bluuebunny/crossref_metadata_2025 huggingface dataset:
Ambient air pollution and health
Authors: Reid John , Leonardi Giovanni , Stewart Alex G.
Published: November 2017

This chapter describes the impact of air pollution, including particulate matter and nitrogen oxides, on human health, through a case scenario where an increase in respiratory disease has been associated with changes in traffic density and increases in pollution indices. Background information on pollutants and air quality measurements is given based on WHO criteria. The importance of multidisciplinary input to such investigations is emphasized, involving specialists in toxicology and environmental science, as well as health protection staff. The role of geographical information systems in mapping air pollution levels to identify localities where guideline values are exceeded is emphasized, together with health impact assessments to monitor public health outcomes. The complex local, social, and political aspects that may arise are considered, and so endure engagement and communication with different interest groups. The final part clearly outlines currently unanswered questions and how they should be studied and managed in the future.
Cancer and chronic disease clusters
Authors: Stewart Alex G. , Ghebrehewet Sam , Jarvis Richard
Published: November 2017

Clusters of disease are often reported to health protection and a finger pointed at a nearby environmental hazard that is thought to be the cause. There is an expectation that the causal linkage will be clarified and action taken to alleviate the resulting anxiety and stop further ill health. Not all reported clusters are real, but all are worth some level of investigation to alleviate anxiety. However, investigating such clusters is not easy. Neither is investigating causal linkages to environmental issues. Using an example of childhood cancer and contaminated land, this chapter takes a stepwise, structured approach to the investigation, defining realistic outcomes and clear criteria to stop such an investigation. The vital role of a multi-agency incident team to integrate health studies and environmental investigations is explored. Readers will be able to undertake such investigations for themselves across a wide range of putative clusters of chronic diseases.
Immunization
Authors: Baxter David , Ghebrehewet Sam , Marsh Gill
Published: November 2017

Immunization has been used by human societies for more than a thousand years to control a number of important vaccine-preventable infections. Currently an infant born in an industrialized society will be immunized against more than 25 pathogens by 13 months of age; an elderly person in the same country will similarly be offered protection against 28 pathogens. The main reasons for continuing with immunization programmes in the face of declining rates of vaccine-preventable diseases/infections are discussed. This chapter also looks at the different vaccines that are widely used in many countries, describing the four main types and explaining how they utilize the body’s natural defence systems to provide protection. Vaccines are the most complex agents used by healthcare workers and this chapter reviews their different components and explains their different functions.
Incidents and outbreak management
Authors: Ghebrehewet Sam , Stewart Alex G.
Published: November 2017

Communicable disease outbreak investigation is one of the key health protection functions. The investigation of environmental situations and incidents is also a developing area in the field. This chapter takes an all-hazard approach to cover the general principles and practice of incident and outbreak investigation and management in all three domains of health protection (communicable disease control, emergency response, and environmental public health). It includes: the key definitions and steps in investigation of incidents and outbreaks; the practical approaches to managing incidents and outbreaks; the steps and processes in the investigation and control of emergency response and environmental public health incidents; and the overall approach to public health risk assessment in all three domains.
Using evidence to guide practice in health protection
Authors: Kliner Merav , Wilkinson Ewan , Ghebrehewet Sam
Published: November 2017

This chapter describes the importance of evidence-based decisions in health protection practice. It describes the hierarchy of evidence, from systematic reviews of randomized controlled trials to case reports and opinion. The chapter emphasizes the importance of assessing methodological quality, the quality of the evidence, and the risks of different types of bias. For policy to be as robust as possible it should be based on the best available evidence, and much evidence is useful even when it isn’t used in policy. Therefore, in this chapter, tools are described for reaching evidence-based recommendations, including the Evidence to Decision Framework. Factors that may influence policy development are reviewed, including social and political pressures that may impede evidence-based policy. Finally, the chapter considers critical appraisal of policy using the AGREE II tool.
Quality assurance and audit
Authors: Rushdy Amal , Ghebrehewet Sam
Published: November 2017

This chapter describes the relationship between quality assurance, clinical governance, and clinical audit. These subjects are clearly defined and their application explored in the context of health protection practice. The chapter clearly outlines the differences between audit, research, evaluation, and surveillance, with health protection examples. Audit in health protection is described in detail, including areas of practice in which clinical audit is relevant, prioritization of audit topics, planning an audit, criteria and standards, data collection, analysis and interpretation, and implementation of change. Furthermore, quality assurance and improvement in health protection are described in detail. Relevant references and sources of audit tools are provided so that the discerning reader may explore the subject in more depth in relation to their specific practice and setting.
Global disasters and risk reduction strategies
Authors: Murray Virginia , Aitsi-Selmi Amina , Stewart Alex G.
Published: November 2017

As the global population increase, the effects of disasters also increase. However, through improved building codes and other disaster risk reduction interventions, the number of deaths appears to be reducing. International frameworks for reduction and response are being built and an audit of the NHS demonstrated the advantages of an integrated health service. Fact sheets, produced internationally with UK involvement, on several aspects of disaster risk reduction have started to increase awareness of the wide variety of needs, although mental health issues need further research. Not all global disasters with far-reaching consequences are catastrophic in nature. The circumstances of congenital rubella and iodine deficiency show the strengths of international collaboration and the need for high-quality science. This chapter explains disaster risk reduction and sets it in its international perspective, with examples of wide-ranging agreements and frameworks, and their application to the wider UK health service.
Sustainability
Authors: Jarvis Richard , Bone Angie , Stewart Alex G.
Published: November 2017

The concepts of ‘sustainability’ (the set of conditions where we meet current need without compromising the ability of future generations to meet their own needs) and ‘sustainable development’ (the plan of actions required to achieve this) are increasingly gaining attention in the field of health protection. This chapter outlines how public health and health protection are intricately interlinked with all three pillars of sustainability (economic development, the environment, social equity) and the existential threats to human survival resulting from unsustainable development. The co-benefits of sustainable development are described (including health benefits: better cardiovascular and mental health, and decreased obesity and diabetes mellitus rates; reduced carbon dioxide emissions and improved household energy use), as well as suggestions as to how health protection can play a part in actions to improve sustainability.
Evidence-based treatment of mania
Authors: Ng Bernardo , Tohen Mauricio
Published: November 2017

Bipolar mania can be one of the most challenging psychiatric illnesses to treat, as it requires the clinician to make rapid and accurate decisions; have a reliable way of evaluating progress and treatment response; and possess keen psychotherapeutic skills. Therefore, the importance of staying updated on the clinical evidence of the various treatment options, which serves as the basis to individualize treatment on the day-to-day progress or deterioration of the manic patient. This chapter presents a review available on the evidence of different psychopharmacological agents including typical antipsychotics, lithium, antiepileptic drugs and atypical antipsychotics, and FDA-approved dosages. This review also includes these agents’ effects on fertility and recommendations about their use during pregnancy and lactation. Bipolar disorder continues to be a complex psychiatric condition, yet the progress in treatment options for the manic phase has evolved such that we have more options than ever before.
The treatment of rapid cycling bipolar disorder
Authors: Fountoulakis Konstantinos N. , Dimellis Dimos
Published: November 2017

Rapid cycling may complicate the course of a significant proportion of patients with bipolar disorder (BD). It is defined in DSM-5 by the occurrence of at least four distinct mood episodes in 12 months. Rapid cycling BD has been consistently associated with worse outcomes compared with non-rapid cycling BD. Thus, rapid cycling BD may require specific treatment strategies. Antidepressants, antipsychotics, and mood stabilizers/anticonvulsants have been studied either as monotherapy or in combination treatments. Concerning the treatment of acute mood episodes, the best available data exist for atypical antipsychotics. On the other hand, maintenance or relapse-prevention treatment, and newer-generation antipsychotics and anticonvulsants seem to be efficacious for rapid cycling BD. Lithium may also be efficacious. Treatment with antidepressants should be avoided in this subpopulation of patients. Overall, few randomized controlled trials have been conducted, and many have been underpowered. Therefore, a significant gap remains in evidence-based treatment of rapid cycling BD.
The treatment of cyclothymia
Authors: Perugi Giulio , Vannucchi Giulia , Mazzarini Lorenzo
Published: November 2017

The treatment of cyclothymia is problematic due to its rather complex clinical picture (early onset, lack of clear-cut episodes, high co-morbidity), a challenging patient–doctor relationship and a high sensitivity to medications. This chapter summarizes available evidence on pharmacological treatment, psychoeducation, and psychotherapy for cyclothymic patients. The management of cyclothymia should rely on integrated strategies. The psychopharmacological treatment has to follow the principle of ‘go slow and stay low’. Mood stabilizers should be the first option and antidepressants and antipsychotics should be used cautiously and for short periods of time to manage depressive, anxious, or hypomanic symptoms. Psychoeducation should be started from the beginning and is aimed to promote a better knowledge of the disorder and its effects on daily life as well as adherence to medications. The inclusion of individual psychotherapeutic treatments (eg, cognitive behavioural treatment) should also be considered.
Treatment implications for bipolar disorder co-occurring with anxiety syndromes and substance abuse
Authors: Vázquez Gustavo H. , Forte Alberto , Camino Sebastián , Tondo Leonardo , Baldessarini Ross J.
Published: November 2017

Anxiety symptoms and syndromes affect approximately half of both types I and II bipolar disorder (BD) patients at some time, more in women than men. Reported prevalence has ranked: generalized anxiety ≥ phobias ≥ panic ≥ post-traumatic stress syndrome ≥ obsessive–compulsive syndrome. BD associated with anxiety disorders is less responsive to mood-stabilizing treatments, with greater disability, substance abuse, and possibly suicidal risk. Emerging treatments for anxiety in BD patients include lurasidone, olanzapine, quetiapine, valproate, and psychotherapies, whereas the efficacy and safety of standard anxiolytics and antidepressants are not established. Abuse of alcohol, cannabis, stimulants, and opioids, alone or in combinations, also affects about half of BD patients at some time—more men than women and possibly somewhat more in type I than II. Substance abuse greatly complicates clinical care, contributing to erratic treatment-adherence, adverse outcomes, disability, increased risk of suicide or accidental death, and increased costs of care and from disability.
Bidirectional relationships between general medical conditions and bipolar disorder: treatment considerations
Authors: Yalin Nefize , Arnone Danilo , Young Allan Y.
Published: November 2017

Increased medical co-morbidity is one of the underlying causes of excess and premature mortality in bipolar disorder. This increased prevalence of medical conditions is likely to result from a range of different factors. Some attention in recent years has been devoted to intrinsic illness factors resulting in excessive allostatic load and oxidative stress potentially predisposing to physical morbidity. Some other contributors have also been identified as unhealthy lifestyle habits and unwanted effects of pharmacological treatment. Irrespective of causality, risk minimization can be obtained by systematically addressing physical needs into the management of bipolar disorder. This can be achieved with a range of interventions including regular monitoring of physical health, tailored management of unhealthy lifestyle choices, and pharmacological optimization.
Pharmacotherapy of bipolar disorder: impact on neurocognition
Authors: Balanzá-Martínez Vicent , Brissos Sofia , Lacruz Maria , Tabarés-Seisdedos Rafael
Published: November 2017

Neurocognitive dysfunction is a core feature of bipolar disorder (BD), which may be further compounded by several clinical factors, such as medications. There is growing interest on the potential impact of pharmacotherapy (lithium, anticonvulsants, antipsychotics, and other) on neurocognition. This chapter summarizes a critical, descriptive update of the literature, mostly focused on human data. Based on current studies, medication-associated neurocognitive side effects cannot be clearly distinguished from those intrinsic to BD. Moreover, available research is limited by several methodological flaws. We suggest some likely profitable directions to move the field forward, as well as several recommendations to manage cognitive deficits in clinical practice. The neurocognitive impact of medications used to treat BD clearly warrants further, higher-quality research.
The impact and cost of axial spondyloarthritis
Authors: Siebert Stefan , Raj Sengupta , Tsoukas Alexander
Published: November 2017

Patients with ankylosing spondylitis (AS) and axial spondyloarthritis (axSpA) consistently report lower health-related quality of life compared to the general population. The effects of the condition include factors such as pain, reduced mobility, poor sleep, fatigue, and depression, with a similar burden of disease in patients with non-radiographic axSpA and established AS. The impact of fatigue and factors associated with fatigue in axSpA are discussed. AxSpA also significantly impacts on social and work participation. Patients with AS have lower work participation and are more likely to retire earlier than the general population. Those patients in work have reduced work productivity, due to absenteeism (ability to attend work) and presenteeism (productivity while at work) as a result of the condition. The financial cost of AS varies significantly between countries; estimates for the costs in the UK are discussed.
Assessment and monitoring outcomes in axial spondyloarthritis
Authors: Siebert Stefan , Raj Sengupta , Tsoukas Alexander
Published: November 2017

Axial spondyloarthritis (axSpA) is a heterogeneous condition with multiple effects and a variable course. Monitoring outcomes is required to optimize treatment and care. There are a significant number of outcomes that could potentially be measured in patients with axSpA. Performing these in routine clinical practice has resource and logistic implications, so clinicians and teams looking after patients with axSpA need to decide which aspects they will monitor locally. Most national and international guidelines for the use of biologics require regular monitoring of disease activity. In this chapter, we outline suggested core data sets and review some of the key validated outcomes for axSpA. These include a range of patient-reported and clinician-assessed measures covering disease activity, symptoms (such as pain, stiffness, and fatigue), function, mobility, work disability, and quality of life. We also review the roles of acute phase blood tests and imaging in monitoring axSpA.
Respiratory drugs
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Bronchodilators 154

Nitric oxide 156

Mucolytics 158

Surfactant 160

Helium–oxygen gas mixtures 162

Bronchodilators, as the name suggests, are used in airways disease, particularly in asthma and COPD, to produce a reversal of airway obstruction. An overview of the three main categories is provided here:...
Cardiovascular drugs
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

β‎-Adrenergic agonists 166

Phosphodiesterase inhibitors 168

Vasodilators 170

Vasopressors 174

Antiarrhythmic agents 176

Chronotropes 178

Antianginal agents 182

Antiplatelet agents 184

Diuretics and the critically ill 186

Levosimendan 190

β‎-Adrenergic agents are used commonly for cardiovascular support in critical care to increase cardiac output via ...
Gastrointestinal drugs
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

H2 blockers and proton pump inhibitors 194

Antiemetics 196

Gut motility agents 198

Antidiarrhoeals 200

Constipation in critical care 202

There is continual basal acid secretion and an increase after meals, from the parietal cells in the body and fundus of the stomach. The dominant mechanism for acid secretion is mediated by histamine from enterochromaffin cells, in turn stimulated by gastrin, released from antral G cells in response to amino acids. Other stimuli acting on parietal cells include acetylcholine, gastrin, calcium and pituitary adenylate cyclase-activating polypeptide....
Resuscitation
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Basic and advanced resuscitation 240

Post-cardiac arrest management 242

Fluid challenge 244

Recovery from cardiac arrest depends on an intact ‘Chain of Survival’, which comprises:

• Early recognition and call for help

• Early CPR

• Early defibrillation

• Post resuscitation care.

•...
Respiratory disorders
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Upper airway obstruction 248

Respiratory failure 250

Pulmonary collapse and atelectasis 252

Chronic obstructive pulmonary disease (COPD) 254

ARDS: diagnosis 256

ARDS: general management 258

ARDS: ventilatory management 260

Asthma 262

Asthma: ventilatory management 264

Pneumothorax 266

Empyema 268

Haemoptysis 270

Inhalation injury 272

Pulmonary embolism ...
Cardiovascular disorders
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Hypertension 284

Tachyarrhythmias 288

Bradyarrhythmias 290

Myocardial infarction: diagnosis 292

NSTEMI 294

STEMI 296

Acute heart failure: assessment 300

Acute heart failure: management 304

Bacterial endocarditis 308

Hypertension is defined as sustained SBP ≥140mm Hg and/or DBP ≥90mm Hg (Table 18.1.1). In the UK, the prevalence of hypertension is ~32%. Of these, only 22% have controlled BP (<140/90mm Hg). Essential (primary) hypertension accounts for 80–90% of cases. Secondary causes of hypertension include renal and endocrine disorders and drug-induced hypertension (...
Gastrointestinal disorders
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Vomiting and gastric stasis/gastroparesis 318

Gastric erosions 320

Diarrhoea 322

Upper gastrointestinal haemorrhage (non-variceal) 324

Bleeding varices 326

Intestinal perforation 328

Intestinal obstruction 330

Lower gastrointestinal bleeding 332

Colitis 334

Intra-abdominal sepsis 336

Pancreatitis 338

Acute acalculous cholecystitis 340

Splanchnic ischaemia 342

Abdominal hypertension (IAH) and abdominal compartment syndrome ...
Hepatic disorders
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Jaundice 348

Acute liver failure 350

Hepatic encephalopathy 352

Chronic liver failure 354

Abnormal liver function tests 356

Jaundice (icterus) is the accumulation of bile pigments in serum and tissues including sclerae and skin. Jaundice is usually clinically detectable once serum bilirubin exceeds 50...
Infection and inflammation
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Pathophysiology of sepsis and multi-organ failure 462

Infection control—general principles 464

HIV 466

Severe falciparum malaria 468

Vasculitides in the ICU 470

Source control 472

Selective decontamination of the digestive tract (SDD) 474

Markers of infection 476

Adrenal insufficiency and sepsis 478

Infectious agents entering the body lead to local inflammation, pus and abscess formation, and affect the whole body through systemic inflammation. Systemic inflammation is recognized by the presence of fever, abnormal WCC, and increased heart and respiratory rate, and is known as systemic inflammatory response syndrome (SIRS). If SIRS is due to infection (as distinct from other causes such as pancreatitis, burns or major trauma) it is defined as sepsis....
Trauma and burns
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Initial management of major trauma 482

Head injury 484

Spinal trauma 486

Chest trauma 488

Pelvic trauma 490

Burns—fluid management 492

Burns—general management 494

Major trauma remains a leading cause of death in both the developed and developing worlds, and has a significant impact on the workload of most critical care units. More people are disabled than killed, which has a significant impact on the economic potential of both the victims and society....
ICU organization and management
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Consent on the ICU 542

Rationing in critical care 544

ICU layout 546

Medical staffing in critical care 548

ICU staffing: nursing 550

ICU staffing: supporting professions 554

Fire safety 556

Legal issues and the Coroner 560

Patient safety 564

Severity of illness scoring systems ...
Endocrine tumours
Authors: Ajithkumar Thankamma , Barrett Ann , Hatcher Helen , Cook Natalie
Published: November 2017

Malignancies of the thyroid gland are the commonest endocrine malignancy but comprise <1% of cancer incidence overall (Coleman et al. 1999). The incidence is increasing slowly. The highest incidence is seen in North and Central America, and Australasia, with the lowest incidence in Africa.
Epidemiology of Schizophrenia
Authors: Brar Jaspreet S.
Published: November 2017

Epidemiology can help us understand who is at risk for developing a disorder, what may happen to them, and perhaps even why people get the disorder to begin with. In this chapter, we will review the incidence and prevalence of schizophrenia and related psychotic disorders, as well as factors affecting such rates. Risk factors for psychosis include socio-demographics (e.g., gender, age, migrant status, class), predisposing factors (e.g., season of birth, perinatal trauma), and precipitating factors (e.g., substance use, psychosocial stress). We will highlight controversial issues such as traumatic life events, prenatal infection, and cannabis use, considering how epidemiological factors can shed light on the pathogenesis of schizophrenia and related illnesses.
Somatic Treatments for Psychotic Disorders
Authors: Ellison Justin C. , Rosenstock Jason B. , Marcsisin Michael J.
Published: November 2017

A variety of somatic therapies can be used to treat individuals suffering from psychosis. Most commonly, providers will prescribe antipsychotics, which generally block dopamine receptors and are particularly useful at reducing positive symptoms. Second-generation antipsychotics have fewer movement side effects than older agents do, but they are more expensive and have more metabolic side effects. Long-acting injectable (LAI) antipsychotics can be useful for improving outcomes, especially in non-adherent patients, and clozapine is the gold standard for treatment-refractory psychosis. Other agents may be useful for adjunct therapy, or in early psychosis, such as antidepressants, mood stabilizers, and benzodiazepines. In this chapter, we will also review other somatic therapies such as electroconvulsive therapy (ECT) and other neuromodulation approaches.
Pain assessment
Authors: Fink Regina M. , Gates Rose A. , Montgomery Robert K.
Published: November 2017

Pain is multifactorial and affects the whole person and family caregivers, and multiple barriers to pain assessment exist. Patients should be screened for pain on admission to a hospital, clinic, nursing home, hospice, or home care agency. If pain or discomfort is reported, a comprehensive pain assessment should be performed at regular intervals, whenever there is a change in the pain, and after any modifications in the pain management plan. The patient’s self-report of pain is the gold standard, even for those patients who are nonverbal or cognitively impaired. Multiple pain scales are available for use in nonverbal or cognitively impaired patients or residents; these should be used in combination with clinical observation and information from healthcare professionals and family caregivers.
Dyspnea, terminal secretions, and cough
Authors: Dudgeon Deborah
Published: November 2017

Dyspnea is a subjective experience, and patients can be very frightened when breathless. Nursing and medical interventions are helpful for patients with dyspnea, and pharmacological and nonpharmacological interventions can help patients with chronic cough. Death rattle is also common in dying patients and is very distressing for people at the bedside. Anticholinergics are the drugs of choice for death rattle, and good teaching and reassurance about death rattle are required for family members. Massive hemoptysis is very frightening and needs to be anticipated.
Urinary tract disorders
Authors: Gray Mikel , Sims Terran
Published: November 2017

Patients receiving palliative care frequently experience urinary system disorders. A malignancy or systemic disease may affect voiding function and produce urinary incontinence, urinary retention, or upper urinary tract obstruction. In addition, upper acute renal insufficiency or renal failure may occur if the upper urinary tract becomes obstructed. These disorders may be directly attributable to a malignancy or systemic disease or they may be caused by a specific treatment such as radiation, chemotherapy, or a related medication. Nursing management of patients with urinary system disorders is affected by the nature of the urological condition, the patient’s general condition, and the nearness to death.
Skin disorders
Authors: Bates-Jense Barbara M. , Petch Sirin
Published: November 2017

Palliative pressure ulcer care is focused on comfort and limiting the extent or impact of the wound. Pressure ulcer prevention for palliative care includes use of flexible repositioning schedules with attention to adequate pain relief interventions before movement and use of pressure redistributing support surfaces for the bed and chair. Palliative care for pressure ulcers also includes attention to prevention measures; obtaining and maintaining a clean wound; management of pain, exudate, and odor; and prevention of complications such as wound infection.
Urgent syndromes at the end of life
Authors: Bobb Barton T.
Published: November 2017

This chapter addresses a group of syndromes that, unless recognized and treated promptly, will cause unnecessary suffering for the patient and family. Emphasis has been given to the epidemiology and basic pathophysiology of each syndrome, as well as diagnostic assessment. Providing this information, although by necessity limited in detail, enables the palliative care nurse to explain to the patient and/or family why particular symptoms are occurring and why a particular management approach is being suggested.
Planning for the actual death
Authors: Berry Patricia , Griffie Julie
Published: November 2017

The care of patients and families near to death and afterward is an important nursing function—arguably one of the most important things nurses do. At the end of life, nurses and other healthcare professionals often only have one chance to “get it right.” Assessment and aggressive management of symptoms must remain a priority, especially as death approaches. Goals of care inevitably change in rhythm with patient and family needs and wishes. Care of the body after death, including normalizing and interpreting postmortem changes and honoring rituals and individual requests, is critically important in communicating to family members and close others that the person who died was indeed important and valued.
Caring for the patient with substance use disorder at the end of life
Authors: Kirsh Kenneth L. , Compton Peggy , Egan-City Kathy , Passik Steven D.
Published: November 2017

Identifying addiction in patients with advanced disease is not an easy task, and old conceptions of addiction such as tolerance and dependence need to be reexamined. Patients with advanced disease and comorbid addiction are difficult to manage but can be successfully treated with careful documentation and planning. The patient with advanced disease and comorbid addiction has two diseases that need treatment: one of drug addiction and one of chronic pain.
Veterans
Authors: Grassman Deborah
Published: November 2017

In many ways, veterans face the end of life in a similar manner to civilians. In some ways, however, they experience death differently. This chapter identifies some of these differences in the hopes that readers will come to understand the unique hospice 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 had permeated their later lives.
Improving the quality of care across all settings
Authors: Bookbinder Marilyn , Arceo Romina
Published: November 2017

This chapter provides perspectives on quality improvement (QI)-based initiatives in US healthcare organizations across settings and populations and discusses their impact on patient, professional, and system outcomes in palliative care. Principles of QI and structural, process, and outcome approaches to conducting QI studies are introduced. A case study is presented of a care-path for the end of life that the author and colleagues pilot-tested. An algorithm addressing dyspnea, a distressing symptom at end-of-life, is offered for testing, and a new approach to evaluating care at the end of life using the Joint Commission’s tracer methodology will be introduced. The chapter closes by showcasing nurses within interdisciplinary teams who are building evidence and providing leadership in the field of quality and palliative care.
The intensive care unit
Authors: McAdam Jennifer , Puntillo Kathleen
Published: November 2017

This chapter discusses the provision of palliative care in ICUs, with an emphasis on end-of-life care. Specifically, challenges and barriers to providing such care in ICUs are described, and recommendations are offered for the provision of symptom assessment and management. Current issues related to holding family meetings, establishing patient goals of care, surrogate decision-making, and withholding and withdrawing life-sustaining therapies are covered. Recommendations are offered for attending to the needs of families and of healthcare providers who care for ICU patients at the end of life. Finally, an international agenda for improving end-of-life care in ICUs is presented.
Palliative care in Canada
Authors: Howell Doris , Syme Ann
Published: November 2017

This chapter describes palliative and end-of-life care from the national and provincial perspectives and trends and innovations in hospice and palliative care service delivery in Canada and specifically the developments in nursing. To provide a context within Canada, factors that have influenced the development of hospice palliative care in Canada inclusive of geographic and population diversity; the three levels of government accountable for healthcare delivery at the federal, provincial, and regional levels; and the advocacy role of the Canadian Hospice Palliative Care Association are also described.
Palliative care in Europe
Authors: Hjermstad Marianne Jensen , Kaasa Stein
Published: November 2017

The purpose of this chapter is to present some of the European experiences with respect to the development, organization, and delivery of palliative care, educational issues, and research. Typical components of palliative care in parts of Europe today include proactive, multidimensional, and quantitative symptom-assessment; communication interventions emphasizing both preparation for the dying process and maintaining hope; and tumor-directed and symptomatic treatment. Quite often specialist palliative care is delivered by specialized palliative care interdisciplinary teams in designated units and is therefore not available to all who may need this level of professional care.
Pediatric hospice and palliative care
Authors: Battista Vanessa , LaRagione Gwenn
Published: November 2017

Providing this type of care throughout the illness process, from the time of diagnosis until the time of death, can be simultaneously challenging, physically and emotionally draining, enriching, and meaningful. This chapter provides an overview of pediatric hospice and palliative care and the special considerations necessary for nurses who may be called on to provide this unique type of care to children and their families.
Introduction
Authors: Charon Rita , DasGupta Sayantani , Hermann Nellie , Irvine Craig , Marcus Eric R. , Colón Edgar Rivera , Spencer Danielle , Spiegel Maura
Published: November 2017

The care of the sick centers on the giving and receiving of accounts of illness. Narrative medicine arose at the turn of this century to equip healthcare professionals with the capacity to skillfully receive these accounts—to recognize, absorb, interpret, and be moved to action by the stories patients tell. The Introduction summarizes the field’s emergence from narrative theory and primary healthcare in an effort to heighten the attention of clinicians for their patients, strengthen their perception of a patient’s situation, and deepen the affiliation between them. The field’s scholarly, educational, and clinical missions are summarized, and a précis of each of the book’s chapters is offered.
Can Creativity Be Taught?
Authors: Hermann Nellie
Published: November 2017

This chapter is a practical manual for teaching writing in unusual places. Reflective and creative writing have become widespread in healthcare settings, yet little is known about how to effectively structure writing experiences, how to respond to creative writing, and how to assess the dividends of writing practices. Written by a novelist on a medical school faculty, the chapter shows how to encourage writing in healthcare and how readers can guide writers toward the discovery potential of writing. “A Reader’s Guide for Reflective Writing” is provided to give guidance to those new to the task of reading and commenting on students’ creative writing. The chapter also provides guidelines for structuring writing seminars, choosing texts to study, and crafting the writing prompts that invite participants to write. Through extensive quotation and close reading of students’ writing, the chapter leads readers toward creative insight into the creativity of others.
Patient Safety
Authors: Stoelting Robert K.
Published: November 2017

Patient safety is a new and distinct healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events. Anesthesiology, via its professional society, the American Society of Anesthesiologists (ASA), was the first medical specialty to champion patient safety as a specific focus. The Anesthesia Patient Safety Foundation (APSF) was launched in late 1985. Evidence from randomized trials is important, but it is neither sufficient nor necessary for acceptance of safety practices. There will never be complete evidence for everything that needs to be done in medicine. The prudent alternative is to make reasonable judgments based on the best available evidence. Anesthesia and surgery are inextricably linked, and recognition of the importance of teamwork, communication, and collaboration among members of the perioperative team has been pivotal to advancing the safety of patients undergoing surgery.
Fatigue
Authors: Keane Michael
Published: November 2017

Fatigue can significantly impair healthcare providers, potentially increasing the possibility of an adverse event. The study of fatigue incorporates concepts from neuroscience, dynamic systems, human factors, and risk management, and relates these elements to circumstances faced by all healthcare professionals. An understanding of the circadian rhythm can help physicians and administrators to develop shift strategies that mitigate the effects of fatigue on human performance. Strategies such as duty-hour limits, “power naps,” and judicious use of caffeine can all help providers who must work at night or during extended shifts.
Crisis Resource Management and Patient Safety in Anesthesia Practice
Authors: Burden Amanda R. , Cooper Jeffrey B. , Gaba David M.
Published: November 2017

Crisis resource management (CRM) and patient safety are fundamental to the practice of anesthesiology. Human error and system failures continue to play a substantial role in preventable errors that lead to adverse outcomes or death. Many of these deaths are not the result of inadequate medical knowledge and skill, but occur because of problems involving communication and team management. CRM addresses these patient safety issues by addressing behavioral skills for critical events. These skills provide tools to help the leader manage the team and to help the team work together; they include calling for help, establishing situation awareness, using checklists, and communicating effectively. Effective strategies to teach these skills include the use of simulation for team training and Team STEPPS.
Medication Safety
Authors: Merry Alan F.
Published: November 2017

Perioperative medication safety consists largely of achieving the six “rights” of medication administration at each stage of every patient’s pathway, from primary care into the hospital, through the ward, operating room, postoperative and/or intensive care units, the ward (again), and back into the community. The abuse of medications by clinicians and the security of the supply chain for essential medications are also relevant. Understanding failures in medication safety requires an understanding of the nature of error and violation within complex systems, and applying these general principles in the context of perioperative care, including particular situations such as pediatrics and anesthesia or sedation in remote locations. Measurement of initiatives to improve medication safety is particularly challenging. Retrospective review of clinical records, incident reporting, facilitated incident reporting, prospective augmented observational techniques, and trigger tools have all been used for this purpose.
Tendon and ligament biochemistry and pathology
Authors: Riley Graham
Published: November 2017

Tendon and ligament pathologies are often seen by general practitioners, rheumatologists, and specialists in musculoskeletal medicine and sports and exercise medicine. Increased participation in recreational exercise and sport, although beneficial for general health and well-being, has led to a substantial rise in their incidence. However, only belatedly are these conditions receiving the attention they deserve from the research community....
Gait analysis
Authors: Roberts Sophie , Dixon Sharon
Published: November 2017

Gait analysis describes the process of systematically quantifying mechanical aspects of walking or running to aid in the examination of a patient/client. In the publication Gait Analysis: An Introduction, Whittle (2002) identifies the eye as being the first tool in this assessment, with technology being available to supplement this visual analysis. Technological analysis tools include two-dimensional (2D) video, three-dimensional (3D) motion analysis, pressure plates, and pressure insoles. The application of technology has increased our understanding of human gait substantially. This chapter introduces the basic tools of gait analysis and highlights specific considerations when selecting appropriate tools for the assessment of walking gait. Details of running gait are provided in Chapter 1.8....
Epidemiology and injury surveillance in sports medicine
Authors: Orchard John , Seward Hugh , Hoskins Wayne
Published: November 2017

Injury surveillance has for many years been considered fundamental to injury prevention in sport (van Mechelen et al. 1992; van Mechelen 1997; Finch 2006). The seminal paper by van Mechelen and colleagues in 1992 described a sequence for achieving injury prevention in sport, with injury surveillance typically being the fundamental first step behind the injury prevention process. Despite this observation, there has been little agreement about the best methodology for injury surveillance and few published examples in the literature of long-term multi-recorder reliable injury surveillance systems....
Injection therapies in sports injuries
Authors: Speed Cathy
Published: November 2017

Local injection therapies are utilized in the management of sports injuries in order to facilitate diagnosis (local anaesthetics), to manage pain and to aid in the process of healing. Routes and injectates for local injection therapies in the management of sports injuries are listed in ...
Physiotherapy and rehabilitation
Authors: Booth Lynn
Published: November 2017

In the broadest sense, there should be no difference in the way a physiotherapist treats a sprained ankle in an elderly patient, an active younger person, or an elite athlete—within reason the pathology and stages of healing remain the same. However proficient the physiotherapist, the process of inflammation and the stages of healing in an acute injury cannot be rushed. All the physiotherapist can do is provide the best environment for healing to occur....
Regional injuries of the cervical spine: sports-related anatomical, pathophysiological, and clinical perspectives
Authors: Gherscovici Ezequiel , Baron Eli , Vaccaro Alexander
Published: November 2017

Cervical spine injuries occur infrequently on the athletic field (Dietz and Lillegard 1999). Nevertheless, sporting events have been reported as the fourth most common cause of spinal cord injury (behind motor vehicle collisions, assaults, and falls) (NSCISC 2006). The possibility of catastrophic cervical spine injury exists with involvement in sports, where it can be defined as ‘structural distortion of the cervical spinal column associated with actual or potential damage to the spinal cord’. This may result in irreversible neurological injury to the athlete (...
Injuries to the thoracolumbar spine and thorax
Authors: Micheli and Laura Purcell Lyle
Published: November 2017

It can be challenging to make a precise diagnosis in patients with pain in the spinal region and chest wall, not least because demonstrable pathology is not always present. Pain originating from the thoracic spine and the chest wall is relatively uncommon. However, low back pain is very common, both in the general population and in athletes....
Soft tissue conditions of the hand and wrist
Authors: Wheeler Patrick , Peirce Nicholas
Published: November 2017

Hand and wrist injuries represent a considerable challenge for sports physicians and musculoskeletal practitioners. The anatomy is complex and the consequences of minor injury, which are sometimes difficult to assess with routine clinical examination, can have significant impact on function (Hodgkinson et al. 1994...
Injuries in swimming and related aquatic sports
Authors: Boyd Kevin
Published: November 2017

Swimming is often hailed as an ideal activity because of the acknowledged benefits of exercise for those both in health and with disease. Therefore the spectrum of swimmers covers those individuals undertaking aerobic exercise as part of a healthy lifestyle, people suffering and rehabilitating from chronic conditions, such as cardiovascular disease and musculoskeletal disorders, and the committed and disciplined elite swimmer with high performance goals. Sports physicians should be familiar with these differing motivations and be able to adapt advice and treatment to each of these population groups. Unusually for a sport, there is a general consensus that everyone should develop the ability to swim for the enhancement of water safety....
Injuries in field (throwing and jumping) events
Authors: Hackney Roger
Published: November 2017

The field events in the sport of track and field athletics include a wide range of very different disciplines. They can be divided into the jumping events (long jump, triple jump, high jump, and pole vault) and the throwing events (javelin, shot putt, hammer, and discus). In modern track and field athletics, all disciplines are performed by both sexes. Injuries relate to the training methods and the specific technical features of each event....
Bicycling injuries
Authors: Speed Cathy , Berman Laurence
Published: November 2017

Cycling as a competitive sport actually preceded the invention of our familiar pedalled chain-driven two-wheeled device by almost two decades. Some traditionalists consider that cycle sport should be confined to the conventional iconic drop-handlebar ‘racing cycle’ in either its fixed-wheel guise on the track or its multi-geared superficially similar cousin used in road racing. The evolution of cycling as an Olympic event gives the lie to this narrow view and is a metaphor for the development of the sport....
Skiing injuries
Authors: Dvorak Viktor , Spring Hans
Published: November 2017

Skiing is defined as a downhill glide on snow-covered slopes or mountain terrain utilizing skis as primary equipment. It is both a recreational hobby and an athletic activity. Skiing is a very technical sport, and suitable equipment is needed for beginners and hobby skiers as well as for top athletes. In addition, it also provides high demands on the physical and coordination skills of the individual skier....
Squash injuries
Authors: Speed Cathy
Published: November 2017

Squash (or ‘squash rackets’) is an intensive sport, placing high physiological demands on the body. Despite its popularity, no epidemiological studies of the relative incidence, patterns, and severity of squash-related injuries have been published. Although representing only a low percentage of all sporting injuries, squash ranks relatively highly as one of the sports with a high rate of severe injuries....
Early diagnosis and screening in cancer control
Authors: Miller Anthony
Published: November 2017

Chapter 4 discusses early diagnosis and screening in cancer control, and tries to place screening into context, and justify the concept that it is impossible to justify screening just because a cancer is found early, and that in fact cancer detection per se is not sufficient evidence that the individual has been benefited.