bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychological adaptation and quality of life of the patient with end-stage renal disease
Authors: Finkelstein Fredric Q , Finkelstein Susan H
Published: October 2023

Successful psychosocial adaptation to dialysis is the key to long-term survival. This chapter sets out to review the various psychological and social problems that dialysis patients have to face.The assessment of the psychological adaptation of the patient with end-stage renal disease (ESRD) has intrigued investigators for many years. In the initial years of ESRD therapy, researchers focused their attention on the physical and psychological limitations and the difficulties and restrictions imposed on patients by their illness and treatment modality (Abram, 1974; Levy, 1994). The increased mortality of patients with ESRD, the demands placed on these patients by their therapy, and the myriad physical and social problems that engulf them because of their illness have been repeatedly emphasized. Developing effective tools and strategies of psychosocial assessment and intervention has perhaps become more important as the incidence and prevalence of end-stage renal failure has increased and the mean age of the ESRD population has increased throughout the world. More recently, however, efforts to understand better the experience of the dialysis patient have focused researchers’ attention on the quality oflife experienced by these patients (Gokal, 1993; Powe et al., 1996; Salek, 1996; Steele etaL, 1996a). The assessment of quality of life has presented problems and raised basic philosophical issues for investigators (Gill and Feinstein, 1994; Nissenson, 1994; Anonymous, 1995; Fallowfield, 1996).
Long hemodialysis: the key to survival?
Authors: Charra Bernard , Laurent Guy
Published: October 2023

The obstinacy of the Seattle team (Scribner et al., 1960) turned an experimental, acute-renal failure treatment (Kolff etal., 1944) into a long-term maintenance therapy. The number of hours of each dialysis was then the only yardstick of the dialysis dose. When dialysis was increased from once to twice and ultimately thrice weekly, the session duration was decreased from 16 to 12 and then to 10 hours.This trial and error process led to a general agreement that the minimum requirement for an average¬ sized adult on a 60 g protein diet was 30 hours per week on the 1 square-meter Kiil dialyzer (Siddiqui and Kerr, 1971).
Long-term peritoneal dialysis: does a spell of peritoneal dialysis prolong survival on hemodialysis?
Authors: Lameire Norbert , Biesen Wim Van
Published: October 2023

Since the inception of peritoneal dialysis (PD) as a form of long-term renal replacement therapy, the number of PD patients has continued to grow and PD therapy is steadily increasing throughout Europe and the USA at an annual rate of15%. (World-wide Registry Update, 1994; Blagg and Mailloux, 1996).This increase in the total dialysis population has been partly related to the inclusion of much higher risk populations (the elderly, those with diabetes mellitus, and those with cardiovascular and multisystem diseases).
The thyroid (Physiology)
Authors: Laycock John , Wise Peter
Published: October 2023

See also Chapter 4 (Qs 3, 18); Chapter 12 (Q 5) is situated in the chest consists of two linked lobes of tissue requires a direct neural link with the brain in order to function d is composed mainly of follicles filled with a protein-rich gel produces iodinated molecules derived from the amino acid tyrosine
The Pancreas (Physiology)
Authors: Laycock John , Wise Peter
Published: October 2023

is transported in the blood mainly bound to proteins b can be synthesized from certain amino acids is stored in cells as the polymer, glycogen enters hepatocytes by an active transport mechanism is the principal source of metabolic energy in the central nervous system
Hypoglycaemia and pancreatic tumours (C finical)
Authors: Laycock John , Wise Peter
Published: October 2023

In regard to spontaneous hypoglycaemia (i.e. not related to antidiabetic hypoglycaemic drugs), which of the following is/are true? The usual threshold for development of symptoms is a blood glucose of 3.6-4.0 mmol/litre (65-72 mg/100 ml) Some insulin must be present in the circulation for neuroglycopaenic symptoms to occur Recovery from hypoglycaemia is mainly mediated by the action of glucagon Cortisol and growth hormone deficiency result in low blood glucose levels, but recovery from hypoglycaemia is not impaired The glucose threshold for triggering the release of each of the four major counter-regulatory hormones is identical
The Myth of Neutrality
Authors: Lomas Peter
Published: October 2023

The traditional objection to bringing values into scientific debate is, of course, that the argument then collapses into a relativistic free-forall which is the very antithesis of what science is supposed to be. However, Kuhn’s close examination of the history of science showed that the grounds on which one paradigm is preferred to another are not exclusively scientific ones: the determinants of that choice lie to a large extent outside science, in social and psychological factors ... This view has naturally been hotly contested, since it blurs almost to vanishing-point the distinction between scientific belief-systems and (say) religious or political ones; but ... Kuhn’s conclusion is only disastrous if one presupposes, as he and most scientists traditionally have, that any choice determined by social or psychological factors is necessarily an irrational one.
The poverty of technique
Authors: Lomas Peter
Published: October 2023

The justification for bureaucratic procedures resides not in any argument in support of intrinsic values but in their capacity to effect the result that is desired. The question as to whether the desire is a good one is bypassed. In discussing these issues, Maclntyre compares the manager with the therapist who also: treats ends as given, as outside his scope; his concern also is with technique, with effectiveness in transforming neurotic symptoms into directed energy, maladjusted individuals well-adjusted ones. Neither manager nor therapist, in their roles as manager and therapist, are able to engage in moral debate. They are seen by themselves, and by those who see them with the same eyes as their own, as uncontested figures, who purport to restrict themselves to the realms in which rational agreement is possible-that is, of course, from their point of view to the realm of fact, the realm of means, the realm of measurable effectiveness.
Acupuncture and TENS
Authors: Filshie Jacqueline , Thompson John W
Published: October 2023

Melzack (1994) described many historical ways in which sensory stimulation and modulation have been used to reduce pain throughout history. These include the more aggressive forms of counterirritation or stimulation, scarification, cauterization and cupping and lesser stimulating therapies, acupuncture and transcutaneous electrical nerve stimulation (TENS).
Development of the normal dentition
Authors: McDonald F , Ireland A J
Published: October 2023

At birth the deciduous teeth are usually unerupted and the alveoli comprise a thickened mucosal covering known as the gum pads (Fig. 1.1). These are subdivided into raised areas corresponding to the position of the unerupted deciduous teeth, by shallow transverse grooves on the mucosal surface. To the lingual of these raised areas, running around the arch in both the upper and lower jaws, is another shallow groove known as the dental groove. It is from here that epithelial ingrowth originates to form the enamel organ. In addition, in the upper jaw a further shallow groove, known as the gingival groove, passes around the arch palatal to the dental groove. This denotes the boundary between the epithelium of the alveolus and the palate.
Extra-oral examination
Authors: McDonald F , Ireland A J
Published: October 2023

Clinical examination should begin as the patient enters the surgery. They will be completely unaware that the examination will have begun and this provides an opportune moment to view the extraoral features at rest and in function.
Intra-oral examination
Authors: McDonald F , Ireland A J
Published: October 2023

Whenever an orthodontic examination is performed it should be completed in a logical and systematic fashion so that no aspect of the examination is omitted. By using such a sequence, a mental picture of the malocclusion can be formulated which, with experience, will help in the formulation of appropriate treatment aims and thus treatment plans. A pro forma for both extra- and intra-oral examination is included in Appendix 1. The intra-oral examination will now be discussed in more detail.
Postgraduate specialties
Authors: Leung Wai-Ching
Published: October 2023

Which of the following statements regarding the Rinne test is/are true? a the base of a tuning fork is held on the vertex of the head b a positive result occurs if the air conduction is better than bone conduction c a positive result implies that the outer and middle ear is functioning properly c a positive result implies that the cochlear is functioning properlyIt may give a positive result in one ear and a negative result in the other.
General anaesthesia in the A & E department
Authors: Illingworth Karen A , Simpson Karen H , Swales Sue
Published: October 2023

Problems can occur with any anaesthetic technique. There is no such thing as a ‘simple’ anaesthetic. All injured patients are at risk of regurgitation and aspiration of gastric contents during anaesthesia or recovery. Thorough preoperative history and examination may prevent anaesthetic problems. Preoperative resuscitation is mandatory. The anaesthetist must plan the anaesthetic technique after consultation about the proposed surgery. Adequate facilities must be available, including trained assistance for the anaesthetist.
Anaesthetic and resuscitation equipment
Authors: Illingworth Karen A , Simpson Karen H , Swales Sue
Published: October 2023

All doctors should be familiar with the anaesthetic and resuscitation equipment in their hospital. Always check equipment before it is used. Anaesthetic problems are often caused by equipment failures. Never bypass safety procedures, no matter how urgent the situation. Anaesthetic equipment and techniques are continuously changing to provide safer and more efficient anaesthesia. These changes often occur more quickly in the operating theatres than in A & E departments. It is essential, when starting a new job, that each doctor becomes familiar with the resuscitation and anaesthetic equipment used in the hospital
Infection risks during anaesthesia
Authors: Illingworth Karen A , Simpson Karen H , Swales Sue
Published: October 2023

Assume that all patients are potential carriers of communicable diseases. Adopt precautions to prevent transmission of infection including goggles, gloves, fluid-impervious gowns, and masks. Avoid injuries by careful handling of needles and blades and the use of biohazard containers. All staff who may come into contact with blood or body fluids should be immunized against hepatitis B. If a non-immune person is contaminated he or she must be treated with immunoglobin followed by active immunization. Counselling may be needed for professionals who are at risk of contracting a communicable disease, for example after a needle-stick injury.
Hugh Smith and the Oxford Nutrition Survey
Authors: Ewin Jeannette
Published: October 2023

As the Nazi shadow moved over the Continent, Hugh Smith prepared to leave for Europe. The British were anxious to have a team of experts survey the nutritional status of factory workers, and one of his first tasks would be to facilitate this work. To Smith’s surprise, he would not make the journey alone. A young British research scientist, interested in nutrition, and currently on fellowship at Harvard University, wanted to return home for war service; the nutritionist was Dr Peter Meiklejohn, Hugh Sinclair’s long-time friend. They later bitterly quarreled.
Eskimos and nutrition at Oxford
Authors: Ewin Jeannette
Published: October 2023

The United Nations Conference on Food and Agriculture was called to order on 18 May 1943, in Hot Springs, Virginia, USA. From then until 3 June, an international group of experts debated the importance of nutrition in the prevention and control of disease. Reading the conclusions of that meeting almost sixty years later, one cannot help but regret our failure to take up their challenge.
An end to the Survey
Authors: Ewin Jeannette
Published: October 2023

In the autumn of 1944, Sinclair applied to an American philanthropic organization, other than the Rockefeller Foundation, for funds. He wanted to conduct a one-year depletion study on a group of conscientious objectors: his subject was vitamin C. This potential donor contacted Hugh Smith in New York, and inquired as to Sinclair’s clinical ability to direct such a study. Smith assured them that Sinclair had an excellent clinical background. A second letter arrived, asking Smith’s opinion on whether or not Sinclair’s proposed study was a peace-time or war-time investigation. Special consideration had been given to research work in Europe as part of the war effort, they said, but peace-time studies outside the United States and Canada were beyond their mandate. Smith responded, saying that any study which Sinclair might carry out in the future would come too late to affect the troops in the present war, but that did not mean the study was not of war-time significance. Sinclair’s proposed study was valuable, and Smith thought the Oxford group was better equipped to conduct the work than any other group in existence. His only concern was whether the study outlined would interfere unduly with the programme of work already under way.
Germany
Authors: Ewin Jeannette
Published: October 2023

During the summer of 1945, the University of Oxford was settling the financial affairs of the Oxford Nutrition Survey in anticipation of its being replaced by a peace-time programme. It was found that Hugh had charged some personal expenses against the Survey, and he was asked to settle the debt. Hard pressed for cash, he turned to Rosalie; specifically, he asked his mother to sell a large diamond necklace. She considered the idea, but, under Catherine’s influence, decided against it. Her lack of support infuriated Hugh and his resentment simmered for months. For a time, his debt would not be paid.
Finance and accommodation
Authors: Ewin Jeannette
Published: October 2023

In late February 1946 the Trustees of the Wellcome Foundation gave provisional approval for a grant of £25 000 towards establishing a Laboratory of Human Nutrition at the University of Oxford. Hugh Sinclair had been the moving force in obtaining the money, but there were conditions that he may not have appreciated. The grant stipulated that the scheme of the Laboratory must fit into the Government’s plans regarding nutrition, and be in accord with the policy of the Medical Research Council. The University Grants Committee must make a recurrent grant to the University of Oxford to support the work of the Laboratory. There was one final consideration: space must be secured for the Laboratory.
Plans for Nuneham Park
Authors: Ewin Jeannette
Published: October 2023

It was 1957. Elvis Presley rocked and rolled, the Russians launched Sputnik, and Sir Wilson Jameson and Lord Porritt proposed and seconded Hugh Sinclair for the high honour of joining the Court of Assistants of the Worshipful Society of the Apothecaries. It was the year Hugh became a Founder member of that Society’s Faculty of the History of Medicine and Pharmacology. This was also the year Hugh reapplied for his Readership in Human Nutrition, and was refused.
Grand dreams and little money
Authors: Ewin Jeannette
Published: October 2023

Hugh was pleased to hear from his old friend, but would gladly have purchased some of the electronic gadgets Smith decried if funds had allowed. The financial pit was deepening. Sinclair wrote and edited works about nutrition whenever possible for income, and was pleased when Robert Maxwell, of Pergamon Press, asked him to edit what he planned to be a twenty-volume encyclopaedia of human nutrition; unfortunately the series was truncated. Tutoring at Magdalen College provided a small income, and there were profits from his flower and produce shops, but all this barely covered the running costs at Lady Place and his not inconsiderable personal expenses. Frequent lunches at the Athenaeum were a necessity. The day before his 50th birthday, Hugh was invited by Hans Krebs to lecture on nutrition for ‘three guineas’ an hour. Hugh gladly accepted, and as a result in May 1961 his name was added to that of members of the Faculty of Physiological Studies.
Life without mother
Authors: Ewin Jeannette
Published: October 2023

Once a year, and sometimes more frequently, a hardy group of Oxford students were transported from the University by car — or rusting and noisy lorry — to Lady Place for tea. The uninitiated were surprised when, immediately upon arrival, they were presented with all manner of garden implements and invited to clean up the flower beds and mow the lawns before tea. It was good humoured hard work. When Hugh felt sufficient sweat had been shed, he called for the cricket bats. Those not interested in such sport were pointed in the direction of the boathouse or, later, a large water tank, where they could picnic and swim. After a time, Rosalie — in suitable attire for an Edwardian hostess — greeted each guest, welcoming him or her to enjoy a ‘proper tea’ of assorted sandwiches, tea, and fruit cake.
Plans for an institute of human nutrition
Authors: Ewin Jeannette
Published: October 2023

A grand plan was taking form. If Hugh sold Lady Place to Mr Pye, he could then lease back some portion of the property for his Institute, and as its Director, could live there and oversee the property as part of his responsibilities. From Sinclair’s point of view, little would change, other than the amount of money in his pocket. To put this idea on a more secure legal footing, and facilitate donations that may be made to the Institute, he decided to set it up as a registered charity, to be known as The Association for the Study of Human Nutrition. To help finance the Charity during its early stages, Christie’s, the well known auction house, handled the sale of some of Rosalie’s jewellery, including a diamond bracelet and tiara.
Trial size
Authors: Girling David J , Parmar Mahesh K B , Stenning Sally P , Stephens Richard J , Stewart Lesley A
Published: October 2023

Chapter 3 introduced the idea that the treatment effect observed in a clinical trial may vary from the true effect because of the two major sources of error – systematic and random error – and emphasized that the random error component can be minimized by randomizing large numbers of patients. The aim of this chapter is to discuss theoretical and practical issues affecting the determination of the ideal sample size for a trial and to describe when and how compromizes from the ideal can be made. While the focus is on randomized trials, we also expand on sample size calculation for the phase II trial designs introduced in Chapter 4. It is beyond the scope of this chapter to detail sample size calculations for all the types of data and circumstances which a researcher may meet. Our aim therefore is to describe ways to determine the appropriate ‘input factors’ – in particular the size of difference a trial is designed to target – with only brief reference to sample size formulae. We refer readers to published books and software for more detailed options.
Quality of life in clinical trials
Authors: Girling David J , Parmar Mahesh K B , Stenning Sally P , Stephens Richard J , Stewart Lesley A
Published: October 2023

In recent years, progress in extending survival in most common cancers has mainly been achieved in small incremental steps. In this situation, other outcomes such as progression-free survival, response rates, toxicity, treatment-related deaths, cost, and particularly quality of life (QL), can help determine whether new treatments should, or should not, be pursued. There is therefore an increasing demand that cancer treatments be assessed in the wider framework of the balance between all the benefits and risks so that patients and their clinicians can make individual informed decisions.
The clinical application of tumour biology
Authors: Harkin D Paul , Johnston Patrick G
Published: October 2023

Cellular growth and division is a carefully regulated process that depends on the precise interaction of multiple regulatory factors. Cancer represents a deregulation of this process, in which some of the normal constraints on cell growth and division have been lost. How this deregulation occurs has been the focus of intense interest over the last three decades. However, it is now generally accepted that tumours arise through the accumulation of several genetic changes affecting the control of cellular growth. Recent advances in molecular biology have made it possible to define some of the molecular changes that regulate the mechanisms by which certain tumours arise.
Ischemic Heart Disease in end-stage Renal Failure
Authors: Andrews Thomas C , Brickner M Elizabeth , Rutherford John D
Published: October 2023

The prevalence of end-stage renal failure (ESRF) in the United States is growing at the rate of 7 to 9% per year, and by the year 2010 an estimated 350 000 patients will be afflicted. Diabetes mellitus is the cause of 35% of new cases of ESRF and hypertension accounts for an additional 30% of new cases. Therefore, since ESRF is an end-stage manifestation of two conditions that increase the risk of atherosclerosis, it is not surprising that cardiovascular disease is the leading cause of death in this patient population.
Structural basis of Cardiovascular Dysfunction in Uremia
Authors: Amann Kerstin , Ritz Eberhard
Published: October 2023

As early as 1827 Richard Bright drew attention to the common presence of left ventricular hypertrophy and thickening of the aortic wall in patients with end-stage renal failure. He postulated that the cause ‘for the unusual efforts to which the heart has been impelled’ were ‘that it so affects the minute and capillary circulation, as to render greater action necessary to force the blood through the distant subdivisions of the vascular system.’ Today, cardiovascular complications are a major clinical problem in uremic patients.
Cerebrovascular disease in end-stage renal failure
Authors: lseki Kunitoshi
Published: October 2023

The number of dialysis patients is increasing worldwide and becoming an economic burden. This study, of a local registry in Okinawa, is intended to complement other studies, with a view on the morbid effects of dialysis. Okinawa is situated in the southernmost part of Japan, and its inhabitants have the longest average life span in the country (85.08 years in women and 77.22 years in men). Okinawa is made up of a number of subtropical islands, and the population is stable at approximately 1.2 million. The number of hemodialysis facilities on the islands, which was 27 in 1990, had increased to 39 in 1998, including 9 public hospitals, 16 private hospitals, and 14 private clinics.
Cognitive enhancement as a treatment strategy in schizophrenia
Authors: Sharma Tonmoy , Harvey Philip D
Published: October 2023

Cognitive dysfunction, a symptom of schizophrenia, is a core and enduring feature of the illness. It recently has been identified as an important measure of long-term outcome and is probably more important than the characteristic psychotic symptoms in the treatment of this disorder. Deficits in cognition are the most consistent findings in the schizophrenia literature. These deficits are pervasive, with virtually all patients affected to some degree, when compared with healthy peers or relatives. Since Kraepelin’s (1919) first clinical accounts, it has been recognized that they are a prominent feature of schizophrenia. It is well established that schizophrenic patients exhibit significant pervasive cognitive impairments when compared with healthy controls. Furthermore, it would appear that a vast array of cognitive domains are affected by the disease, as outlined in Section 1 of this book. Thus, understanding of the pattern and reversibility of specific cognitive dysfunctions may provide important clues to pathophysiological processes and the mechanisms of effective treatments. This chapter focuses on neurocognitive impairments that occur in schizophrenia, with the possibility that cognitive enhancement or reversal of these deficits may have an impact on the longer term outcome of the illness.
Structural Imaging
Authors: Stevens John M , Fox Nick C
Published: October 2023

Structural neuroimaging traditionally has been used to exclude potentially treatable surgical causes of dementia, such as neoplasm, subdural haematomas, and hydrocephalus (Moseley 1995; Alexander et al. 1995). In recent years, newly recognized entities such as AIDS dementia complex (Barker et al. 1995), and venous hypertensive encephalopathy associated with arterio-venous malformations (Deveikis 1998) have entered the list of diagnosable causes, along with a legion of medical conditions which include multiple sclerosis, neurosarcoidosis, and metabolic disorders (Moseley 1995). In most of these conditions, structural neuroimaging plays a central role in confirming central nervous system involvement.
Molecular pathology of early onset dementia
Authors: McLean Catriona A , Beyreuther Konrad , Masters Colin L
Published: October 2023

An understanding of the molecular basis of the more common neurodegenerative diseases of late adulthood has advanced rapidly in the last decade. Accumulation of various proteins either within neurons, glia, or the extracellular space is becoming recognized as a common feature of many of the diverse forms of early onset dementia. These host-encoded proteins accumulate in aggregated insoluble complexes that serve as markers of the underlying molecular pathology. At some stage during the process of protein aggregation, the protein undergoes a ‘toxic gain of function’ which causes neurodegeneration. While the mechanisms of pathogenesis are only partly understood or remain speculative, the genes encoding these proteins and the mechanisms of the neurodegenerative changes are areas of intense research (Table 8.1).
Familial and sporadic Alzheimer’s disease
Authors: Kennedy A M , Rossor M N , Hodges John R
Published: October 2023

Ever since the original descriptions of Alzheimer’s disease (AD) debate has raged concerning the nosological status of the condition (Alzheimer 1907). For many years a distinction between ‘presenile’ and ‘senile’ forms was widely accepted with an arbitrary cut-off at 65 years. More recently, however, a classification based upon age has become less tenable and with the discovery of a range of genetic mutations in familial cases the subdivision of ‘familial’ versus ‘sporadic’ has been adopted.
Huntington’s disease
Authors: Paulsen Jane S , Robinson Robert G
Published: October 2023

Numerous collaborative efforts have been formed in the spirit understanding and conquering Huntington’s disease (HD), many of which have resulted in significant changes to our under- standing of and care for people with the disease. The goal of this chapter is to summarize what is known about HD and what challenges remain. Several aspects of the disease will be covered, including genetics, pathophysiology, clinical characteristics, treatment, and predictive testing. When possible, manifestions of HD will be addressed in terms of basal ganglia circuitry dys- function.
Introduction
Authors: Burn Loïc
Published: October 2023

When someone has a medical problem they ask four main questions. What IS it? What will it DO to me? What will THEY (the clinicians) do to me? What can I (self-help) do about it? Back and neck pain raises some additional complications. Firstly, for unknown reasons, it is a neglected subject in medical education. This means that your doctor is likely to be less informed about it than about other common conditions. Secondly, there are specific problems in making an accurate diagnosis (which we cover in some detail later). Thirdly, and probably as a result of the first two, there are many different groups all offering you various treatments and advice —much more so than for other medical problems. This may be very confusing for you and in this book we try to provide a balanced view of everything that is on offer. However, there are few areas where actually more information for patients is needed.
The Causes And Extent Of The Problem
Authors: Burn Loïc
Published: October 2023

The causes of back and neck pain have been investigated intensively for many years in the hope of finding ways to prevent them. The outcome of all this work may be both surprising and comforting.
Your Experience Of Acute (Short-Lived) Back And Neck Pain
Authors: Burn Loïc
Published: October 2023

As we mentioned in the introduction, you will want to know what causes neck and back pain, how it affects you, what the clinicians will do about it, and what you yourself can do about it. In this chapter we discuss what it does to you and what you may think and feel about it.
Management Of Your Acute Pain
Authors: Burn Loïc
Published: October 2023

In view of the fact that back and neck pain is a growing problem, it would seem that traditional NHS management is not a success and that present methods of treatment do not work. Up until now, little has changed. However, the CSAG guidelines are prompting major initiatives.
Self Help —What You Can Do About Your Acute Pain
Authors: Burn Loïc
Published: October 2023

The last chapter outlined new advice for the management of acute back and neck pain —namely, stay out of bed, consider manipulation, exercise, stay active, and continue working. In this chapter we spell out the practicalities of this advice as it is applied on ‘day one’, ‘day four’, and ‘day seven and beyond’.
Management of your Chronic Pain
Authors: Burn Loïc
Published: October 2023

As with acute pain, the present system for managing chronic pain does not work as well as it should. The We describe the present hospital referral system and show why a multidisciplinary back and neck pain rehabilitation service and bio psychosocial assessment (as recommended in the guidelines) are necessary.
Your Consultation —The Good, The Bad, And How To Prepare For It
Authors: Burn Loïc
Published: October 2023

We have discussed a considerable number of people and treatments that you may come across. We will now give you some general ideas on how to detect whether your consultation is good or bad, whoever you are consulting. This is not only to ensure that you are getting the right help and advice but is also to prevent you being taken advantage of financially by the unscrupulous. We detail what should or should not happen to you, on the basis that forewarned is forearmed.
Special Investigations
Authors: Burn Loïc
Published: October 2023

Special investigations are rarely needed or useful for mechanical pain. On the other hand, they are essential for an accurate diagnosis of potentially serious conditions. Blood tests and, particularly, X-rays are the most common investigations currently ordered by doctors. However, as we shall show, the number of routine X-rays taken is set to fall.
The limb-girdle muscular dystrophies
Authors: Bushby Katharine M D
Published: October 2023

Literature on any disease is merely a snapshot of the level of understanding of a condition at that time. Since the introduction of the term in the mid 1950s someone reviewing the literature on the limb-girdle muscular dystrophies (LGMD) would recognize immediately that the field has often been confused and controversial over this period, inciting at times quite extreme views and vigorous debate.
Gene and cell therapy for primary myopathies
Authors: Cossu Giulio , Clemens Paula R
Published: October 2023

During the last 15 years, following the identification of dystrophin as the gene responsible for Duchenne Muscular Dystrophy (Hoffmann et al. 1987), the genes responsible for the large majority of primary myopathies have been identified.Most of these genes encode for proteins that form a supra-molecular link between the cytoskeleton and the extra-cellular matrix (Nawrotzki et al. 1996). In the absence of one of these proteins, the mechanical stress associated with contraction progressively leads to degeneration of the muscle fibre, though the molecular mechanism is not yet understood in detail.
Animal models of muscular dystrophy
Authors: Noguchi Satoru , Hayashi Yukiko K
Published: October 2023

Scientists have employed animal models for research into muscular dystrophy over the last two decades. These models have been used for pathophysiological analysis as well as for biochemical studies. The clinical symptoms and pathological features observed in animal models are somewhat different from those in human patients.However, they provide us with valuable information and experimental material, and contribute to our progress in understanding human diseases and help in devising possible therapies. There is no doubt about the benefits of animal models.
Sexual problems
Authors: Hudson-Allez Glyn
Published: October 2023

In primary care, patients are presenting daily with a sexual dysfunction that they feel is affecting their relationship and their lives (Duffy 1999).
Fertility
Authors: Jennings Sue
Published: October 2023

This chapter addresses the concerns of those people who are experiencing difficulty in conceiving and the type of counselling that could be useful for>r the GP and the primary health care team (PHCT) to provide.
Xenotransplantation: An ethical dilemma
Authors: Levinsky Norman G
Published: October 2023

There is a shortage of transplantable organs, and because of this many people who need them do not benefit from one of the major medical advances of the past 50 years. In the United States in 1999, 6448 individuals on waiting lists for an organ died before they could get a transplant (UNOS, 2000). Such preventable deaths have been the principal impetus to scientific exploration of the possible use of animal organs for transplantation into humans. Xenotransplantation was tested as early as the turn of the twentieth century.
Slipped capital femoral epiphysis: natural history, results of treatment, and controversies
Authors: Willis R Baxter
Published: October 2023

Slipped capital femoral epiphysis (SCFE) is a condition which occurs during a period of rapid growth in adolescence. Owing to a weakening of the proximal femoral growth plate and increased shear stress most commonly associated with obesity, the capital femoral epiphysis displaces posteriorly and medially, resulting in a deformity of the hip which alters normal hip motion, causes pain, and may eventually lead to degenerative joint disease.
Wandering and restlessness
Authors: Ballard Clive , O’Brien John , James Ian , Swann Alan
Published: October 2023

The term ‘wandering’ is commonly used both clinically and in the literature to describe a wide range of different behavioural abnormalities. The looseness of the term is evident by the wide range of definitions used in various studies. One useful definition is ‘a tendency to move about in either the seemingly aimless or disorientated fashion or in pursuit of an indefinable or unobtainable goal’. (Snyder et al. 1978, Stokes 1986). De Leon et al. (1984) suggest a putative causal mechanism by stating that ‘wanderers are patients with navigational difficulties.’
Side effects of psychotropic medication
Authors: Ballard Clive , O’Brien John , James Ian , Swann Alan
Published: October 2023

Before discussing individual classes of drugs and specific compounds, it is important to make some general observations regarding pharmacotherapy in the elderly and, in particular, those with dementia. Although changes in normal ageing are often complex (for example, a decline in a neurotransmitter may be accompanied by a compensatory increase in its receptors) and controversial, decreases in dopaminergic, noradrenergic, cholinergic and serotonergic neurones and/or neurotransmitter have been described in association with normal ageing (Blennow and Gottfries 1998).
Pharmacotherapy of agitation, aggression and restlessness
Authors: Ballard Clive , O’Brien John , James Ian , Swann Alan
Published: October 2023

The majority of treatment trials have grouped together different behavioural and psychological symptoms in dementia (BPSD), as discussed in Chapter 3. As the trials of neuroleptics are covered in detail in that chapter, the focus of this chapter will be mainly on the use of non-neuroleptic drug treatments. The use of varying and overlapping terminologies makes it difficult on occasion to pull the literature together in a meaningful way. Most studies combine different BPSD syndromes, whilst others focus upon symptom clusters such as agitation. Others evaluate the treatment of specific symptoms, such as aggression or restlessness.
Narrative and patient choice
Authors: Greenhalgh Trisha
Published: October 2023

This chapter is about the patient’s unique story and how it fits in with ‘evidence-based decision making’ and ‘shared decision making’ about health interventions. As Brian Hurwitz and I have argued in more detail elsewhere (Greenhalgh and Hurwitz 1998), five features of narrative distinguish it from other linguistic forms: It has a finite and longitudinal time sequence—that is, it has a beginning, a series of unfolding events, and (we anticipate) an ending.
Developing a Culture of Change in the Workplace: Applying Processes and Principles from Action Research to Sports Injury Settings
Authors: Gilbourne David
Published: October 2023

This chapter outlines how a process of systematic reflection can enhance working practice. The thinking behind a chapter of this nature is built around a series of intuitive connections. First of all, it is clear that an the chapters within this textbook are written with the sports medicine practitioner in mind. Second, it is likely that certain ideas and guidelines, embedded within the preceding chapters, will motivate practitioners to instigate ‘changes’ into their own working practice. It is proposed here that an aware ness of certain action-research themes and processes might help to facilitate this process. In making the above observations there is no intention to suggest that, somehow, bringing about workplace change is straightforward.
Judgement in the clinic
Authors: Downie R S , Macnaughton Jane , Randall Fiona
Published: October 2023

We have argued that if we adopt a broad interpretation of ‘science’ we can assert that all medical research is in some sense scientific, or evidence-based, although not necessarily quantitative. It follows from this that the research base of clinical practice is scientific in a broad sense. It does not follow, however, that clinical practice itself is, or indeed ought to be, fully scientific or evidence-based. If medical research is ‘science’, our question in this chapter is: To what extent is a clinical consultation simply a matter of applying that science? It will emerge that there is much more to the consultation, or to good clinical practice, than simply applying science, or applying the evidence, to a given patient. Our discussion will be concerned with the extent and nature of the ‘much more’.
Conclusion: clinical judgement
Authors: Downie R S , Macnaughton Jane , Randall Fiona
Published: October 2023

The title of our book is Clinical Judgement: Evidence in Practice. We have examined the concepts in the title as they apply to medical research, to clinical practice, to public health, and to resource management. The concept of evidence, as it is used by scientists, is logically related to that of an hypothesis. Information, data, observations, and experiments become ‘evidence’ when they are for or against a specific hypothesis. Moreover, the hypothesis concerns what is universally, or at least generally, believed to be the case. The concept of evidence as used by detectives or forensically differs in two respects: the data and observations suggest a hypothesis, rather than confirm or disconfirm one; and the hypothesis is about a particular or specific state of affairs, rather than one which is more generally the case. The concept of evidence that applies to medical research is like that of the scientist, and the concept that applies to clinical consultations is like that of the detective. The reason that the detective model of evidence is appropriate for the clinician is that he is dealing with specific patients. The relevant evidence for the clinician to establish diagnosis, prognosis, and treatment comes from or applies to this particular patient.
Pain – there’s a lot of it about
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Pain relief has been a major medical interest since Sumerian times 6000 years ago, when poppy juice was first used. Yet there is still a lot of pain about, it is a source of great disability, it detracts from the quality of life, and is often poorly treated. What is needed is more (and perhaps different) research, a concentration on evidence of what works and what does not, and education and dissemination of knowledge to make better use of what we have now. What is not likely is a magic bullet of a treatment that cures all pain without doing any harm. What we have is actually quite effective. The problem is that while the best pain relief can be very good indeed, all too often the best is not attained. Reasons are often simple, and have nothing to do with complicated science.
Outputs and utility
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Output – ‘quantity produced or turned out; data after processing by a computer’. This dictionary definition is the first clue to what this section is all about. If our best evidence comes from systematic reviews, then one of the most important things is how that systematic review gives us the result. From a clinical point of view we want to know how much benefit (or harm) a treatment will produce, and results of data processing might not be much help.
Adverse events
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

One of the problems with adverse events is that they can be various things at various times. Some of the properties of adverse events are shown in Figure 1.8.1. There are at least three dimensions – common or rare, minor or major, reversible or permanent. By and large, though, they fall into two distinct groups: they tend to be common, minor and reversible on the one hand, or rare, major and permanent on the other. Examples might be dry mouth with antidepressants, and upper gastrointestinal bleeding on the other.
Placebo
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

This is perhaps one of the most difficult of all topics, especially with a subjective outcome like pain. If we were discussing a topic like myocardial infarction and our outcome were death, then we might be reasonably sure that a placebo would have no effect on the outcome. But with pain, we might surmise that patients would feel better, and consequently have less pain, if the doctor or nurse was nice to them, or appeared authoritative, or the placebo were given as a big red capsule instead of a tiny white pill, or as an injection and not a tablet. Whatever we think, proving it will be difficult because of the problems of size, as discussed in section 1.6.
Introduction
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Acute pain is not always well treated. For instance, a survey of UK hospitals [1] showed that many patients (medical and surgical) had moderate or severe pain in hospital (Table 2.1.1). The problem is not that we have ineffective treatments, but that the delivery of effective treatments is often ineffective. Dealing with acute pain is not just a question of doling out analgesics effectively, and there are many other features to dealing with acute pain in hospital [2] and elsewhere. This section is not a comprehensive survey of everything that might be done in any particular circumstance, but a look at the evidence behind what might commonly be used in many circumstances.
League table of analgesics in acute pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

This league table was constructed for analgesics in acute pain. Data were taken from systematic reviews of randomised, double blind, single-dose studies in patients with moderate to severe pain. For each review the outcome was identical – that is at least 50% pain relief over 4–6 h. The pain measurements were standardised, and have been validated. The league table works because it only has apples, and is not a fruit salad. Only like is compared with like, and there is a common comparator throughout, namely placebo.
Aspirin in postoperative pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Clinical bottom line. A single oral dose of aspirin is effective in the relief of postoperative pain (doses 600–1200 mg). A dose of 600/650 mg had an NNT of 4.4 (4.0–4.9) for at least 50% pain relief over 4–6 h compared with placebo in pain of moderate to severe intensity with information on over 5000 patients. It was associated with increased adverse effects (gastric irritation and nausea). Aspirin (acetylsalicylic acid) is an important analgesic. It is widely available, and prescriptions of 300 mg tablets total approximately three quarters of a million annually in England alone (1996).
Ibuprofen in postoperative pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Clinical bottom line. Ibuprofen is an effective analgesic. A single dose administration of 400 mg had an NNT of 2.4 (2.3–2.6) for at least 50% pain relief over 4–6 h compared with placebo in pain of moderate to severe intensity. This is as effective as 10 mg intramuscular morphine. Ibuprofen is an NSAID with prominent anti-inflammatory, antipyretic and analgesic actions. Analgesic effects are due to both peripheral and central effects. It is a potent inhibitor of cyclooxygenase, which results in marked reductions in prostaglandin synthesis. In 1996 ibuprofen accounted for nearly 5.5 million prescriptions in England.
Paracetamol (acetaminophen) in acute postoperative pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Clinical bottom line. Paracetamol is an effective analgesic. A single dose of 1000 mg paracetamol had an NNT of 3.8 (3.4–4.4) for at least 50% pain relief over 4–6 h in patients with moderate or severe pain compared with placebo based on information from 2759 patients. Paracetamol 600/650 mg had an NNT of 4.6 (3.9–5.5) based on information from 1886 patients. Paracetamol is not associated with increased adverse effects in single dose administration. Paracetamol (acetaminophen) is an important non-opiate analgesic. It accounts for over 5 million prescriptions in England alone (1995), as well as being widely available without prescription.
Oral tramadol in postoperative pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Clinical bottom line. Tramadol is an effective analgesic in postoperative pain. A single 100 mg oral dose of tramadol is equivalent to 1000 mg paracetamol. A dose of 100 mg had an NNT of 4.6 (3.6–6.4) for at least 50% pain relief over 4–6 h in patients with moderate to severe pain compared with placebo. At doses of 50 and 100 mg incidence of adverse effects (headache, nausea, vomiting, dizziness and somnolence) was similar to comparator drugs. In dental trials there was increased incidence of vomiting, nausea, dizziness and somnolence.
Paracetamol plus tramadol for acute pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Clinical bottom line. Based on somewhat limited information, a combination of paracetamol plus tramadol is an effective analgesic in acute postoperative pain. The NNT compared with placebo over 6 h was about 2.7. The combination of tramadol with paracetamol is not commonly available for prescription, but has recently (2002) become available in the USA. The exact dosage strengths in the combinations may vary from country to country, so affecting its efficacy.