bluuebunny/crossref_metadata_2025 huggingface dataset:
I can’t remember what just happened
Authors: Li Michael , Garcia-Pittman Erica C.
Published: May 2022

The pharmacologic treatment of Alzheimer’s disease (AD) with mild to severe impairment is centered on the use of acetylcholinesterase inhibitors (AChEIs), which have been shown to provide benefit in improving or blunting cognitive and functional symptoms. The three AChEIs approved by the U.S. Food and Drug Administration are donepezil, rivastigmine, and galantamine. Memantine is an NMDA- or glutamate-receptor antagonist that has been shown to have similar cognitive-enhancing properties but with an alternate mechanism of action and only in moderate to severe AD. Combination treatment with memantine and an AChEI is the standard of care with moderate to severe symptoms of AD, and may provide further benefit in blunting functional decline and behavioral disturbances and delaying long-term care placement. Nonpharmacologic strategies are important to improve quality of life and overall cognitive and functional engagement in all stages of AD. Novel experimental treatments show early signs of promise, but more clinical trials are needed to guide recommendations.
I felt as though I was about to die
Authors: Ishikawa Rachel Zack , Marouf Feyza
Published: May 2022

Panic disorder is an anxiety disorder commonly seen in older adults, but diagnosis may be complicated by a symptom profile that overlaps with common medical illnesses, particularly pulmonary or cardiovascular disorders. Cognitive–behavioral therapy is an effective treatment for panic disorder with an approach that combines repeated and controlled exposure to autonomic physical sensations along with cognitive and somatic coping strategies. Although benzodiazepines are the most common psychopharmacologic treatment for panic disorder due to their immediate effects, they carry risks for older adults and are best used to treat acute panic while waiting for the effects of an antidepressant to kick in. Selective serotonin reuptake inhibitors and serotonin–norepinephrine reuptake inhibitors are considered first-line treatments.
Every reminder throws me off
Authors: Bankole Azziza O.
Published: May 2022

Post-traumatic stress disorder (PTSD) is a relatively common clinical condition in older adults and may be triggered by a wide range of traumas, not just major events such as war, conflict, or assault. Careful screening and history-taking is the key to diagnosis. A range of screening instruments exist to help identify PTSD. Psychotherapy, especially cognitive–behavioral therapy or approaches derived from it, represents the mainstay of treatment, though engagement in ongoing therapy can often be challenging, especially for older adults. Medications have an adjunctive role, primarily to manage significant mood or comorbid anxiety symptoms. Selective serotonin reuptake inhibitors and antidepressants are considered the first-line agents for pharmacotherapy. Benzodiazepines should be avoided.
Sad or just unconcerned?
Authors: Holiman Jennifer Junko , Kieran Kathryn , Bader Caroline S.
Published: May 2022

Apathy is characterized by a lack of initiation, planning, and execution of previous activities and interests, in the absence of low mood, guilt, and altered self-concept. The presence of depression needs to be initially assessed for and continuously monitored, as these conditions often coexist. Hearing and vision deficits, as well as physical weakness and all other comorbid medical concerns, should be thoroughly assessed and addressed, as they can contribute significantly to social withdrawal. A multimodal approach is often best to target apathy, comprising working with caregivers, cognitive–behavioral techniques, and pharmacologic management, including the use of stimulating antidepressants and psychostimulants.
It’s like she lost her mind overnight
Authors: Balaram Kripa , Tampi Deena J. , Tampi Rajesh R.
Published: May 2022

When a patient presents with new-onset psychosis within the setting of a medical condition, it is essential that a thorough history and physical examination and a detailed diagnostic work-up are completed. This will help determine whether the medical condition is the main cause of the psychosis, or an exacerbating factor. Acute psychotic symptoms can be managed with antipsychotics or benzodiazepines depending on the degree of distress and disruption to the patient, but the mainstay of treatment involves treating the underlying medical condition. Patients may also require inpatient psychiatric hospitalization for acute stabilization and to minimize the risk of harm to self or others.
I live with these voices
Authors: Rajji Tarek K.
Published: May 2022

Schizophrenia persists into late life but can also start in later life. Late-life onset is more common in women and is associated with positive symptoms such as delusions and hallucinations. Negative symptoms tend to be more common in late life and include apathy, social withdrawal, and affective blunting. Although mild forms of cognitive impairment can be seen across the age spectrum in schizophrenia, they are more common and impactful in late life, and come with an increased risk of neurocognitive disorders. Schizophrenia in late life is comparable to many chronic medical conditions, and optimal management requires adequate access to integrated medical and psychiatric services.
Triage and Napoleon Bonaparte
Authors: Rega Paul P.
Published: May 2022

This chapter discusses an immediate response to a mass casualty incident, in this case a multiple vehicular accident. When first reporting the incident, journalism’s 5Ws and 1H (who, what, where, weather, why, and hazards) can be adapted to provide vital information to the 911 operator in a succinct fashion. A first aid kit can be put together from common items lying around. Triage processes for the wounded are covered in detail, including the START triage algorithm for adults and the Jump-START triage algorithm for children. The SALT triage algorithm is also discussed. The chapter outlines the activities that emergency personnel are responsible for upon their arrival at the disaster scene as well as the roles and responsibilities of its leaders in the Incident Command System.
The case of the pesticide and the melancholy farmer
Authors: Rega Paul P.
Published: May 2022

Sometimes, caregivers may not recognize a HAZMAT situation in real time and it could create a dangerous situation for all concerned. This chapter discusses a man who ingested a pesticide and, during his trip to the ED, became diaphoretic, dyspneic, and somewhat confused. This case represents a HAZMAT situation, with the patient as the hot zone. The key action is to ensure the safety of the potential victims while, secondarily, expediting the care of the patient. The chapter explains how to protect the people, patients, and staff in the ED to avoid secondary contamination; the use of PPE is stressed. The author details how to isolate, decontaminate, and stabilize a patient presenting with pesticide ingestion. A brief discussion of a newer class of organophosphate agent, Novichok, is also provided.
Fever, rash, and one helluva cough: One approach to a biological incident, etiology unknown
Authors: Rega Paul P.
Published: May 2022

This chapter discusses an infectious disease threat and outlines the multiple obligations that need to be accomplished almost simultaneously. During the initial stages of patient care management, it may not be obvious that the situation is a natural occurrence or the index case in a bioterror attack. Regardless, the basic precepts remain the same. The author explores how to stabilize the patient while simultaneously maintaining the safety and well-being of the caregivers. The chapter shows how to utilize a negative pressure environment, isolate the patient, quarantine the entourage, shut down HVAC, and make appropriate communications to infection control, local public health, and even law enforcement authorities.
“Is that a car backfiring?”: The active assailant
Authors: Rega Paul P.
Published: May 2022

This chapter discusses an active shooter situation in a hospital. Every active shooter situation is unique. The standard course of action is “run, hide, fight.” The difference between the concepts: “run, hide, fight” and secure, preserve, fight is also discussed. Healthcare professionals may be facing a dual conflict: duty to themselves and duty to their patients. Healthcare professionals have a duty to care for their patients and to assume some level of personal risk in doing so. The author stresses the importance of preparing for an active assailant situation and offers tips for hiding, barricading a room, and improvising weapons from materials that are on hand. Also discussed are actions to take when the event is neutralized, and how to then begin triage. Follow-up analysis of the incident and mental health care for everyone affected are vital.
Explosions along the riverfront: A tragic accident
Authors: Rega Paul P.
Published: May 2022

The chapter explores what to do when an accidental ammonium nitrate explosion happens and a Level 1 Trauma Center needs to be prepared. The first step is to initiate communications with hospital leaders and trauma services. The next step is to reacquaint the team with the impact that high-energy explosives have on a human being. High-energy detonations consist of two components, the blast wave and the blast wind, whereas low-velocity explosions consist of just the blast wind effect. Factors that contribute to blast injuries and their level of severity are discussed. Primary, secondary, tertiary, and quaternary blast injuries are explained, including crush syndrome. Two examples are provided of real-life disasters involving ammonium nitrate explosions.
From fireball to mushroom cloud
Authors: Rega Paul P.
Published: May 2022

This chapter explores what to do when a hospital receives victims from the detonation of a nuclear improvised explosive device. The chapter lists various injuries that may result from a nuclear detonation. These include flash blindness, burns, multiple layers of blast in juries, acute radiation syndrome, psychological issues and the after-effects of fallout. There is also a discussion on the three zones of damage after a detonation and the likelihood of survivors. Finally, there is a summary of the RTR response system and how the proximate hospitals will likely respond to survivors of the detonation. It also covers the considerations involved in evaluating any victim of a nuclear explosion and discusses the concept of the “allocation of scarce resources.”
They want you!: A regional response to a future pandemic
Authors: Rega Paul P.
Published: May 2022

This chapter discusses a scenario where a regional pandemic plan needs to be created. To obtain an historical perspective, previous American infectious disease outbreaks are covered, including the smallpox epidemics in 1775, 1894, and 1947; the yellow fever outbreaks in 1793 and 1858; the cholera outbreak in 1892; the plague outbreak in San Francisco in 1907; and the influenza pandemic in 1917. These historical cases are also viewed in light of the public health issues that emerged from each, as well as the positive and negative lessons learned. The chapter then addresses an incident command system, community pharmaceutical and non-pharmaceutical interventions, alternate care facilities, and points of distribution.
A vehicle for all seasons
Authors: Rega Paul P.
Published: May 2022

Whether in times of disaster or simply a long trip, this chapter explores how to prepare a vehicle to ensure your own safety and survival. Tables list tools, equipment, and other items that should be in the vehicle while on the road as well as items that ensure the driver’s personal protection, such as warm clothing, food, and communications equipment. It is stressed that this is an elective situation, and not an emergency evacuation. The chapter briefly discusses the relative merits of electric cars versus fuel-powered vehicles in terms of evacuating from a disaster. The importance of performing a hazard vulnerability analysis and preparing accordingly is stressed.
Heart failure syndromes
Authors: Clark Andrew L.
Published: May 2022

Heart failure is a protean condition, presenting acutely to hospital in most cases, but often presenting with a more insidious course to primary care physicians. Patients may only be diagnosed as having a primary cardiac problem after being seen by respiratory physicians or even, on occasion, after gastrointestinal work-up for hepatomegaly (with or without jaundice) or weight loss. Nevertheless, there are common presenting clinical syndromes in patients with heart failure which should prompt different initial treatment strategies. The diagnosis of heart failure is most commonly made during an admission to hospital; with successful treatment, patients go on to have chronic heart failure. A particular challenge is so-called ‘heart failure with preserved (or more accurately, normal) ejection fraction’. The term does not describe a single condition and it is difficult to diagnose with the consequence that all clinical trials of treatment have been unsuccessful so far.
Heart failure in congenital heart disease
Authors: Alonso-Gonzalez Rafael , Swan Lorna
Published: May 2022

Congenital heart disease is the most common congenital abnormality, present in an estimated 8 cases per 1000 live births. This prevalence varies significantly among continents, being higher in Asia with 9.3 per 1000 births (95% confidence interval (CI): 8.9–9.7) compared to Europe with 8.2 per 1000 births (95% CI: 8.1–8.3) or North America with 6.9 per 1000 births (95% CI: 6.7–7.1). Whereas some defects are trivial, for example a septal defect that spontaneously closes during childhood, about 0.6 per 1000 adults will have a severe form of congenital heart disease.
Acute viral myocarditis
Authors: Heymans Stephane
Published: May 2022

This chapter examines acute viral myocarditis (VM), its pathophysiology, diagnosis, and specific treatment. VM typically presents with unexpected symptoms, raised blood biomarkers suggesting acute cardiomyocyte injury, and a dynamic and changing electrocardiogram. Similar to other forms of heart disease, men are more often and severely affected than women, yet the mechanisms driving sex differences in myocarditis remain poorly understood. The most commonly identified pathogens in acute myocarditis are everyday cough viruses. The concept of the transition from acute viral infection through active inflammation to dilated cardiomyopathy determines the opportunities for therapeutic intervention, which vary by stage of the disease. Patients suspected of having acute myocarditis should undergo a complete cardiological work-up, including cardiac magnetic resonance imaging. Endomyocardial biopsy is useful for both polymerase chain reaction and immunohistochemical analysis. The chapter then looks at the treatment of VM, considering antiviral therapies and immunosuppression.
Peripartum cardiomyopathy
Authors: Coats Caroline , Jackson Alice , Petrie Mark
Published: May 2022

Peripartum cardiomyopathy (PPCM) is an important cause of maternal and infant mortality worldwide. Although heart failure presenting in the puerperium is well recognized, PPCM is a distinct cardiomyopathy that requires a high index of suspicion for diagnosis. There are known risk factors, but the aetiology and natural history of this disorder are not fully understood. The past decade has seen an increase in knowledge about the epidemiology, pathophysiology and genetics of this condition, leading to the first treatment trials, alongside international guidelines and registries.
Cytokines and inflammatory markers
Authors: Miliopoulos Dimitrios , Gkouziouta Aggeliki , Leontiadis Evangelos , Adamopoulos Stamatis
Published: May 2022

This chapter focuses on cytokines and inflammatory markers. An important pathway in chronic heart failure progression is inflammatory activation. Experimental studies have shown that proinflammatory cytokines may induce many aspects of the syndrome of chronic heart failure, such as left ventricular dysfunction, pulmonary oedema, and the process of left ventricular remodelling. Although the cause of the inflammation is unknown, both infectious and non-infectious events could be operating, including interaction with the neurohormone system. Thus, inflammatory markers have emerged as potential indicators of the evolution of heart failure, ranging from their use for screening, diagnosis, determining prognosis, and guiding treatment. Indeed, the emerging association of inflammatory mediators with the pathogenesis and progression of chronic heart failure has already resulted in the development of new anti-inflammatory strategies, which might be used as adjunctive therapy in patients with chronic heart failure. Moreover, there is accumulating evidence that a critical network of interactions is formed by inflammatory and the classic neurohormonal mediators, and that many of the conventional therapies for heart failure may, at least partially, modulate the proinflammatory cytokine milieu. However, therapies tested so far have been largely disappointing.
The interstitium and collagen in heart failure
Authors: Pizard Anne , Zannad Faiez
Published: May 2022

This chapter addresses interstitium and collagen in heart failure. By definition, the interstitium represents the space between the specialized cells of a tissue. It is a complex compartment in which interstitial fluid and many different types of insoluble molecules (forming the extracellular matrix) undergo constant alterations to fulfil physiological needs. In the heart, the cardiac interstitium plays an instrumental role in dynamic myocyte activity and the plasticity, elasticity, and turgor of the interstitium are vital to allow the cardiac chambers to reach their optimal contractile and relaxation states. The chapter then explores the structure of the interstitium before looking at its pathological expansion, considering myocardial fibrosis in particular. The ability of treatment to reduce myocardial fibrosis in patients with heart failure may be monitored by the measurement of various serum peptides arising from the metabolism of collagen types.
Basic investigation of heart failure
Authors: Beggs Simon A. S. , Gardner Roy S.
Published: May 2022

Although the clinical history and examination may suggest a diagnosis of heart failure, objective evidence of cardiac dysfunction is also required. A number of diagnostic tests can be reliably employed to identify patients with left ventricular systolic dysfunction. However, heart failure with preserved systolic function is less reliably pinpointed, particularly as the syndrome is a mixture of conditions rather than a specific entity. As well as investigating patients to identify the presence and severity of cardiac dysfunction and any relevant comorbidities, it is important to clarify the underlying aetiology. Some causes are potentially correctable with possible improvement in the degree of cardiac dysfunction. Appropriate investigations will also help to risk-stratify patients, identifying those suitable for advanced therapies such as device therapy (implantable cardioverter–defibrillator, cardiac resynchronization therapy, ventricular assist devices) and cardiac transplantation. Although echocardiography is currently the principal diagnostic test for patients with heart failure, cardiac magnetic resonance imaging is now considered to be the ‘reference standard’ method of assessing cardiac function. This chapter concentrates on the first-line investigations.
Cardiovascular magnetic resonance in heart failure
Authors: Halliday Brian P. , Prasad Sanjay K.
Published: May 2022

Cardiovascular magnetic resonance (CMR) has an increasingly important role in the assessment of patients with heart failure. One major advantage of this modality is the ability to perform tissue characterization without exposure to ionizing radiation, enabling accurate diagnosis and improved prognostication. Given the high spatial resolution and the ability to image in any plane, it also provides reference-standard quantification of chamber size and function. Accurate assessment of left ventricular ejection fraction is fundamental to current decision-making in the contemporary management of heart failure. This chapter covers the basics of magnetic resonance imaging, including the components of a typical scan performed to evaluate a patient with heart failure, and discusses the major benefits CMR offers in the assessment of patients with heart failure and reduced ejection fraction and those with preserved ejection fraction.
Invasive investigation
Authors: Beggs Simon A. S. , Gardner Roy S.
Published: May 2022

This chapter describes the prognostication of heart failure. Heart failure is a frequently progressive condition, although after commencing treatment patients usually reach a period of clinical ‘stability’, the duration of which varies between individuals. Most patients, if they do not suffer from sudden death, will ultimately deteriorate with refractory heart failure symptoms leading up to their death. Identifying such patients is one of the great challenges of heart failure management. Decisions regarding appropriateness and timing of scarce treatments—such as cardiac transplantation or mechanical circulatory support—or the need for end-of-life care can be aided by repeated prognostic assessment. As the one-year mortality following cardiac transplantation is approximately 15.5%, the selection of candidates for cardiac transplantation is therefore determined by identifying those patients whose annual mortality from heart failure exceeds this rate and who might therefore benefit prognostically from advanced therapy. Prognostic assessment of chronic heart failure can be made by a number of methods, including evaluation of univariable predictors, as well as multivariable clinical models.
Anaemia and iron deficiency
Authors: Kalra Paul R. , Pope Michael
Published: May 2022

Anaemia is identified in approximately one-third of patients with chronic heart failure (CHF). Low haemoglobin levels are related to impaired functional status and increased all-cause mortality. The association is independent of ejection fraction and renal function. Attempts to increase haemoglobin levels using recombinant human erythropoietin have not improved mortality or risk of heart failure hospitalization. Iron deficiency (ID) is common in patients with CHF both with and without anaemia. Iron metabolism is altered in CHF, resulting in both absolute and functional ID. Whereas the precise pathophysiological mechanisms are not fully understood, inflammatory activation with upregulation of hepcidin is thought to play a central role. In patients with CHF, ID is associated with an adverse prognosis irrespective of the presence of anaemia. Trials show that intravenous iron replacement in patients with CHF is associated with improvement in symptoms and functional status. Ongoing studies evaluating the impact of intravenous iron on cardiovascular mortality and heart failure hospitalization will determine whether this treatment strategy will be incorporated into future routine clinical practice.
Diabetes mellitus
Authors: Jamieson Andrew
Published: May 2022

Heart failure and diabetes mellitus (DM) are both increasing in prevalence worldwide, and heart failure is a serious and increasingly common co-morbidity in the patient with DM. The patient with heart failure and DM may present particular problems in relation to a number of management areas, and as a consequence, it is increasingly important that practitioners dealing with patients with heart failure have some knowledge of the interplay between DM and heart failure, and the potential pitfalls encountered when treating the diabetic patient with heart failure, and vice versa. Recently, newer agents developed to treat diabetes have been shown in clinical trials to improve cardiovascular out, particularly heart failure, opening a new chapter in the treatment of diabetes.
Arthritis
Authors: Rodgers Sam , Walker Niki L.
Published: May 2022

Heart failure and arthritis are both common in adults, and both increase in incidence and prevalence with age. The term arthritis covers a wide spectrum of disease. Broadly, the diseases involve the cartilage, bone, tensile structures (ligaments, tendons and muscles), or synovial tissue. Pathological processes may impact on any of these structures. The most common arthritis is osteoarthritis resulting from cartilage fragmentation and loss, usually with wear and age. The major target for autoimmune and inflammatory arthritides is the synovium. Inflammatory arthritis can cause or exacerbate heart failure, and heart failure treatment can cause or exacerbate arthritis, particularly in relation to gout.
Vasodilators
Authors: Piper Susan , McDonagh Theresa A.
Published: May 2022

Vasodilatory compounds have long been used in the treatment of heart failure. Whereas they have mostly been used in the setting of acutely decompensated heart failure, there is evidence to support the use of oral preparations in certain subgroups with chronic heart failure. This chapter explores the current evidence and guidelines for the use of vasodilators in clinical practice, both in the acute and chronic setting; and it examines the potential for novel vasodilatory compounds and possible future directions. Although there remains a compelling physiological basis for the use of vasodilators, lack of robust evidence has led to differing opinions about their use both in acute and chronic heart failure. Much of the difference is due to the difficulties in performing clinical trials, particularly in the acute setting where time-limited interventions and the diverse presentation of patients makes the logistics of studies challenging.
Angiotensin receptor blockers and angiotensin receptor–neprilysin inhibitors
Authors: McMurray John
Published: May 2022

This chapter addresses angiotensin receptor blockers (ARBs) and angiotensin receptor–neprilysin inhibitors (ARNIs). ARBs or angiotensin II receptor antagonists were introduced as a potentially superior alternative to an angiotensin converting enzyme (ACE) inhibitor and, later, as a possible addition to an ACE inhibitor. Unlike ACE inhibitors which block the generation of angiotensin II from angiotensin I, ARBs antagonize the action of angiotensin II at the angiotensin II type 1 receptor. This receptor mediates the known actions of angiotensin II considered harmful in heart failure, such as vasoconstriction and sodium retention. That ARBs were developed after ACE inhibitors had become evidence-based ‘standard of care’ in heart failure with reduced ejection fraction made clinical evaluation of ARBs in these patients challenging.
Mineralocorticoid receptor antagonists
Authors: Rekhraj S. , Szwejkowski Ben. R. , Struthers Allan D.
Published: May 2022

This chapter studies the use of aldosterone antagonists, also known as mineralocorticoid receptor antagonists (MRAs), in chronic heart failure (CHF). Overall, the results for aldosterone blockade in CHF due to left ventricular systolic dysfunction—now called heart failure with reduced ejection fraction (HFrEF)—have been very impressive with three large, undoubtedly positive results. These are the Randomized Aldactone Evaluation Study (RALES study); the Eplerenone Post-acute Myocardial Infarction Heart failure Efficacy and Survival Study (EPHESUS) study; and the Eplerenone in Mild Patients Hospitalisation and Survival Study in Heart failure (EMPHASIS-HF) study. Importantly, there are no neutral or negative studies for aldosterone blockade in HFrEF. Thus, all CHF guidelines recommend MRAs as third-line drugs after angiotensin converting enzyme inhibitors and β‎-blockers.
Digoxin
Authors: Cuthbert Joseph J. , Clark Andrew L.
Published: May 2022

This chapter focuses on digoxin, one of many cardiac glycosides (also known as cardiotonic steroids) that have been studied to varying degrees over the years. Digoxin is used for ventricular rate control in patients with atrial fibrillation (AF), a common co-morbidity in patients with heart failure. A patient with heart failure who is taking digoxin is likely taking it for rate control rather than for heart failure itself. Digoxin remained the only treatment for heart failure until the introduction of intravenous mercurial diuretics in the 1950s. The use of digoxin as a treatment for patients with heart failure has declined ever since, with the emergence of medications with proven prognostic benefit. Despite the decline in its use, digoxin is still cautiously recommended by the European Society of Cardiology in its guidelines both for heart failure and for AF. In the heart failure guidelines, digoxin is recommended for the treatment of heart failure in patients in sinus rhythm who are symptomatic despite ‘triple therapy’ or for ventricular rate control in patients with heart failure and AF when other options have been exhausted.
Antithrombotics
Authors: Cleland John G. F.
Published: May 2022

There are many reasons to consider treating patients with heart failure with antithrombotic agents, including atrial fibrillation, coronary artery disease (CAD), intracardiac thrombus, prevention and treatment of deep vein thrombosis, and to reduce thrombotic complications of left ventricular assist devices or mechanical valves. Current clinical practice is based largely on clinical opinion or extrapolation from trials that did not focus primarily on heart failure. There is good evidence that anticoagulants, compared to aspirin, reduce the risk of stroke in patients who have heart failure, whether or not they have atrial fibrillation, but it is uncertain whether this translates into a reduction in disability or death. The increased risk of bleeding should be weighed against the benefits of stroke reduction. For patients with heart failure and CAD, new evidence suggests that adding low-dose (2.5 mg bd) rivaroxaban to aspirin reduces vascular events and mortality, but perhaps only if left ventricular ejection fraction is >40%. There is no evidence that aspirin alone or any other antiplatelet agent improves outcome in patients with heart failure with or without CAD, regardless of left ventricular ejection fraction. Patients with heart failure were included in many of the clinical trials showing that prophylactic use of heparin or anticoagulants reduces the risk of deep vein thrombosis and pulmonary embolism among acute medical admissions. Extending anticoagulation for 6 weeks after discharge may further reduce the risk of deep vein thrombosis but it is not clear that this reduces the risk of pulmonary embolism or mortality.
Implantable cardioverter–defibrillators
Authors: Cannon Jane A. , Connelly Derek T.
Published: May 2022

The implantable cardioverter–defibrillator (ICD) is established as an effective therapy for ventricular arrhythmias and is now routinely used for both primary and secondary prevention of sudden cardiac death in at-risk populations. Patients with heart failure have an increased propensity to arrhythmic sudden death and large randomized trials have demonstrated a clear mortality benefit following ICD implantation in selected cohorts of heart failure patients. Despite this, the optimal use of ICDs in patients with heart failure remains a particularly challenging area of clinical practice. This is primarily due to the fact that patients with heart failure are exposed to competing risks, which are both dynamic and difficult to quantify. As the cost and morbidity associated with ICD implantation are not insignificant, careful consideration of the risks and benefits associated with ICD implantation in each individual patient is required. This chapter reviews ICD therapy and considers the rationale for ICD implantation in patients with heart failure.
Heart transplantation
Authors: Karagiannis Georgios , Saez Diana Garcia , Burke Margaret M. , Simon André R. , Banner Nicholas R.
Published: May 2022

Heart transplantation is the reference standard treatment for advanced acute and chronic heart failure, although limited by the scarcity of donor hearts. Careful selection of transplant candidates is therefore essential in combination with optimal donor recipient matching. In the current era, most surgeons use the bicaval heart transplant technique. Approximately half of the patients receiving a heart transplant are on mechanical circulatory support. Allograft rejection is clinically categorized according to its temporal occurrence (hyper-acute, acute, and chronic) and by the underlying mechanism (cellular, antibody-mediated, and mixed). The calcineurin inhibitors ciclosporin and tacrolimus are the cornerstones of current maintenance immunosuppression regimens and are used in combination with an anti-proliferative agent and corticosteroids to prevent rejection. The target of rapamycin inhibitors offer an alternative to chronic anti-rejection treatment. Despite the increasing complexity of heart transplant recipients, survival is improving progressively.
Revascularization, remodelling, and mitral valve surgery
Authors: Pepper John
Published: May 2022

Although guideline-directed treatment has resulted in a significant improvement in survival and quality of life in patients with heart failure characterized by a reduced ejection fraction, most individuals are not able to return to normal activities. They are faced with the consequences of an end to their working lives. New ideas and a reappraisal of the STICH trial at 10 years has given rise to a sense of optimism. To many people’s surprise, the assessment of myocardial viability does not appear to be helpful in deciding which patients will benefit from myocardial revascularization by surgery or percutaneous coronary intervention. The role of surgical ventricular reconstruction remains controversial. Ischaemic mitral regurgitation remains a substantial challenge in its late stages but better recognition and appropriate intervention at an early stage in its natural history is likely to be rewarded by improved results and the ability to continue an active life.
Reparative therapies for the failing heart
Authors: Jabbour Richard J. , Lyon Alexander R.
Published: May 2022

A variety of novel strategies has been developed with the aim of repairing damaged myocardium in patients with heart failure. Exogenous cell therapies including bone marrow mononuclear and mesenchymal stem cells, skeletal myoblasts, and cardiac progenitor cells have been studied extensively in preclinical models, and have also been assessed in early clinical trials. The efficacy and safety of different approaches with relevance to patients with heart failure of different aetiologies will be discussed. Biological reparative and regenerative therapies including engineered heart tissue, pluripotent stem cell technology and gene therapy are in the pipeline with early clinical trial experience for gene therapy. Future directions for regenerative therapies include activation of endogenous repair strategies. These are still in the preclinical development phase and include direct reprogramming and cell cycle re-entry.
The genetics of heart failure
Authors: Limongelli Giuseppe , Elliott Perry M.
Published: May 2022

This chapter reviews the clinical presentation and pathophysiology of the most common genetic forms of cardiomyopathy. Heart failure, defined in its broadest sense as a syndrome characterized by symptoms and signs of ventricular dysfunction in the presence of structural and or functional abnormalities of heart function, affects millions of people worldwide; in addition, a substantial number of individuals have asymptomatic abnormalities of heart function that predispose them to symptomatic heart failure in later life. Coronary artery disease and hypertension are by far the most common causes of heart failure, but a substantial minority of cases is caused by a heterogeneous group of heart muscle diseases, the cardiomyopathies. These disorders differ in several important respects from other causes of heart failure in that they are often familial and present throughout life. With recent advances in the understanding of the molecular genetics of cardiomyopathies, cardiologists are having to adapt diagnostic and treatment protocols in order to optimize management of individual patients and their families.
International palliative care policy: public health in relation to the ‘new’ palliative care
Authors: Larkin Philip J.
Published: May 2022

The importance of a strong public health message for palliative care has been endorsed globally by international agencies and key players in the discipline, including the case for a more equitable model of care. Yet a number of challenges and gaps exist and solutions to these challenges remain elusive. This chapter outlines strategic changes which have taken place, particularly since the 2014 World Health Assembly resolution. It critiques messages of equality, human rights, and social justice and provides two examples of where these principles underpin effective public health palliative care programmes. At a time when palliative care is becoming more established in global health, a key message from the chapter is that contemporary palliative care needs to be clear how it defines and describes its contribution to population health.
Health promotion and palliative care
Authors: Grindrod Andrea
Published: May 2022

This chapter examines the theoretical perspectives and practical application of integrating health promotion and palliative care, and argues that health promotion approaches can improve end of life experiences when used in conjunction with palliative care strategies. Health promotion is concerned with health across the life span but despite this has paid little attention to health at the end of life. Palliative care focuses on illness experience at the end of life, but often neglects broader issues of health because of its focus on the signs and symptoms of dying. An overview of key concepts, terminology, theoretical constructs, practice principles, and policy contexts for the integration of palliative care and the end of life through the central organizing framework of the World Health Organization’s Ottawa Charter for Health Promotion is provided. Finally, this chapter summarizes the literature and progress in this field, including the gaps that provide indications for future directions.
Digital technologies in public health palliative care
Authors: Mills Jason , Mills Shyla
Published: May 2022

This chapter explores the use of digital technologies in the context of public health palliative care. In an increasingly digital society, there is a growing imperative to understand the benefits and limitations of the use of digital technologies within a social model of care. Through a dual lens of digital public health and thanatechnology, this chapter provides an overview of the digital technologies used in palliative care, outlining their application to the growing field of public health palliative care. Despite the inherent risks of technological developments in society, a broad range of public health palliative care benefits can be realized in both clinical and community settings. Key considerations including the need for co-design of digital health interventions, outcome evaluation, and awareness of social inequities are highlighted to guide practice, education, and research.
Public health palliative care, equity-oriented care, and structural vulnerability
Authors: Prince Holly , Kortes-Miller Kathy , Stajduhar Kelli I. , Marshall Denise
Published: May 2022

This chapter focuses on public health palliative care and its relationship to equity-oriented care and structural vulnerability. Contemporary concepts related to equity, diversity, and inclusivity are outlined then situated within palliative/end of life care and public health palliative care. Many people and communities face significant, enduring structural and systemic barriers that severely affect access to health and social care, create health disparities, and impinge on people’s quality of life. Framing hospice care, palliative care, and end of life care around equity and social justice issues are fundamental to the public health palliative care approach. Three examples are shared of communities of people who benefit greatly when key dimensions of equity-oriented approaches to care are considered. A final discussion consolidates overarching themes to provide direction for broad, enduring, and global application.
Public health palliative care design and practice in low- and middle-income countries
Authors: Kumar Suresh , Ramakrishnan Jairam Kamala
Published: May 2022

Palliative care in low- and middle-income countries poses unique challenges in the context of resource-strapped health systems and social environments. This chapter explores how the community, practitioners, and policy makers can approach palliative care in such contexts using methods that maximize strengths and capacity within such areas without imposing models of palliative care from high-income contexts. Community-partnered palliative care bringing together practitioners and the community around health systems using a step-wise approach is outlined. Case studies are used to illustrate this approach and guidelines and indicators included to aid the practitioner embarking on such an approach. Communities enabled to address suffering, with stewardship rather than ownership by health systems, is argued as the desirable outcome.
Using and building toolkits to support community action
Authors: Tompkins Bonnie , Malleck Dan
Published: May 2022

Toolkits can be effective resources providing communities with information and tools to support community-led action in health-promoting palliative care. This chapter provides guidelines for assessing effectiveness of toolkits in empowering communities to strengthen their capacity to support members experiencing death, dying, loss, and grief. It examines seven prominent toolkits that are based upon the principles of health promotion in palliative care, considering their resources against criteria of best practices in toolkit structure. It then provides detailed steps for readers who intend to develop their own toolkit to strengthen community capacity. The chapter also includes links to resources and toolkits for building an effective toolkit.
Effects of Alkaline Calcareous and Magnesium Soil Amendments on the Incidence of Bacterial Wilt of Tomato
Authors: Imazaki Iori
Published: May 2022

Bacterial wilt of tomato caused by Ralstonia solanacearum is one of the major hindrances in tomato production. Previously, we demonstrated that increases of field soil pH up to the weakly alkaline condition at approximately pH 7.5 using slag fertilizer led to the reduction of disease severity caused by bacterial wilt. However, the method was laborious and needed large quantities of slag fertilizer. Therefore, in this study, I develop a labor- and cost-effective method that can be used in integrated pest management (IPM) programs based on the previous information. First, the effects of several alkaline minerals on the incidence of bacterial wilt were examined. Alkaline minerals alone did not cause a stable reduction of disease incidence. Then, the efficacy of the representative alkaline minerals calcium carbonate (CaCO3) and magnesium carbonate (MgCO3) against the disease were tested in the combination with supplemental minerals. In 2018, the disease incidences were reduced by the combined treatment CaCO3 + a micronutrient fertilizer (MF) + iron (III) oxide (Fe2O3) + a silicon fertilizer (SF) or MgCO3 + MF + SF. Furthermore, synergistic effects were detected among the alkaline and supplemental minerals. Thus, the combinations of CaCO3 or MgCO3 with the MF, Fe2O3, or SF were synergistic against the disease and were labor and cost saving. However, in 2019, the disease incidences were not significantly reduced by each of the combined treatments, which suggests that more combinations with other IPM tools are needed for sufficient control of bacterial wilt.

[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Percutaneous Strain Reduction Screws Are a Reproducible Minimally Invasive Method to Treat Long Bone Nonunion
Authors: Bence Matthew , Kothari Alpesh , Riddick Andrew , Eardley William , Handley Robert , Trompeter Alex
Published: May 2022

Objectives:

(1) Evaluate whether initial results from percutaneous treatment of nonunion are reproducible (2) Estimate the relative cost of percutaneous treatment of nonunion versus traditional methods.

Design:

Retrospective multicentre case series.

Setting:

Four Level 1 trauma centers.

Patients/Participants:

Fifty-one patients (34 men and 17 women) with a median age of 51 years (range 14–81) were treated for nonunion at a median of 10 months (range 4–212) from injury.

Intervention:

Percutaneous strain reduction screws (PSRS).

Main Outcome Measured:

Union rates and time to union were compared for patients treated in the developing institution versus independent units as well as with previously published results.

Results:

Forty-five (88%) patients achieved union at a median time of 5.2 months (range 1.0–24.7) confirming the previously published results for this technique. Comparable results were seen between the developing institution and independent units. No patients experienced adverse events beyond failure to achieve union. PSRS seems to offer savings of between £3177 ($4416) to £11,352 ($15,780) per case compared with traditional methods of nonunion surgery.

Conclusions:

PSRS is a safe, efficacious treatment for long bone nonunion and may be more cost-effective than traditional nonunion treatment methods. The promising initial results of this technique have now been replicated outside of the developing institution.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
EFFECT OF ORAL CARBONIC ANHYDRASE INHIBITOR ON CYSTOID MACULAR EDEMA ASSOCIATED WITH RETINITIS PIGMENTOSA
Authors: Yeo Joon Hyung , Min Chan Hong , Yoon Young Hee
Published: May 2022

Purpose:

To investigate the factors associated with visual improvement in response to oral carbonic anhydrase inhibitors (CAIs) and the occurrence of microvascular changes in patients with retinitis pigmentosa–associated cystoid macular edema (RP-CME).

Methods:

This retrospective cohort study included 59 eyes from 39 patients with RP-CME who underwent at least 3 months of oral CAI treatment. The eyes were divided into responding and nonresponding groups based on optical coherence tomography (OCT) criteria (resolution of cyst and reduction of foveal or parafoveal volume). All eyes were assessed before and after treatment using OCT and OCT angiography.

Results:

Thirty-three eyes (55.9%) demonstrated a positive response to treatment, and 26 eyes (44.1%) did not. Compared with nonresponding eyes, responding eyes had a significantly higher frequency of multilayer CME than CME limited to the inner nuclear layer (P = 0.016). Subgroup analysis within the responding group revealed that improvements in visual acuity were more likely in eyes with fovea-involving CME and a higher baseline external limiting membrane and ellipsoid zone width. Microvascular parameters showed no significant changes after treatment.

Conclusion:

Eyes with CME extending to the outer nuclear layer or central fovea, and higher initial photoreceptor integrity may be prognostic factors associated with structural and functional improvements after carbonic anhydrase inhibitors treatment. Early treatment of multilayer CME with foveal involvement seems to be crucial in preventing irreversible photoreceptor damage.
SARS-CoV-2 Infection Is Not Associated With Pediatric Appendicitis
Authors: Jiang Yike , Mehl Steven C. , Hawes Ella E. , Lino Allison S. , Rialon Kristy L. , Murray Kristy O. , Ronca Shannon E.
Published: May 2022

Although case reports have suggested an association between severe acute respiratory distress syndrome coronavirus 2 and appendicitis, we found that the overall incidence of appendicitis was stable throughout the pandemic at our tertiary pediatric hospital. Furthermore, we did not find evidence of CoV2 infection in 9 appendicitis tissues. Therefore, we conclude that severe acute respiratory distress syndrome coronavirus 2 infection of the appendix is not a common etiologic cause of pediatric appendicitis