bluuebunny/crossref_metadata_2025 huggingface dataset:
Systemic Inflammatory Diseases and the Kidney
Authors: Monroy-Trujillo Jose Manuel , Geetha Duvuru
Published: February 2019

The kidneys are targets of systemic autoimmunity as well as pathogenic immune responses against renal auto antigens. Systemic autoimmunity against ubiquitous antigens leading to renal inflammation is seen in antineutrophil cytoplasmic antibodies (ANCA) associated vasculitis, immunoglobulin (Ig) A vasculitis, systemic lupus erythematosis, scleroderma and IgG4 disease while immune responses against specific renal antigens is seen in antiglomerular basement membrane disease. Renal involvement can be the presenting feature in these diseases and can manifest as a rise in serum creatinine or asymptomatic urinary abnormalities or can present with rapidly progressive renal failure. For the majority of systemic inflammatory disorders, renal involvement heralds a poor prognosis and warrants timely initiation of immunosuppressive therapy. This chapter will review the clinical, laboratory, and histologic features and discuss management of renal disease associated with ANCA-associated vasculitis, IgA vasculitis, antiglomerular basement membrane disease, polyarteritis nodosa, scleroderma, and IgG4 disease.
Cast Nephropathy in Plasma Cell Dyscrasias
Authors: Manohar Sandhya , Leung Nelson
Published: February 2019

Plasma cell dyscrasias are associated with a wide spectrum of renal lesions and clinical presentations. The most common is cast nephropathy, which clinically presents as severe acute kidney injury. It is usually seen in patients with multiple myeloma. In fact, the recent criteria of the International Myeloma Working Group from 2014 consider renal failure by light chain cast nephropathy as a myeloma defining event. Renal failure is a major cause of early mortality in patients with multiple myeloma, being second only to infection. Early diagnosis and treatment of multiple myeloma is the key to better outcomes in these patients. This chapter reviews, among other topics, the history of the terminology, mechanism of light chain cast formation and the clinical picture, precipitating factors, pathology, treatment, therapy, and future outlook for cast nephropathy.
Sickle Cell Nephropathy
Authors: Revuelta Katia López , Andres María Pilar Ricard
Published: February 2019

Sickle cell Disease (SCD) is the commonest and most serious inherited anemia in the world and its burden is expected to markedly increase in the next decades. Kidney disease (SCN) is one of the most frequent and severe complications of SCD having a high impact on SCD patient survival and quality of life. SCN phenotypic expression is very heterogeneous and standard markers of kidney damage may not be useful for the early detection of sickle cell disease. Tubular creatinine hypersecretion may mask significant renal impairment before serum creatinine rises, also proteinuria and Hypertension are late markers of irreversible CKD. Treatment with hidroxyurea with broader criteria of SCD patients and SCN screening with early referral to a specialist are needed to improve their survival and quality of life.
Cystic Kidney Diseases
Authors: Chebib Fouad T. , Torres Vicente E.
Published: February 2019

Autosomal dominant polycystic kidney disease (ADPKD), the most common monogenic kidney disease, is characterized by relentless development of kidney cysts, hypertension, and eventually end-stage renal disease. The enlargement of the bilateral kidney cysts is gradual throughout the lifetime of the patient until little renal parenchyma is recognizable. At that stage, the average rate of GFR decline is 4.4 to 5.9 mL/min/year. Over the past few years, several advancements in diagnosing, prognosticating, and understanding the pathogenesis of the disease have been made. The natural course of ADPKD makes it an ideal disease to be targeted for renal protection. This chapter discusses various aspects of pathophysiology and molecular pathways and addresses in details the various pharmaceutical and nonpharmaceutical interventions in the journey of prevention of clinical complications of ADPKD.
Cardiorenal Syndrome
Authors: Ross Edward A. , Batnyam Uyanga , Asmar Abdo M.
Published: February 2019

Renal and cardiac crosstalk plays an essential role in maintaining physiological homeostasis. Both organ diseases are prevalent and share common risk factors. Impairment in one organ has the potential to affect the other. This interaction is referred to as cardiorenal syndrome, and it is driven by complex neurohumoral and vascular processes. Cardiorenal syndrome refers to a state of either acute or chronic impairment of both renal and cardiac functions. Despite progress in therapeutic interventions, treatment of cardiorenal syndrome remains challenging. In this chapter, we review the current understanding of the pathophysiological mechanisms of cardiorenal syndrome, as well as its management options.
High-Risk Kidney Transplantation
Authors: Gomatos Ilias P. , Lerner Susan , Menon Madhav C.
Published: February 2019

Outcomes after solid organ transplantation have improved dramatically with the development of better surgical techniques and effective therapies for rejection. As a result, higher numbers of end-stage renal disease patients with hepatitis C, HIV, cardiovascular disease, and pretransplant tumor history are listed for a potential kidney transplant, posing increasing challenges for the transplant team. Modifying cardiovascular risk factors while awaiting or after transplantation, novel antiviral therapies, close follow-up, and tailored management of posttransplant malignancies are imperative to further improve long-term graft and patient survival in high-risk kidney transplants.
Error and Accountability
Authors: Bruno Michael A.
Published: February 2019

In this chapter we will explore the issues related to individual and organizational accountability for error, particularly when a patient suffers harm that is attributable to physician error. We will review the blameless culture and “just culture” models, as well as related issues of peer-review, regulatory compliance, medicolegal, and ethical aspects of error in this context. We will discuss the ethical duty to provide open disclosure of all errors and lapses directly to patients and their families, regardless of cause (and separated from the issue of blame) and in some circumstances coupled with financial or other compensation for any harm done.
Artificial Intelligence and Machine Learning in Radiology
Authors: Bruno Michael A.
Published: February 2019

This final chapter, which assumes no prior reader knowledge of the topic, reviews the promise of artificial intelligence (AI), especially machine learning and deep learning in radiology. We initially discuss key concepts in the field of AI and gain a broad overview of the field and its potential, as well as the impact it is having on multiple areas of human endeavor. Subsequently, we focus on current and projected aspects of AI as applied to diagnostic radiology, specifically on how AI might provide an avenue for error prevention and remediation in radiology. The possible impact of AI in changing the radiologist’s role and basic job description is also considered.
Communication in Palliative Care
Authors: Dahlin Constance M. , Wittenberg Elaine
Published: February 2019

Communication is a learned skill that establishes the nurse–patient relationship; it is composed of 20% verbal and 80% nonverbal characteristics. The art of nursing communication includes listening, silence, presence, and therapeutic use of self to facilitate a patient- and family-centered process. Nursing communication includes gathering and imparting information and providing support and reassurance, as dictated by the individual needs of patients and families. Nurses have a direct role in difficult conversations such as advance care planning, delivery of bad news or poor prognosis, or discussing the transition to hospice and palliative care. This chapter discusses in detail the techniques and approaches to good communication in palliative care nursing.
Interdisciplinary Palliative Care Teams
Authors: Mazanec Polly , Reimer Rebekah , Bullington Jessica , Coyne Patrick J. , Harris Herman , Dubois Mary Catherine , Rogers Catherine , Aron Jennifer
Published: February 2019

This chapter defines the composition and roles of interdisciplinary team members on a palliative care team. The team has the responsibility to deliver patient-centered, family-focused care based on the recommendations from the National Consensus Project Guidelines for Quality Palliative Care. Within this chapter, interdisciplinary team members from an academic medical center discuss their respective roles on the team and describe how these roles supported a patient and family case study. The chapter provides an overview of the four most common models of palliative care delivery: inpatient consult teams, with or without a palliative care unit; ambulatory palliative care teams; community-based palliative care teams; and hospice teams. An introduction to essential considerations in the development of a palliative care team and the important components for maintaining a healthy, functional team are described.
Pain Assessment
Authors: Fink Regina M. , Gates Rose A. , Jeffers Kate D.
Published: February 2019

Pain is prevalent and undertreated in the palliative care setting, contributing significantly to patient discomfort and suffering at the end of life. Pain assessment is the cornerstone to evidence-based pain management strategies. However, multiple barriers to pain assessment persist. Patients should be routinely screened for pain on admission to a hospital, clinic, long-term care facility, hospice, or home care setting. If new, persistent, or worsening pain exists, comprehensive pain assessment and reassessment is crucial and includes a detailed history (including substance abuse or misuse), a comprehensive physical examination, and patient self-report of pain, whenever possible. In the absence of patient self-report of pain, observing for nonverbal pain behaviors using reliable and valid assessment instruments is appropriate. Nurses and healthcare providers should follow the hierarchy of a pain assessment framework to guide pain assessment approaches.
Dyspnea, Cough, and Terminal Secretions
Authors: Donesky DorAnne
Published: February 2019

This chapter presents the pathophysiology, measurement tools, and recommended interventions for three common conditions experienced by people diagnosed with serious illness: dyspnea, cough, and terminal secretions. Self-management experiences of people who lived with chronic dyspnea for many years provide a foundation for the discussion of pharmacological, mechanical, and behavioral therapies for dyspnea. Attention to the common neurological pathway for dyspnea is important for dyspnea management in addition to correcting the physiological defect. Cough is a physically exhausting and socially distressing experience, with little recent progress toward consistent management solutions. Terminal secretions or “death rattle” can be distressing for loved ones and staff, although it does not seem to cause discomfort for the patient.
Lymphedema Management
Authors: Fu Mei R. , Lasinski Bonnie B. , Van Cleave Janet H. , Tilley Charles P.
Published: February 2019

Nurses are the ideal resource for providing and improving quality care for patients suffering from lymphedema because they have access to large, diverse patient populations. Lymphedema or abnormal swelling is seen regularly in palliative and acute care settings. Lymphedema is a major health problem affecting thousands of individuals worldwide, yet it is often overlooked or neglected despite its capacity to cause pain and multiple distressing symptoms as well as to impair patients’ physical, functional, social, sexual, and affective well-being. Even with modern medical advances, lymphedema remains a lifelong, incurable disease requiring ongoing attention, appropriate therapy, and long-term management. Palliative care to alleviate symptoms and control swelling is the ultimate goal for lymphedema treatment and management. This chapter prepares nurses to understand, assess, and manage lymphedema in various clinical settings, including acute, outpatient, community, and palliative care.
Sexuality and Intimacy in Serious Illness and at the End of Life
Authors: Shaw Heather , Fronk Joshua
Published: February 2019

Intimate relationships and sexual expression are fundamental human experiences that are impacted by serious illness and the end of life. People will experience changes in the physical, psychological, social, and spiritual aspects of their relationships and expressions of their sexuality. While people wish to talk with their healthcare providers about changes in their intimate and sexual relationships, many barriers exist. Despite a lack of prospective studies to guide assessment of the sexual and intimate needs of people at the end of life, healthcare providers can and should strive for inclusivity by using the multidisciplinary team, asking open-ended questions, and assessing the physical, emotional, psychological, and spiritual needs of their patients. While some physical symptoms can be palliated, the physical and emotional changes that accompany serious illness and the dying process can be normalized and supported by healthcare providers.
Urgent Syndromes at the End of Life
Authors: Robertson Quinten , Gershon Kelli
Published: February 2019

During the end-of-life stage, patients can experience a variety of urgent syndromes that can be treated effectively to reduce pain and improve quality of life. Conditions such as superior vena cava obstruction, pleural effusion, hemoptysis, spinal cord compression, hypercalcemia, and pathological fractures often result from progression across the disease trajectory and are particularly common among patients with advanced cancers. Nursing and medical caregivers must be familiar with these conditions, recognize them when they occur, and provide appropriate education and support for the patient and his or her family in addition to effective medical intervention. Awareness of urgent syndromes that may occur at end of life can help caregivers to provide more effectual palliative care that diminishes distress and suffering for the patient and their family.
Spiritual Screening, History, and Assessment
Authors: Taylor Elizabeth Johnston
Published: February 2019

Spiritual care is integral to palliative care. Palliative care patients and their family members often use spiritual coping strategies, and spiritual well-being is a commonly high-ranked pursuit for those at the end of life. Appropriate spiritual care, however, must reflect the spiritual needs and preferences of the care recipient. Thus, numerous approaches to spiritual screening, history-taking, and assessment exist. Whereas the spiritual screening is proposed as a skill and expectation that nurses and others can be trained to complete, the spiritual assessment is the domain of the spiritual care expert—typically, a skilled chaplain. These diverse approaches are described here along with some additional observations that can guide the process.
Poor, Homeless, and Underserved Populations
Authors: Olney Caroline , Stroe Sarah , Hughes Anne
Published: February 2019

While many of the basic tenets of palliative care are universally applicable, there are particular truths and accompanying strategies to providing best-practice palliative care to marginalized, impoverished, and vulnerable populations. Maintaining a curious and gracious attitude that honors patients’ experiences and respects commitments regardless of patients’ socioeconomic status or external presentation must be kept at the forefront of the interaction to allow those who have been marginalized to build trust with providers. When providing palliative care to marginalized and vulnerable populations, it is critical to hold in mind the encompassing effects that poverty has on a person, as well as the sociopolitical challenges and injustices that people living in poverty experience daily, including during serious illness.
Caring for the Patient with Substance Use Disorder at the End of Life
Authors: Compton Peggy , Chang Yu-Ping , Meghani Salimah
Published: February 2019

With the changing face of treatments for cancer and other advanced diseases, patients are living for longer periods of time, which creates new challenges in treating pain and potential addiction issues on a longer term basis. Identifying substance use disorder in patients with advanced disease can be challenging, and old conceptions of addiction such as tolerance and physical dependence, need to be reexamined. Patients with advanced disease and comorbid substance use disorder can be difficult to manage but can be successfully treated with careful documentation, planning, and a therapeutic approach. The patient with advanced disease and comorbid substance use disorder may have two conditions in need of concurrent treatment: one of drug addiction and one of pain.
Veterans
Authors: Grassman Deborah
Published: February 2019

In many ways, veterans face the end of life in a similar manner as civilians. In some ways, however, they experience death differently. Military experiences often change veterans in fundamental ways that shape, mold, destroy, and redeem the rest of their lives, including the ends of their lives. This chapter identifies some of these differences in the hopes that readers will understand the unique hospice and palliative care needs of veterans and their families. For example, the value of stoicism so earnestly and necessarily indoctrinated in young soldiers may interfere with a peaceful death for veterans depending on the degree to which stoicism has permeated their post-military lives. This chapter provides lessons that inform healthcare delivery for veterans and bereavement care for their families. It explains how posttraumatic stress disorder (PTSD) can become exacerbated at the end of life, complicating peaceful dying. An overlooked, unassessed wound, now identified as “soul injury” and distinguishable from moral injury, will also be addressed.
Value-Based Care
Authors: Zachariah Finly , Dale William
Published: February 2019

The unsustainable growth of healthcare costs has precipitated the need for significant reforms in healthcare with a focus on shifting from volume to value. Value-based care is evidence-based care that helps patients improve their health, reduce the effects from chronic diseases, and live healthier lives. The Institute of Medicine (IOM) report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, detailed several recommendations to improve care through the provision of palliative care. Palliative care is conducted by an interdisciplinary team and, in addition to addressing bio-psycho-socio-spiritual concerns, facilitates the alignment of patient preferences with healthcare delivery and minimizes under- and overtreatment. This chapter explores key opportunities aligned with the IOM’s report that recommend nurses and the healthcare team facilitate the incorporation of palliative care and execution and the adoption of a value-based care delivery model.
End-of-Life Decision-Making in Pediatric Oncology
Authors: Lafond Deborah A. , Kelly Katherine Patterson
Published: February 2019

Decision-making for parents facing the serious illness of a child is difficult, particularly when facing end-of-life decisions. Healthcare providers can influence patients’ and parents’ end-of-life decision-making involvement by communication style and timing of the discussion. Children and adolescents need assistance making decisions based on their cognitive development, which necessitates the assessment of each patient’s competence and preference for decision involvement. Competence and preference for decision-making should also be explored for parents and other surrogate decision-makers. Preferences for treatment should be balanced between the child or adolescent and the caregiver or surrogate. Nurses have a professional responsibility to facilitate informed patient and surrogate decision-making at the end of life.
Palliative Care in the Perinatal Setting
Authors: Ann Thaxton Cheryl , Jacobson Diana , Murphy Heather , Whitley Tracey
Published: February 2019

The nurse is an essential interdisciplinary partner in the delivery of family- and patient-centered palliative care for families faced with perinatal or newborn loss in the labor and delivery (L&D) unit and in the neonatal intensive care unit (NICU). Early identification and referral of the family to perinatal and neonatal palliative care services is paramount. Improving nursing communication with the family, advocating for the family, and providing supportive nursing care, which includes physical and psychological symptom management, are emphasized. The L&D unit is an area in which patients can experience both joy and loss; it is imperative that L&D nurses receive education about palliative care in the event of maternal complications and/or congenital anomalies that lead to the death of a newborn. Principles of essential individualized, compassionate, and culturally competent palliative care interventions are reviewed using patient and family exemplars.
Access to Pediatric Hospice and Palliative Care
Authors: Lindley Lisa C. , Keim-Malpass Jessica
Published: February 2019

Access to high-quality pediatric hospice and palliative care is becoming increasingly important as the prevalence of children with serious illness grows and the complexity of their health at end of life rises. Pediatric hospice and palliative care is end-of-life care focused on enhancing the quality of end of life for the child and the family, preventing and/or minimizing suffering, optimizing function, and offering opportunities for personal and spiritual growth. Access to care is a multidimensional process proceeding from health policy through the characteristics of the healthcare delivery system to the utilization of healthcare services and quality of care accessed.
Palliative Care and Requests for Assistance in Dying
Authors: Ramirez Carey T. , Fundalinski Kathleen , Knudson Judy , Himberger John
Published: February 2019

Assistance in dying, though highly controversial, is requested of an increasing number of palliative clinicians. This necessitates an exploration of the current nomenclature, history, and ethical and legal foundations of the topic, followed by an evaluation of the characteristics of those who request physician assisted dying (PAD), suggestions for responding to requests, and recommended alternatives. As of 2017, medical aid in dying is legal in six states and the District of Columbia, jurisdictions in which 16.4% of the United States population live. In 2018, 27 states are considering legalization. Furthermore, assisted dying and euthanasia are legal in five countries and assisted dying without euthanasia is legal in three. The goal of this chapter is to ensure palliative specialists are prepared to handle requests for physician assistance in dying.
Advocacy in Palliative Nursing
Authors: Coyle Nessa , Kirk Timothy W.
Published: February 2019

This chapter explores what it means for a nurse to advocate for a patient with serious illness. Six integrated components constitute a conceptual model of palliative nursing advocacy. A case study is used to illustrate seven functional elements embedded in the model. The focus is on relational care that empowers patients and their loved ones, highlighting advocacy as an approach to care rather than a set of tasks discrete from, or in addition to, good nursing care. Palliative nursing advocacy fully engages the bio-psycho-socio-spiritual orientation that is the hallmark of nursing education and practice. This enables nurse advocates to use a full spectrum of skills and knowledge to partner with patients, families, and care team members, identifying common ground and building upon areas of agreement to deliver care driven by patient values and preferences. Common pitfalls and challenges that nurses may encounter as advocates are reviewed.
Sociocultural Investigation of Cancer Caregiving
Authors: Pedreira Patricia B. , Mitchell Hannah-Rose , Ting Amanda , Kim Youngmee
Published: February 2019

This chapter provides theoretical perspectives and empirical findings on the role of sociocultural factors in caregiving involvement, caregiving stress, caregivers’ unmet needs, and caregivers’ quality-of-life outcomes. This chapter concludes that taking socioculturally tailored and targeted approaches is promising for identifying subgroups of caregivers who are vulnerable to the adverse effects of cancer in the family and developing evidence-based interventions. To improve caregiver quality of life and minimize caregiver morbidity and premature mortality, sociocultural resources and risk factors should be further studied and integrated into clinical practice. Transdisciplinary and cross-cultural collaborations are necessary to achieve the ultimate goals of the emerging field of cancer caregiver research and practice around the globe.
FOCUS
Authors: Northouse Laurel , Shuman Clayton , Visovatti Moira , Dockham Bonnie , Titler Marita
Published: February 2019

This chapter describes the development and testing of the FOCUS program with patient-caregiver dyads (i.e., pairs) as the unit of care. The chapter reviews studies that examined (1) the efficacy of the FOCUS program when tested in randomized clinical trials, (2) the effectiveness of the program when implemented in Cancer Support Community affiliates in three states, and (3) outcomes when translated to a tailored, web-based program. Results indicate that FOCUS consistently produced positive outcomes for cancer patients and their caregivers in these studies. The program also improved patient and caregiver outcomes when delivered to patients with different types and stages of cancer, to spousal and nonspousal family caregivers, and in various intervention doses (three-, five-, and six-session programs). The chapter concludes with plans for further implementation of FOCUS and existing dissemination activities.
Cognitive Behavioral Therapy for Insomnia for Caregivers
Authors: Shaffer Kelly M. , Carter Patricia , Garland Sheila N. , Applebaum Allison J.
Published: February 2019

Between 40% and 76% of cancer caregivers report clinically significant symptoms of insomnia, likely due in part to the unique responsibilities, stressors, and compensatory behaviors endemic to the role. Insomnia negatively affects one’s mental and physical health, is frequently chronic, and may impair the normal grieving process among bereaved caregivers. Cognitive behavioral therapy for insomnia (CBT-I) is a first-line treatment for insomnia and is well suited to address the multifaceted contributing factors unique to caregivers’ sleep disturbance. This chapter addresses the distinct presentation of insomnia among cancer caregivers and describes key modifications to standard CBT-I that address these specific needs to enhance sensitivity and feasibility. A case example demonstrates the implementation of CBT-I tailored to one caregiver’s presentation. Future research must demonstrate effectiveness and acceptability of CBT-I among active caregivers, as well as develop a wide range of effective CBT-I delivery modalities to best serve this vulnerable population.
CancerCare
Authors: Kelly Sarah K. , Goeren William
Published: February 2019

As the population in the United States continues to grow and life expectancy increases, the need for quality cancer care increases accordingly. A cancer diagnosis and related treatments can significantly impact the quality of life of not only the person with cancer, but also the caregiver. Caregivers’ physical, emotional, and spiritual well-being are affected throughout the cancer trajectory. CancerCare was founded in 1944 in New York City to address these needs in both patients and caregivers and improve quality of life and overall care. Today, CancerCare is a leading national organization providing free, professional support services and information to help people manage the emotional, practical, and financial challenges of cancer. This chapter provides a comprehensive overview of CancerCare’s specialized caregiver services that address the unique needs of this population and seek to improve caregiver quality of life.
Conclusions and Future Directions
Authors: Applebaum Allison J.
Published: February 2019

This chapter summarizes the material presented in Cancer Caregivers and highlights significant progress made in the state of the science of cancer caregiving research over the past decade. Additionally, several important directions for future research are suggested. These include making distress screening a standard of care for cancer caregivers, and expanding our understanding of how life stage and culture significantly impact the caregiving experience. In addition to continued efforts to refine our psychotherapeutic technologies, greater attention is needed on dissemination and implementation research, which together will move us toward accomplishing precision and individualized medicine for cancer caregivers. Finally, we must understand how the changing public policy landscape will impact cancer caregivers and push for additional policies that will improve the capacity of caregivers to serve in this crucial role. Caregivers are a critical part of the patient care unit, and we must continue to advocate for a paradigm shift from patient-centered to family-centered care.
Urological investigations
Authors: Reynard John , Brewster Simon F , Biers Suzanne , Neal Naomi Laura
Published: February 2019

This chapter contains clearly titled sections covering the entire range of urological investigations, including assessment of renal function, urine investigations, and a range of imaging modalities. Ultrasound, computerized tomography scanning, magnetic resonance imaging, and isotope scans are discussed in detail. The fourth edition of this chapter also includes details of positron emission tomography scans and the indications for their use in urology, specifically in urological cancers. An overview of uroflowmetry, post-void residuals, and cystometry is also included. Detailed descriptions of each investigation are accompanied with illustrative examples, providing a clear overview of the wide range of urological investigations used in clinical practice.
Bladder outlet obstruction
Authors: Reynard John , Brewster Simon F , Biers Suzanne , Neal Naomi Laura
Published: February 2019

This chapter outlines the pathophysiology and causes of bladder outlet obstruction, along with diagnostic investigations and treatment options depending on the cause. Minimally invasive management of benign prostatic hyperplasia no longer includes thermotherapy or transurethral radiofrequency needle ablation, though these are briefly discussed by way of historical context. The new procedure of UroLift is discussed. Holmium laser enucleation of the prostate (HoLEP) has essentially replaced other forms of laser prostatectomy. Prostate artery embolization is increasingly used for troublesome prostatic bleeding. Management of acute and chronic forms of urinary retention are comprehensively discussed.
Urological neoplasia
Authors: Reynard John , Brewster Simon F , Biers Suzanne , Neal Naomi Laura
Published: February 2019

This chapter contains 61 clearly titled sections covering the basic science of neoplasia, radiological assessment and management of the benign renal mass, and the rapidly developing fields concerning the diagnosis and treatment of the entire spectrum of childhood and adult urological cancers. The fourth edition of this chapter significantly updates the previous edition, in particular the most important randomized trial data and management guidelines (published between 2013 and 2017) on diagnostic approaches, surveillance, and surgical and oncological treatments of organ-confined and advanced prostate, renal cell, and bladder cancers. All new data are referenced, often using online web links, and follow recommended guidelines from highly respected authorities, notably the United Kingdom’s National Institute of Health and Care Excellence (NICE) and the European Association of Urology (EAU).
Upper tract obstruction, loin pain, hydronephrosis
Authors: Reynard John , Brewster Simon F , Biers Suzanne , Neal Naomi Laura
Published: February 2019

This chapter covers upper tract obstruction, loin pain, and hydronephrosis. A comprehensive discussion of causes and management of unilateral and bilateral hydronephrosis is included. The pathophysiology of renal obstruction is detailed, including the physiology of urine flow from the kidney to the bladder. An overview of the management of non-pelviureteric junction obstruction (PUJO) ureteric strictures is included, including minimally invasive treatment options. The causes of retroperitoneal fibrosis are outlined, and this fourth edition includes the newer diagnosis of IgG4-related disease (causative in up to half of previously considered idiopathic cases). Common presentations, investigation, and management options are detailed, including both emergency management and longer-term treatments.
Urological surgery and equipment
Authors: Reynard John , Brewster Simon F , Biers Suzanne , Neal Naomi Laura
Published: February 2019

This chapter covers the principles of urological surgery and the equipment commonly used in urological procedures. This includes preoperative preparation, including the management of patients on anticoagulants, and the fourth edition includes novel oral anticoagulants. Technology such as catheters, lasers, stents, telescopes, and diathermy are all discussed in detail and at a level suitable for the FRCS(Urol) examinations. The principles of consent and the recent Montgomery ruling are included in the fourth edition. The surgical principles of a range of urological operations are outlined, ranging from inguinoscrotal procedures to pelvic oncology procedures, including reconstruction.
Madness and the demand for recognition
Authors: Rashed Mohammed Abouelleil
Published: February 2019

Madness and the Demand for Recognition: A Philosophical Inquiry into Identity and Mental Health Activism is the first comprehensive philosophical examination of the claims and demands of Mad Pride and mad-positive activism (Mad activism). Contemporary developments in mental health activism pose a radical challenge to psychiatric and societal understandings of madness. Mad activism rejects the language of mental illness and mental disorder, reclaims the term “mad,” and reverses its negative connotations. Not content with reform of psychiatry, activists seek cultural change in the way madness is viewed, and demand recognition of madness as grounds for culture or identity. But can madness constitute such grounds? Is it possible to reconcile delusions, passivity phenomena, and the discontinuity of self often seen in certain mental health conditions with the requirements for identity formation presupposed by the theory of recognition? And, in any case, why does recognition matter, and how should society respond to such demands? Locating itself in the philosophy of psychiatry, Mad studies, and activist literatures, and in the tradition of philosophical thought on recognition, freedom, and identity that begins with Georg Hegel and Immanuel Kant, and continues into the present day through the work of Charles Taylor, Axel Honneth, Nancy Fraser, Kwame Appiah, and Richard Rorty, the book develops a rich theoretical framework for understanding, justifying, and responding to Mad activism’s demand for recognition. It charts a pathway for reconciling opponents and supporters of Mad activism and, ultimately, for reconciling madness and society.
Mental health activism and the demand for recognition
Authors: Rashed Mohammed Abouelleil
Published: February 2019

This chapter, “Mental health activism and the demand for recognition,” overviews developments in mental health activism in the United Kingdom and the United States from the late nineteenth century to the present day. It begins by outlining the discourse of “mental hygiene, the “antipsychiatry” of the 1960s, the 1970s civil rights movements, and the consumer/service-user/survivor movements. The chapter continues with a focus on contemporary Mad Pride activism, describing the origins of the movement, the elements of the discourse, and the social and political demands that arise from it. It also discusses the problem of essentialism as it relates to social identities including Mad identity. The chapter concludes with an overview of philosophical engagement with Mad Pride and mad-positive activism.
The problem of distress and disability
Authors: Rashed Mohammed Abouelleil
Published: February 2019

This chapter, “The problem of distress and disability,” responds to common objections that madness is inherently distressing and disabling. These objections are seen to undermine positive constructions such as Mad Pride. On the question of disability this chapter responds by developing two bulwarks against the tendency to assume too readily the medical view that madness is inherently disabling: the first arises from the normative nature of disability judgments, and the second from the implications of political activism in terms of being a social subject. The chapter explores the social model of disability in light of debates on naturalism and normativism; the applicability of the social model to madness; and the difference between physical and mental disabilities in terms of the unintelligibility often attributed to the latter. On the question of distress, the chapter demonstrates that a phenomenon can be distressing and valuable, and this despite distress or because of it.
Misrecognition: Political reform or reconciliation?
Authors: Rashed Mohammed Abouelleil
Published: February 2019

Chapter 5 “Misrecognition: Political reform or reconciliation?” interrogates two possible responses to demands for recognition. It begins by outlining the harms of misrecognition and the way in which they are social harms (i.e., collectively generated). Having identified some possible harms, the chapter asks whether misrecognition should be addressed through political reforms (bringing in considerations of human flourishing and social justice) or through cultivation of interpersonal reconciliation (bringing in attitudes and practices aimed at mutual acceptance). After examining both possibilities, it concludes with an argument for a dual perspective in which both institutional responses and the attempt to seek interpersonal reconciliation are required for addressing demands for recognition. In pursuing this, the chapter engages with key arguments by Nancy Fraser, Axel Honneth, and Richard Rorty.
Mad culture
Authors: Rashed Mohammed Abouelleil
Published: February 2019

This chapter examines the viability of the notion of “Mad culture” as an alternative to the formulation of madness as a disorder of the mind. The chapter addresses the following questions: What is culture? Can madness constitute a culture? What are the justifications for cultural rights? Do people have a right to their culture or to any culture? In the process of answering these questions, the chapter compares and contrasts Mad culture and Deaf culture. It also engages with Will Kymlicka’s theory of cultural rights as civil rights, which centers on the idea of culture as a “context of choice.”
Mad identity II: Unity and continuity of self
Authors: Rashed Mohammed Abouelleil
Published: February 2019

Chapter 8, “Mad identity II: Unity and continuity of self,” examines two objections to Mad activism. Certain mental health phenomena are considered to undermine unity and continuity of self and hence to undermine two requirements for identity formation. This chapter explores the nature and extent of these problems, and whether or not they are fatal to the claim that madness can be grounds for identity. With regard to disunity of self, the chapter investigates passivity phenomena with a focus on thought insertion. It uncovers the cultural psychological basis of judgments of disunity, and offers a more complex appraisal of passivity phenomena. With regard to discontinuity of self, the chapter investigates patterns of discontinuity in spirit possession, dissociative identity disorder, schizophrenia, and bipolar disorder. It notes similarities and differences in these patterns, and ways of overcoming discontinuity. In pursuing this, the chapter engages with key arguments by Jennifer Radden and Christine Korsgaard.
A framework for prognosis research
Authors: Croft Peter , Riley Richard D , Moons Karel GM , Hemingway Harry
Published: February 2019

This chapter introduces the PROGRESS framework, which describes four types of prognosis research, each addressing different questions. The four types concern: studies of overall prognosis (the average outcome, or outcome risk, in people with a particular health condition, in the context of the nature and quality of current care); prognostic factors (characteristics associated with changes in the average outcome, or outcome risk, across individuals); prognostic models (development, validation, and impact evaluation of statistical models, incorporating multiple prognostic factors for use in clinical practice to predict an individual’s outcome value or to estimate their outcome risk); and predictors of treatment effect (characteristics that predict whether an individual responds to a particular treatment or not). Examples of each type are given to illustrate the framework.
Systematic reviews and meta-analysis of prognosis research studies
Authors: Riley Richard D , Moons Karel GM , Debray Thomas PA , Altman Douglas G , Collins Gary S
Published: February 2019

Systematic reviews and meta-analyses identify, evaluate, and summarize prognosis research studies and their findings. The chapter provides a guide to the key components and methods for conducting a systematic review and meta-analysis for each of the four types of prognosis studies. The CHARMS checklist is introduced as a guide to identifying clear review objectives and design, and to extracting the relevant information from each included study. Many existing prognosis studies are at high risk of bias, because (for example) of selective recruitment and reporting. Tools for examining quality of studies are discussed—the QUIPS for prognostic factor research and PROBAST for prognostic model research. The statistical principles of meta-analysis are described, and the key statistics that can be synthesized are outlined. Challenges are identified, such as the potential for publication bias and substantial heterogeneity in published prognostic factor cut points and methods of prognostic factor measurement. Despite these challenges the chapter emphasizes the crucial importance of prognosis reviews for evidence-based guidelines and clinical decision making.
Prognosis research in people with low back pain
Authors: Foster Nadine E , Dunn Kate M , Croft Peter
Published: February 2019

Prognosis has dominated recent low back pain (LBP) research because of the lack of disease pathological explanations of LBP that lead to safe and effective treatments in many patients; the hazards of overdiagnosis and overtreatment; and the potential for beneficial outcomes in patients if treatment approaches are carefully matched to the likelihood of recovery, recurrence, or persistence, or the likely effect of specific treatments. This chapter uses examples from each of the four types of prognosis research to illustrate how prognosis research has contributed to understanding LBP and provided evidence to inform classification and treatment of patients with LBP.
Prognosis research in people with coronary heart disease
Authors: Timmis Adam , Perel Pablo , Croft Peter
Published: February 2019

Coronary heart disease (CHD) outcomes have improved in recent decades because of better treatment, improved investigations, and better secondary prevention. The results of prognosis research have contributed to the development and evaluation of these new components of healthcare for CHD, but have also critically questioned traditional classifications of CHD, emphasized the importance of long-term outcomes in judging the success of healthcare in CHD patients, and highlighted the potential of risk stratification to guide better treatment decisions for individual patients with CHD. This chapter uses example studies to illustrate this story.
Novel statistical methods for prognosis research
Authors: Crowther Michael J , Rutherford Mark J
Published: February 2019

This chapter introduces some advanced statistical methods that are growing in their application to address more complex data arising from prognosis research studies. Three major topics are covered: competing risks, multi-state models, and joint modelling of longitudinal and survival data. The advances in such statistical methods allow complex relationships and intricate prognosis pathways to be modelled, including multi-morbidities over time. They are needed to help identify prognostic factors at different parts of an individual’s time course, and to develop more dynamic prognostic models where outcome risk can be updated over time. Practical clinical examples are used throughout the chapter to illustrate the approaches.
Philosophical influences on Thomas Szasz
Authors: Luft Eric v.d.
Published: February 2019

We would naturally expect Szasz, a libertarian conservative, to have been influenced by, for example, Rousseau, Burke, Hayek, von Mises, Thoreau, Socrates, Camus, Sartre, Mill, Mencken, Seneca, Nietzsche, Stirner, and individualism in general. But this is not entirely the case. As somewhat of a philosophical rogue, his influences were subterranean, selective, and so eclectic that we could almost accuse him of cherry-picking. He could not use many philosophers to his advantage since they mostly accepted the reality of mental illness. Yet in Szasz’s works we detect Popper’s rejection of historicism and social determinism, Russell’s linguistic analysis, Reichenbach’s logical empiricism, Bridgman’s operationalism, Langer’s and Cassirer’s systematic understanding of non-linguistic expressions such as symbols, Kierkegaard’s indirect communication, and Hobbes’s idea that government may not legitimately take away any individual’s rights unless the individual has first freely empowered the government to do so.
Agency, mental illness, and psychiatry: A response to Thomas Szasz
Authors: Daly Robert W.
Published: February 2019

Szasz’s understanding of persons as agents underwrites his ideas about mental illness and clinical psychiatry as a medical specialty. He asserts that the phenomena of mental illnesses, including suffering, signal “problems in living” or difficulties in determining the best use of one’s agential powers. The goals of the relationship are to enhance the client’s knowledge of his or her personality, to refine his intentions and sense of responsibility for his “symptoms” and other actions, and to achieve his aims and satisfy his desires, as long as he does not, by his actions, harm others. For the author of this chapter and other clinicians, the experience of phenomena exhibited by persons judged to be mentally ill are, to some extent and sense, apprehended as events that happen, rather than as actions authored by the person as agent. These untoward activities suggest a undesirable organismic condition of a person as agent, a diminution of the agent’s capacity for living a life, the signal of a organismic disorder, a problem with the human organismic equipment for living a life—not solely a problem about the best use of that equipment (as Szasz contends) but a state of ill health and a suffering person in need of treatment.