bluuebunny/crossref_metadata_2025 huggingface dataset:
Consequences of Professional Burnout
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Work environments and interpersonal relationships often merge, eroding the passion and altruism of health care professionals and promoting burnout. Burnout of health care professionals negatively impacts safety, team effectiveness, staff turnover, professional productivity, organizational effectiveness, and organizational brand. Professionals also experience personal consequences from burnout including higher rates of relationship issues, alcohol and substance abuse, clinical depression, and suicide. Even more important, however, burnout has a profound, negative bearing on patient experience and outcomes.
Quality Shortfalls From Health Care Waste: A Unifying Root Cause of Burnout
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

The current health care delivery system is perfectly designed to create high rates of professional burnout in physicians, nurses, advanced practice providers, and other health care professionals. In most organizations, a gap exists between the quality of care professionals aspire to deliver and the quality of care actually delivered, which creates burnout. Poor quality health care is fundamentally about waste, and leaders in the health care industry have primary accountability and responsibility for system waste. The following are five categories of waste in health care: Failures of care delivery and care coordination, overtreatment, administrative complexity, pricing failures, and fraud and abuse.
The Blueprint for Cultivating Esprit de Corps
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

The Blueprint is an evidence-based framework for cultivating esprit de corps in an organization. It is grounded on a moral imperative and a business case, which is necessary to gain the support of senior leadership. The framework is aligned with the best interests of patients, health care professionals, and mission-driven organizations. From a systems perspective, the goal is to increase structural and functional sources of positivity and decrease structural and functional sources of negativity in the work environment. The imperative to improve clinician esprit de corps is a shared responsibility. Achieving it requires individuals and leaders across the organization working together to create the ideal work environment.
Ideal Work Elements
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Organizations that develop the eight Ideal Work Elements (community at work and camaraderie, intrinsic motivation and rewards, control and flexibility, fairness and equity, professional development and mentorship, partnership, safety, and trust and respect) produce meaning and purpose in work, promote engagement and discretionary effort, and cultivate esprit de corps. Such organizations flourish because they have professional staffs who come to work with passion and who do not limit their work to what is in their job description. They do whatever is necessary to support each other and to get the job done.
Assessment
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

The most important determinant of value in a health care organization is an intangible asset called social capital. Social capital comprises the talent, knowledge, goodwill, trust, skill, and interconnectedness of people. Social capital is a critical characteristic of organizations and the ingredient that allows people to work together for a common purpose. Organizations need objective data to understand the experience and well-being of their health care professionals. A baseline measurement is necessary to assess the current state and to evaluate progress toward an ideal future state. Objective measures of the efficiency of the practice environment can also serve as improvement targets and often provide continuous real time data on progress without burdening staff with repeated surveys.
The Three Action Sets of the Intervention Triad: Evidence-based Strategies for Reducing Burnout and Promoting Esprit de Corps
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Experience and research show that the evidence-based Action Sets of the Intervention Triad (Agency, Coherence, and Camaraderie) are an effective means to reduce burnout and cultivate professional fulfillment. They transform individual behavior and organizational culture to provide the Ideal Work Elements and mitigate the drivers of burnout. Addressing burnout and promoting esprit de corps are a shared responsibility. The actions are focused on what individuals, work unit leaders, and organizational leaders can refine within their spheres of influence.
Agency Ideal Work Element: Partnership
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Partnerships are an inherent attribute of esprit de corps, and partnership is one of the three Ideal Work Elements fostered by Agency actions. Partners have a shared vision, invest discretionary effort, and look to accomplish a vision together. Health care professionals should be treated as partners, never as employees. In a partnership market arrangement, the culture is intentionally one of collaboration and cooperation; cultures have high levels of social capital because they function with higher levels of trust and interconnectedness. Physicians are hired, selected, and developed so that their behaviors and actions are aligned with the mission strategy and vision of the organization. Physicians are more likely to feel as though they are an important part of the organization, and they are dedicated and work together to promote the organization’s mission.
Agency Ideal Work Element: Trust and Respect
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Health care professionals need to feel trusted by the leaders of their organization. Micromanagement and unnecessary adherence to process without justification are the antithesis of trust and respect. Without trust and the supportive, respectful environment it creates, health care professionals will be less likely to do their best or be invested in the organizational mission. Organizations build trust and respect by making every attempt to treat all staff fairly. All team members must work together to make sure an inclusive and respectful work environment is created and maintained.
Agency Ideal Work Element: Control and Flexibility
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Control and flexibility are strong moderators of work pressures and an important work element to balance. Control gives health care professionals permission to change their work lives, and flexibility gives them the capacity to manage the circumstances of their work lives. Health care professionals function optimally when they have greater ability to determine when they work, how they work, where they work, and how much they work. The ideal is a balance of personal control and flexibility coupled with standard processes and work flows that maximize patient safety and organizational efficiency.
Agency Action: Measuring Leader Behaviors
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

The most effective leaders concentrate more on their organization and its people than on themselves. They know that, collectively, the leadership team has greater wisdom than they do individually and that they will perform at a higher level if they draw on the expertise of the team. Good leaders treat everyone with respect and nurture a culture where all are welcome and are psychologically safe. They also transparently share what they know with the team and consistently solicit input of those they lead (participatory management. Good leaders nurture and support the professional development and aspirations of staff and express appreciation and gratitude in an authentic way to those they lead. The most successful organizations select and develop leaders for these behaviors.
Agency Action: Introducing Control and Flexibility
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

There is a healthy tension between standard work, which is controlled, and flexible work. Standardization of processes that improve quality and safety is good for patients. Flexible work in other areas is good for employees’ mental and physical health. Executed properly, standard and flexible work can be complementary. In a collaborative environment, leaders and organizations create increased flexibility for health care professionals when they focus more on outcomes than on specific processes. How decisions are made at all levels of the organization substantially determines the degree of control and flexibility in the workplace.
Agency Action: Creating a Values Alignment Compact
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Values alignment forms a powerful bond between individuals and an organization—one that cultivates meaning and purpose in work. Values alignment is central to well-being, mitigates burnout, and promotes esprit de corps. The Values Alignment Compact clarifies roles: what clinicians expect from their organization and what their organization expects in return. The process of developing a compact is a dialogue that nurtures the culture of “interdependency” of leadership (administration) and health care professionals.
Coherence Ideal Work Element: Fairness and Equity
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Fairness and equity are important elements of the ideal work environment. Health care professionals need transparency in all matters that make sense including the way pay, privileges, and work schedules are determined. This Ideal Work Element also requires fair and just accountability to provide support when clinicians experience a traumatic patient adverse care event.
Coherence Ideal Work Element: Safety
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Physical and psychological safety are important elements of the ideal work environment for health care professionals. Health care organizations should regularly assess both types of safety in their clinical work environments and mitigate factors that erode these qualities. Improving physical and psychological safety is central to creating Coherence and must be embedded into the leadership and organization infrastructure.
Coherence Action: Selecting and Developing Leaders
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Leader Selection and Development is the first of four actions designed to create Coherence and cultivate the three Ideal Work Elements just presented. Selecting and developing leaders with team-driven, psychologically safe, consensus-building skills is an evidence-based and validated action in the Coherence Action Set that will combat professional burnout and promote esprit de corps
Coherence Action: Establishing Fair and Just Accountability
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Instilling principles of fair and just accountability into the work culture enhance Coherence, which cultivates work elements necessary for combating professional burnout and creating esprit de corps. Health care professionals must feel that they and their co-workers are supported and being treated fairly and consistently. When a culture of fair and just accountability is suboptimal, health care professionals feel socially isolated and stressed, and patient harm events increase, as does the risk of burnout.
Coherence Action: Forming Safe Havens
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Creating safe haven for health care professionals experiencing occupational stress helps to create the coherence necessary for esprit de corps. Safe haven and a supportive team culture should mitigate the negative effects of occupational stress and create a refuge for health care professionals involved in adverse patient care events.
Camaraderie Action Set: Introduction
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Camaraderie is the loyalty, social capital, mutual respect, teamwork, and boundarylessness that organizations need to thrive. There is social connectedness inherent in camaraderie and it is inextricably linked with the meaning and purpose, intrinsic motivation, and personal relationships that health care professionals find in work.
Camaraderie Action: Cultivating Community and Commensality
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Cultivating Community and Commensality, the first of three Camaraderie Actions, builds space for colleagues to connect and support each other on a deeper level than afforded in day-to-day work. When an organization supports commensality, the return on investment is high: a greater sense of community that enhances professional fulfillment, reduces burnout, and promotes esprit de corps.
Camaraderie Action: Optimizing Rewards, Recognition, and Appreciation
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

The second Camaraderie Action is Optimizing Rewards, Recognition, and Appreciation. It connects with and fuels intrinsic motivation and also influences community and collegiality. Embracing compensation and acknowledgment systems based on intrinsic motivators is part of the foundation for cultivating esprit de corps.
Camaraderie Action: Fostering Boundarylessness
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Boundarylessness practices demonstrate humility, respect for all, and the power of teamwork. Organizations that foster boundarylessness can help to create esprit de corps. Leaders play a central role in modeling and facilitating engagement and connectedness across boundaries.
Applying the Action Sets to Address the Unique Needs of Medical Students, Residents, and Fellows
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Although medical students, residents, and fellows have some drivers of professional distress that differ from those of practicing clinicians, the themes of Agency, Coherence, and Camaraderie are equally relevant. As described, actions in the Intervention Triad can be adapted and used as a framework to decrease burnout and promote esprit de corps among trainees as part of a comprehensive educational program initiative to address unique needs of the target group.
Summary
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

We have presented an organizational framework and tactics that leaders and health care professionals can deploy to reduce professional burnout and cultivate esprit de corps. The three Action Sets of the Intervention Triad presented include tactics that help co-create fulfilling jobs for health care professionals. Collectively, the Actions promote Agency, Coherence, and Camaraderie and are integral to the comprehensive Blueprint—to cultivate the Ideal Work Elements, address the drivers of professional burnout, and nurture esprit de corps.
The Public Psychiatrist in History
Authors: Baker Sarah E. , Fletcher Erica Hua
Published: March 2020

Just as the patient’s history is important to understanding his or her current situation, an understanding of the social, economic, and political forces that have shaped public psychiatry can offer insight into the public psychiatrist’s contemporary role in the United States. This chapter reviews the many historical factors that shaped the field’s development and that continue to motivate system transformation within public psychiatry today. It explores psychiatry’s shifting understanding of mental illness and treatment, alongside the rise and fall of the asylum movement and the evolution of outpatient psychiatry in the early 20th century and beyond. Then, it describes national legislation that led to the deinstitutionalization movement, the fragmentation of social services in the 1980s and 1990s, and the efforts of patient advocates that resulted in public psychiatry’s adoption of recovery-oriented services under the George W. Bush administration. Last, this chapter provides context to mental health parity laws under the Affordable Care Act.
The Public Psychiatrist as Clinical Team Member
Authors: Trust Ashley , Baker James G.
Published: March 2020

Patients served in community mental health settings often have multiple psychiatric, physical health care, and psychosocial needs. Because of this complexity, clinical care by a multidisciplinary team is required. This chapter describes team member responsibilities and the role of the community psychiatrist within the various treatment team structures that community psychiatrist might encounter. Contemporary treatment planning, including wraparound services, the resiliency/strengths model, use of peer services, and cultural competency, is described. In contemporary community psychiatry, the patient is an integral part of the team, and so person-directed treatment planning is discussed as well as the recovery movement and its implications for psychiatry. The chapter discusses how to foster cross-discipline collaboration and describes the importance of systemic thinking and approaches to patient care. Examples of the treatment team process are provided.
The Public Psychiatrist and Integrated Health
Authors: Winston Helena , Lowdermilk Elizabeth
Published: March 2020

This chapter provides a brief introduction to the role of integrated mental health care in improving access to care. It outlines some of the major models of integrated care, including the collaborative care model and the primary care behavioral health model, focusing on commonalties and differences in the models and considerations that drive the choice among models or their adaptation. It then describes ways in which integrated care psychiatrists may serve in clinics, including ways in which they can best use their expertise to expand psychiatric care access to more people. Special situations and specialty clinics are briefly described. Finally, the personal characteristics of psychiatrists considering a career in integrated care are reviewed.
The Public Psychiatrist as Researcher
Authors: Rakesh Gopalkumar , Swartz Marvin
Published: March 2020

Most psychiatrists undergo 4 years of residency training after medical school before being eligible to practice independently. Apart from basic training in biostatistics and exposure to research methodology in a few training programs, most trainees spend their training primarily taking care of patients. As attending, most psychiatrists have little time for research. However, psychiatrists in the community offer an important resource for clinical trials. Collaborating with a pharmaceutical company or university hospitals requires an understanding of basic concepts in biostatistics and interpretation of study results. This chapter is intended to empower community psychiatrists in research collaborations. In addition to a statistics refresher, the chapter elucidates the history, terminology, and methodological nuances of clinical trial design. It discusses how to address ethical concerns and fulfill ethical requirements for initiating research studies. Finally, it describes notable clinical trials in psychiatry, how community-based centers can be a valuable research resource, and how technology can complement these endeavors in the community.
Fundamentals of HIV Medicine 2019
Authors: American Academy of HIV Medicine
Published: March 2020

Oxford University Press is a department of the University of Oxford. It furthers

the University’s objective of excellence in research, scholarship, and education...
Epidemiology and the Spread of HIV
Authors: Bolduc Philip , Alfred Benjamin , Onabanjo Babafemi
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Provide an overview of the global AIDS pandemic and the US epidemic

• Demonstrate and apply knowledge about the evolving epidemiology of HIV to both individual and population-wide aspects of clinical practice

•...
Mechanisms of HIV Transmission
Authors: Nambiar Puja , Short William R.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Describe the relative risk of acquiring HIV infection based on various types of sexual activity, occupational exposures, drug use, and vertical transmission

• Discuss the significance of viral load quantity and its relationship to transmission risk...
HIV Cure Strategies
Authors: Juelg Boris , Gandhi Rajesh
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Identify key hurdles for HIV eradication strategies and explain how the “Kick and Kill” approaches might overcome these challenges.

Identify key hurdles for HIV eradication strategies and explain how the “Kick and Kill” approaches might overcome these challenges....
HIV Testing and Counseling
Authors: Delgado Alejandro , You Hojoon
Published: March 2020

Upon completion of this chapter, the reader should be able to

• List and describe the types of HIV testing.

• Present an overview of HIV counseling, as well as how to adapt counseling to the variety of situations or environments in which these conversations can take place....
Laboratory Testing Strategies Detection and Diagnosis
Authors: Meisner Jessica A. , Alby Kevin
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Understand the various laboratory testing methods used for screening and diagnosis of HIV infections.

• Explain how available immunoassays can be used for screening and diagnosing most early and primary HIV infections.

•...
The Medical History and Physical Examination of the Patient with HIV
Authors: Schlecht Hans P. , Skiest Daniel J.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Describe key elements of the HIV-oriented history and physical.

Describe key elements of the HIV-oriented history and physical.

This chapter discusses additional questions to pose in the history-taking of patients infected with HIV....
Initial Laboratory Evaluation and Risk Stratification of the Patient with HIV
Authors: Schlecht Hans P. , Skiest Daniel J.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• describe the core baseline laboratory evaluation of the recently diagnosed HIV-infected patient.

• Describe the core baseline laboratory evaluation of the recently diagnosed HIV-infected patient.

Baseline resistance testing is indicated, but integrase resistance is not indicated as it is remains rare....
Recognition of Acute and Advanced HIV Infection
Authors: Schlecht Hans P. , Skiest Daniel J.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Describe the syndrome complexes of acute (primary) and chronic HIV infection, including HIV wasting syndrome.

Describe the syndrome complexes of acute (primary) and chronic HIV infection, including HIV wasting syndrome.
Health Maintenance
Authors: Appelbaum Jonathan , Haas Michelle K. , Brendemuhl Christopher , Baker Jason V. , Speights Anthony C.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Describe tuberculosis screening indications (including exposure history) and assessment methods (including selection, interpretation, and limitations of screening tests in HIV-infected patients).

• Discuss the importance of routine dental care for HIV-infected patients and essential information to be included in the treating physician’s written referral....
Issues in Specific Patient Populations
Authors: Spinner Gary F. , Church Joseph A. , Arrington-Sanders Renata , Sangarlangkarn Aroonsiri , DenOuden Paul W. , Deutsch Madeline B. , Wlodarczyk Daniel , Zevin Barry , Prosser Rachel A. , Dahya Vishal
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Provide an understanding of the diversity of patients with HIV, the complexity of their unique cultures that are shaped by a multitude of factors, and the importance of becoming competent in developing a clinician–patient relationship across cultural differences....
HIV Care Coordination
Authors: Long Sally Spencer , Skiest Daniel J.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Demonstrate knowledge and practice of interdisciplinary care coordination in HIV patient care.

Describe the importance of an interdisciplinary team approach to the optimal management of the patient with HIV.
The Pharmacist’s Role in Caring for HIV-Positive Individuals
Authors: Cocohoba Jennifer
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Understand how a pharmacist might be incorporated into a healthcare team that is caring for persons living with HIV

• Discuss medication-related issues for which it would be optimal for an HIV to provide expert consultation on....
The Role of the Physician Assistant and the Nurse Practitioner in Caring for Persons Living with HIV
Authors: Deckard D. Trew
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Understand the contributions of Physician Assistants and Nurse Practitioners in HIV/AIDS care since the beginning of the epidemic through today.

• Realize the body of research, clinical applications, and treatment advancements made by Nurse Practitioners and Physician Assistants....
Hospice and Palliative Care in Advanced HIV Disease
Authors: DenOuden Paul W.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Demonstrate knowledge about both hospice and palliative care options in the context of end-stage HIV disease.

• Know when each option may be best appropriate.

• Optimally counsel and educate patients and their families in an effective, professional, and sensitive manner....
HIV Virology
Authors: Livingston Schuyler , Markowitz Martin , Wright William , Young Benjamin , Mathur Poonam , Gilliam Bruce L.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Demonstrate and apply knowledge about established and evolving science describing HIV virology, both in the cell and in the host.

• Effectively counsel and educate patients and their communities regarding HIV treatment.
Principles of Applied Clinical Pharmacokinetics and Pharmacodynamics in Antiretroviral Therapy
Authors: Pandit Neha Sheth , Heil Emily L.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Understand the basic principles of applied pharmacokinetics and pharmacodynamics of antiretroviral agents, and apply this knowledge to improve individual patient treatment regimens.

Understanding the basic principles of applied clinical pharmacokinetics and pharmacodynamics can help the clinician gain insight into contemporary HIV pharmacotherapy and improve therapeutic responses. This information can be used to improve antiretroviral (ARV) treatment for the individual patient by gaining a fundamental working knowledge of concepts that contribute to the occurrence of drug–drug interactions (DDIs), adverse drug reactions, poor adherence, decreased efficacy, and the selection of viral resistance. These factors, alone or in combination, can lead to treatment failure of antiretroviral therapy (ART) and subsequent progression of HIV disease. This chapter discusses some of the applied clinical pharmacokinetic and pharmacodynamic principles that relate to the treatment of HIV....
HIV-1 Resistance to Antiretroviral Drugs
Authors: Bininashvili Tamara , Doperalski Quentin , Nassar Naiel
Published: March 2020

Discuss the different HIV drug resistance mutations and cross-resistance patterns in each class of HIV medication.

In recent years, newer HIV medications have been introduced, and several studies have identified resistance mutations associated with the newer medications.

• Previous exposure to antiretroviral (ARV) medications has a significant role in the development of drug resistance, especially in patients who are noncompliant with medications....
Managing the Patient with Multidrug-Resistant HIV
Authors: Doperalski Quentin , Bininashvili Tamara , Nassar Naiel
Published: March 2020

During the past 15 years, HIV infection has been transformed into a chronic, manageable disease primarily due to the effectiveness of antiretroviral therapy (ART). Well-tolerated, potent combination ART with simpler dosing schedules has led to a reduction in the rates of virologic failure and the proportion of patients harboring multidrug-resistant HIV....
Antiretroviral Therapy in Pregnant Women
Authors: Short William R. , Schafer Jason J.
Published: March 2020

Upon completion of this chapter, the reader should be able to describe the appropriate management of antiretrovirals for pregnant women living with HIV.

Over time, research has demonstrated that proper prevention strategies and interventions during pregnancy, labor, and delivery can significantly reduce the rate of mother-to-child transmission (MTCT) of HIV. In 1994, a pivotal study in the field of HIV medicine, the Pediatric AIDS Clinical Trials Group 076, demonstrated that the use of zidovudine (ZDV) monotherapy during pregnancy substantially reduced the risk of HIV transmission to infants by 67% (...
Antiretroviral Therapy for Children and Newborns
Authors: Nielsen-Saines Karin
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Understand the basics regarding pathogenesis of mother to child HIV transmission (MTCT) and be aware of landmark studies targeting prevention of HIV mother to child transmission (PMTCT).

• Understand the concept of HIV-exposure versus HIV-infection....
Immunosuppressants and Antiretroviral Therapy in HIV-Positive Transplant Patients
Authors: Kramer Carolyn , Blumberg Emily
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Explain the key drug-drug interactions between immunosuppressive agents and HIV antiretroviral therapy.

• Describe the expected effect of administration of protease inhibitors on drug levels and need for monitoring of immunosuppressive agents.

•...
Understanding and Managing Antineoplastic and Antiretroviral Therapy
Authors: Schafer Jason J. , Sherman Elizabeth M. , Gill Taylor K. , Birney Jatandra
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Identify contemporary challenges and describe strategies in managing antineoplastic and antiretroviral therapy in patients with cancer and HIV infection.

In 2010, more than 7,500 of the estimated 1.1 million people living with HIV (PLWH) in the United States were diagnosed with cancer (National Comprehensive Cancer Network [NCCN] Guidelines, 2018). The incidence is approximately 50% greater than the incidence of cancer expected in the general population. The elevated risk of cancer in PLWH is likely multifactorial and due to underlying immune deficiency, coinfection with oncogenic viruses, and a higher prevalence of other cancer-related risk factors such as the use of tobacco products....
Substance Abuse in HIV Populations
Authors: David Elizabeth , Casas John P. , Wilkins Rakel Beall
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Discuss issues, implications, diagnosis, and treatment of substance abuse in HIV-positive individuals.

The prevalence of substance use in HIV-positive individuals is high, with rates of abuse/dependence much greater than those in the normal population. These substances include alcohol, opioids, cocaine/crack, methamphetamine, MDMA (“ecstasy” or “molly”), benzodiazepines, marijuana, ketamine, ...
Understanding the Use of Antiretrovirals in the Aging Patient
Authors: Samson Brandon H. , Scott James D.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Discuss the course of HIV disease in people >50 years of age.

• List treatment concerns that are of greater concern in older people with HIV.

• Discuss the outcomes of clinical trials focused on older people with HIV....
Opportunistic Infections
Authors: Armitige Lisa , Vigil Karen J.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Recognize and manage the most common opportunistic infections found in persons infected with HIV.

• Describe the issues concerning starting ART in the setting of an opportunistic infection.

• Summarize the recommendations for starting ART in the setting of an opportunistic infection....
Malignancies in HIV
Authors: Clark Eva , Chiao Elizabeth
Published: March 2020

• Review the epidemiology and role of antiretroviral therapy (ART) on the impact of AIDS-defining malignancies, which remain common among individuals with HIV.

• Discuss the role of human herpes virus-8 (HHV-8) in the development of Kaposi’s sarcoma (KS), which remains the most common tumor associated with HIV infection....
Dermatologic Complications
Authors: Mutyambizi Kudakwashe
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Review the dermatologic complications of HIV infection and treatment.

Review the approach to skin findings in the context of HIV.

Multiple biopsies increase diagnostic yield for identification of cutaneous complications of HIV....
Endocrine and Metabolic Disorders
Authors: Sekhar Rajagopal V.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Understand the endocrine and metabolic complications affetecting HIV infected patients, and clinical management of these complications.

• After reading this chapter, the reader should understand the mechanism and clinical management of endocrine and metabolic diseases in HIV-positive patients....
Nonopportunistic Infections
Authors: Vigil Karen J.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Demonstrate knowledge regarding the diagnosis and treatment of respiratory complications in patients living with HIV infection.

Review and characterize the respiratory complications related to HIV infection to provide early and accurate diagnosis and treatment....
Neurological Effects of HIV Infection
Authors: Hasbun Rodrigo , Dunham Richard , Das Rituparna , Nunez-Wallace Karen , Sharp Lydia J. , Kung Doris , Kass Joseph S.
Published: March 2020

Discuss the clinical features, differential diagnosis, and management of HIV-associated neurocognitive disorders.

• CD8+ T cell encephalitis has been described as a severe form of HIV-associated neurocognitive disorder (HAND).

• The central nervous system (CNS) penetration effectiveness score has been correlated with cerebrospinal fluid (CSF) viral escape....
Ocular Complications
Authors: Dunn James P.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Describe the symptoms and signs of cytomegalovirus (CMV) retinitis in patients with AIDS.

• Describe treatment options for CMV retinitis and the need for systemic therapy whenever possible.

• Identify risk factors, clinical findings, and treatment of immune recovery uveitis....
Renal Complications
Authors: Menez Steven , Fine Derek M. , Waheed Sana
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Recognize the increasing prevalence of renal disease in HIV-positive patients, the broad spectrum of pathologic involvement including medication-induced renal injury, and potential future targets of interventions in HIV-related renal disease.

Discuss the epidemiology, risk factors, broad pathologic spectrum, and current therapeutic interventions for HIV-related renal disease....
Body Composition Changes, Frailty, and Musculoskeletal Complications of HIV
Authors: Willig Amanda L. , Overton Edgar T.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Discuss changing epidemiology in HIV from wasting to obesity, the concepts of frailty and sarcopenia, as well as other musculoskeletal consequences of HIV infection.

With the advancement of HIV therapies, HIV infection has become a mangeable chronic illness with a distinct change in the metabolic manifesations from a wasting disease to a disease of obesity and its complications. Here, we review the changing epidemiology of metabolic disease associated with HIV and potential interventions to mitigate these metabolic derangements....
Sexually Transmitted Diseases
Authors: Vigil Karen J.
Published: March 2020

Upon completion of this chapter, the reader should be able to demonstrate knowledge regarding the diagnosis and treatment of most prevalent sexual transmitted diseases in patients living with HIV infection, in order to decrease rate of transmission.

Sexually transmitted diseases (STDs) are common in PLWH. Education and counseling on changes in sexual behaviors of patients with STDs and their sexual partners, identification of asymptomatically infection, and effective diagnosis and treatment form the cornerstone for prevention....
HIV and Bone Health
Authors: Overton Edgar Turner
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Familiar with the concept that metabolic bone disease is a common manifestation of HIV infection leading to an increased risk of fracture.

• The reader should also recognize key risk factors for metabolic bone disease and strategies to mitigate this risk....
Immune Reconstitution Inflammatory Syndrome (IRIS)
Authors: Coppock Dagan , Short William R.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Understand the epidemiology of IRIS and its associated opportunistic infections.

• Recognize the timing considerations regarding opportunistic infection treatment and antiretroviral therapy intiation as related to the risk for IRIS.

• Understand the management approaches to IRIS, based upon its presentation and the underlying opportunistic infection....
US Healthcare Systems, HIV Programs, and Coverage Policy Issues
Authors: Forbes Anna , Packett II Bruce J.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Broadly understand the landscape of the US healthcare systems and payers as they relate to the provision of HIV care, treatment, prevention and medical coding.

HIV-related healthcare services have historically been covered or provided by a patchwork of federal, state, and local programs, such as Medicare, Medicaid, the Ryan White Program, and state and local health programs. HIV/AIDS service organizations (H/ASOs) and private and charitable health organizations also provided services for HIV patients without coverage. These programs represent the long-standing pathways to insurance coverage, access to care, and access to treatment for people living with HIV (PLWH). Some of these programs also supply coverage for, or access to, medications that treat co-occurring conditions for PLWH....
Legal Issues
Authors: Schouten Jeffrey T.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Demonstrate knowledge about legal issues surrounding HIV health care and to interact more effectively, professionally, and sensitively with patients and their families.

Discuss the Centers for Disease Control and Prevention’s (CDC) recommendations for routine HIV testing in various health care settings....
Ethical Conduct of Clinical Trials, Institutional Review Boards, Informed Consent, and Financial Conflicts of Interest
Authors: Ramers Christian B.
Published: March 2020

Describe the essential components of the ethical conduct of research, the role of the institutional review board, the process of informed consent, the potential areas of conflict of interest for clinicians participating in research, and other ethical issues related to research in HIV medicine.
Other People Die
Authors: Adams Peter J.
Published: March 2020

This chapter, outlines the extent to which the deaths of other people, particularly loved ones, constantly surround us and at times intrude in significant ways into our lives. It begins by summarizing the ways that, throughout childhood, we develop a conceptual understanding of the physical reality of death in terms of inevitability, universality, and causality. It then explores how our appreciation of personal mortality continues to develop through adolescence, adulthood, middle age, old age, and then into end-of-life phases. While our understanding of other people’s deaths informs how we view our own death, the chapter finishes by arguing that the nature of other people’s death is different from our own.
My-Death
Authors: Adams Peter J.
Published: March 2020

This chapter begins by exploring the various ways that we use features of other people’s death to make sense of my-death. This includes beliefs in various forms of life after death, projecting our experience into the minds of those who are dying, and constructing a sense of living on in some form of afterlife. It then shifts to looking critically at the appropriateness of transposing other-death onto my-death and concludes that these two aspects are very different. The chapter then moves to considering other ways of looking at my-death which do not rely on other-death and focuses specifically on understandings of my-death as total annihilation.
Limits of Intelligibility
Authors: Adams Peter J.
Published: March 2020

This chapter examines reasons for why my-death is so difficult to think or talk about and also explores how we find our own death such an uneasy and, at times, disturbing topic. The discussion starts by exploring the idea of my-death as total annihilation but moves on to questioning even this formulation because conceptions of annihilation still draw on concepts of continuation that provide a backdrop for what is being annihilated. In its fullest sense, once my-death is separated from understandings derived from other-death, there is very little that can be thought or talked about.
Aversion and Evasion
Authors: Adams Peter J.
Published: March 2020

This chapter summarizes the literature on personal fears of death and examines the various common ways in which thinking about death is avoided. Fear of death has been a recurring theme in novels, plays, and poems, as well as in social and psychological research. Responses to this fear can vary from ongoing anxiety, to active evasion, and sometimes to adopting a sense of strategic immortality. This chapter teases out the various forms of fear associated with death, including fear of dying, fear of other-death, and fear of annihilation. It focuses particularly on a common engagement with a sense of immortality, then looks at moments when this pretense of immortality is challenged.
Essential Structures
Authors: Adams Peter J.
Published: March 2020

This chapter provides the first example of an enabling frame and draws on Martin Heidegger’s seminal work on personal mortality in his writings on the concepts of Being, time and finitude. The discussion focuses particularly on his interpretation of personal mortality, or being-toward-death, as an integral part of what structures individual existence. As such, talk about existence after death becomes nonsensical because death is tightly bound to what it means to be alive. The discussion also introduces Heidegger’s understanding of finitude and its relationship to my-death. His concept of finitude will be developed in a different way in the next chapter.
Passionate Suffusion
Authors: Adams Peter J.
Published: March 2020

This chapter provides the second example of an enabling frame that focuses on a different and more intimate embrace with my-death as it manifests itself in everyday markers of finitude. Finitude has emerged as a catch-all concept referring to the many ways in which individual existence is bounded and constrained by its position in time and place, by its embodiment, and by being constrained by character and perspective. This frame shares the view of the previous frame, which approaches death as intrinsic to life, but it shifts this to a far more emotional and intuitive form of connection. It explores the different ways in everyday life that we encounter the many aspects of our finitude and how this provides the basis for staying connected with my-death.
What’s to Gain?
Authors: Adams Peter J.
Published: March 2020

This chapter’s discussion builds on the previous chapter in exploring in more detail three positive advantages of my-death awareness: first, in the way it enhances one’s quality of life; second, in the way it prompts re-evaluation of life values and objectives; and, third, in the way engagement with my-death during life helps prepare the individual for its role at the end of life. The chapter also explores a vibrant area of psychological research, “terror management theory,” in which existential fears of death contribute in negative and positive ways to broader attitudes and beliefs.
Conclusion
Authors: Adams Peter J.
Published: March 2020

This chapter briefly summarizes the intent of the book as to seek out ways to engage on an ongoing basis with my-death and what it means for daily life. It finishes the book by thanking the four companions in the form of one final farewell conversation.
What does it mean to have a stroke?
Authors: Newell Ossie
Published: March 2020

‘What does it mean to have a stroke’ is the first chapter of the book. It is written by a ‘Stroke Conqueror’, someone who suffered a stroke more than 20 years ago and is now attempting to impart a little of the flavour, drama, and trauma a stroke event brings, not only to the person suffering the stroke, but also to everyone in that persons family and beyond. Nothing is ever the same again, stroke is for life. The fundamental issue is that everyone on this planet of ours should, if required, have the same opportunity and access to the best possible stroke care services should such an event occur to them. The chapter explores the lessons learned, the consequences, and the perspective of the patient and the carers.
Epidemiology and aetiopathogenesis
Authors: England Timothy J.
Published: March 2020

Stroke is a common disabling condition associated with a high mortality, especially in the elderly. Subsequent social and monetary costs are high and despite a decreasing incidence of stroke in developed countries in recent years, prevalence has not declined due to an ageing population. Chapter 2 deals with ‘Epidemiology and aetiopathogenesis’ and examines the definitions of stroke and its pathological subtypes; epidemiology on a worldwide basis; age-specific data; mortality rates; cerebral blood flow and its relationship with ischaemic thresholds; and macroscopic and microscopic changes in the brain with increasing age and their relationship with ischaemic and haemorrhagic strokes. Changes related to large vessel disease, cardioembolism, small vessel disease, inflammatory arteriopathies, spontaneous intracerebral haemorrhage and cerebral amyloid angiopathy, are also described.
Diagnostic investigations for stroke in older people: A practical approach
Authors: Raghunathan Senthil
Published: March 2020

‘Diagnostic investigations for stroke in older people: A practical approach’ examines in some detail the challenges of formulating a thorough and simultaneously pragmatic approach to investigating older people with stroke. Diagnostic investigation plays an important role along with a comprehensive history and thorough clinical examination in assessing severity, prognosis, and initiating appropriate management. This chapter describes emergency investigations, brain imaging, biochemical and haematological investigations, the importance of electrocardiography and prolonged cardiac monitoring (including evidence from recent trials), echocardiography, the role of vascular imaging including ultrasonography and angiography. It also discusses the importance of performing all the essential investigations and the evidence for investigating stroke in the frail older person.