared with stems were associated with the presence of thicker bark and a greater size of xylem cells. Across species, Estr and Gstr were correlated with wood density, which was mainly driven by the wall thickness to lumen area ratio of fibres. Higher fractions of parenchyma did not translate directly into a lower wood density and reduced mechanical stiffness in spite of parenchyma cells having thinner, and in some cases less lignified, cell walls than fibres. The presence of wide, partially non-lignified rays contributed to low values of Estr and Gstr in Clematis vitalba. Overall, our results demonstrate that higher demands for mechanical stability in self-supporting stems put a major constraint on xylem structure, whereas root xylem can be designed with a greater emphasis on both storage and hydraulic functions.
Introduction
Authors: Williams Monnica T. , Wetterneck Chad T.
Published: June 2019

Sexual obsessions are perhaps the least understood manifestation of obsessive-compulsive disorder (OCD) and include worries about sexual orientation, infidelity, sexual deviations, incest, pregnancy, and blasphemous thoughts. Although about 25% of those with OCD are believed to have symptoms with sexual themes (S-OCD), mental health professionals have difficulty making a proper diagnosis. Few clinicians know how to treat this form of OCD, and there are very few materials available to guide clinicians. Treatment using cognitive-behavioral principles is sometimes unconventional, and few therapists receive training in how to address S-OCD their academic programs. Even well-educated psychology students and practicing therapists have stigmatizing attitudes toward sexual obsessions compared to other types of OCD content. This manual takes the best cognitive-behavior therapy strategies for the treatment of OCD, and illustrates how to apply them to clients with S-OCD. It contains direct written step-by-step instructions for therapists as well as educational handouts and diagrams for clients to promote learning.
Understanding Sexual Obsessions
Authors: Williams Monnica T. , Wetterneck Chad T.
Published: June 2019

Obsessive-compulsive disorder (OCD) has a heterogeneous presentation, and many of those afflicted experience symptoms that include sexual content. Sexual obsessions occur across ethnicity, race, and culture, although they may present as culturally bound syndromes. Common types of sexual obsessions include pedophile obsessions, sexual orientation obsessions, fears surrounding sexual/gender identity changes, religious sexual obsessions (scrupulosity), fears about committing a sexual assault, and irrational impregnating fears. This chapter reviews common concerns about the dangers posed by individuals with these forms of OCD and discusses the prognosis for those receiving proper treatment. The authors also review the four manifestations of OCD—contamination fears and cleaning rituals, doubting and compulsive checking rituals, symmetry obsessions and ordering rituals, and unacceptable/taboo thoughts and mental rituals. They describe how sexual symptoms fit into these four major dimensions.
Assessing Clients with Sexual Obsessions
Authors: Williams Monnica T. , Wetterneck Chad T.
Published: June 2019

This chapter reviews the most important considerations when assessing a client with sexual obsessions within OCD (S-OCD). Clients typically experience increased shame surrounding symptoms and obsess about the cause and meaning of obsessions, and this chapter provides guidance for therapists during the initial consultation. Also reviewed are recommended assessment strategies and helpful clinical tools, with a table of measures. Differential diagnosis for S-OCD versus pedophilic disorder and sexual identity confusion are contrasted. Also provided are examples of OCD surrounding transgender fears, bestiality fears, and S-OCD with psychosis. Clients with OCD are often undermedicated by their physicians, and so included is a review of medication options for OCD and common side effects, written to be accessible to therapist nonprescribers. The chapter ends with a discussion of how to communicate with other mental healthcare providers, including physicians and other prescribers, therapists, social workers, clergy, and traditional healers.
Treating Pedophile Obsessions
Authors: Wetterneck Chad T. , Nghe Erin C.
Published: June 2019

This chapter contains a case study of the treatment of pedophilic obsessions in OCD (also called P-OCD). The case study includes the background and case conceptualization of an adult client who was effectively treated using exposure and response prevention with values-based exposures using acceptance and commitment therapy. Examples of values-based exposure hierarchies are provided from the case and serve as realistic examples of what treatment may include. The authors discuss treatment and outcome session by session and include complicating factors and treatment implications. In addition, this chapter includes detailed example ideas of in vivo and imaginal exposures that can be used as part of treatment for P-OCD for clients.
Troubleshooting Common Problems, Issues, and Resources
Authors: Williams Monnica T. , Nghe Erin C. , Hart John , Wetterneck Chad T.
Published: June 2019

Practitioners working with OCD sufferers are sometimes presented with complicated issues that make it difficult to see significant progress within a client’s treatment. Being skilled at recognizing when treatment is at a standstill is important in and of itself. It is impossible to predict all of the problems that can arise, but being mindful of common glitches can support therapists in recognizing the barriers that sometimes make clients and therapists feel stuck. Discord within a client’s sense of self, fear, lack of trust, time management, family dynamics, and comorbidities are some of the common themes therapists see come up for their clients. There are also matters related to logistics and ethics that therapists may face. This chapter includes illustrations of real-life situations that therapists can take note of, as well as suggestions on how to address the obstacles to better support clients in reaching their goals for OCD wellness. Also included is a list of books, articles, and other resources.
Helping Families of Youth with School Attendance Problems
Authors: Kearney Christopher A.
Published: June 2019

This book is a highly practical guide to efficiently address cases of youth with school attendance problems at different levels of severity and complexity. School attendance problems are a pervasive and difficult dilemma faced by many types of mental health professionals (e.g., psychologists, psychiatrists, marriage and family therapists), school officials (e.g., administrators, guidance counselors, school-based social workers, school psychologists), and others (e.g., pediatricians, probation officers). School attendance problems, even in mild forms, are a significant risk factor for social, behavioral, and academic problems in middle childhood and adolescence as well as psychiatric, economic, and occupational difficulties in adulthood. This book takes a “nuts and bolts” approach that provides very specific and detailed recommendations and guidelines for assessment and intervention across a short period of time (e.g., four weeks). The book focuses less on descriptions of overall programs for absenteeism and more on specific procedures for many different types of cases. Many mental health and school-based professionals cannot logistically implement large-scale programs or even detailed manualized treatment protocols for their clients and schools. Thus, this book is meant to be a very practical guide to address school absenteeism at a relatively fast pace, and within the constraints of most private practices and school settings, while relying on empirically supported techniques. The book also considers developmental levels, with some chapters more applicable to elementary school children and others more suited to middle and high school adolescents.
Rapid Assessment, Consultation, and Immediate First Steps
Authors: Kearney Christopher A.
Published: June 2019

Chapter 2 first offers an overview of methods to assess youths with school attendance problems. These methods target youth who are just beginning to refuse school and/or have scattered absences, a few skipped classes, recurrent tardiness, premature departures from school during the day, excessive crying or resistance going to school, and noncompliance regarding school attendance, in addition to more subtle behaviors such as frequent requests to leave class, visits to the school nurse, or escalating distress about attending school. An emphasis is placed on time-sensitive and highly efficient ways to gather substantial information about a youth’s school attendance problems and related variables. Focus is on the crucial interview questions and topics to cover in a short period of time. The discussion also covers consultation and immediate first intervention steps, which co-occur with evaluation in one session in many of these cases.
The Attention-Seeking Elementary School Child
Authors: Kearney Christopher A.
Published: June 2019

Chapter 4 focuses on elementary school children who refuse school primarily due to attention-seeking behavior. Many of these children are not necessarily anxious about school, though separation anxiety could be present, but instead desire to remain home from school to be with a parent or primary caregiver. This chapter includes detailed recommendations for psychoeducation, contingency management, and reintroduction to school, with a focus on parents. Recommendations are made for encouraging parents to supervise attendance more closely, refrain from keeping a child home from school, maintain a regular morning routine for school preparation behaviors, and implement consequences for attendance and nonattendance as appropriate. Core intervention components and procedures to expand the effectiveness of these core components are covered.
An Updated List of Principles of Change That Work
Authors: McAleavey Andrew A. , Xiao Henry , Bernecker Samantha L. , Brunet Hannah , Morrison Nicholas R. , Stein Mickey , Jeong Youn Soo , Castonguay Louis G. , Constantino Michael J. , Beutler Larry E.
Published: June 2019

This chapter presents a list of empirically based principles of therapeutic change that was revised from the one published in this book’s previous volume. The chapter describes the ways in which the original list was modified, and how an extensive review of scientific literature led to the identification of 38 principles clustered into 5 categories: client prognostic principles, treatment/provider moderating principles, client process principles, therapy relationship principles, and therapist intervention principles. This chapter concludes with two appendices. The first is a glossary of terms featured in the list of principles. The second is a list of references that provided empirical support for each principle retained in the list.
Principles of Therapeutic Change in Treating Depression with an Integrative Application of the Cognitive Behavioral Analysis System of Psychotherapy
Authors: Vivian Dina
Published: June 2019

This chapter describes how the author would implement each of the empirically based principles of change identified in Chapter 2, as they specific related to the three cases of depression presented in Chapter 3. The chapter begins with the author’s initial reaction to the list of principles, as well as to the task of describing their implementation in her day-to-day clinical work. Also included in the chapter are the author’s case formulation and treatment for each case, which serve as the general context for the author’s detailed explanation of why and how she would apply the principles in ways that are best attuned to the needs of particular clients. The chapter ends with the description of the author’s thoughts and experience about writing this chapter.
Communication Styles
Authors: Rustici Matt
Published: June 2019

This chapter examines how communication styles can influence how effectively people are able to convey information to others while working in the emergency department. In one model, styles are described as assertive, passive, aggressive, and passive-aggressive, where the assertive style is the most effective. In leadership development models like the Myers-Briggs Type Indicator or the DISC personality instrument, there is no superior style of communication but different personality types may prefer to use specific styles of communication which at times can lead to conflict. Understanding one’s own communication style and the communication styles of others can help a person recognize situations in which his or her preferred style is not working and adapt to improve communication.
EMS Communication
Authors: Barrett Whitney , Fisher Benjamin
Published: June 2019

Communication in emergency medical services (EMS) with the emergency department (ED) is frequently difficult, with many barriers to success. This chapter describes the roles of different providers involved in EMS communication and then divides communication with EMS into 3 phases: online medical direction, prearrival notification, and the in-person EMS-ED handoff. Each of these phases is unique and each has communication pitfalls that can interfere with a successful patient transition to the emergency department. Many of these pitfalls can be avoided simply by awareness that they exist and appreciation of the differing roles each provider plays. All levels of providers who receive prearrival notifications from EMS and EMS-ED handoffs should be familiar with these communication barriers to avoid them.
Interactions With Consultants
Authors: Burkholder Taylor , Buchanan Jennie
Published: June 2019

Clear communication with consultants is essential for safe and efficient patient care in the emergency department, yet many interactions with consultants result in incomplete transfer of information, misunderstandings and conflict. Providers in the emergency department must therefore understand the complexities of communicating with consultants in person, over the phone, or even through novel telemedicine technologies in order to efficiently harness the expertise and services offered by consultants for the ongoing care of their patients. This chapter provides an overview of the key components of communication with consultants, introduces tools for standardizing consults, and offers advice on troubleshooting difficult interactions with consultants.
Electronic Health Records
Authors: Victoroff Michael S.
Published: June 2019

The nature of emergency medicine is to be a transition hub for patients between providers, sites, and episodes of care. A critical safety hazard to EM patients is information loss between these nodes. Communication is information in motion. In emergency medicine, it proceeds at high density, precision, and tempo. A meaningful number of failures in EM care result from gaps in information management. Clinical communications involve myriad channels, which are increasingly electronic and asynchronous, beyond telephones, radios, pagers, and faxes. This chapter explores a range of electronic communication options and applications relevant to emergency medicine, with the objective of identifying benefits and risks to be considered when using health information technology to improve patient safety and care effectiveness.
Media Communication
Authors: Colwell Christopher B.
Published: June 2019

Skillful management of media communications can support strong relationships with the communities we serve as well as provide vital sources for distribution of information. Failing to understand the value of media communications can result in misconceptions and misunderstandings that can be impactful on day-to-day operations and career progress and can have legal implications as well. Often emergency medicine physicians are called upon to speak with the media. This chapter will provide pointers for speaking to the media while remaining HIPAA compliant. It will also discuss the benefits of developing a relationship with the media and why this relationship can be beneficial for all involved.
Email and Social Media
Authors: Jarou Zach , Zuckerman Matt , Taylor Todd
Published: June 2019

Social media is a prevalent part of today’s society. Its main use is for communication. Social media has become ingrained in the daily lives of digital natives. As educators continue to engage their learners, social media has become a tool for education. This chapter examines social media’s role in daily life and how educators are harnessing the power of social media to build connections, enhance education, and further their career. Additionally, this chapter provides information on how to use a wide variety of social media platforms and provides best practices to avoiding violating HIPAA when posting medical content online. Electronic communication between physicians and patients is also explored.
Idiopathic Trigeminal Neuralgia in the Healthy Patient
Authors: Sagher Oren
Published: June 2019

Abstract: Idiopathic trigeminal neuralgia is one of the most common pain syndromes encountered in a typical neurosurgical practice. The approach to these patients is nuanced, and is based on their overall health status, the characteristics of their pain, and the distribution of symptoms. This chapter describes the assessment of a healthy patient with trigeminal neuralgia and provides key differential diagnoses of this pain syndrome. The counseling of the patient regarding treatment options is also described. Finally, the chapter outlines the operative management of a healthy patient using a microvascular decompression (MVD), including surgical pearls and strategies for complication avoidance and management.
Idiopathic Trigeminal Neuralgia in the Elderly
Authors: Raygor Kunal , Lee Anthony , Chang Edward
Published: June 2019

Treatment of trigeminal neuralgia (TN) in the elderly is accomplished using both medical and surgical approaches. Medical therapies are similar to those used in younger patients, but drug-drug interactions are more common in the elderly. Oxcarbazepine is one drug that has fewer side effects due to its bypassing of the cytochrome P-450 metabolic pathway. Surgical options are used for medically refractory TN; the only non-ablative procedure—microvascular decompression (MVD)—provides the most durable pain freedom but may be deferred in patients deemed to be high risk. Both outcomes and complications are similar in young and elderly patients undergoing MVD. In those deemed unsafe for MVD, ablative procedures including stereotactic radiosurgery (SRS) and various percutaneous procedures can be offered. Future studies directly comparing outcomes after MVD and SRS in the elderly with large, prospectively collected databases would help guide management strategies in elderly patients with medically refractory TN.
Secondary Trigeminal Neuralgia (Balloon Compression Rhizolysis)
Authors: Brown Jeffrey A.
Published: June 2019

Multiple sclerosis is a common secondary cause of trigeminal neuropathic pain. It occurs because of the presence of sclerotic plaque within the highly myelinated trigeminal pathway. Patients with multiple sclerosis (MS) may also have a vascular compressive etiology; however, the two-year success rate for microvascular decompression is merely 15%. Ablative treatment also has a high pain recurrence rate that is as high as 50% in one year regardless of the surgical option selected. Balloon compression rhizotomy is a simple treatment option in MS patients. When done, the balloon compression site is at the retrogasserian portion of the trigeminal nerve and not the trigeminal ganglion. Balloon compression is associated with a trigeminal depressor response for which one must be prepared to treat with iv atropine.
Postherpetic Neuralgia
Authors: Rubino Sebastian , Hwang Roy S. , Pilitsis Julie G.
Published: June 2019

Postherpetic neuralgia (PHN) after acute herpes zoster ophthalmicus involves unilateral pain persisting or recurring for at least 3 months in the distribution of one or more branches of the trigeminal nerve. Patients often describe the pain associated with PHN as a deep aching or burning, dysesthetic, hyperesthetic, or electric shock-like sensation. The incidence of PHN increases with age and varies from 7 to 27%, depending on age group.
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A subset of these patients develops medication-refractory PHN and should be referred for neurosurgical evaluation. Motor cortex stimulation (MCS) and trigeminal nucleus caudalis dorsal root entry zone (NC DREZ) lesioning are two therapies that may provide substantial relief to patients suffering from medication-refractory, postherpetic neuropathic facial pain.
Intrathecal Drug Therapy for Painful Vertebral Metastases
Authors: Rubino Sebastian , Sabourin Shelby , Pilitsis Julie G.
Published: June 2019

Vertebral metastases often lead to a complex pain syndrome that consists of both nociceptive and neuropathic pain. Multimodal medical management often includes paracetamol, non-steroidal anti-inflammatory agents, bisphosphonates, opioids, antidepressants, anti-epileptics, and neuroleptics. Surgical treatment to address oncologic burden and spinal instability, radiation therapy, and vertebroplasty or kyphoplasty may be indicated for some patients. However, often times patients with advanced malignancies are not able to safely undergo surgery and have medication-refractory oncologic pain. For these patients and for patients unwilling to undergo large oncologic or spinal stabilization surgeries, intrathecal drug therapy (IDT) serves as a safe and effective adjunct in the management of cancer-related pain.
Cingulotomy for Intractable Pain
Authors: Hunt Patrick J. , Karas Patrick J. , Viswanathan Ashwin , Sheth Sameer A.
Published: June 2019

Chronic pain is a common and often debilitating condition. This pain can be intractable to pharmacologic treatment, thereby necessitating non-pharmacologic approaches. Here we review anterior cingulotomy as a surgical solution to intractable chronic pain, from assessment and planning through the procedure and aftercare. Ablating tissue within the anterior cingulate cortex may allow for the amelioration of the affective aspect of chronic pain. This is especially beneficial to patients with significant psychiatric components to their pain, patients who are unfit for neuromodulatory implants, and patients with terminal diagnoses. Anterior cingulotomy is irreversible and is less commonly used than reversible neuromodulatory approaches. However, anterior cingulotomy remains an important option for patients suffering from intractable chronic pain.
Cervical Spine Trauma
Authors: Read Paul J.
Published: June 2019

Chapter 2 aims to introduce the reader to important concepts relevant to interpreting imaging of the cervical spine after trauma. Cervical spine traumatic injuries are categorized by mechanism of injury, stability, and location. The most common mechanisms of injury in the cervical spine are hyperflexion, hyperextension, and axial compression, and these mechanisms often result in predictable radiographic abnormalities. Injuries can be divided into those that are stable and those that are unstable. In addition, the 3-column model, which divides the spine into anterior, middle, and posterior columns, is described. Pertinent anatomy and imaging strategies will be reviewed followed by a pattern-based review of injuries, typical imaging findings, and standard treatment options.
Sternum Trauma
Authors: O’Keeffe Michael , Khursid Kiran , Munk Peter L. , Taljanovic Mihra S.
Published: June 2019

Chapter 7 provides an overall look at sternum fracture. The sternum is a flat bone at the anterior center of the chest, which protects the mediastinum. The sternum along with the ribs and vertebrae form the thoracic cage, which protects the thoracic organs and vessels. Fractures are usually associated with direct blunt trauma which most commonly occurs during motor vehicle accidents or from vigorous cardiopulmonary resuscitation. Significant mortality may be associated with displaced sternal fractures because of aortic, cardiac, or pulmonary injury. CT examination has surpassed radiographs in the assessment of sternal fractures and adds identification of secondary findings. It has superior sensitivity to radiography and is valuable in diagnosing serious associated injuries.
Radius and Ulna Trauma
Authors: O’Keeffe Michael , Khursid Kiran , Munk Peter L. , Taljanovic Mihra S.
Published: June 2019

Chapter 15 discusses radius and ulna trauma. Forearm fractures are common and may be isolated to the ulna or more commonly involve both bones. Fractures of the radius or ulna are usually because of direct trauma and are often displaced. Depending on their complexity, isolated fractures of the ulnar diaphysis may be treated nonoperatively or operatively whereas both bone (radius and ulna) diaphyseal fractures are typically treated operatively. Galeazzi fracture-dislocations are comprised of radial diaphyseal fractures in association with distal radioulnar joint (DRUJ) dislocation/subluxation. Monteggia fracture-dislocations are comprised of a proximal ulnar fracture in association with radial head dislocation. In type IV Monteggia injuries, there is an additional fracture of the proximal radial diaphysis. Essex-Lopresti fracture-dislocations include radial head fractures in association with DRUJ dislocation/subluxation.
Femur Trauma
Authors: Mar Winnie A. , Chadaz Tyson S.
Published: June 2019

Chapter 20 discusses femur trauma and reviews the mechanism of injury and clinical features, imaging strategy, imaging characteristics, and classification and treatment options. Subtrochanteric, femoral shaft, and distal femoral fractures are discussed. Subtrochanteric fractures are usually high-energy fractures, but are also seen in osteoporotic patients after low-energy trauma and those on bisphosphonate treatment. Distal femoral fractures may be supracondylar, intercondylar, or condylar. Femoral shaft fractures may be associated with life-threatening trauma elsewhere. Atypical femoral fractures are briefly reviewed. Intraarticular extension of distal femoral fractures is important to note as this will affect management. Evaluation of femoral fractures begins with anterior-posterior (AP) and lateral radiographs of the femur.
Knee Trauma
Authors: Mar Winnie A. , Chadaz Tyson S.
Published: June 2019

Chapter 21 reviews the mechanism of injury and clinical features, imaging strategy, imaging characteristics, and treatment options of knee trauma, including tibial plateau fractures with description of the Schatzker classification, knee dislocation, patellar fractures, and avulsion fractures about the knee. Associated vascular injury with knee dislocation and certain tibial plateau fractures are also discussed. Concomitant ligamentous and meniscal injuries associated with avulsion fractures are described. Oblique radiographs are helpful for detecting tibial plateau fractures. CT is useful in quantifying the degree of depression in tibial plateau fractures. Certain avulsion fractures and signs about the knee are often associated with significant ligamentous injury and should be evaluated with MRI.
Tibia and Fibula Trauma
Authors: Mar Winnie A. , Chadaz Tyson S.
Published: June 2019

Chapter 22 reviews the mechanism of injury and clinical features, imaging strategy, imaging characteristics, and treatment options of tibia and fibula trauma including tibial shaft fractures and fibular fractures. Because tibial shaft fractures are common with potential complications, associated complications including infection, compartment syndrome, and delayed union are discussed. The ankle should be closely evaluated when an isolated fibular fracture is found. Imaging should begin with anterior-posterior (AP) and lateral radiographs of the entire tibia and fibula. Additional radiographs of the pelvis, femur, knee, and ankle may be obtained as additional fractures may be present. Treatment is usually with intramedullary nail, plate, or external fixation and casting for low-energy fractures without significant displacement.
Ankle Trauma
Authors: Parasu Pavan , Mar Winnie A.
Published: June 2019

Chapter 23 reviews the mechanism of injury and clinical features, imaging strategy, imaging characteristics and classification and treatment options of ankle fractures. The Lauge-Hansen and Weber classifications for malleolar fractures are described. The Lauge-Hansen classification of ankle fractures is based on the mechanism of injury. Weber classification of ankle fractures is based on the fibular fracture location relative to the ankle mortise. Pilon, Maisonneuve, and osteochondral fractures are also discussed. Ankle injuries are first evaluated with radiographs. CT examination is helpful in preoperative planning for distal tibial Pilon fractures, which are generally underestimated radiographically. MRI may be useful in determining associated ligamentous injury.