bluuebunny/crossref_metadata_2025 huggingface dataset:
Urinary problems and diabetes mellitus
Authors: Modell Michael , Mughal Zulf , Boyd Robert
Published: November 2023

Approximately five per cent of girls and two per cent of boys will suffer from at least one symptomatic urinary tract infection (UTI). Thus, girls are more likely to develop UTI than boys, except in the neonatal period, when the reverse is true. The hall marks of childhood UTI are their, difficulty in diagnosis in infancy, recurrent nature, and association with renal tract malformation and with risk of renal damage. Antibiotics for an imaginary UTI, and failure to diagnose a genuine one are common errors. The former results from treating all dysuria as urinary infections, or from taking the growth found in poorly collected or poorly stored specimens to be a positive culture; the latter because symptoms of UTI in childhood are commonly non-specific.
Clinical types of homosexuality
Authors: Limentani Adam
Published: November 2023

In recent years there has become apparent an increasingly marked division in the attitude to homosexuality: at a time when there is a growing tendency for people in all walks of life to regard homosexuality as normal, there remain many who use the term in a derogatory and insulting manner, quite often with an implication of social menace. The view presented in this chapter is that homosexuality is a syndrome, and that it is not sufficient to regard it only as an adjustive process, as was proposed by Sullivan (1955).
A model for peer review and audit
Authors: Grol Richard , Lawrence Martin
Published: November 2023

Medical audit and peer review are concepts which have gradually gained currency among general practitioners, although many do not know exactly what is meant by these terms nor what they involve precisely. The many terms related to audit have reached a stage where they can be seen merely as confusing jargon (Shaw 1980): clinical audit, peer audit, quality assessment, quality control, quality improvement, quality assurance, quality management, etc.
Effects of peer review: the evidence
Authors: Grol Richard , Lawrence Martin
Published: November 2023

What is the evidence from the literature concerning audit, feedback, and peer review? Do these really have any impact on the quality of care in medical practice and on the performance of care providers? In this chapter a brief overview is presented of available studies in this area. One project is presented as an example of a continuous peer review process: ‘Peer review in The Netherlands’.
Use of data on clinical performance i n peer review
Authors: Grol Richard , Lawrence Martin
Published: November 2023

All general practitioners have developed fixed routines of clinical performance in the course of running their practices. This may mean routinely carrying out certain physical examinations, ordering a certain laboratory test, or prescribing a particular medication for a condition. These routines will be rational in part and based on the most recent scientific information from the literature. In part they may be irrational or represent outdated behaviour or lack of understanding. It is virtually impossible for a practising GP to keep up to date continuously with all the new developments in the field.
Instruments for review of patient education
Authors: Grol Richard , Lawrence Martin
Published: November 2023

The giving of information to patients is a specific and very important aspect of the consultation process and one of the central tasks of the general practitioner. For this reason, skills described in a general fashion in the previous chapter are presented more extensively in this chapter.
Evolving role of women and children in our society
Authors: Avery Mary Ellen
Published: November 2023

Towards the end of the twentieth century, we have reason to celebrate the great advances of child health throughout the industrialized world. Consider the eradication of smallpox world-wide and the eradication of polio in the western hemisphere in 1992. Immunization against diphtheria, tetanus, measles, and now Haemophilus infiuenzae has prevented untold thousands of deaths of infants and children, so that now among the industrialized nations infant mortality rates are at an all-time low level. Central to this remarkable achievement has been a substantial and continuing improvement to the standard of living, which brings with it sanitation, nutritious foods, and the benefits of health education, including family planning.
Female adolescent health care: international perspective
Authors: Gardner Roxane
Published: November 2023

Attention has long been directed towards improving the health status of infants and children. The time has come to focus a greater portion of this attention towards improving the health of adolescents, especially female adolescents. This chapter is a discussion of demographics and socio-economic issues which affect the health of teenagers throughout the world, and a review of specific reproductive health issues. It has been said that children are our future. With adolescents, this statement becomes more cogent and immediate because adolescents are our tomorrow.
Contraception
Authors: Mastroianni Luigi
Published: November 2023

Methods designed to prevent pregnancy have been the subject of intense social and religious scrutiny. Although the earliest medical writings refer to efforts to control reproduction, debate did not intensify until methods became available that were at least somewhat effective. Firm positions were taken based on an evolving religious dogma relating to sexuality and the family. There continue to be widely diverging opinions on the appropriateness of contraception. Earlier, rerhaps because of a need to increase the population and because of high infant mortality, the position against contraception was almost universal. This nearly unanimous position has been supplanted by a more liberal stance that takes i1nto account the effect of uncontrolled population growth on quality of life and survival on an increasingly crowded planet.
Induced abortion
Authors: Henshaw Stanley K , Gold Rachel Benson
Published: November 2023

Induced abortion has been practiced for thousands of years. Descriptions of methods of inducing abortion have been found in writings from ancient Egypt, China in the twenty-eighth century bc, and Rome (David 1981). Abortion was common in nineteenth century Europe and North America and is usually considered to have been an important factor in the sharp reduction in birth rates that began in that century in France and other countries. In the twentieth century, abortion has become one of the most common surgical procedures in industrialized countries.
Assisted fertilization
Authors: Wood Carl , Dawson Karen
Published: November 2023

Despite the long history of IVF and embryo transfer (ET) in animals (Westmore 1984), the modern approach to human fertility problems—which involves exposing the human ovum to spermatozoa outside the mother and transferring the resulting embryo to her uterus—has been in use for a relatively short time. The first reports of pregnancies following the use of this technique in humans were published during the 1970s (de Kretser et al. 1973; Steptoe and Edwards 1976, 1978), and the use of JVF, ET, and gamete intrafallopian transfer (GIFr) have since resulted in many live births for couples with infertility problems. The recent rapid growth of these techniques has demonstrated their potential for treating a range of infertility conditions and has required considerable hack-up support. Perhaps more than most therapies, assisted fertilization has relied for its development and growth on a favorable social and scientific climate.
Cesarean section
Authors: Nielsen Thorkild F
Published: November 2023

Cesarean section is an operation of great antiquity. It was practiced by the early Romans, the ancient Hindus, and the ancient Hebrews. These first abdominal deliveries were performed only after the death of the mother, however and it is impossible to ascertain when the operation was first done on a living woman. The first documented cesarean section performed on a living woman in Europe was carried out on 22 April, 1610 by a German surgeon, Jeremias Trautman of Wittenberg. The operation was described in detail by Professor Daniel Sennert who was present during the procedure. The mother died 24 days later; the child survived (Bailer 1982).
Evaluation of monitoring techniques in pregnancy
Authors: Freeman Roger K
Published: November 2023

With the advances in technology emanating primarily from the space, biochemical, and electronics industries, there has been an understandable desire to apply this new knowledge to health care. Medical researchers have been aiming to use new scientific methods to develop new strategies that can improve outcomes for many previously devastating diseases. In obstetrics, there certainly have been great benefits seen from the introduction of antibiotics, the understanding, treatment and prevention of rhesus disease, amniocentesis and the ability to prevent the birth of children with Down syndrome, and the use of blood and blood products to replace substances necessary for the sustenance of life.
Substance abuse in pregnancy
Authors: Chavkin Wendy
Published: November 2023

In recent years illicit drug use by pregnant women has garnered an unprecedented level of medical and popular concern. In part this is a direct result of a dramalic increase in their drug use. It also results from heightened medical sophistication. Advances in pcrinatology and epidemiological research have led to recognition of a wider range of consequences of in utero exposure to drugs.
Doctors’ and patients’ roles
Authors: Myerscough Philip R , Ford Michael J , Currie C T , Doyle D , Hewitt A N M , Laing I A , Speirs A L , Wrate R M
Published: November 2023

To understand more clearly how doctors and patients interact, it is helpful to specify what is special about the doctor-patient relationship. Just as the pattern of communication affects a relationship, so the relationship, in a circular interaction, shapes and influences the manner of communication. How do the doctor and the patient, as they interact, view themselves and one another?

Pendlenton et al. [19] describe and discuss six ways of studying the interation between doctor and patient. These are (1) medical; (2) sociological; (3) anthropological; (4) transactional; (5) social psychological; (6) psychoanalytical. The different behavioural sciences direct attention to particular features of the roles and behaviours of the doctor and the patient. Interviews may be studied by categorization of utterances and phrases; by finely focused discourse analysis; by psychoanalytic interpretations, or by study of non-verbal behaviour. Given this diversity of viewpoints, a panoramic catholic approach seems appropriate here, to provide a broad basis of understanding. Let us consider the patient first.
Communication in the setting of primary care
Authors: Hewitt A N M
Published: November 2023

The doctor–patient relationship is the cornerstone of general practice, and places great influence in the practitioner’s hands. Most patient care starts in general practice, and most long-term care occurs in the community. Most patients have a general practitioner, who maintains a unique record of their medical history from cradle to grave. Having a long-term knowledge of and relationship with patients, their families and friends, within a social setting, gives a special insight into patients’ problems. The doctor-patient relationship rests on good communication-the ability of practitioners to talk and listen to their patients and to appreciate their individual problems. The medical, social, and psychological setting is of paramount importance in understanding the patient as a whole person, and not just as a disease or a condition.
Talking to children
Authors: Speirs A L
Published: November 2023

Many doctors, other than paediatricians, have to deal with sick children. General practitioners, orthopaedic and ENT surgeons, eye and skin specialists all find that children make up a significant proportion of their patients. Therefore, most clinicians need to learn how to conduct a consultation with parent and child with consideration, care, and understanding. This is an essential requirement if the consultation is to achieve its objectives. Some doctors are regarded as naturally good with children, but through training, experience, and patience these skills can be developed and improved.
Talking about pregnancy and reproduction
Authors: Myerscough Philip R , Ford Michael J , Currie C T , Doyle D , Hewitt A N M , Laing I A , Speirs A L , Wrate R M
Published: November 2023

Normal pregnancy is not an illness, and so the mother to be rightly assumes a much less dependent role. The attendants’ central concern should be to stimulate confidence and self-reliance in preparation for motherhood. Child-bearing is thus likely to be experienced as a challenge, putting the woman on her mettle. But some of the vocabulary often used by professionals can be insensitive, so that, by their choice of words, they not only filch for themselves much of the credit for the woman’s achievement-by ‘supervising’ her pregnancy, ‘managing’ her labour, and ‘delivering’ the infant—but in some cases may appear to stigmatize the mother through the use of terms that could imply inadequacy. The ‘growth retarded’ infant has a ‘poor’ score on biophysical profile; a failed induction or failure to progress then necessitates operative intervention. Bastian [109] drew attention to the way in which this sort of terminology can erode the self-confidence that sensitive care would seek to foster.
Historical background and concepts in rapidly progressive glomerulonephritis
Authors: Rees Andrew J , Pusey Charles D
Published: November 2023

In 1914, Volhard and Fahr provided the classic description of what has come to be known as ‘crescentic glomerulonephritis’. The glomeruli were severely damaged and the tuft was surrounded by a mass of cells filling Bowman’s space. This was referred to as ‘extracapillary’ proliferation, but its appearance in crosssection on light microscopy led to the widespread use of the term ‘crescentic’ nephritis. It was appreciated that patients with crescentic nephritis usually died of renal failure within weeks of the apparent onset of the disease. Later, Ellis (1942) approached the same topic from a clinical standpoint and introduced the term ‘rapidly progressive glomerulonephritis, type I’ (subsequently condensed to ‘rapidly progressive glomerulonephritis’, ‘RPGN’) for patients with nephritis who developed renal failure within weeks or months. Most patients with RPGN were shown to have crescentic nephritis and were thought to have severe poststreptococcal disease.
Immediate medical and nursing needs
Authors: Nash Julie , Appleton Richard , Rowland Bridget , Saltmarsh Jane , Sellars Julie
Published: November 2023

The purpose of this chapter is to identify and discuss the more common immediate nursing and medical issues, and needs of the brain-injured child (and his family), following the acute resuscitation period and on transfer to the neuro-rehabilitation ward. The chapter also outlines and discusses the importance of play as an integral component of the rehabilitation process.
Physical (motor and functional) difficulties
Authors: Weston Juliet , Kinley Eileen , Hughes Bronwen , Fishwick Sue
Published: November 2023

This chapter discusses the gross and fine motor rehabilitation which is aimed at maximizing the child’s functional independence. It focuses on the role of physiotherapy and occupational therapy in the early, and intermediate rehabilitation as well as the long - term management. It is important to stress that the identification of any physical difficulties and the subsequent approach and methods employed to treat them are almost invariably multi disciplinary, involving not only physiotherapy and occupational therapy but also ward nursing staff and play specialists.
Managing feeding and swallowing problems in the brain--injured child
Authors: McMahon Siobhan
Published: November 2023

The child with a severe brain injury who has required ventilatory support will have been nourished by enteral or parenteral (intravenous) feeding. For the minority of children who have to remain on the intensive care unit for some time and require prolonged intravenous feeding, their metabolic response and nutritional status are crucial: this is clearly an important issue but falls outside the remit of this chapter, and is well reviewed by Roberts (1995). Fortunately the vast majority of children with brain injuries do not require long-term ventilatory support, intensive care, or prolonged intravenous (‘total parenteral’) nutrition. As the child is weaned from the ventilator and begins to show signs of arousal, the reintroduction of oral feeding is often viewed as the next important step in the child’s recovery.
Community liaison
Authors: Gregg Jackie , Appleton, Richard , Baldwin Tony
Published: November 2023

In Liverpool, the head-injury rehabilitation team (HIRTI member respon sible for community liaison is a consultant community paediatrician within the Trust. Her role is to look at the ‘whole’ child within the hospital and community settings.
Non-imaging radionuclide investigations
Authors: Elliott AT , Hilditch TE
Published: November 2023

Some 12% of nuclear medicine investigations carried out in the UK do not involve imaging and, although being replaced by methods not involving the use of radioactivity, a number of laboratory tests still utilize radioimmunoassay. The counting of samples is a neglected area and the aim of this chapter is to cover the essentials of this topic in addition to describing the actual investigations.
Data processing
Authors: Middleton Gordon W
Published: November 2023

The standard gamma camera image, despite undergoing significant digital processing designed to improve the detector performance, has several shortcomings which were discussed in Chapter 1. For example a major weakness is that one cannot attempt to quantify the uptake of a radiopharmaceutical by a specific organ by simply viewing the image. In this chapter the emphasis is on the post-acquisition digital image processing which can be performed in order to improve image quality and to extract additional information from an image or a series of images. There are four principal areas in which such image manipulations are of particular value:
The radiopharmacy
Authors: Doherty James , Graham David
Published: November 2023

In a little under 25 years, radiopharmacy has become firmly established as a specialist branch of the hospital pharmaceutical service in the UK, Europe, and the USA. This specialist pharmacy service is an integral part of the multidisciplinary team providing nuclear medicine services. Radiopharmacies have tended to develop in two patterns: one where each nuclear medicine facility has its own radiopharmacy, the other where a number of nuclear medicine facilities are supplied by a centralized radiopharmacy. In this chapter we shall describe the principles of radiopharmacy design together with what we believe to be the principles of good radiopharmaceutical practice.
Radiation protection
Authors: Dendy P P , Goldstone, KE , Barber R W
Published: November 2023

This chapter deals with a problem that has direct implications for every other chapter in the book - namely that ionizing radiation, even at very low doses, is potentially capable of causing serious and lasting biological damage. If this were not so, the stringent measures that have to be taken to limit the amount of radioactivity administered to the patient, and thereby the radiation dose, would be unnecessary. Indeed they would be undesirable since the key factor limiting radionuclide image quality is the very low count density that results from the strict protocols of dose limitation.
The cardiovascular system
Authors: Walton S
Published: November 2023

The heart is a relatively small, irregularly shaped organ. Although under resting conditions it remains in the same position relative to the chest wall from one heart beat to another, increased diaphragmatic excursion, particularly that associated with exercise, can result in marked displacement within the thorax. During each cardiac cycle the heart indulges in a complex routine of contraction, rotation, translation, and relaxation, which results in marked changes of shape and position. It is inhomogeneous, consisting of four major blood pools surrounded by myocardium of varying thickness; only that surrounding the left ventricle is sufficiently substantial to permit reliable imaging under normal conditions. The heart lies eccentrically within the thorax surrounded by tissues of different density and, therefore, different capacity to absorb and to scatter radiation.
The lung
Authors: Gray H W
Published: November 2023

The lungs are the principal organs of the respiratory system. They function as a gas exchange unit to facilitate uptake of oxygen and elimination of carbon dioxide from the blood as it traverses the pulmonary capillaries. The techniques of nuclear medicine provide a window through which the normal function of lung (physiology) and abnormal function resulting from disease processes (pathology) can be studied. This view of lung function assists the diagnosis of venous thromboembolism (pulmonary embolism) from chronic obstructive or parenchymal lung disease and permits assessment of the blood-gas barrier.
How many disease concepts of alcoholism are there?
Authors: Heather Nick , Robertson Ian
Published: November 2023

In the previous chapter we traced the development of the disease view of alcoholism from its origins in the late eighteenth century to the present day. We saw that the chief motivation behind the rediscovery of the idea that alcoholism is a disease, which took place after the repeal of Prohibition in the United States, was the hope that the suffering alcoholic would thereby obtain a better deal from a largely ignorant and uncaring society. We also saw that this idea soon acquired some degree of professional and academic respectability through its endorsement by sections of the medical profession and other interested scientists.
Conditioning
Authors: Heather Nick , Robertson Ian
Published: November 2023

In the previous chapter we gave a brief overview of social learning theory. In this, we shall discuss in greater detail the two earliest types of learning theory advanced by psychologists, classical conditioning and instrumental learning. The deceptive simplicity of these theories is at odds with their importance and complexity when applied to alcohol use.
Some practical implications
Authors: Heather Nick , Robertson Ian
Published: November 2023

No one theory is absolutely true for all time. Newtonian physics appeared to explain most physical phenomena satisfactorily until Einstein developed the theory of relativity. For most situations on earth, however, Newton’s theory of physics allows us to make accurate predictions about space, time, and motion, and is still useful within clear limits. If it is their usefulness which distinguishes good theories from bad in the physical sciences, then in the behavioural sciences, like psychology, this is even more true. The touchstone for evaluating the new paradigm of problem drinking must be how useful it is in understanding and predicting the behaviour of problem drinkers, as well as in suggesting effective means for solving their problems.
Natural History and Factors Affecting the Progression of Human Renal Diseases
Authors: Locatelli Francesco , Vecchio Lucia Del
Published: November 2023

Following renal injury, a progressive deterioration in renal function generally occurs, regardless of the nature of the original nephropathy. In some patients, the disease process responsible for the initial renal injury may remain active throughout the progression of renal failure. However, in the majority of cases, renal failure progresses after a well-defined initiating process has remitted spontaneously or has been therapeutically controlled.
Natural history and prognosis of chronic primary glomerulonephritis
Authors: D’Amico Giuseppe
Published: November 2023

Among the various idiopathic glomerulonephritides with a chronic course and a potential progression toward renal failure, four major types, on which we will focus our attention in this chapter, have been identified because of their distinctive morphological and clinical features: Numerous studies have been performed in these last 30years in different geographical areas, to try to define the natural history and prognosis of these diseases, but the results have been conflicting, because many factors, that we will briefly analyze, may influence the clinical course and be responsible for completely different outcomes in different patients with the same clinicomorphological type of GN.
Outcome and interventions in chronic renal disease: evidence from adequately designed clinical trials and meta-analysis
Authors: Swan Suzanne K , Kasiske Bertram L
Published: November 2023

Treatment of glomerular diseases constitutes a significant portion of the practice of clinical nephrology. Yet, a paucity of knowledge and experience concerning the treatment of glomerular diseases often results in a confused therapeutic decision-making process. Conducting clinical trials in patients with primary glomerular disease, however, has become increasingly difficult in recent years. Nephrology practice has been steadily moving from tertiary care centers into private, multi-specialty, outpatient clinics. As a result, within a given practice, it is no longer possible to identify adequate numbers of patients with a specific renal disease for which experimental protocols can be applied. Further, clinical trials conducted in tertiary care centers or government-funded research institutions in the past often used protocols that would be difficult to implement in community-based practice today. Additionally, the natural history of a specific glomerular disease may be so variable that formulation of a rational therapeutic approach is precluded. This is particularly true when the only published data are from small, short-term studies that are neither randomized nor controlled, and did not carry out risk stratification. The relative absence of sound risk/benefit data from long-term trials has only served to widen the gap between therapeutic ‘nihilists ‘ and ‘enthusiasts ‘ as described in a recent editorial [l].
Epidemiology of type 2 diabetes and diabetic nephropathy in different ethnicities
Authors: Ismail Nuhad , Cornell Scott
Published: November 2023

The assessment of prevalence and incidence type 2 diabetes is made difficult by differing sampling methodology, diagnostic criteria used in community studies, and target populations. For example, all minorities in the United States (African-Americans, Hispanics, Native Americans, Asian, and Pacific Islanders), except natives of Alaska, have a prevalence of type 2 diabetes that is two to six times greater than that of white populations (Carter et al. 1996).
Genetics of nephropathy in type 2 diabetes
Authors: Schmidt Susanne , Ritz Eberhard
Published: November 2023

Hypertension is an important risk factor for development and progression of diabetic nephropathy in patients with type 2 diabetes. The role of hypertension differs in type l and type 2 diabetes. In type l diabetes, hypertension usually develops with the onset of diabetic nephropathy. However, in type 2 diabetes, hypertension frequently precedes the onset of diabetes.
Clinical renal findings in incipient type 2 diabetes
Authors: Fioretto Paola , Saller Alois , Vestra Michele Dalla , Mauer Michael
Published: November 2023

Type 2 diabetes has a less benign renal prognosis than thought in the past. The incidence of end-stage renal disease (ESRD) in patients with type 2 diabetes has dramatically increased in the United States, in Europe, and in Japan. Worldwide, the increasing prevalence of type 2 diabetes-will certainly lead to an increase in the number of patients with type 2 diabetes developing ESRD. The cost of haemodialysis amounts to US$50 000-100 000 per person per year. These considerations justify intense efforts to implement: (l) early detection of type 2 diabetes; (2) adequate treatment to prevent initiation and progression of diabetic nephropathy;(3) intensive research in this field. In this chapter, we shall focus on renal findings and associated clinical characteristics in newly diagnosed type 2 diabetic patients with an emphasis on items which may help to improve renal prognosis.
Vision and hearing problems in later life
Authors: Iliffe Steve , Drennan Vari
Published: November 2023

Visual impairment is common amongst older people and increases with advancing age. In community-based surveys of older people undertaken in the United Kingdom, visual acuity of less than 6/12 has been found in around 2% of subjects aged 65-74, and around 20% of subjects aged 75 and over. This level of visual acuity is below the UK driving requirements. Larger surveys have been performed in the United States, and similar trends are seen there. Cataract and age-related macular degeneration (AMD) are the commonest causes of this visual loss, producing 63% and 20% of loss respectively in people aged 65 and over in a UK community survey.1 Macular degeneration, with its bilateral clouding of central vision, is a particularly disabling impairment, affecting nearly one in five of those aged 85 or more. Glaucoma is relatively uncommon, occuring in 7% of people in the same survey, but is the leading cause of acquired blindness.
Cardiovascular disease and stroke
Authors: Iliffe Steve , Drennan Vari
Published: November 2023

There are four target areas in cardiovascular disease as it affects older people where the evidence base for intervention is good enough to warrant a systematic approach to case-finding and case management. They are: identifying all individuals with left ventricular failure and initiating ACE inhibitor therapy. The evidence supporting the use of ACE inhibitors in reducing mortality and morbidity from ventricular failure is good, with reduction in hospital admissions. Ventricular failure is over diagnosed clinically and requires echocardiography for reliable diagnosis. Reducing the mortality from stroke and myocardial infarctions (Mis) through better blood pressure control may increase the number of patients entering this diagnostic group (see below).
Optimal care of the pediatric patients with end-stage renal disease
Authors: Broyer Michel
Published: November 2023

Pediatric patients should not be considered as adults but of small size. Of course, the physician must take into account the size of children but the goal, ,When taking care of these patients, is to achieve normal growth and development in order to bring children and adolescents to adulthood in the best possible status.

Today, in this age-group, dialysis is not considered an optimal approach, since it often seriously affects the overall quality of life. All efforts are now made to succeed pre-emptive transplantation before the time dialysis may be needed, or before the functional end of a first or second graft.
Breast lumps
Authors: Stonebridge Peter , Smith David , Duncan Lesley , Thompson Alastair
Published: November 2023

Chapter contents

Chapter contents

It is important to find out any relationship to the menstrual period in patients with breast lumps/breast pain.

Breast pain related to periods is called cyclical mastalgia and is quite common. Breast pain is usually benign: 80% of patients can be treated by simple reassurance.

Examination should include both breasts and also check for any surrounding palpable lymph nodes (in the axilla and supraclavicular). This girl probably has benign lumpy changes responding to the hormonal cycle. Breast lumps that change with the hormonal cycle are usually benign.
Sampling and observational studies.
Authors: Bland Martin , Peacock Janet
Published: November 2023

A census is a count of a population, where every member of the population is studied. For many purposes this is impractical so we use a sample. We want the sample to be representative, i.e. to have the same characteristics as the population. To achieve representativeness, we must not allow the subjects’ own characteristics to affect whether they are included in the sample. We allow chance to select the sample, giving each subject the same probability of being selected. We can use random number tables to do this. We need a sampling frame, a list of the population, from which to sample. In medical research access to subjects is often difficult and several different, non-random designs are used.
Probability
Authors: Bland Martin , Peacock Janet
Published: November 2023

Probability is the proportion of occasions on which an event would happen if the circumstances were repeated indefinitely. It lies between 0.0 and 1.0, inclusive. A different way of presenting probability is odds, the probability of the event divided by the probability that the event does not occur. If we have a set of all possible events which are mutually exclusive (i.e. if one occurs then the others cannot occur) then their probabilities form a probability distribution. The sum of the probabilities is one. These probabilities can be summarized using the mean and variance of the distribution.
Antenatal problems
Authors: Neuberg Roger
Published: November 2023

The majority of pregnant women will experience some minor ‘nuisance’ problems which can certainly reduce their sense of well-being. Many women will simply put up with these, being reluctant to appear to be making a fuss. An important role of every professional involved in antenatal care is to ensure that patients should never feel that they are wasting anybody’s time by seeking reassurance, even if the problem proves to be only a trivial one. Sometimes it isn’t. It is to be hoped the information given to them at the booking clinic, whether at the GP’s surgery or the consultant unit, will encourage them always to seek medical advice.
Postnatal period
Authors: Neuberg Roger
Published: November 2023

The postnatal period, or puerperium, is defined as the time taken for the uterus to involute back to the normal non-pregnant size. This is usually 6 weeks postpartum.
Diagnosis
Authors: Ebrahim Shah , Harwood Rowan
Published: November 2023

Diagnoses provide medical explanations for health problems and define specific curative, palliative, and preventative treatments and enable prognoses to be given. Diagnosis gives both the patient and the doctor a certain security associated with this knowledge, and a means of communicating the nature of the problem succinctly. The use of ‘stroke’ as a diagnostic term is not straightforward. Strokes are caused by thrombosis, embolus, or haemorrhage. Not all patients who present with signs and symptoms of hemiplegia have had a stroke, however. The nomenclature used to describe patients can lead to problems, in particular, calling strokes ‘cerebrovascular accidents’ or CVAs. The implication is that, given hemiplegia, a stroke has occurred and no other pathological processes need to be ruled out. The terms ‘right’ or ‘left’ CVA can also cause confusion because they may refer to the side of the lesion or the side of the signs.
Severity
Authors: Ebrahim Shah , Harwood Rowan
Published: November 2023

The severity of disease can be described in many different ways, ranging from the patient’s perception, the amount of physiological disturbance, and the consequent disability and handicap caused, to the burden for society (Stein et al. 1987). The severity of a stroke may be assessed in terms of the amount of brain damaged (e.g. size of the lesion found on CT), the extent of any arterial lesion(s) demonstrated on angiography, or the function of the brain (by positron emission tomography (PET) scanning, or presence of symptoms and signs of decompensation). Alternatively, the severity of a stroke may be measured by the distance walked in a fixed time, the ability to climb stairs, or the ability for self-care. From a social perspective, severity may be measured by impact on work, enjoyment of usual sex life, and social engagement. The pathological differences between types of stroke and the alternative ways of assessing severity make a simple answer to the question ‘Is it a bad stroke?’ difficult.
Rehabilitation
Authors: Ebrahim Shah , Harwood Rowan
Published: November 2023

Rehabilitation is ‘about the tertiary response to insult or disease’ (Goodwill and Chamberlain 1988), so is concerned with the prevention of complications of disease. The effects and complications of stroke are discussed in Chapter 14, but rehabilitation is about more than prevention of complications. It is concerned with reablement (the restoration to former abilities and rights) and resettlement (the use of new or prosthetic environments). The World Health Organization defines rehabilitation as ‘the combined and coordinated use of medical, social, educational and vocational measures for training or retraining the individual to the highest possible level of functional ability’. Using this definition, a case could be made for everyone, sick or well, receiving their share of ‘rehabilitation’!
Biomechanics
Authors: Zavatsky Amy
Published: November 2023

Biomechanics is the application of the principles of mechanics and the techniques of engineering to the study of biological systems, including the human body. From an early date, one of the major areas of biomechanical study has been the musculoskeletal system or locomotor system. Diagnosis and treatment of disorders and diseases of the musculoskeletal system are the main goals of orthopaedics. Practitioners in this field require an understanding of bone, muscle, connective tissue, and nerve. They need to understand how these tissues function and interact on all levels—from genetic and cellular levels to the macroscopic level of the joints and limbs.
History and Examination: General Principles Regarding The Diagnosis of Soft Tissue Disorders
Authors: Östör Andrew
Published: November 2023

In all disciplines of medicine the history and examination form the foundation upon which a diagnosis is made. The majority of diagnoses are made after the history alone with physical findings playing a confirmatory role. The level of experience and knowledge base of the clinician has significant bearing on the chance of achieving the correct diagnosis. Further investigations, although helpful, may be timeconsuming, expensive, and unnecessary.
Infrared Thermal Imaging In Musculoskeletal Conditions
Authors: Hazleman Brian
Published: November 2023

Thermal imaging has been used in musculoskeletal conditions for 40 years. It provides sensitive and reproducible means for diagnostic imaging and monitoring treatment. The diagnosis of inflammatory, degenerative, and traumatic conditions is assisted by infrared imaging. Vasospastic conditions affecting the hands can be monitored by thermal imaging using a mild cold stress test and the efficacy of vasoactive drugs proven by this technique.
The Investigation of Soft Tissue Disorders: Nerve Conduction Studies and Electromyography
Authors: Ray Julian , Mcnamara, Brian , Boniface Simon
Published: November 2023

In clinical neurophysiology the fundamental principles of neurophysiology are applied to develop clinical methods of objectively testing central nervous system and peripheral nervous system function. The two techniques with most relevance to soft tissue rheumatology are nerve conduction studies (NCS) and electromyography (EMG).(1)
Soft Tissue Injuries and Sport
Authors: Speed Cathy
Published: November 2023

Since the health benefits of regular physical activity are well established, it is thus considered to be a physician’s responsibility to promote it as part of a patient’s health and well-being. This strategy has its challenges, as our society has become more sedentary, having exchanged man’s role as a hunter–gatherer for a lifestyle that centres around the laptop, mobile phone, and TV remote control. Children are also less physically conditioned and, within the population as a whole, exercise is often seen as a chore rather than a pleasure.
Therapeutic Modalities
Authors: Speed Cathy
Published: November 2023

Therapeutic modalities may be defined as thermal, mechanical, electrical, or electromagnetic energies used for the treatment of medical complaints. A range of such modalities is used in the treatment of soft tissue complaints, including thermal agents, ultrasound, and electrical agents (Table 1). In this chapter, the basis for the use of specific modalities and the existing evidence relating to their clinical effects are outlined.
Hypermobility
Authors: Bird Howard
Published: November 2023

Articular hypermobility, perhaps better termed joint hyperlaxity, describes the possession by an individual of a joint or joints with a much wider range of movement than average. A single joint or many joints may be so affected. The term does not define aetiology since many factors contribute to a wide range of movement at a joint and several may contribute. The threshold at which the syndrome can be defined remains the subject of debate, not least because the range of movement at a given joint displays a Gaussian distribution in a population. The cut-off point above which generalized hypermobility is held to be present is therefore somewhat arbitrary. Hyperlaxity is not synonymous with reduced joint stiffness though rheologically this is often present. Neither does it equate with functional disability, though in many circumstances hyperlax joints do contribute to impairment of function and often produce symptoms of pain and sometimes, paradoxically, stiffness.
Complex Regional Pain Syndrome (Type I): The Pain Clinic Perspective
Authors: Chong Carol , Munglani Rajesh
Published: November 2023

Investigations are not usually helpful but may help to exclude other conditions. There are no pathognomonic blood tests. In 40 per cent of patients, there is radiological evidence of bone demineralization of the periarticular area on plain X-ray films. These changes are seen after 4–8 weeks.(1)
Childhood disorders
Authors: Thapar Anita , Scourfield Jane
Published: November 2023

As recently as a decade ago, it might have been considered reasonable to make the accusation that child psychiatry, unlike other medical specialties, was slow in embracing genetics research. This is clearly not the case now. There has been a rapidly escalating interest in conducting genetic studies of childhood psychopathology, and this has undoubtedly been accompanied by a marked increase in our knowledge base. There is now a wealth of evidence from family and twin studies, not only demonstrating that many child psychiatric disorders run in families but that genes play an important role in contributing to this familial transmission. For conditions such as autism and attention deficit hyperactivity disorder (ADHD) that have been shown to be strongly influenced by genetic factors, the search for susceptibility genes has attracted many researchers.
The dementias
Authors: Liddell Malcolm B , Williams Julie , Owen Michael J
Published: November 2023

The most successful applications of molecular genetic approaches to mental disorders have been to the various forms of dementia. Dementia can occur as a result of more than 55 different diseases. Consequently, the focus of this chapter will be upon the most common disorders; Alzheimer’s disease and vascular dementia, and on those in which advances have been especially striking; frontotemporal dementia, Huntington’s Disease and the transmissible spongiform encephalopathies.
Data into numbers
Authors: Armstrong David , Grace John
Published: November 2023

But look at your data: a pile of questionnaires? A collection of tape cassettes? A jumble of field notes? How are these to be analysed to produce those heady ‘results’? This chapter examines the first stage in that process (mainly insofar as it relates to quantitative studies), namely the procedures by which newly collected data are transformed into numbers. Chapter 5 outlined the overall process of collecting specific data from the mass of data ‘out there’. These data could be collected by unstructured, semi structured, and structured means and each of these forms of data require different treatments to enable analysable results to emerge.
Using data analysis software
Authors: Armstrong David , Grace John
Published: November 2023

Data analysis can be carried out manually, but the availability of personal computers makes the task much easier and allows a more rigorous approach. At one end are spreadsheets such as Excel which often have quite sophisticated data manipulation facilities as well as some basic statistical functions. The same goes for databases, that, with a little ingenuity, will allow you to analyse a data set. If you already use a spreadsheet or database you might want to consider this route, but it is probably not worth buying and learning how to use such a program just to analyse your research data, especially as there is a much easier and cheaper solution.
The drug therapy of psychiatric disorders
Authors: Grahame-Smith D G , Aronson J K
Published: November 2023

In Table 31.1 are listed the groups of drugs used in psychiatric disorders. The term psychotropic drug is widely used and means a drug that affects a person’s mental state; it usually refers to therapeutic use. The terms psychotomimetic and psychedelic refer to drugs that produce an abnormal mental state; these aspects are dealt with in Chapter 34.We have chosen to illustrate the practicalities of psychotropic drug use by referring to a strictly limited number of drugs, about which a good deal is known. These representative drugs may not be ideal for every patient, but they provide an introduction to each therapeutic class, on which further experience can be built.
The relief of pain
Authors: Grahame-Smith D G , Aronson J K
Published: November 2023

In this Chapter, we shall consider the symptomatic treatment of pain, remembering that the treatment of pain should also take account of the cause of the pain (see below). Pain is a subjective symptom that is affected by psychological factors. Some patients complain of pain in response to seemingly negligibly painful stimuli; this is known as a low pain threshold. Others do not complain in the face of apparently severely painful stimuli—a high pain threshold. Even an individual appreciates the intensity of pain differently at different times, and factors such as anxiety, depression, boredom, or distraction influence the way in which we perceive pain. For example, men injured in war may not feel the pain of their injuries until long after they have been sustained. Pain can be reduced in intensity by simple reassurance, by hypnosis, by trance-like meditative states, and by acupuncture. I
General anaesthesia and local anaesthetics
Authors: Grahame-Smith D G , Aronson J K
Published: November 2023

Anaesthetists are practical clinical pharmacologists. Through the skilled use of drugs, the patient is tranquillized and prepared for operation, quickly and pleasantly rendered unconscious and unfeeling, and kept so at a finely tuned level throughout the operation. During this time, muscle relaxants are used to facilitate surgery, the patient’s airways are carefully kept patent, and meticulous attention is paid to oxygenation and the preservation of normal blood gases and acid–base balance. Cardiovascular function and blood pressure are monitored and kept within well-defined acceptable limits.
The principles of cancer chemotherapy
Authors: Grahame-Smith D G
Published: November 2023

Cancers kill 20 per cent of people. Although certain cancers can be cured by local treatments, such as surgery and radiotherapy, many are incurable because of systemic spread. The management of disseminated tumours is complex, and often involves several different types of therapy, even with tumours that are sensitive to cytotoxic drugs.