bluuebunny/crossref_metadata_2025 huggingface dataset:
Is Compassion Innate? A Psychological Perspective
Authors: Wong Agnes M.F.
Published: February 2021

In this chapter, the author looks at compassion from two psychological perspectives: evolutionary and developmental. Evolutionary psychology proposes that there are three emotion systems: threat/self-protect, drive/reward, and affiliative/soothing. By developing our capacity to mindfully access, accept, and direct affiliative motives and emotions—for others and ourselves—we can cultivate compassion skills to shift our mind toward the affiliative/soothing system and down-regulate the threat/self-protect and drive/reward systems. Developmental psychology further contributes to our understanding of compassion by proposing two behavioural systems: the attachment behavioural system that governs support-seeking and the caregiving behavioural system that governs support provision. It suggests that the interplay between these two systems may account for individual differences in the disposition to compassion. Last, the author shows that compassion not only benefits the recipients, but also improves the psychological health of the caregivers.
East Meets West
Authors: Wong Agnes M.F.
Published: February 2021

In this chapter, the author explores the relevant brain networks and their plasticity in response to mindfulness and compassion training. The chapter begins by reviewing how foundational mindfulness practices, in the form of focused attention and open monitoring, set the stage for compassion/loving-kindness training by modulating attentional resources (in the attention networks), regulating emotion processing and control (in the limbic system), and altering self-referential processing (in the default mode network). The author then reviews the unique effects of compassion/loving-kindness training on different brain areas that result in increased receptivity to others’ emotions, enhanced positive affect and reward processing, and increased motivation for prosocial connection. The author shows that “compassion fatigue” is a misnomer because the neural mechanisms underlying empathic distress and compassion are distinct, with empathic distress activating the brain network involved in pain processing and compassion activating the pleasure and reward system. The author concludes that compassion is both innate and a trainable skill, exerting its effects through neuroplasticity.
What Does It Take to Cultivate Compassion?
Authors: Wong Agnes M.F.
Published: February 2021

In this chapter, the author reviews some skills that help us to cultivate compassion. They include training in the development of cognitive, attentional, affective, and somatic skills that draw on both contemplative and scientific disciplines. The author reviews two powerful models for cultivating compassion—the A.B.I.D.E. and G.R.A.C.E. models—that enhance compassion at a personal level. The author also looks at some strategies to cultivate inner compassion based on an extension of cognitive-behavioural therapy. The author then explores techniques that enhance compassion at an interpersonal level (compassionate leadership to build a compassionate culture) and a system level (compassionate healthcare). Last, the author reviews the benefits of compassion in healthcare, including the physiological and psychological benefits on patients, how it acts as an antidote to burnout for healthcare professionals, and how compassion benefits the healthcare system by improving quality, increasing revenues, and reducing costs.
A Wholistic Approach to a Compassionate and Flourishing Life
Authors: Wong Agnes M.F.
Published: February 2021

In this chapter, the author looks at some additional ingredients that are essential for leading a compassionate, flourishing life. They include psychological well-being, ethics, and moral resilience, as well as social engagement and principled compassionate actions. The author shows that counselling, coaching, and psychotherapy can bring about additional clarity, openness, and deep healing. The author also looks at the importance of moral resilience to deal with moral challenges that include moral uncertainty, moral conflict, and moral dilemma. The author shows that moral development consists of four components: moral sensitivity, judgment/reasoning, motivation, and character/courage, and describes how following the precepts could aid in moral development and building moral resilience. Last, the author shows that a truly transformative approach to living a compassionate life needs to address not only our personal relations to suffering, but also acknowledge that personal suffering has societal causes which require us to be socially engaged through principled compassionate actions.
Angiography
Authors: Tomey Matthew I.
Published: February 2021

‘As an aid to diagnosis in ischaemic heart-disease’, Lancet editorialists wrote in 1966, coronary angiography ‘seems at present to offer little that cannot be more easily obtained by much simpler methods, such as good history-taking and electrocardiography’. Since its serendipitous origins at the Cleveland Clinic laboratory of Dr F. Mason Sones in 1958, selective coronary angiography has taken on central importance in the diagnosis of coronary artery disease and characterization of coronary anatomy prior to coronary artery bypass graft surgery. Performance has become simpler and safer, evolving from a brachial artery cut-down approach with stiff, large-calibre multipurpose catheters to percutaneous femoral, radial, and now ulnar approaches with softer, lower-profile catheters specially designed to atraumatically engage the coronary ostia.
Evidence basis for decision-making between coronary artery bypass grafting and percutaneous coronary intervention
Authors: Farooq Vasim , Puskas John D. , Serruys Patrick W. , Taggart David P.
Published: February 2021

Historically, the 15 randomized clinical trials comparing coronary artery bypass graft surgery and percutaneous coronary intervention for intervention in coronary artery disease have been criticized for profound selection bias (‘cherry-picking’ of patients). The stringent clinical and angiographic-based inclusion criteria led to only 2–12% of all screened patients actually being randomized in these trials, resulting in recruitment of mainly low-risk subjects with predominant one- or two-vessel disease (and a low incidence of three-vessel disease), preserved left ventricular ejection fraction, and a low incidence of diabetes. This highly selective selection practice echoes that of a review of 31 antidepressant efficacy trials in 2002, demonstrating that despite the large number of trials and participants, only a minority of patients treated for depression in routine clinical were eligible for inclusion because of a large number of exclusion criteria.
Lifestyle management and secondary prevention of coronary artery disease
Authors: Ahmad Mansoor , Weiss Sandra A. , Weintraub William S.
Published: February 2021

Cardiovascular disease has been the leading cause of death in industrialized nations since the early 1900s. According to the American Heart Association, there are more than 1 million new and recurrent cardiac events occurring each year. Those with a history of cardiac ischaemic events have a high risk of recurrent events; however, the death rate from coronary artery disease declined from 1995 to 2005 by 26%. Thus, the burden of chronic non-fatal coronary artery disease remains high and therefore underscores the importance of secondary prevention measures. This chapter focuses on lifestyle modification, which is considered a major component of secondary prevention.
Early and late outcomes after coronary artery bypass grafting
Authors: Fremes Stephen E. , Sabik Joseph F. , Taggart David P. , Tam Derrick Y. , Karkhanis Reena
Published: February 2021

A review of outcomes following coronary artery bypass grafting (CABG) must be studied in the context of changing patient risk profiles. While overall CABG volumes have declined in Western nations over the last decade, there has been an increase in the number of patients referred with prior percutaneous coronary intervention, and presenting with worse distal disease. The advent of extracorporeal life support and mechanical circulatory support has allowed extremely high-risk patients to proceed to CABG where risk would have been historically prohibitive. Clinical trial evidence strongly supports CABG over percutaneous coronary intervention in patients with severe multivessel coronary artery disease, diabetes, and low ejection fraction. Unprotected left main disease was not previously judged appropriate for percutaneous coronary intervention; recent trials suggest that percutaneous coronary intervention is non-inferior to CABG in low SYNTAX score patients with left main stenosis (SYNTAX score <22). As such, those currently referred to surgery will often have more complex coronary disease than previously.
Postoperative management after coronary artery bypass graft surgery
Authors: Chui Jason , Murkin John M.
Published: February 2021

Postoperative management of patients following coronary artery bypass graft surgery is focused on fast-track recovery but can be challenging, and is often characterized by haemodynamic fluctuations that may require inotropic support, fluid compartment shifts, an increased bleeding tendency, and occasional surgical complications that require urgent re-exploration. This chapter focuses primarily on haemodynamic management and the attendant indications for and choices of pharmacological therapy, as well as considering the indications for continuance or initiation of longer-term medications. Other aspects of acute care such as bleeding and coagulopathy, respiratory support and ventilation and weaning protocols, sedation, and pain control are also important to ensure a smooth transition from acute care to hospital discharge.
Minimal invasive extracorporeal circulation for coronary revascularization surgery
Authors: Anastasiadis Kyriakos , Carrel Thierry
Published: February 2021

Coronary artery bypass grafting is associated with improved long-term outcome in severe coronary artery disease compared to percutaneous techniques since refinements in surgical technique have reduced morbidity and mortality. Use of cardiopulmonary bypass remains the standard strategy to perform cardiac surgery, which also applies to coronary artery bypass grafting surgery. However, despite major advancements, systemic inflammatory response syndrome and coagulation derangement during conventional cardiopulmonary bypass are still involved in postoperative end-organ injury.
Cardioplegia strategies
Authors: Athanasuleas Constantine L. , Buckberg Gerald D.
Published: February 2021

There are many cardioplegic strategies for coronary surgery. The goal is a dry operative field while maximizing myocardial recovery. Prospective randomized clinical trials have historically been difficult to achieve because of confounding variables such as solution used, route of administration, temperature, and so forth. This chapter describes an ‘integrated method’ of cardioplegia, so named because it combines many of the salient feature of various methods. It is designed to provide the maximum metabolic support of the myocardium during each phase of the operation. A vast literature from the laboratory to the bedside supports its use. Perhaps most importantly, integrated cardioplegia provides excellent protection of the septum and avoids paradoxical septal motion that may be a form of myocardial injury which is common with other methods of myocardial protection. Any future evaluation of cardioplegia methods should include not only survival but enzyme release and echocardiographic measurements of septal function.
Patient blood management strategies in cardiac surgery
Authors: Shander Aryeh , Ferraris Victor A.
Published: February 2021

This chapter discusses patient blood management strategies in cardiac surgery, including sections on the burden of anaemia in cardiac surgery, blood transfusion in cardiac surgery, patient blood management in cardiac surgery (management of anaemia, optimization of haemostasis, autotransfusion techniques, and other supportive measures), and outcomes of patient blood management programmes.
No-touch saphenous vein grafts in coronary artery bypass surgery
Authors: Samano Ninos , Souza Domingos
Published: February 2021

After almost 30 years since the first harvesting of the saphenous vein graft with a pedicle of surrounding tissue (no-touch technique), there is no doubt that this method is superior to the conventional technique in which a denuded vein is harvested. In summary, the no-touch harvesting technique decreases risk of graft spasm and the requirement for manual dilatation, limiting endothelial cell loss and long-term damage. The preservation of the vasa vasorum allows retrograde blood flow from the graft lumen, thereby decreasing transmural ischaemic damage. This also preserves endothelial nitric oxide synthase, known to decrease intimal hyperplasia, atherosclerosis, and long-term graft failure. Furthermore, the perivascular tissue acts as a natural external stent reducing the neointimal and medial thickening of the vein graft and preventing it from kinking, which is especially vital for sequential grafts. Finally, target vessel size, quality, and degree of stenosis have little effect on the patency rates of no-touch saphenous vein grafts, in contrast to arterial grafts.
External stenting of vein grafts in coronary artery bypass graft surgery
Authors: Taggart David P.
Published: February 2021

The use of external stents to support vein grafts placed into the arterial circulation was first proposed by Parsonnet and colleagues in 1963 using a carotid artery model. The rationale was to reduce the diameter mismatch between the vein graft and the artery and to minimize vein dilatation when subjected to higher flow and pressure in the arterial system, thereby reducing the risk of intimal damage and thrombosis. The role of external stents has been reviewed extensively.
The right gastroepiploic artery graft
Authors: Suma Hisayoshi , Tavilla Giuseppe , Kim Ki-Bong
Published: February 2021

The right gastroepiploic artery (RGEA) conduit is the only other in situ arterial graft available for use in coronary artery bypass graft surgery other than the internal thoracic artery. Total arterial revascularization using only pedicled grafts can be achieved using the RGEA in combination with the bilateral internal thoracic artery in three-vessel disease. Early graft patency rate is high and the late patency rate is excellent when the RGEA is harvested by the skeletonized technique and deployed to target coronary arteries with severe stenosis (>90%). Abdominal complications are rare since only a small laparotomy is required. Late graft disease is uncommon in the RGEA conduit. At repeat coronary artery bypass graft surgery involving solely the right coronary artery territory, a small laparotomy approach using the RGEA can be performed with an off-pump technique without sternotomy. The RGEA conduit also can be used as a free or composite graft if the RGEA had low free flow, or if intraoperative flow measurement suggested a competitive flow pattern.
Robotic coronary artery surgical revascularization
Authors: Kiaii Bob , Giambruno Vincenzo , Chu Michael W. A. , Sutter Francis P. , Wertan Mary Ann C.
Published: February 2021

With a general trend in surgery towards endoscopic approaches, cardiac surgeons, over the last 15 years, have recognized the importance of achieving video dexterity and are adopting video-assisted techniques in increasing numbers. The early work by Drs Nataf in Paris, Mayfield in Atlanta, and Wolf in Cincinnati, laid the groundwork for an endoscopic minimally invasive revolution. The development of video-assisted techniques and the use of new equipment in cardiac procedures represented a paradigm shift and quantum leap in our efforts to provide a less traumatic coronary revascularization procedure. In parallel to these developments, new robotic technology was emerging and demonstrating efficacy in endoscopic surgery in other disciplines.
Avoiding stroke during coronary artery bypass grafting
Authors: Bolotin Gil , Mack Michael J. , Di Franco Antonino , Puskas John D.
Published: February 2021

Stroke is the most devastating non-cardiac complication of cardiac surgery. It is second only to heart failure as a cause of morbidity and mortality and increases significantly the likelihood of requiring long-term care. Stroke sequelae (with specific reference to death, prolonged hospitalization, and long-term disability) were described as the main concern of patients undergoing invasive procedures by Sun and colleagues in a survey involving 3112 cardiac patients in 2018.
Prevention of mediastinitis
Authors: Lazar Harold L.
Published: February 2021

Sternal wound infections resulting in mediastinitis following coronary artery bypass graft surgery increase morbidity, prolong hospital length of stay, raise hospital costs, and increase both short- and long-term mortality. The increased risk for sternal infections has discouraged the use of bilateral internal thoracic artery grafts, especially in diabetic patients. This chapter reviews the preoperative, intraoperative, and postoperative principles for preventing sternal wound infections and mediastinitis following coronary artery bypass graft surgery.
Coronary artery bypass grafting in women
Authors: Rove Jessica Yu , Lawton Jennifer S.
Published: February 2021

Cardiovascular disease poses the greatest health threat to women in the developed world. Despite the fact that up until 2013 in the United States more women than men died annually of cardiovascular disease, women remain underdiagnosed and undertreated for cardiovascular disease. This chapter acknowledges perceived and actual differences in the manifestation of coronary artery disease between women and men. Further, it summarizes data on the modern performance and outcomes of coronary artery bypass surgery in women compared to men.
Coronary artery bypass graft surgery in the setting of acute myocardial infarction
Authors: Yerokun Babatunde A. , Smith Peter K.
Published: February 2021

Revascularization is standard therapy for patients who present with acute myocardial infarction. Coronary artery bypass graft surgery remains a critical option for revascularization specifically in patients with acute myocardial infarction. Certain clinical or patient factors should help in deciding whether coronary artery bypass graft surgery is appropriate for an individual case as supported by international guidelines. Where coronary artery bypass graft surgery is indicated, perioperative management of the patient should be optimized to ensure the best outcomes while minimizing risk. This chapter discusses the surgical management of patients with acute myocardial infarction, specifically, perioperative management and indications for revascularization.
Coronary artery bypass grafting with surgical ventricular reconstruction
Authors: Castelvecchio Serenella , Molfetta Raffaella , Garatti Andrea , Menicanti Lorenzo
Published: February 2021

The increase in left ventricular volume after a myocardial infarction is a component of the remodelling process leading to heart failure and it is associated with poor clinical outcomes. Hence, the current management strategy for ischaemic left ventricular dysfunction has been aimed to reverse the remodelling process by medical therapy, devices and/or surgical strategies. Surgical ventricular reconstruction, usually combined with myocardial revascularization, has been introduced as an optional therapeutic strategy aimed to reduce the left ventricle through the exclusion of the scar tissue. Surgical ventricular reconstruction is recommended in selected heart failure patients, especially if a postoperative left ventricular end-systolic volume index less than 70 mL/m2 can be predictably achieved, because a smaller residual volume is associated with improved survival. This chapter briefly discusses the rationale to surgically reverse left ventricular remodelling, the technique, and the indications to the best of the authors’ knowledge, coming from one of the centres with the most experience in SVR worldwide.
Coronary anomalies
Authors: Nguyen Anita , Reddy Ramachandra C. , Schaff Hartzell V.
Published: February 2021

Anomalous coronary arteries are relatively common, occurring in approximately 1.3% of the general population. Most variants of anomalous coronary arteries do not cause disability and have a benign course. Surgery is warranted to alleviate symptoms. However, some anomalies, such as a left coronary artery arising from the right sinus of Valsalva and passing between the great vessels or anomalous left coronary artery arising from the pulmonary artery, are considered malignant as they have been associated with sudden cardiac death or heart failure, and in these cases, surgery is indicated. Coronary artery fistulas are abnormal communications between a coronary artery and another cardiovascular structure. They are relatively rare, and surgical or transcatheter closure may be necessary in patients with large left-to-right shunts and/or regional myocardial ischaemia.
Imaging in Paediatric Oncology
Authors: McHugh Kieran , Huisman Thierry A.G.M.
Published: February 2021

All superficial and abdominal masses in children should be first evaluated with ultrasound including Doppler assessment for lesion vascularity. Many benign and all malignant masses will need further evaluation with CT or MRI. For non-CNS tumours, MRI is preferred over CT, if feasible, bearing in mind anaesthesia may be needed for children under seven years of age. MRI is preferable to CT because of a lack of ionizing radiation, better soft-tissue evaluation in general, improved depiction of possible bone marrow disease, and, where present, better demonstration of spinal cord compression. Most non-CNS tumours, with the exception of neuroblastoma, would merit a routine CT of the chest for disease staging. Characteristics of individual tumour types, and the emerging role of nuclear medicine in staging and response assessment, will be mentioned in the chapter.
Clinical Trials in Childhood Cancer
Authors: Valsecchi Maria Grazia , Galimberti Stefania , Kearns Pamela
Published: February 2021

Many important improvements have been achieved in the last decades in the diagnosis, therapy, and prognosis of paediatric cancers. These were possible through clinical trials that were mainly the result of collaborative efforts of national and international groups. For a clinical trial to have the best chance of success, it must ask a clear question that is seen as important both to the clinicians who will implement the trial and to the patients who will participate. Moreover, the design of such trials needs a sound methodological approach in order to provide reliable evidence. This chapter has the following aims: (a) to review the most common conventional approaches that allow to reliably define the benefit of a new drug or a new treatment strategy, and (b) to provide information on novel strategies for clinical trial design that can be useful in the context of rare diseases such as paediatric cancers.
Evidence-Based Paediatric Oncology
Authors: Kremer Leontien C.M. , Loeffen Erik A.H. , Phillips Robert S.
Published: February 2021

The practice of evidence-based medicine (EBM) is very important in delivering optimal patient care and the terms evidence-based medicine, or evidence-based practice, are used all around the world. This chapter discusses evidence-based paediatric oncology, including its history, an outline of what EBM is, EBM in paediatric oncology, steps in evidence-based paediatric oncology for a user of EBM, steps in guideline development as an implementer of EBM, common criticisms of EBM, and the future of EBM. The chapter gives an overview how EBM can be used in a non-exhaustive but still comprehensive way in daily practice of care for children with cancer, and which tools are available for paediatric oncologists. The majority of the chapter focuses on how to learn to become a skilled user of EBM.
Cancer Treatment in Low- and Middle-Income Countries
Authors: Molyneux Elizabeth , Israels Trijn , Howard Scott C.
Published: February 2021

eCancer treatment in low- and middle-income countries (LMIC) differs substantially from that in high-income countries (HIC), and these differences are the focus of this chapter. In looking at these differences in cancer treatment, this chapter discusses healthcare disparities between LMIC and HIC, the importance of paediatric cancer units (PCU) (recruitment, training, and retention of personnel, continuous quality improvement, development of PCUs, and national paediatric oncology programmes), protocol-based care (adapted treatment regimens and clinical research, regional and global networks), treatment challenges in LMIC (toxicity of treatment, abandonment of treatment, palliative care), and advocacy.
Acute Myeloid Leukaemia
Authors: Kaspers Gertjan , Reinhardt Dirk
Published: February 2021

Acute myeloid leukaemia (AML) is the second most frequent type of leukaemia in children, and is cured nowadays in about 75% of patients in settings with essentially unlimited resources. This chapter discusses the aetiology and epidemiology of this interesting disease, its typical clinical presentation, diagnostics, and biology. The classifications, prognostic factors, and risk stratification (including minimal residual disease), and AML treatment (covering chemotherapy and allogeneic stem-cell transplantation) is presented. Several practical illustrations are included, and results of recent studies from the main cooperative study groups are summarized. Finally, side effects during treatment and late effects, as well as acute promyelocytic leukaemia (APL) and myeloid leukaemia of Down syndrome (ML-DS), are discussed. The chapter concludes with the actual challenges and perspectives.
Myelodysplastic Syndrome, Myeloid Leukaemia of Down Syndrome, and Juvenile Myelomonocytic Leukaemia
Authors: Hasle Henrik , Niemeyer Charlotte M.
Published: February 2021

Myeloid malignancies in children are divided into acute myeloid leukaemia (AML), myelodysplastic syndrome (MDS), juvenile myelomonocytic leukaemia (JMML), and the myeloid leukaemia of Down syndrome (ML-DS). Predisposing genetic conditions are common in MDS. Differentiating MDS from inherited bone marrow failure or AML may be challenging. Therapy consists of observation, immunosuppression, or stem-cell transplantation (SCT). Germline and somatic mutations deregulating the Ras/MAPK signal pathways are key initiating events in JMML. Genetics in JMML defines clinically relevant subgroups and indications for SCT. ML-DS presents with unique clinical characteristics and responds favourably to reduced doses of AML chemotherapy; however, relapse is often refractory to therapy.
Other Central Nervous System Tumours of Childhood
Authors: Conter Cecile Faure , Frappaz Didier , Pajtler Kristian W. , Pfister Stefan M.
Published: February 2021

This chapter discusses a number of central nervous system (CNS) tumours of childhood. It details the diagnosis, radiology, molecular pathology, biology, and current treatment strategies for germ-cell tumours (both intracranial and extracranial) and craniopharyngiomas (WHO grade I tumours of the intra/suprasellar region). It also outlines the histopathology, molecular classification, risk stratification, surgery, and outlook for ependymomas. Ependymomas are the third most common paediatric tumour of the CNS, accounting for 10% of brain tumours in children. The chapter also covers choroid plexus tumours (CPT). These rare intraventricular neoplasms derive from the choroid plexus epithelium and represent 0.2% of all CNS neoplasms.
Bone Tumours
Authors: Bielack Stefan , Paulussen Michael , Helman Lee
Published: February 2021

This chapter reviews the biology, diagnostics, multidisciplinary treatments, and prognosis of the most common bone sarcomas of childhood and adolescence—osteosarcoma and Ewing sarcoma. Both have their peak incidence among teenagers; both carry a high risk of metastatic spread. Local therapy alone is therefore rarely curative. Combining local therapies with intensive multidrug chemotherapy, usually employed both before and afterwards, can lead to long-term disease-free survival in approximately two thirds of affected young patients. Bone sarcomas should only be treated by experienced centres able to provide access to the full spectrum of required expert care. This includes access to essential diagnostic methods such as conventional radiography and magnetic resonance imaging (MRI) for evaluation of the primary, computed tomography (CT) of the chest to search for lung metastases, and radionuclide bone scan, positron emission tomography/computed tomography (PET/CT) and/or whole-body MRI to search for bone metastases. Local treatment of osteosarcoma is surgery whenever feasible. Limb-saving resections have largely replaced amputations. There is also a trend towards surgery in Ewing sarcoma, where radiotherapy has traditionally held a larger role. Histological response of the primary to preoperative chemotherapy is an important prognostic factor in both malignancies. Attempts to improve the prognosis of poor responders by postoperative treatment modifications have failed in osteosarcoma, but may work to some extent in Ewing sarcoma. Unfortunately, the many recent advances in the knowledge about their tumour biology have not yet resulted in better treatments for either of these two most common bone sarcomas of childhood and adolescence.
Retinoblastoma
Authors: Chantada Guillermo , Rodríguez-Galindo Carlos
Published: February 2021

Retinoblastoma is the most common paediatric ocular malignancy. Its disease-free survival rate in developed countries is higher than 95%, but in the developing world this tumour presents with advanced disease leading to poorer outcome. Late diagnosis and problems with compliance for treatment affect the outcome in that setting. Retinoblastoma may occur in children with germline mutations of the RB1 gene, who usually present with bilateral heritable disease. In those with somatic mutations, it always presents as unilateral and non-hereditable disease. The former have a higher susceptibility for secondary malignancies occurring later in life. Enucleation of the affected eyeball is often curative when the disease presents intraocularly, but conservative therapies have evolved from conventional external photon-beam radiotherapy, which was associated with severe long-term toxicity, to chemotherapy plus local treatments. Recently, local intra-arterial and intravitreal chemotherapy has been more intensively used, leading to higher preservation rates.
Mouth, pharynx, oesophagus, and stomach
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The mouth, pharynx, oesophagus, and stomach chapter discuss the diseases and conditions that can occur in the initial part of the gastrointestinal tract (GI). These diseases are defined and the possible presenting symptoms listed. The occurrence rates of the conditions within the mouth, pharynx, oesophagus, and stomach are detailed and the potential causes explored. The investigations that might be necessary to diagnose the condition are described. Treatment options or preventative measures are explained with identification of any potential complications. Within the mouth there might be oral thrush; a condition of the oesophagus is Barrett’s oesophagus; and in the stomach there may be gastric ulcers. A succinct description of these conditions and diseases can assist the nurse in managing the care of patients with these problems.
Rectum and anus
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The rectum and anus chapter explains diseases and conditions of the rectum and anus. The diseases of the rectum and anus are explored with the common presenting symptoms identified. The occurrence rates of these conditions are defined and any potential causes listed. The investigations that are required to diagnose the conditions are described. Treatment options or preventative measures are also explained with identification of any potential complications. There are many conditions that can affect the rectum and anus including rectal prolapse, haemorrhoids, pilonidal sinus, and rectocele. Other conditions include anorectal abscess, anal fistula, anal warts, and anal fissure. Succinct descriptions of caring for people with diseases and conditions of the rectum can increase the knowledge of the nurse.
Gall bladder
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The gall bladder chapter describes conditions and diseases of the small organ of the gall bladder. The common diseases of the gall bladder are described with the more frequently presenting symptoms listed for the nurse. The occurrence rates of these pancreatic conditions are defined and any potential causes described. The investigations that are used to diagnose the condition are explored. Treatment options or preventative measures are also explored with a description of any potential complications. There are a number of conditions and diseases related to the gall bladder that include primary sclerosing cholangitis and gallstone. Inflammation of the gallbladder, cholecystitis may be acute or chronic. Succinct details related to people with diseases and conditions of the gall bladder are easy to use by the nurse within clinical practice.
Endoscopy
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The endoscopy chapter explains how the endoscope can be used as a diagnosis tool or a treatment modality. The endoscope can look at various part of the gastrointestinal tract, such as the stomach, that is a gastroscopy, also termed an oesophagogastroduodenoscopy, or the colon, that is a colonoscopy. An endoscope can be used as a diagnostic tool, such as a double balloon endoscopy or capsule endoscopy. An endoscope may be used to remove a polyp; this is termed a polypectomy. Endoscopy can also be used a method of treatment, such as an endoscopic retrograde cholangiopancreatography. Concise descriptions related to endoscopes as a treatment or investigative piece of equipment within this chapter can be referred to by the nurse when necessary within clinical practice.
Colorectal cancer
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The colorectal cancer chapter explores one of the top four cancers being diagnosed in the UK. Within this chapter are explanations of the staging of colorectal cancer. There are also descriptions of the symptoms and causes associated with cancer within the colon or rectum. The incidence and necessary investigations are detailed. Treatment for colorectal cancer is explored in relation to surgery, chemotherapy, radiotherapy, and biological therapy. Ways the nurse can advise prevention of colorectal cancer are identified and bowel screening is examined. Additionally, prognosis for people with colorectal cancer is described. The important nursing issue of long-term care, termed survivorship is reported upon. Succinct details on the issues related to colorectal cancer can be used by the nurse within clinical practice.
Surgery
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The surgery chapter discusses surgical treatment for bowel diseases. There are many surgical procedures that are explored with inclusion of the indication for surgery, such as cancer or inflammatory bowel disease, and any common surgical complications so that the nurse is aware of observations to undertake. Nursing advice is added where appropriate to ensure that the nurse knows what advice might be necessary to give to the patient. Operations discussed include anterior resection to remove part of the rectum for a rectal cancer and bariatric surgery to help weight loss. Diagrams help to explain what the operation entails. Nursing care of surgical patients on the enhanced recovery pathway is included with details on preoperative, intraoperative, and postoperative care. Concise exploration of gastrointestinal surgery within this chapter can be used within clinical practice by the nurse.
Introduction
Authors: Bhugra Dinesh
Published: February 2021

Migration is a universal and an age-old phenomenon. Human beings have migrated for millennia for a multitude of complex reasons. The three stages of migration—pre-migration, migration, and post-migration—are a crude division of the actual physical process of migration and often tend to overlap and are not always clearly divisible. Furthermore, it is entirely possible that each stage can have substages and different steps. Geopolitical determinants of migration also independently determine social determinants. Identity formation as an individual and as a migrant can play a major role in post-migratory adjustment. People migrate for short or long periods, and each person has specific issues that need to be taken into account while attempting to understand their healthcare needs. In this introduction, some indications for the chapters in this volume are presented.
Geopolitics of migration and refugees
Authors: Persaud Albert , Ventriglio Antonio , Valsraj Koravangattu , Bhugra Dinesh
Published: February 2021

Humankind is on the move all the time, but in the past few decades this movement has become massive in different parts of the world. We are living in an era of unprecedented mobility of ideas, technology, money, and people. Globalization has changed the world and is continuing to change the relationships between nation-states, corporations, and international organizations. By 2030, 80% of the world’s poor will be living in an area defined as ‘fragile’—a status that may reflect any number of political, social, security, economic, or environmental causes, forcing millions who are suffering to flee their country and homes. The CAPE Vulnerability Index tool helps assess the causes of violent conflict, terrorism, climate change, poverty, inequality and injustice, migration and displacement through this new axis of geopolitical determinants of health rather than focusing disproportionately on the effects. Leaders across the globe have a moral imperative to provide security, economic prosperity, and well-being to their people, but the policy needs to be fit for the local environment, be it geographical, political, or cultural, to help people to function well.
Global cultures as a consequence of globalization of mental health
Authors: Moussaoui Driss , Bhavsar Vishal , Bhugra Dinesh
Published: February 2021

Globalization is a term used widely to describe ‘homogenization’ of the world and various cultures. Although it is to do with trade, with an impact on resources, manufacture, and consumption, its impact is often seen on economics, development, international relations, and health. However, its effect on individual and population mental health across cultures deserves detailed study. The term means different things to different people and is often misused and misinterpreted in a number of ways. The geopolitical impact of globalization on social determinants of mental health of individuals and populations is of particular interest, especially because globalization affects migration and consequent changes in well-being. Cultures vary and have various dimensions, which change in response to globalization. The challenges in the global mental health agenda are of critical interest to policymakers and service planners. Often, mental health is regarded as separate from aspects of physical health and well-being, thereby creating specific problems. In the context of globalization and resulting migration, we propose a conceptual model to understand the effects of globalization on mental health and identify some action points for future research and policy-making.
Trauma and migration
Authors: Stubley Joanne
Published: February 2021

This chapter explores the links between migration and trauma, drawing on research findings for traumatized asylum seekers and refugees to explore some of the controversies and debates with in the field, particularly in the area of therapeutic interventions. Interwoven with this is a description of a psychoanalytic understanding of trauma and migration. This is used to elaborate on the complexity of the experiences, as well as touching on the impact on the professional in working with traumatized people. The two themes running through this chapter are the complex interaction between migration and trauma, on the one hand, and managing traumatic experiences, on the other hand. Using case examples these features are illustrated to enable clinicians to offer the right therapeutic interventions. Complex post-traumatic disorder is not uncommon and requires focused and targeted interventions. Post-migration stress or culture shock need to be identified and managed.
Experiences of elderly migrants in a new country
Authors: Mhlanga Fungai , Mhlanga Rosemary
Published: February 2021

International elderly migration is characterized by the movement of elderly people from their home countries to settle in new countries either as migrants in search of better opportunities or as refugees forced to flee as a result of unpleasant circumstances such as war. In their new countries elderly migrants face both pleasant experiences and challenges that may affect their settlement and integration in the new societies. The challenges include language difficulties, culture shock, loneliness, difficulties in accessing social and health services facilities, and inadequate support systems. Various policies in the new countries impact on the settlement outcome of this group. Upon retirement some elderly migrants remain in their new countries, others relocate back to their original countries, or live in both countries at different seasons of the year. This article explores the elderly migration experiences and the support systems that could assist the well-being of this population.
Families migrating together
Authors: Papadopoulos Renos K.
Published: February 2021

This chapter focuses on refugee families, but the processes that it discusses are also applicable to other forms of migration. The term ‘involuntary dislocation’ is employed to address the uniqueness of these phenomena, emphasizing that under these conditions not only is the family members’ psychosocial state shaken, but their entire being. Hence, another key term is used, that of ‘onto-ecological settledness’ to refer to the familiar arrangement individuals and families have, which relates the totality of their being to the entirety of their environment, and it is this arrangement that is thrown into turmoil during involuntary dislocation. Then, families experience ‘onto-ecological unsettledness’, and specific forms of this are identified and discussed. Emphasis is given to the complexity of the impact such upheavals create, which include not only negative, but also positive outcomes. The ‘Adversity Grid’ is introduced as a useful framework to counteract simplified and polarized perceptions of the complex implications of involuntary dislocation, and which also differentiates distress from disorder.
Disability and forced migration
Authors: Yeo Rebecca
Published: February 2021

Forced migration and disability often are ignored in the research literature. In spite of the equalities legislation for the rights of disabled people, often the responses to disabled migrants are not helpful. In theory, the UK’s National Health Service is founded on the basic principle of universalism. The theoretical hegemonic commitment to universal human rights has often been most overtly broken in relation to migrant rights. In contrast to official condemnation of racism and disablism, successive governments of different political persuasions have continued to, and indeed competed to, prove their hostility towards migrants, whether they are disabled or not. The British asylum system itself is disabling by design. Some people are disabled on arrival in the UK; others become disabled later on. Disabled asylum seekers often describe the system as psychological torture. Therefore, ongoing mental distress can create difficulties in further adjustment, thus compounding problems. Using case histories, this chapter illustrates some of the difficulties faced by migrants with disabilities. A fundamental systemic change is needed to address the injustice encountered by disabled asylum seekers.
Physical and psychological resilience and migration
Authors: Willans Bex , Stewart-Brown Sarah
Published: February 2021

Whereas in the past, resilience was seen as a character trait of the few, enabling a ‘bounce back’ to some prior healthy state, it is described as something that is transitional, that enables a ‘bouncing forward’ for all those who experience growth from having survived or even thrived through challenging experiences. This interpretation enables action as it opens the possibility of exploring what can be put in place to ensure these experiences can be opportunities for positive change for all, leading to improved mental well-being and physical health. While for most migrants the act of migration is an active choice driven by hopes for life improvement, migration can create challenges. For refugee and asylum-seeker populations, who have been the focus of most migrant-resilience research, their status suggests an increased likelihood of having experienced adversity and a risk of experiencing ongoing challenges. Qualitative studies with migrant populations indicate high levels of resilience, including personal characteristics, beliefs, behaviours, and cultural understandings that enable people to survive and even thrive following such experiences. Policies and interventions to support resilience should include both external protective factors such as access to basic human needs, social integration and relationships in destination countries, and services for those who require intervention. Few intervention studies use asset-focused outcomes such as resilience and well-being, and there is an opportunity for established and emerging therapies to use these to enhance evaluation and understanding.
Migration governance and mental health
Authors: Schininá Guglielmo
Published: February 2021

The chapter presents the Global Compact on Migration, the UN 2030 Agenda for Sustainable Development, and other global governance instruments, focusing on their links with mental health of migrants. The possibility to limit some of the stressors that accompany certain migration paths, and to promote all migrants’ access to mental health care in new countries of residence is enshrined in these documents. The actual impact and effect on governance of these documents needs to be seen, read, and acted upon within the wider context of migration management, as well as a public discourse that tends to objectify and abjectify migrants and diversity. The chapter proposes strategies for action and is concluded with a series of recommendations for the promotion of inclusive and holistic mental health services, with a right-based approach.
Principles for the management of physical and mental health care in migrants
Authors: Bhavsar Vishal
Published: February 2021

The relationship between physical and mental health is often ignored in many clinical settings. However, across different cultures there is an expected and real integration between physical and mental health. In most countries around the globe there is no equity between funding for services or research. The key aim of this chapter is to provide an overview of the provision of physical and mental health care to migrants, emphasizing the equity of provision of physical and mental health care, and equity of provision of care for migrants, as well as non-migrants, as its starting point. The impact of migration as a result of geopolitical factors, as well as globalization, on access to cultural, material, and economic materials with the visibility of migration and anti-migration feeling raises the importance and the significance of migration as a global phenomenon, and also, in the form of transnationalism or intersectionality, the idea that individuals who are not migrants may equally occupy disparate, stigmatized, or culturally different identities.