bluuebunny/crossref_metadata_2025 huggingface dataset:
Students’ awareness of physics application in the medical field
Authors: Alsufyani Daniah
Published: October 2023

To assess students’ awareness of physical sciences’ significance in the medical field and relate this awareness to their academic achievement. A multiple-choice questionnaire was distributed to first- and second-year medical sciences students. The questionnaire consists of four particulars, two questions aimed at assessing the students’ awareness of physics implementation in medical sciences and 12 relatively basic questions designed to measure the participant’s knowledge. A total of 370 eligible students participated in this study (187 unified-track students and 183 nursing-track students). Students showed a higher awareness of familiar applications compared to unfamiliar physics applications. 63.6% of students with high academic achievement (unified-track students) indicated awareness of the importance of studying physics, compared to 34.9% of students with lower academic achievement (nursing-track students). Our results also indicated a slightly weak correlation between students’ awareness and knowledge level (r = 0.251). We found that students’ awareness of the positive impact of studying physics on their professional development varied based on their academic achievement. In general, students displayed a higher ability to recognize physics’ medical applications if introduced to the concept by relating it to its real-life medical application. Conversely, when students were introduced to the topic without relating it to real-life medical applications, we found that they were generally less able to correctly recognize the underlying physics principle.
The use of astronomical databases to perform practical work in the process of teaching astronomy
Authors: Holovko Mykola , Kriachko Ivan , Kryzhanovskyi Serhii , Matsyuk Viktor , Melnyk Yurii , Mokhun Serhii
Published: October 2023

The process of learning astronomy should include such a component as the search for astronomical information, as well as provide conditions under which each student will be able to turn such information into his/her knowledge. That is why an important component of a modern lesson should be the students’ purposeful mastery of the skills of working with information, its search and assessment in terms of compliance with the educational goal, etc. Currently, multimedia educational products, pre-prepared by the teacher with the help of a computer and information from the Internet, are an essential means for creating and satisfying students’ interest in learning in general. An important condition for deepening the interest in learning, and therefore deeper assimilation of knowledge, is not the eyeing of interesting pictures (for example, multimedia presentations), but the individual work of the student to transform information while doing educational tasks. However, the essential thing, in this case, is that, on the one hand, the information arrays have huge volumes, and therefore certain experience is needed to search for specific information, and on the other hand, although they are concentrated in numerous repositories, access to them is often open.
Kinetic simulation of ion thruster plume neutralization in a vacuum chamber
Authors: Nishii Keita , Levin Deborah A
Published: October 2023

The electrical environment of a ground vacuum testing chamber creates facility effects for gridded ion thrusters. For example, it is well known that the plume from the thruster generates current paths that are very different from what occurs in space, and the neutralization of this plume is also different. For reasons such as this, it is important to clarify how the experimental testing environment affects plasma flows, but understanding this effect solely through ground experiments is difficult. To that end, this study utilizes particle-in-cell and direct simulation Monte Carlo methods to simulate xenon beam ions and electrons emitted from a neutralizer. First, we compare simulations conducted within the chamber to those conducted in space, demonstrating that grounded chamber walls increase the electric potential and electron temperature. Next, we investigate the impact of the neutralizer’s position and the background pressure on the plume in the vacuum chamber. We find that as the neutralizer position moves closer to the location of maximum potential, more electrons are extracted, resulting in increased neutralization of the plume. We also observe that high background pressure generates slow charge-exchange ions, creating ion sheaths on the side walls that alter ion current paths. Finally, we discuss how the potential at the thruster and neutralizer exits affects the plume. The relative potential of the neutralizer to the vacuum chamber wall is observed to significantly influence the behavior of the electrons, thereby altering the degree of plume neutralization. These findings are shown to be consistent with experimental results in the literature and demonstrate the promise of high-performance simulation.
The development of porous metallic materials: a short review of fabrication, characteristics, and applications
Authors: Li-Yin Gao , Hao-Kun Yang , Xuan Chen , Wei-Dong Tang , Xing-Ming Huang , Zhi-Quan Liu
Published: October 2023

Metallic porous material plays an irreplaceable role in weight reduction, heat dissipation, catalyst, and other industrial applications. The customized, large production and environment-friendly fabrication of porous metallic material are becoming increasingly important. Moreover, the selection of matrix material, control of porosity, and foaming parameters are critical for determining the quality of porous metallic material and product. As the porous metallic material is often used as the structural and/or functional component, its mechanical, heat dissipation, corrosion resistance and other properties need to be evaluated before industrial application. This review provides an overview of the fabrication techniques, characteristics, and applications of porous metallic materials. Additionally, current industrial applications and potential future areas are discussed.
Decoding plant adaptation: deubiquitinating enzymes UBP12 and UBP13 in hormone signaling, light response, and developmental processes
Authors: Feng Hanqian , Tan Jinjuan , Deng Zhiping
Published: October 2023

Ubiquitination, a vital post-translational modification in plants, plays a significant role in regulating protein activity, localization, and stability. This process occurs through a complex enzyme cascade that involves E1, E2, and E3 enzymes, leading to the covalent attachment of ubiquitin molecules to substrate proteins. Conversely, deubiquitinating enzymes (DUBs) work in opposition to this process by removing ubiquitin moieties. Despite extensive research on ubiquitination in plants, our understanding of the function of DUBs is still emerging. UBP12 and UBP13, two plant DUBs, have received much attention recently and are shown to play pivotal roles in hormone signaling, light perception, photoperiod responses, leaf development, senescence, and epigenetic transcriptional regulation. This review summarizes current knowledge of these two enzymes, highlighting the central role of deubiquitination in regulating the abundance and activity of critical regulators such as receptor kinases and transcription factors during phytohormone and developmental signaling.
MENINGIOMA-06 CYSTIC MENINGIOMA CASE STUDY AND LITERATURE REVIEW
Authors: Mala Zeus , Aniba Khalid
Published: October 2023

BACKGROUND

Intracranial meningiomas are generally solid tumors with a characteristic radiological appearance. The incidence of cystic meningioma is very low. withe an estimated frequency of 1.6 to 11.7%. It is often misinterpreted on radiological only the anatomopathological exams study can confirm the diagnosis. We report an unusual case of cystic meningioma through which we discuss pathogenic, clinical, radiological and therapeutic characteristics.

CASE

The patient is a 46 years old woman, with left parieto-occipital headaches for three months with recent appearance of right hemiparesis. The brain scan showed a lesion occupying the left posterior cystic parietal space with a solid nodule and perilesional edema, and enhancement of the solid component and cystic wall. The patient was operated using a left posterioparietal approach.The intraoperative appearance was that of a well defined encapsulated lesion attached to the dura mater, whitish in colour with a cystic part containing xanthochromic liquid and a solid nodule. The tumor is completely extra-axial with a plane of cleavage relative to the peritumoral cortical surface having facilitated its complete excision. Histological examination of the resected confirmed the diagnosis of cystic meningioma. There was no recurrence after 20 months of follow up.

CONCLUSION

Cystic meningioma is a rare entity. The diagnosis is often difficult to make preoperatively. Dural tail is a specific radiological sign, but not enough to evoke the diagnosis of meningioma with total precision. The surgical excision must be complete especially before signs of contrast of the cystic wall, in order to avoid a possible recurrence or anaplastic transformation.
OTHER-05 THE CHALLENGES IN MANAGING CHILDREN WITH PRIMARY CENTRAL NERVOUS SYSTEM TUMORS IN UGANDA
Authors: Katasi Victoria , Naitala Ronald , Muwonge Peter Wasswa , Munube Deo , Namazzi Ruth , Nabaggala Catherine , Zungu Jennifer , Nyesiga Amos , Ssali Alex
Published: October 2023

BACKGROUND

Pediatric central nervous system tumors (CNS) are the second commonest childhood malignancy and the commonest solid tumor in children. Brain tumors are the commonest cause of death among all childhood cancers.

OBJECTIVES

To describe the challenges in managing children with CNS tumors in Uganda, treated at Mulago National Referral Hospital (MNRH) from March 2019 to March 2023, using a subset of patients with the diagnoses of medulloblastoma, pineoblastoma and ependymoma.

METHODS

A retrospective study was conducted in MNRH, in patients below 18 years of age, admitted with one of the three histological diagnoses. The data included time to presentation to a tertiary health center from occurrence of initial symptoms, time to surgery from time to presentation to a tertiary health center, time to a histological diagnosis from time to presentation to a tertiary health center and time to starting radiotherapy from time to presentation to a tertiary health center.

RESULTS

The total number of patients was 32(44% had medulloblastoma, 37% had pineoblastoma). Of 30 patients with a recorded date of occurrence of initial symptoms, the median time to presentation to a tertiary health center was 2.5 months (95% median Cl- 1.702,3,711), with the maximum at 30 months. The median time to surgery for 24 patients was 0.92 months995%Cl- 0.460, 2.143), with a maximum of 13.8 months. The median time to a histological diagnosis for 30 patients was 1.39 months (95%median Cl- 0.680, 2.163). The median time to starting radiotherapy for 16 patients was 6.5 months (95%median Cl- 3.168, 8.724) and a maximum of 23 months. The overall one-year survival for children with ependymoma was at 62.5% (95%CI- 14.2,89.3), followed by medulloblastoma at 39.5%(95%CI-12.9,65.6) and pineoblastoma at 37.45%(95%CI-9.5,67.0).

CONCLUSION

The management of pediatric CNS tumors in Uganda is still sub-optimal due to referral, diagnostic and treatment challenges.
OTHER-07 NEUROSURGICAL ONCOLOGY CAPACITY IN KENYA: RESULTS FROM A NATIONWIDE SURVEY OF CONSULTANTS AND RESIDENTS.
Authors: Shitsama Sylvia , Henderson Jr Fraser
Published: October 2023

Neurosurgical oncology services (NOS) in Kenya have grown in tandem with resident training programs yet little is known objectively on current capacity and challenges. A 37-item electronic survey was distributed to neurosurgical consultants and residents practicing in Kenya. Among 49 respondents [27 consultants (69% national response rate), 22 residents; median age of 36 – 40; 51% practice < 5 years], 100% and 88% had access to CT scan and MRI brain respectively. 57% performed more than 40 cranial tumor surgeries annually and 48/49 (98%) perform oncology cases on a “regular basis”. Radiotherapy, chemotherapy, and pathology are performed within the respondents’ institutions in 63%, 65% and 61% of surveys, while the rest are sent out. 45 (96%) utilize an operating microscope, and 8 (17%) have an ultrasonic aspirator. Palliative care services are available for 45 (92%). 41 (84%) “agree” or “strongly agree” that delays in referrals between specialties are a major challenge to practice. 38 (78%) “agree” or “strongly agree” that treatment abandonment is also a major challenge. 49% participate in a tumor registry however major barriers to conducting research included lack of funding and protected research time. Having a mentor is perceived as the greatest facilitator for conducting research. No respondents enrolled any patient in a clinical oncology trial during the past year yet nearly every neurosurgeon performs oncology cases and 60% of Kenyan neurosurgeons carry a major tumor case load, in contrast to countries where elective spine surgery predominates neurosurgical practice. Clinical trial enrolment remains uncharted in Kenyan neurosurgery and more than 2/3 of Kenyan counties lack NOS. This survey highlights progress in availability of neurosurgical oncology services while identifying that containing treatment cost, reducing referral delays, and embedding clinical research in clinical practice through mentorship can be NOS growth catalysts.
PAEDIATRIC-12 MANAGEMENT OF PAEDIATRIC LOW-GRADE GLIOMA IN CAPE TOWN, SOUTH AFRICA
Authors: Tsimane Katlego , Parkes Jeannette , Figaji Anthony , Pillay Komala , Davidson Alan
Published: October 2023

OBJECTIVE

To assess the management of paediatric low-grade gliomas by the combined neuro-oncology services of the University of Cape Town.

METHODS

A retrospective analysis was performed on the folders of patients diagnosed at the Red Cross War Memorial Children’s Hospital (RCWMCH) and Groote Schuur Hospital (GSH) between 2000 and 2022. The data includes 2 patient cohorts, the first cohort being patient data collected from 2000-2016 and the second from 2017-2022.

RESULTS

A total of 127 patients, aged 0.38-13.76 years (mean 5.71) were treated at RCWMCH and GSH. Predisposition syndromes observed included Neurofibromatosis 1 11, Tuberous sclerosis 6, and Trisomy 21 1. The most common sites were the cerebellum 27%, hypothalamus 17%, cerebrum 12%, and optic pathway 13%. Metastatic disease was noted in 12 patients (9%). Gross total resection (or debulking) was performed in 67 (53%) of patients, 40 had biopsy only, and 20 had no surgery (mostly OPGs). Histology was predominantly Juvenile Pilocytic Astrocytoma 70%, Diffuse Astrocytoma 9%, Low-Grade Glioma Nos 8%,5% Subependymal Giant cell Astrocytoma, and 5% Pilomyxoid Astrocytoma. BRAF v600E mutation was tested in 17 patients: all were negative. Forty-four (35%) received chemotherapy and 36 (82%) as first-line therapy with vincristine and carboplatin as the most used agents. Newer therapies Bevacizumab/irinotecan and Trametinib were recently used in 10 patients as third or fourth-line regimens. There was an increase in chemotherapy usage for patients with irresectable tumours between the 2 cohorts, from 27% in the first cohort to 49% in the second. Thirty (23.6%) patients received radiotherapy and of those 8 were in an upfront setting. There was no difference in the 5-year OS between the 2 cohorts, 84% in the first and 85.7% in the second.

CONCLUSION

Multi-disciplinary treatment of paediatric LGG in LMIC is essential. Patterns of management have changed without affecting outcomes.
PATIENT ADVOCACY-02 BRAIN TUMORS MATTER: HOW TO IMPROVE THE MANAGEMENT OF PATIENTS WITH BRAIN TUMORS AT THE CNHU HKM OF COTONOU IN BENIN?
Authors: Gankpe Gbetoho Fortune
Published: October 2023

Cancer care in Benin is still in its inception in Benin. The first cancer registry was created in Benin in 2014. In the study of Egué et al, published in 2019, there were 1086 cases of cancer recorded in the cancer registry in Benin from 2014 to 2016, including 18 cases of nervous system cancer representing 2.3% and 1.2% of cancers in men and women respectively. When compared to other types of cancers including liver and prostate in men and cervix and breast in women, brain cancers appear very low. However, there is no structure dedicated to the treatment of nervous system cancers since there are no neuro-oncologist in Benin and many patients diagnosed with brain tumors are frequently refer outside our country for treatment. Rare patients undergo surgery in our country for brain tumors. Therefore, we can assume that brain tumors statistics are not really indicative of the burden of morbidity and mortality related to nervous system cancer in Benin. The need to organize the management of patients suffering from nervous system tumors is therefore necessary. In order to meet this need, we plan to set up a neuro-oncology unit in Benin in order to improve the neurosurgical management of patients with intracranial tumors at the CNHU HKM Cotonou and also to initiate research projects related to brain tumor care in Benin.
SPINAL TUMORS-04 SOLITARY FIBROUS TUMOUR, A DIAGNOSTIC CONUNDRUM (A CASE REPORT)
Authors: Kamande Kenneth , Cheruiyot Davies , Mukono Samuel , Fazal Akil , Waweru Angela , Cheserem Beverly , Kabethi Penina
Published: October 2023

A 33-year-old male presented with neck pain and early signs of cervical myelopathy. He had a circumferential enhancing C4 tumour with bone demineralization. He had previously had an ACDF and a biopsy of the affected region with variable histology results. Imaging revealed a circumferential C4 tumour with bilateral vertebral encasement and cord compression. He had an extensive tumour debulking , corpectomy and posterior fusion. His neck pain resolved and myelopathy is stable at Nurick grade I. Histology Sections showed cellular tumor composed of spindle cells with little intervening stroma CD34 positive, progesterone receptor negative and EMA. STAT6 was positive confirming a solitary fibrous tumour. Patient has commenced adjuvant radiotherapy. Solitary tumours, formerly classified hemangiopericytoma are rare. In this case, the patient had had three previous inconclusive histological evaluations. Utilization of immunohistochemistry tests enabled the establishment of a conclusive diagnosis and treatment planning. Previously solitary fibrous tumors were classified as hemangiopericytomas with the option of three grades. However, in the current 2021 WHO 5th edition, the term hemangiopericytomas has been dropped to align these tumors fully with the soft tissue pathology nomenclature. These tumors have the characteristic alteration of the NAB2-STAT6 gene/molecular profile.
Planning and implementation
Authors: Jelliffe Derrick B , Jelliffe E F Patrice , Zerfas Alfred , Neumann Charlotte G
Published: October 2023

The sequence and range of activities undertaken in nutritional assessment will obviously vary with objectives (Table 7.1) and the type of investigation proposed (Table 7.2), financial and other resources, and other constraints (geographical, time, weather). Most of the following section is concerned with relatively large-scale surveys in technically less developed countries. However, a systematic approach is needed in nutritional assessment in all situations relating to both populations and individuals. The contents and suggestions in the present chapter are mainly concerned with large-scale surveys. They need to be used selectively in other forms of nutritional assessment (Fig. 7.1).
Consciousness and unconsciousness
Authors: Bannister Sir Roger
Published: October 2023

There is a broad distinction between the content of consciousness, that is, what we are at any moment conscious of, sensations, emotions, ideas, or memories, for example, and the process of consciousness itself. This is borne out by everyday clinical experience. A person may be at one moment conscious of one thing and at another moment conscious of another, but on each occasion he is equally conscious. Moreover, the content of consciousness may be impaired by disease, as when a patient loses part of a visual field or sensation over part of the body. Nevertheless, such a person remains fully conscious. On the other hand, a person may be completely unconscious, and between full consciousness and unconsciousness there are states in which he is partially conscious, that is, he has some degree of awareness of his surroundings, but it is incomplete.
CFS: a social history of twentieth century illness
Authors: Wessely Professor Simon , Hotopf Dr Matthew , Sharpe Dr Michael
Published: October 2023

To introduce the social context of CFS we will use two fictional examples to set the scene for the remainder of this chapter. The device of fiction is particularly useful; since it can portray the symbolic elements of CFS/ME without being encumbered by facts - fiction can deal entirely in perception.
Introducing two children with autism
Authors: Baron-Cohen Simon , Bolton Patrick
Published: October 2023

Autism is a condition that affects some children from either birth or infancy, and leaves them unable to form normal social relationships, or to develop normal communication. As a result, the child may become isolated from human contact and absorbed in a world of repetitive, obsessional activities and interests. Children with autism may behave in strange ways. They may jump up and down excitedly at the sight of the water running from the taps, yet ignore attempts by adults to turn activities into a ‘social’ game in which others can share. They may look past you, or only very briefly at you, and make you feel as if you are an unimportant part of their world. They may call you when they need something, but otherwise virtually ignore you, spending hours lining up objects in the living room, or flapping their hands and fingers excitedly as they repeatedly flick through picture books or magazines.
Psychological problems
Authors: Baron-Cohen Simon , Bolton Patrick
Published: October 2023

In this chapter we go on to describe how the brain abnormalities thought to underlie autism may produce anomalies in psychological functioning. These two levels of description, the brain and the mind, are separated into two chapters for convenience, though of course ultimately they are inseparable. As we mentioned in Chapter 2, the three key psychological problems in children with autism are in the development of social relationships, of language, and of the imagination. These need a closer look in order to try to understand them.
Intelligence and special talents
Authors: Baron-Cohen Simon , Bolton Patrick
Published: October 2023

This chapter continues our summary of psychological abnormalities in autism from the last chapter, but focuses specifically on intelligence and special talents. This merits its own chapter because of the finding that intelligence is often unusual in autism, and that special abilities are more commonly associated with children with autism than with other conditions. Intelligence is a difficult thing to define. However, we need not get bogged down in definitions here. Instead, for the present purposes, we can define intelligence as those abilities that are measured by IQ (or ‘Intelligence Quotient’) tests. When IQ is measured at different times over a person’s life, it is found to be approximately the same, give or take about 15 points. For example, if a child is in the average IQ range (70-130) at the age of 8 years old, then he or she is also likely to be in this range of scores at any stage in the future. If a person’s IQ is below the average range (i.e.: less than 70) he or she may have difficulties in learning, and require special education. In such cases, people are said to have a mental handicap.
Other therapies
Authors: Baron-Cohen Simon , Bolton Patrick
Published: October 2023

In the years since autism was first described, a range of different psychological treatments have been tried. While there have been no independently assessed demonstrations of an absolute cure, different kinds of psychological treatment have nevertheless had considerable beneficial effects. The clearest example is behaviour therapy, and this is described first. Behavioural programmes are designed by psychologists and psychiatrists working in consultation with parents, teachers, or care staff, and are essentially ways of shaping adaptive behaviours (such as toilet training) or decreasing maladaptive behaviours (such as spitting). As such, behaviour therapy can be of immense practical value. In behaviour therapy, the behaviour is analysed into its causes and consequences, and then a behavioural programme is implemented. The aim is to identify the factors that reward or encourage appropriate behaviours, as well as those that succeed in discouraging disruptive behaviours. Rewards need to be based on what each individual child values, and have to be given clearly and consistently. Modern behaviour therapy does not punish children for bad behaviour, as this is often ethically unjustifiable. Instead, it attempts to reduce such maladaptive behaviour by removing the factors that may be encouraging it, and replacing it with more positive skills.
Informed consent
Authors: Silverman William A
Published: October 2023

A survey of interventions and outcomes from November 1987 through October 1988 in seven American neonatal centers disclosed wide variation in practices for the care of very-low-birth weight infants. There were, as well, appreciable differences in survival and in morbidity. ‘It appears’, the survey group concluded, ‘that the practice of neonatal medicine remains in part an art rather than an exact science.’ Under these conditions of uncertainty about ‘best’ medical management, a paradoxical duality has flourished. There are opposing attitudes about the need to obtain parental consent for a specific ‘customary’ treatment, in contrast to the need for consent to use the same treatment when it is ‘under study’.
Government regulations in the United States
Authors: Ariagno Ronald L
Published: October 2023

The influence of the US Federal Government on the practice of medicine in the 1990s is felt very clearly by the entire nation. The powerful position of the Food and Drug Adminieitration has been experienced by anyone who has attempted to introduce a new medical device or treatment, such as the high-frequency jet ventilator for infant use, or surfactant replacement therapy for pre-term infants who have respiratory failure due to immature lungs and surfactant deficiency at birth. The government regulation process seems to be an intentionally slow administrative maze which is demanding, difficult, often frustrating, and costly to the individual(s) requesting a review and seeking an approval. Nevertheless, the ultimate goal and purpose of the process is to ensure the ultimate protection of the nation’s health and people.
The economics of perinatal care in the United Kingdom
Authors: Stevenson Richard C
Published: October 2023

Only a few years ago some clinicians were willing to question the whole morality of economic intrusions into medical matters. Is it right, they would ask, to place a value on the life of a baby? Is it proper, or even conceivable, that an infant might not be treated for want of funds? These questions, understandable in a National Health Service (NHS) when clinicians were not expected to count costs, now seem almost antediluvian. Resources were always limited, and difficult choices had to be made between and within specialties; but these choices were made implicitly. For better or worse, the application of economics to health-care issues has tended to make costs and choices explicit. It can also be argued that health economics has added a dimension to medical ethics.
Pediatric nursing ethics
Authors: Penticuff Joy Hinson
Published: October 2023

In approaching nursing ethics in perinatal care, it is useful to take a broad view, because many of the factors that bear on nurses’ ethical reasoning and actions are influenced by the context of the hospital environments in which they practice and nurses’ close interactions with patients. Nursing ethics is an ethics of obligations within practice environments-environments that impose some degree of constraint on nurse autonomy. Within this milieu, nurses, expectant families, pregnant women, infant patients and their parents, the medical team, and administrative personnel are in dynamic interaction.
Induction Of General Anaesthesia
Authors: Runde C J , Gillies G
Published: October 2023

Until the 1840s, operations were performed without any anaesthetic. In that decade, the anaesthetic gas nitrous oxide and the anaesthetic vapour ether were demonstrated for the first time. Intravenous anaesthetic drugs were first used in the 1930s and muscle relaxant drugs in the 1940s. Modem concepts of anaesthesia date from that time.
Maintenance And Monitoring Of The Adequacy Of Anaesthesia
Authors: Morton N S
Published: October 2023

Monitoring of the adequacy of anaesthesia relies on clinical signs of too light a level of anaesthesia, and specialized electronic brain monitors. The anaesthetist is constantly on the look out for signs of ‘lightness’ and tries to titrate or match the delivery of anaesthesia to the intensity of the surgical stimulus. Clinical signs are patient movement, tear formation, dilation of the pupils, sweating, increase in heart rate, increase in blood pressure and increase in respiratory rate. It is important to relate these signs to what is happening surgically as there may be other explanations for these signs of ‘lightness’. For example, inadequate ventilation with a rise in CO2 can produce many of these signs!
Maintenance And Monitoring Of The Adequacy Of Muscle Relaxation
Authors: Morton N S
Published: October 2023

Monitoring of muscle relaxation should be routine whenever a neuromuscular blocking drug is used. This allows the anaesthetist to more accurately assess the effect of a dose of muscle relaxant (i.e. is it producing adequate muscle relaxation for surgery) but also how long a dose lasts, when is another dose needed, when it is safe to reverse the effects of the relaxant and whether reversal is adequate.
Ear, Nose And Throat Surgery
Authors: Runcie C J
Published: October 2023

Nose and throat operations are carried out on the upper respiratory tract. The airway is therefore shared between the surgeon and the anaesthetist. The anaesthetist must preserve a clear airway while allowing the surgeon adequate access and must also prevent soiling of the trachea and lungs with blood and debris.
Minimally Invasive Surgery
Authors: Morton N S
Published: October 2023

Recently, interest in surgical techniques via telescopic instruments using fibreoptic technology has developed, although some basic techniques and principles have been in use in gynaecology for many years. Laparoscopy is where a fibreoptic light source and imaging system is pushed through a small incision in the abdomen into the peritoneal cavity. A miniature TV camera is often attached so that the surgeon, trainees, and theatre staff can see clearly. Specialized instruments are passed through other small incisions to grasp, cut, or diathermy as required. To gain a better view, carbon dioxide (CO2) is insufflated into the peritoneal cavity and special equipment is used so that the pressure inside the peritoneum does not rise too high. Patients are intubated and ventilated for this procedure to counteract the splinting of the diaphragm and the absorption of CO2 into the bloodstream. Things can go wrong with this technique such as overpressure of CO2, CO2 tracking into the chest cavity or tissues, embolism of CO2 into blood vessels and bleeding.
Orthopaedics And Trauma
Authors: Morton N S
Published: October 2023

A wide range of general anaesthesia and local or regional anaesthesia techniques is used in orthopaedic and trauma surgery. Some patients with bone and joint disease present particular problems, such as difficult intubation (e.g. rheumatoid arthritis; ankylosing spondylitis). Positioning of patients is particularly important in orthopaedics with care required to avoid pain, stretching of nerves, dislocation of joints, movement of fractures and pressure point damage. Careful monitoring of blood loss and replacement is needed, especially for re-operation for joint replacement surgery and for spinal fusion cases. Some artificial joints are secured in place using acrylic cement and this can occasionally cause an increase or decrease in blood pressure.
Chronic Pain
Authors: Morton N S
Published: October 2023

Chronic pain problems are complex and patients are best cared for by a multidisciplinary pain clinic team involving anaesthesia, neurosurgery, psychiatry, psychology, physiotherapy, oncology, and others. The key to chronic pain management is accurate diagnosis and the assessment process can be prolonged. The anaesthetist may require assistance with diagnostic or therapeutic nerve blocks and sometimes these need to be carried out in the X-ray department to ensure correct needle placement. As well as blocks of peripheral nerves and plexuses, sympathetic nervous system blocks may be used (e.g. cervical sympathetic or stellate block, lumbar sympathetic block). Coeliac plexus block is used to control the pain for example from pancreatic cancer.
Tests in epilepsy
Authors: Hopkins Anthony , Appleton Richard
Published: October 2023

The preceding chapter has made it clear that epilepsy is a clinical diagnosis based on a detailed description of events. There is no single test which can always make, or exclude, a diagnosis of epilepsy. Moreover, as also explained in earlier chapters, epilepsy is not a single condition. There are many different types of epilepsy, and there are many different causes of epilepsy. Investigations may be useful to: add weight to, or support the clinical diagnosis of epilepsy; help ‘classify’ the type of epileptic seizure and epilepsy syndrome. This is important in predicting the likely outcome of the epilepsy in a given individual, and the treatment that should be used; and help detect or find a cause for the epilepsy.
The treatment of epilepsy
Authors: Hopkins Anthony , Appleton Richard
Published: October 2023

The treatment of epilepsy begins with making a correct diagnosis— the diagnosis that the events are truly seizures, the diagnosis of the seizure type, and the diagnosis of the epilepsy syndrome (pp. 10-22). This is particularly important in children in whom other non epileptic, brief disturbances may be confused with and misdiagnosed as epilepsy (pp. 54; 57-8). The drugs which are used to prevent or control epileptic seizures (anti-epileptic drugs; anticonvulsant drugs) may have to be used for some years—even for life—and have side effects which are occasionally serious. It is therefore important that the diagnosis of epilepsy is correct before these are prescribed.
Living with epilepsy
Authors: Hopkins Anthony , Appleton Richard
Published: October 2023

What should a bystander do during a grand mal attack? The onset is often so sudden that it is difficult to do much at all in the early stage, though it may be possible to break the person’s fall. Parents or other relatives may recognize the warning signs that may occur if the generalized seizure follows a focal discharge, and so may have time to help the person to a chair or to a bed before the grand mal begins. Don’t try to open the person’s clenched mouth. The tongue, if bitten, is bitten at the onset of the attack, so there is no point in trying to save it. If the bystander uses his own fingers to try to force the mouth open, they may well be bitten in the clonic phase.
Electrocution and burns
Authors: Frca R F Armstrong
Published: October 2023

A 25-year-old male electrician was admitted with burns sustained whilst maintaining an electrical plant in a factory. The history obtained from the firemen was of rescue from a smoke-filled room. He was unconscious at the time of rescue. There were signs of an electrical fire. On admission he was covered in soot. There was a 40% skin surface burn, including face and neck. He was coughing up black sputum. Examination of the palate revealed soot particles. There was a deep burn on the right hand consistent with an electrical injury and a possible exit wound in the anterior surface of the left thigh. BP was 90/70 mmHg; pulse 120/min. GCS was 11.
Metabolic acidosis
Authors: Frca S Sinclair
Published: October 2023

A 58-year-old woman was admitted in extremis, having been unwell for 24 hours with a severe exacerbation of her asthma. Past medical history included a cerebrovascular accident at age 37 years, with minimal right-sided residual weakness. She was being treated for a hiatus hernia recently diagnosed by her GP.
Biological Treatments in Psychiatry
Authors: Lader Malcolm , Herrington Reginald
Published: October 2023

The easing of mental suffering by treatments which directly affect the substance of the brain has a long history and an established place in psychiatric practice. This new edition of a highly successful book reviewing the current status of these treatment methods has been updated to include discussion of new groups of compounds and also new families of drugs which have come into greater prominence, such as newer antidepressants, The book is concerned particularly with clinical practice and discusses in detail the management of individual conditions and the use of psychotropic drugs. The rational and effective use of these techniques needs an understanding of the scientific background, and chapters are devoted to basic pharmacology, the evaluation of treatment methods, the development of new techniques, the psychosocial and politico-ethical aspects of treatment, and the special problems encountered in treating children and the elderly. The economic aspects of prescribing are also outlined. The book will be of interest to psychiatrists, especially those reading for postgraduate qualifications, to those dealing with the mentally ill, and to neruopharmacologists who wish to understand current treatment methods in clincial psychiatry.
Drug treatment in the elderly
Authors: Lader Malcolm , Herrington Reginald
Published: October 2023

The proportion of the aged m developed countries will increase three to fourfold from 1950 to the end of the century. This will place an increasing burden on health services, and especially psychiatric facilities.
General practitioners’ contributions what’s really going on?
Authors: Smith Lindsay , Jewell David
Published: October 2023

Complete obstetric care (antenatal, intrapartum, and postnatal) used to be a normal, essential part of British general practice. The norm now is for GPs to provide only antenatal and postnatal care. The number of women giving birth under the care of their general practitioner has steadily decreased from more than 85% in 1927 (Registrar General 1929), through 50% in 1946 (Royal College of Obstetricians and Gynaecologists 1948), to about 15% in 1975 (Campbell and Macfarlane 1994).
The social context of maternity care
Authors: Selman Peter , Haimes Erica
Published: October 2023

The social context of childbirth has been constantly changing over the past hundred years. In the mid nineteenth century the average family size was over six and 63% of married women had five or more live births before the end of their reproductive period (Table 7.1). Pregnancies were largely unplanned and family limitation practised on only a very limited scale. Many children died before reaching maturity.
Maternity care for women with special needs
Authors: Hepburn Mary
Published: October 2023

It is well recognized that antenatal care should be appropriate to women’s needs. In Changing Childbirth (Department of Health 1993), the Expert Maternity Group emphasized the importance of accessibility, service delivery in the community, provision of appropriate high-risk management when necessary, involvement of women in planning their care, and cost effectiveness.
Surgery, splints, and dressings
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Many limitations to practising surgery on the hand are imposed by the average A&E department-lack of space, poor choice of instrumentation and magnification, pressure of work, poor lighting, no hand table, and problems of follow-up and rehabilitation. This is why it is suggested throughout the text that many procedures are carried out by the hand service rather than in the A&E department. Most procedures carried out in A&E can be performed adequately under local anaesthetic. However, not all patients can cope with this, and so very occasionally a patient may require a general anaesthetic.
Local anaesthetic techniques
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Many minor hand surgical procedures can be carried out under local anaesthetic in the A&E department. Lignocaine is the usual anaesthetic used. It has a quick onset and short duration of action. It is commonly available as 0.5, 1, or 2 per cent. Use 1 per cent with or without adrenaline 1:200 000 This prolongs its action and reduces bleeding. It is safe to use adrenaline in the hand except for the digits.
The late sequence of child abuse
Authors: Wakley Gill
Published: October 2023

‘I can’t see what it’s got to do with me,’ said one general practitioner as he sat unwillingly in a small group on an up-dating course, ‘I am perfectly well aware of the places I can refer people to’. The experiences of some of the other doctors in the group changed his attitudes to identifying prior sexual abuse. He heard about some patients who had large numbers of investigations for somatic complaints. They had often not attended for these investigations, only later to insist they were done urgently. They were difficult patients, alternately demanding or compliant.
Avoiding hepatitis in patients on dialysis
Authors: Pereira Brian F G
Published: October 2023

Patients on chronic dialysis are at increased risk of acquiring parenterally transmitted hepatitis viruses from blood product transfusions or nosocomial transmission in hemodialysis units (Knudsen et al., 1993; Jadoul et al., 1993; Irie et al., 1994; Okuda eta!., 1994; Cendoroglo-Neto etal., 1995). Biochemical abnormalities in liver function are seen in 10-44% of patients on chronic hemodialysis (Pereira and Levy, 1997). In the past, hepatitis Bvirus (HBV) was the major cause of parenterally transmitted viral hepatitis in dialysis patients, and the remaining cases were attributed to non-A, non-B hepatitis (NANBH). The discovery of new, parenterally transmitted hepatitis viruses such as hepatitis C (HCV) and GB virus (GBV)/hepatitis G (HGV) has shed light on the cause and clinical course of NANBH in patients on dialysis. Indeed, among dialysis patients serum markers of HBV, HCV, and GBV/HGV have been reported in 0.3--25.9%, 3.3-55%, and 3.1-55%, respectively (Anonymous, 1991; Mondelli et al., 1992; Chaveau et al., 1993; Dussol et al., 1993; Geerlings et al., 1994; Kohler, 1994; Tokars et al., 1994; Valderrabano et al., 1995).
Clinical Medicine
Authors: Leung Wai-Ching
Published: October 2023

In our new Key Questions Answered series, Clinical Medicine KQA has been written to cover the breadth of clinical medicine for the medical undergraduate. Most students buy a selection of multiple choice question across the specialties to help them revise for exams etc. This book has been designed to provide a starting point - using just this one book the student can assess their knowledge and understanding of the different specialties, and build their confidence for their exams. The book has been written to complement the Oxford Handbook of Clinical Medicine.
Biochemistry, Hans Krebs, and essential fatty acids
Authors: Ewin Jeannette
Published: October 2023

Hugh Sinclair was appointed the first Reader in Human Nutrition at the University of Oxford in 1951; he could reapply for the post in 1958. Although tainted by the sour history of the Survey and burdened by limited funds, he began his new position determined to make nutrition an important and independent science within the Oxford community. To help achieve this, he secured staff for his Laboratory from every possible source, putting each person to work using the scientific skills he or she had already mastered. True to his concept of programme design, their topics were diverse, involving both clinical and experimental work.
Exchanges in the Lancet
Authors: Ewin Jeannette
Published: October 2023

Hugh Sinclair was concerned that new forms of food processing might influence human nutrition and, when he wrote his letter to the Lancet, this was uppermost in his mind. Coincidental with the publication of Hugh’s letter, the British Government was debating the possibility of allowing the production of highly processed wheat flour. This troubled many nutritionists because, as bread was a major source of nutrients in the British diet, the change meant that the majority of British people would run the risk of becoming deficient in certain vitamins. During the war and the years that followed, when food had been scarce, the milling and extraction processes used to make flour were minimized as a means of preserving as much of the grain’s nutrient value as possible; but the baked goods it produced left much to be desired. Now that Great Britain was free from war-time privation, a public tired of being forced to eat heavy cakes and beige-grey bread was demanding finer and whiter flour. Technology used to produce a more acceptable grade of flour not only caused the extraction of nutrients, but also the introduction of bleaching agents and substances classified as ‘improvers’.
Shared decision-making: a summary and future issues
Authors: Coulter A
Published: October 2023

Previous chapters in this book have argued the case for giving patients greater access to information and improving communication in clinical settings. There is also increasing enthusiasm for involving patients more closely in decisions about their care.
Decision-making for breast cancer predisposition gene testing:considerations in women at risk, their relatives, and health care professionals
Authors: Eeles R , Ardern-Jones A
Published: October 2023

Cancer is a genetic disease at the cellular level because a cancer arises when genetic changes occur in the cancer cell. In a proportion of cases, a genetic change is inherited (in the germ line) and predisposes to the other changes causing cancer development.
Radiotherapy treatment
Authors: McPhail G , Habeshaw T
Published: October 2023

Mastectomy was the treatment of choice for breast cancer until the results of randomized clinical trials published in the 1980s demonstrated no difference in overall survival in women treated by mastectomy or breast-conserving treatment (Veronesi et al. 1981; Fisher et al. 1985). Fisher et al. (1989) subsequently demonstrated that those women who received radiotherapy following breast-conserving surgery had significantly lover local recurrence rates (5% vs 30%). As a result of these clinical trials, women with early breast cancer now typically have a choice of local treatment with either mastectomy or breast-conserving treatment (Street et al. 1995), although Bergh (1997) points out that 60-70% of women receiving breast-conservmg treatment may be overtreated, because they will not experience disease relapse irrespective of postoperative radiation therapy.
Arterial structure and function in end-stage renal failure
Authors: London Gérard M , Marchais Sylvain J , Guérin Alain P , Métivier Fabien
Published: October 2023

Cardiovascular disease is a major cause of morbidity and mortality in patients with end-stage renal failure (ESRF). and clinical studies have shown that damage of large conduit arteries is a major contributing factor. Macrovascular disease develops rapidly in ESRF patients and is responsible for the high incidence of congestive heart failure, left ventricular hypertrophy (LVH), ischemic heart disease, sudden death, cerebrovascular accidents, and peripheral artery diseases. Although the most frequent underlying cause of these complications is occlusive lesions due to atheromatous plaques, many vascular complications arise in ESRF patients in the absence of clinically significant atherosclerotic disease.