bluuebunny/crossref_metadata_2025 huggingface dataset:
Simulation of Uniaxial Deformation of a Ferrogel Sample Exposed by the External Magnetic Field
Authors: Melenev P , Ryzhkov A
Published: July 2019

Ferrogels are magnetoactive composite materials with very soft hydrogel matrix, filled by ferromagnetic particles. This work is devoted to a numerical investigation of magneto-mechanical behaviour of a small sample of ferrogel. Our model is based on a coarse grained molecular dynamics approach: polymeric matrix is emulated by lattice of bead-strings chains and magnetic single-domain particles are considered as rigid spheres and placed in a nodes of the lattice. This model was previously successfully used for a research of equilibrium magnetization of the material. Here we examine of the reaction of ferrogel sample on uniaxial tension in presence of an external magnetic field. Modelling proves that key role in a changes of mechanical response during the magnetization plays an internal structure of material, specifically, the existence of particles aggregates, induced by forces of dipolar magnetic interaction. Also the influence of magnetic anisotropy on a process is considered.
Delirium and post-discharge dementia: results from a cohort of older adults without baseline cognitive impairment
Authors: Garcez Flavia Barreto , Apolinario Daniel , Campora Flavia , Curiati Jose Antonio Esper , Jacob-Filho Wilson , Avelino-Silva Thiago Junqueira
Published: July 2019

Objectives

to investigate the association between delirium occurrence in acutely ill older adults and incident dementia after hospital discharge.

Methods

retrospective cohort study examining acutely ill older adults aged +60 years and consecutively admitted to the geriatric ward of a tertiary university hospital from 2010 to 2016. Inclusion criteria were absence of baseline cognitive decline on admission and documented clinical follow-up of +12 months after discharge. Admission data were collected from our local database, including results from a standardized comprehensive geriatric assessment completed for every patient. Pre-existing cognitive decline was identified based on clinical history, CDR and IQCODE-16. Delirium was diagnosed using short-CAM criteria, while post-discharge dementia after 12 months was identified based on medical records’ review. We used competing-risk proportional-hazard models to explore the association between delirium and post-discharge dementia.

Results

we included 309 patients. Mean age was 78 years, and 186 (60%) were women. Delirium was detected in 66 (21%) cases. After a median follow-up of 24 months, 21 (32%) patients who had experienced delirium progressed with dementia, while only 38 (16%) of those without delirium had the same outcome (P = 0.003). After adjusting for possible confounders, delirium was independently associated with post-discharge dementia with a sub-hazard ratio of 1.94 (95%CI = 1.10–3.44; P = 0.022).

Conclusion

one in three acutely ill older adults who experienced delirium in the hospital developed post-discharge dementia during follow-up. Further understanding of delirium as an independent and potentially preventable risk factor for cognitive decline emphasizes the importance of systematic initiatives to fight it.
Higher dementia incidence in older adults with type 2 diabetes and large reduction in HbA1c
Authors: Lee Allen T C , Richards Marcus , Chan Wai C , Chiu Helen F K , Lee Ruby S Y , Lam Linda C W
Published: July 2019

Background

although type 2 diabetes increases risk of dementia by 2-fold, whether optimizing glycemic level in late life can reduce risk of dementia remains uncertain. We examined if achieving the glycemic goal recommended by the American Diabetes Association (ADA) within a year was associated with lower risk of dementia in 6 years.

Methods

in this population-based observational study, we examined 2246 community-living dementia-free Chinese older adults with type 2 diabetes who attended the Elderly Health Centres in Hong Kong at baseline and followed their HbA1c level and cognitive status for 6 years. In line with the ADA recommendation, we defined the glycemic goal as HbA1c < 7.5%. The study outcome was incident dementia in 6 years, diagnosed according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) or Clinical Dementia Rating of 1–3.

Results

those with HbA1c ≥ 7.5% at baseline and HbA1c < 7.5% in 1 year were associated with higher rather than lower incidence of dementia, independent of severe hypoglycemia, glycemic variability and other health factors. Sensitivity analyses showed that a relative reduction of ≥10%, but not 5–10%, in HbA1c within a year was associated with higher incidence of dementia in those with high (≥8%) and moderate (6.5–7.9%) HbA1c at baseline.

Conclusion

a large reduction in HbA1c could be a potential predictor and possibly a risk factor for dementia in older adults with type 2 diabetes. Our findings suggest that optimizing or intensifying glycemic control in this population requires caution.
Central European polyploids of Sorbus subgenus Aria (Rosaceae) recurrently evolved from diploids of central and south-eastern Europe: evidence from microsatellite data
Authors: Feulner Martin , Weig Alfons , Voss Tobias , Schott Lea F , Aas Gregor
Published: July 2019

Sorbus subgenus Aria in Europe consists of sexual diploid and predominantly apomictic polyploid taxa. Tetraploid taxa of Sorbus subgenus Aria, including S. danubialis and S. collina, are endemic to central Europe, but it is unclear from which taxa or populations they originated. South-eastern European taxa of subgenus Aria were suggested to have contributed to the tetraploids S. danubialis and S. collina by polyploidization or hybridization. Genetic microsatellite data, flow cytometry and multivariate morphometrics were used (1) to investigate the genetic relationship of the tetraploid taxa throughout Europe, (2) to disentangle the population structure of diploid S. aria from central and south-eastern Europe and (3) to use the resulting subgroups for estimating the parentage of polyploids. Parentage analyses revealed that the allele patterns of the polyploid central European taxa such as S. danubialis and S. collina and other as yet undescribed polyploids from south-western Germany could be explained in most cases by recurrent crosses between diploid S. aria from south-eastern and central Europe. These origins are discussed in the context of historical biogeography. Furthermore, we report the exceptional case of a polyploid subgenus Aria population from south-western Germany showing no clonal genetic structure at all, making its taxonomic treatment challenging.
Estimating normal rates of capacity utilisation and their tolerable ranges: a comment on Mark Setterfield
Authors: Botte Florian
Published: July 2019

Taking the potential instability of the Kaleckian model of growth as his starting point, M. Setterfield (‘Long-run variation in capacity utilisation in the presence of a fixed normal rate’, Cambridge Journal of Economics, 2018, doi:10.1093/cje/bey016) investigates, inter alia, the possibility of taming Harrodian instability. His investigation uses a range of tolerable values, rather than a unique value, for the normal rate of capacity utilisation. After illustrating his point theoretically, Setterfield then proposes empirical methods to estimate the normal capacity utilisation rate and the corresponding tolerance range. This paper suggests improved methods to estimate the normal rate of capacity utilisation and its tolerance range. The proposed alternative solutions offer better consistency with post-Keynesian behavioural theories, and the presented exploratory narrative based on these suggestions can partly explain the current stagnation.
In-hospital and 12-month follow-up outcome from the ESC-EORP EHRA Atrial Fibrillation Ablation Long-Term registry: sex differences
Authors: Grecu Mihaela , Blomström-Lundqvist Carina , Kautzner Josef , Laroche Cecile , Van Gelder Isabelle C , Jordaens Luc , Tavazzi Luigi , Cihak Robert , Rubio Campal Jose Manuel , Kalarus Zbigniew , Pokushalov Evgeny , Brugada Josep , Dagres Nikolaos , Arbelo Elena ,   ESC-EORP EHRA Atrial Fibrillation Ablation Long-Term Registry investigators
Published: July 2019

Aim

The purpose of this study was to compare sex differences of atrial fibrillation (AF) catheter ablation (CA) and to analyse the opportunities for improved outcomes.

Methods and results

All data were collected from the Atrial Fibrillation Ablation Long-Term registry, a prospective, multinational study conducted by the ESC-EORP European Heart Rhythm Association (EHRA) under the EURObservational Research Programme (ESC-EORP). A total of 104 centres in 27 European countries participated. Of 3593 included patients, 1146 (31.9%) were female. Female patients were older (61.0 vs. 56.4 years; P < 0.001), had more comorbidities (hypertension, diabetes, and obesity), more episodes of arrhythmias per month (6.9 vs. 6.2; P < 0.001), and a higher average EHRA score (2.6 vs. 2.4; P < 0.001). The duration of the procedure was shorter in females (160.1 min vs. 167.9 min; P < 0.001), irrespective of additional ablation lesions added to pulmonary vein isolation. Overall cardiovascular complications were more frequent in women than in men (5.7% vs. 3.4%; P < 0.001). Furthermore, cardiac perforations (3.8% vs. 1.3%; P = 0.011) and neurological complications (2.2% vs. 0.3%; P = 0.004) were found in females in less experienced centres than in experienced ones. On a final note, at 12 months, AF recurrence rate was similar in females and males (34.4% vs. 34.2%; P = 0.897), but more females were still on antiarrhythmic drugs (50.6% vs. 44.1%; P < 0.001) when compared with men.

Conclusion

Females underwent CA procedures for AF less frequently than males throughout Europe, despite more recurrent symptoms. With the same success rate, severe acute complications remained considerable in females, especially in less experienced centres.
‘The Age of Louis XIV’: Frederick the Great and French Ways of War*
Authors: Storring Adam L
Published: July 2019

This article demonstrates that the military ideas of King Frederick the Great of Prussia up to the Seven Years War (1756–1763) were primarily inspired by France, and particularly by the towering figure of King Louis XIV. It examines the intellectual inspirations for Frederick’s military ideas, showing that French military influence reflected the strength of French cultural influence in the long eighteenth century and the importance of Louis XIV as a model for monarchical self-representation. Frederick’s famous personal command of his armies reflected the Enlightenment concept of the ‘great man’ (grand homme), but Frederick thereby sought primarily to outdo the Sun King, whom Voltaire had criticized for merely accompanying his armies while his generals won battles for him. The example of Frederick thus demonstrates that not only rulers but also enlightened philosophers often looked backwards toward older monarchical examples.

Frederick sought to create his own ‘Age of Louis XIV’ in the military sphere by imitating the great French generals of the Sun King. Frederick’s famous outflanking manoeuvres followed the example of famous French generals, reflecting the practice of the more mobile armies of the mid-seventeenth century. Frederick used French practice to justify his attacks with the bayonet, and his ‘short and lively’ wars reflected French strategic traditions. The evidence of French influence on Frederick seriously challenges concepts of a ‘German Way of War’, and indeed of supposed national ‘ways of war’ in general, emphasizing the need for a transnational approach to the history of military thought.
Antibiotic choice in UK general practice: rates and drivers of potentially inappropriate antibiotic prescribing
Authors: Nowakowska Magdalena , van Staa Tjeerd , Mölter Anna , Ashcroft Darren M , Tsang Jung Yin , White Andrew , Welfare William , Palin Victoria
Published: July 2019

Objectives

To identify the rates of potentially inappropriate antibiotic choice when prescribing for common infections in UK general practices. To examine the predictors of such prescribing and the clustering effects at the practice level.

Methods

The rates of potentially inappropriate antibiotic choice were estimated using 1 151 105 consultations for sinusitis, otitis media and externa, upper respiratory tract infection (URTI) and lower respiratory tract infection (LRTI) and urinary tract infection (UTI), using the Clinical Practice Research Datalink (CPRD). Multilevel logistic regression was used to identify the predictors of inappropriate prescribing and to quantify the clustering effect at practice level.

Results

The rates of potentially inappropriate prescriptions were highest for otitis externa (67.3%) and URTI (38.7%) and relatively low for otitis media (3.4%), sinusitis (2.2%), LRTI (1.5%) and UTI in adults (2.3%) and children (0.7%). Amoxicillin was the most commonly prescribed antibiotic for all respiratory tract infections, except URTI. Amoxicillin accounted for 62.3% of prescriptions for otitis externa and 34.5% of prescriptions for URTI, despite not being recommended for these conditions. A small proportion of the variation in the probability of an inappropriate choice was attributed to the clustering effect at practice level (8% for otitis externa and 23% for sinusitis). Patients with comorbidities were more likely to receive a potentially inappropriate antibiotic for URTI, LRTI and UTI in adults. Patients who received any antibiotic in the 12 months before consultation were more likely to receive a potentially inappropriate antibiotic for all conditions except otitis externa.

Conclusions

Antibiotic prescribing did not always align with prescribing guidelines, especially for URTIs and otitis externa. Future interventions might target optimizing amoxicillin use in primary care.
1 General Theory of Fundamental Rights
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter presents an overview of the general theory of fundamental rights, which are embodied in the German Basic Law, or Grundgesetz (GG), as a fundamental component of the idea of a democratic constitutional state which is open — that is, embedded in the international community of states. The fundamental rights in GG combine private, social, and political ideals of freedom into an overarching conception of a free, legally regulated and socially structured community. The chapter considers who may claim fundamental rights (natural persons, legal persons), the duty of the state to uphold fundamental rights, effects of fundamental rights, and institutional guarantees protected by fundamental rights. It also discusses the state's duty to protect, the effects of fundamental rights on private parties or third parties, and further effects of fundamental rights.
2 Art. 1 para. 1 GG: Human Dignity
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter discusses the duty of all state power to respect and protect human dignity as set out in Art. 1 para. 1 of the Grundgesetz (GG). It first explains the scope of state protection against violations of human dignity by citing the decisions of the Federal Constitutional Court in two cases, one concerning the Aviation Security Law and another concerning the constitutionality of life imprisonment. It then considers the benefits dimension of the guarantee of human dignity, in particular the individual's claim to the level of social support necessary to live in dignity (the so-called existence minimum). It also addresses the question of whether an interference with human dignity can ever be justified, and especially whether human dignity can be limited.
5 Art. 4 GG: Freedom of Faith and Conscience
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter discusses Art. 4 of the Grundgesetz (GG), which guarantees freedom of faith and conscience. Art. 4 para. 1 GG encompasses freedom to profess a religious faith, whereas Art. 4 para. 2 GG deals with freedom to practice a religion without interference. These fundamental rights are available to all persons. GG provides special protection for religious societies (Art. 140 GG in combination with Art. 136 et seq. of the Weimar Constitution). The chapter first considers the jurisprudence of the Federal Constitutional Court concerning the scope of protection for freedom of religion, taking into account the principle of state neutrality, and the constitutional justification for interference with religious freedom. It then explains the scope of protection for freedom of conscience, focussing on the conflict of norms between the state legal order and the freedom to act according to one's conscience.
7 Art. 6 GG: Marriage and Family
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter deals with Art. 6 of the Grundgesetz (GG), which guarantees protection for marriage and the family. Art. 6 GG protects marriage and the family from state interference, and also creates a special principle of equality. Paragraphs 4 and 5 create constitutional rights for mothers and children born outside of marriage. The chapter first considers the jurisprudence of the Federal Constitutional Court concerning the scope of protection for marriage and the family, including issues concerning discrimination against same-sex relationships, freedom to marry, marital cohabitation, the right to divorce, and the right to spousal maintenance. It then examines the constitutional rights of parents and the social rights of mothers before concluding with an analysis of the social rights of children born outside of marriage.
11 Art. 10 GG: Privacy of Correspondence, Post, and Telecommunications
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter deals with three independent fundamental rights guaranteed by Art. 10 of the Grundgesetz (GG): privacy of correspondence, privacy of post, and privacy of telecommunications. Under Art. 10 GG, free development of personality is guaranteed through private communication shielded from the public. The fundamental right protects the confidentiality of individual communication and is intended to compensate for the reduction in privacy which goes along with use of these technologies. The chapter examines the Federal Constitutional Court's jurisprudence regarding the scope of protection for postal privacy, privacy of correspondence and telecommunications privacy, focussing on cases relating to eavesdropping devices, online search and data retention. It also considers the question of interference with the privacy of correspondence, posts, and telecommunications, along with the constitutional justification of such interferences.
13 Art. 12 GG: Occupational Freedom
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter discusses freedom of occupation, a fundamental right guaranteed by Art. 12 of the Grundgesetz (GG). It first examines the Federal Constitutional Court's jurisprudence regarding the scope of protection for occupational freedom, focussing on cases that emphasise the importance of occupational freedom to the human personality, consequences of the personal interpretation of occupational freedom, and restrictions on the guarantees afforded by the scope of protection. It then considers the reservation of authority to regulate the practice of an occupation, with emphasis on the three-step theory of regulatory authority. It also analyses the issue of interference with the right to choose an occupation, along with the definition of occupations. It concludes by giving examples of the step theory in operation, one for an objective condition on entry and another for a subjective condition on entry.
15 Art. 14 GG: Property
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter examines the right of property, a fundamental right protected under Art. 14 of the Grundgesetz (GG). It first provides an overview of the functions of property and basic problems in the property rights doctrine before discussing the transformation of this doctrine. In particular, it considers the principles established by the Federal Constitutional Court to form the foundation of the doctrine of property rights. These principles are also important in the area of state liability law. The chapter goes on to analyse the Court's jurisprudence regarding the constitutional definition of property and the protected objects of statutes, focussing on cases that address the question of whether trademarks are property, for example, or the doctrine of constitutional protection for an ‘established and operating business’. Finally, it tackles the issue of interference with property rights and the constitutional justification of such interferences.
19 Art. 20 GG: Democracy
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter discusses the democracy principle as articulated in Art. 20 of the Grundgesetz (GG). Art. 20 para. 2 GG defines democracy in this manner: ‘All state authority is derived from the people. It shall be exercised by the people’. GG associates the concept of democracy with the concept of the state. Although the Federal Constitutional Court has avoided any reference to the principle of democracy, it has interpreted some fundamental rights in light of the principle. The chapter first considers the Court's jurisprudence regarding political will formation in a representative democracy, focussing on cases dealing with voting rights of foreigners, elections to district assemblies, popular referendum, and public-information campaigns. It then examines cases relating to exercise of state authority, with emphasis on the position of Parliament in relation to other branches of government, forms of democratic legitimation, and functional self-government.
28 Arts. 70 et seq. GG: Legislation
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter discusses the relevant provisions of Art. 70 et seq. of the Grundgesetz (GG) with regard to legislation, and more specifically the division of legislative power between the federal government and the states. The division of powers between the federal state and the states means that, for each area, either one is responsible. In the case of conflicts between federal and state law, it generally suffices to determine that either the federal state or the state lacks the required legislative power. This observation probably remains accurate even after the federalism reforms of 2006. The chapter first considers the apportionment of legislative power between the federal state and the states after the 2006 federalism reforms, focussing on the exclusive legislative powers of the federal state and its newly regulated concurrent legislative power, before analysing the Federal Constitutional Court's jurisprudence concerning legislative powers and the legislative process.
30 Arts. 83 et seq. GG: The Execution of Federal Laws and the Federal Administration
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter discusses the relevant provisions of Art. 83 et seq. of the Grundgesetz (GG) with regard to the execution of federal laws by the federal state and the states. In the Federal Republic of Germany, the federal state and the states are each assigned their own separate administrative powers by the Grundgesetz. The question that arises is how strict the separation of state administration vs federal administration of federal laws is required by the constitution, and whether it always makes sense. To answer this question, the chapter examines the Federal Constitutional Court's jurisprudence concerning the presumption of state responsibility and joint administration (joint execution of federal laws) between federal and state governments. It also considers the states' autonomous execution of federal laws as well as their execution of federal laws on federal commission before concluding with an analysis of the federal administration/execution of federal laws.
Neuroimmunology for the Non-Immunologist
Authors: Bielekova Bibiana
Published: July 2019

The chapter begins with a short introduction to the components of the immune system, outlining both the innate and adaptive components. It discusses the role of the immune system in protecting against infections and abnormal tissues. It describes the concepts of self-antigens, antigen presentation, and immune synapse. It then examines immune tolerance and the differing functions and capacities of the innate and adaptive immune systems. Finally, the chapter considers infections and autoimmune phenomena and how the immune system responds to these challenges.
Therapies of Neuroimmunologic Diseases
Authors: Birnbaum Gary , Bielekova Bibiana , Lisak Robert P.
Published: July 2019

This chapter provides an overview of the ever-increasing armamentarium of disease-modifying therapies available for the treatment of neuroimmunologic disease. It stresses the importance of determining whether a particular condition is or is not immune-mediated. Choosing the proper immune-modulating therapy for an immune-mediated neurologic disease can be difficult, and the chapter provides an algorithm for such choices. The authors emphasize that clinical responses are of paramount importance. The chapter then provides detailed information on mechanisms of action, dosing, and monitoring of the major immune modulation therapies.
Neuromyelitis Optica Spectrum Disorders
Authors: López-Chiriboga A. Sebastian , Weinshenker Brian G.
Published: July 2019

Neuromyelitis optica spectrum disorders (NMOSD) are inflammatory diseases of the central nervous system, traditionally diagnosed in patients with inflammatory attacks restricted to the optic nerves and spinal cord. The chapter considers the epidemiology, pathophysiology and immunopathogenesis of NMOSD. The clinical presentation and radiographic features are reviewed and the prognosis of patients with NMOSD is considered. The mortality and morbidity of untreated NMOSD is much greater than those of MS. Treatment options are summarized and finally future prospects of research are considered.
Immune-Mediated Disease of the Neuromuscular Junction
Authors: Lisak Robert P. , Selwa James
Published: July 2019

The chapter is concerned with disorders that affect the neuromuscular junction (NMJ). Myasthenia gravis (MG) is a prototypic antibody-mediated disease affecting the neuromuscular junction. The chapter looks at the epidemiology of MG. It also considers clinical manifestations and presentations, classification and staging, and diagnosis. The chapter also examines immunologic testing and issues such as pregnancy in MG. It considers future directions and treatment options in this area. Next, the chapter considers Lambert Eaton myasthenic syndrome (LEMS), which is a rare disease of the NMJ that is difficult to diagnose. The chapter looks at clinical manifestations, diagnosis, and treatment. Finally, the chapter briefly considers other immune-mediated diseases.
Immunopathogenesis of Inflammatory Myopathies
Authors: Dalakas Marinos C.
Published: July 2019

This chapter looks at inflammatory myopathies (IM), which constitute a heterogeneous group of acquired myopathies that have in common the presence of inflammation in the muscle tissue. The chapter looks at specific clinical features such as dermatomyositis, polymyositis, necrotizing autoimmune myositis, antisynthetase syndrome-overlap myositis, and inclusion body myositis. It then considers diagnosis, which can be made through muscle biopsy and the detection of autoantibodies. Finally, it looks at treatment options.
Neurologic Complications of Systemic Autoimmune Diseases
Authors: Bhattacharyya Shamik , Samuels Martin A.
Published: July 2019

This final chapter looks in detail at systemic inflammatory diseases that frequently affect both the central and peripheral nervous systems and can begin with neurological symptoms. These diseases cross traditional boundaries between neurology and rheumatology, and diagnosis and treatment require familiarity with the spectrum of neurological involvement with interdisciplinary communication. The chapter reviews some of the more common neurological manifestations of selected autoimmune diseases such as systemic lupus erythematosus, Sjögren syndrome, rheumatoid arthritis, scleroderma, sarcoidosis, primary angiitis of the central nervous system, systemic vasculitis syndromes, and antiphospholipid syndrome.
Infection-related and renal-limited glomerulonephritis
Authors: Glassock Richard J , Hebert Lee , Moroni Gabriella , Ponticelli Claudio
Published: July 2019

This chapter covers the infection-related glomerulonephritides, which encompass a wide swath of epidemic and endemic diseases. Bacteria, fungi, protozoa, nematodes, helminths and viruses all contribute to the glomerular disease burden. Most of these have numerous and varied extra-renal manifestations and are commonly classified as secondary glomerular diseases. However, a few have mainly or exclusively renal involvement and can be classified within the rubric of primary glomerular disease. This group of glomerular diseases is characterized by intraglomerular inflammation and cellular proliferation resulting from immunological events triggered by a variety of organisms. This chapter discusses the prototypical renal-limited forms of infection-related glomerulonephritis.
International perspectives on inpatient mental health care
Authors: Molodynski Andrew
Published: July 2019

Inpatient care varies enormously, both between countries and regions and within them. These variations are most stark when based on economic factors, but stigma, prevailing societal attitudes, and the role of the family also play a significant part in the amount and quality of mental health care overall. This chapter begins by outlining global economic factors and their impact on provision. It then focuses on the concept of a whole systems approach, looking briefly at the evidence base for different components of services generally seen in high-income group countries. Alternative suggestions to ‘high-income group’ models are discussed as the evidence internationally emanates almost exclusively from a small number of wealthy westernized countries. The chapter ends with a section looking at several internationally important themes in inpatient care and outlining examples of differences between countries in challenges and in solutions to what is one of the longest standing issues in mental health care: how to provide humane, effective inpatient care to those who need it (and not to those who do not).
The design and function of inpatient wards
Authors: Burns Tom
Published: July 2019

Inpatient wards in asylums were the cradle of modern psychiatry and have remained a central component ever since, even in the most radical services. Their configuration has evolved pragmatically but since the arrival of evidence-based practice in mental health care in the early 1980s, attempts have been made to derive guidelines and provide principles for their design. There is little in the way of experimental evidence but there is a growing international consensus. Wards now strive to be small (around 15–20 places) and to provide single en-suite accommodation. Isolated small wards emphasizing a domestic configuration have generally faced problems with caring for disturbed patients. The last decade has seen a disappointing move back to single-sex wards, with greater emphasis on security and doors often locked as bed numbers have fallen and patient acuity has increased. International observations are provided about staffing, design, and standards.
The context of inpatient mental health care in England
Authors: Chaplin Rob
Published: July 2019

This chapter reviews the practice of inpatient care in relation to the provision of overall psychiatric care in England. The structure of mental health care in the UK National Health Service (NHS) is outlined and in particular the various subspecialties of inpatient care. Recent trends in the provision of inpatient psychiatric care in the UK are considered in comparison to those in Europe and North America. There follows a review of the role of public sector care under the NHS and a debate about the effectiveness of inpatient care and whether it should be a separate psychiatric subspecialty. Finally, local service developments are discussed as a type of case study to illustrate how services are currently undergoing rapid changes.
Multidisciplinary work, multidisciplinary team
Authors: Hammond Jean , Hammond Derek
Published: July 2019

Putting the patient at the centre of their care is a fundamental principle of the multidisciplinary team (MDT) approach. It is generally recognized as being an effective model for delivering individualized care to patients with complex needs and is promoted in a growing number of local and national policies and best practice guidelines, in a wide range of clinical specialities. While clinical staff seem clear on the assumed benefits of MDT working, there is surprisingly little written about its clinical effectiveness. This chapter briefly explores some of the challenges presented to effective MDT working within the acute mental health inpatient ward. The key principles and characteristics of MDT working are described with an exploration of the key roles and functions within the MDT and their application to acute mental health inpatients wards.
Modern matron, ward manager, consultant nurse
Authors: Attard Caroline , Canning Catriona , Warne Rose
Published: July 2019

Nursing leadership focuses on three nursing roles that have particular significance for the smooth management, quality of care, quality improvement, and well-being of patients and staff on a ward. The three roles of ward manager, modern matron, and nurse consultant are discussed and the challenges these roles pose are explored in this chapter. Nursing leadership is identified as a significant factor in developing a positive culture in the inpatient environments and aspects of effective leadership are suggested along with ways to successfully manage, lead, and inspire a team in these roles. The roles of ward manager, modern matron, and NC play an important part in developing a positive culture within the inpatient setting, transforming the care provided as well as the image of inpatient nursing.
Initial assessment, ward rounds, the discharge process
Authors: Barrera Alvaro
Published: July 2019

Hospital admission to an acute psychiatric unit can be a challenging and at times distressing experience for patients, relatives, and friends. This chapter outlines the main multidisciplinary clinical tasks that must be carried out from admission to discharge, with a view to provide care that promotes dignity, autonomy, as well as a sense of hope for patients and all those involved. Taking as context the frameworks and standards provided by a several bodies, the chapter follows a chronological order starting and ending with a close look at the community mental health teams with which inpatient units must closely work for the benefit of patients and their families and friends.
Substance misuse disorders on the psychiatric ward
Authors: Critchlow Gail , Bargiotas Theodoros
Published: July 2019

The focus of this chapter is the management of substance misuse and addiction on the psychiatric ward in patients who have presented with a psychiatric disorder. Some patients will display other forms of addictive behaviour such as gambling, sexual activity, or Internet use. Where this is not the primary focus, the same principles of broad-based biopsychosocial management apply. There are a number of guidelines available, such as those from the Department of Health (the ‘Orange Book’) and the National Institute for Health and Care Excellence, and prescribing advice, such as the British Association for Psychopharmacology guidelines and The Maudsley Prescribing Guidelines in Psychiatry, that are useful references for the treatment of patients with substance misuse disorders and addiction. This chapter does not seek to replicate this advice, but does include useful and common scenarios that will be encountered on the general psychiatric ward.
Autoimmune-related psychosis
Authors: Lennox Belinda
Published: July 2019

Autoimmune encephalitis is a neuropsychiatric disorder. While it is generally managed by neurologists, many of the presenting symptoms and most of the challenges in management are psychiatric. The description of psychiatric symptoms as part of the presenting symptoms of encephalitis dates back to the first descriptions of the disorder. The more recent discovery of autoimmune causes of encephalitis has particular relevance for psychiatry: there is significant overlap between the initial presentation of encephalitis with other core psychiatric disorders such as depression and psychosis. The particular challenge for inpatient psychiatry is to screen and detect these disorders early. The current evidence indicates that the rapid detection and delivery of immunotherapy, rather than the use of psychiatric treatments, is associated with better long-term outcomes for patients. Conversely, the risks of not detecting encephalitis are of long-term disability, or even death in a proportion of patients. This chapter describes the evolution in understanding of autoimmune encephalitis, the characteristics associated with particular antibodies, and the investigations and management of patients with autoimmune encephalitis from a psychiatric perspective.
Clinical pharmacy: safe prescribing and monitoring
Authors: Bhatti Sandeep , Brown Rachel , Macdonald Orla , White Dan
Published: July 2019

The roles of the clinical pharmacists and medicines management technicians within the inpatient psychiatric setting are many and varied. This chapter explores some of these roles and examines how they enhance patient care and support the aims of mental health trusts and inpatient psychiatry. This is primarily achieved through effectively and efficiently managing medicines. The aim of the clinical pharmacy team is to promote high-quality, value-for-money care which is patient-centred and based upon improving patient outcomes. The chapter also discusses how pivotal papers and reports have shaped the services that pharmacy departments deliver to psychiatric inpatients.
Daily ward process in inpatient mental health care
Authors: Walsby Katalin , Attard Caroline
Published: July 2019

This chapter describes regular daily processes within the inpatient mental health ward that form the backbone of the ward’s functioning and underpin the ability of wards to provide therapeutic and safe environments. Precisely because acute inpatient wards can be unpredictable, with changing circumstances generating unremitting challenges to patients, carers, and staff, these daily processes, such as handover, medication, and mealtimes, are crucial to help create a sense of structure as well as safe clinical care. These processes must be followed if inpatient psychiatric wards are going to be able to provide an environment that allows the development of enabling and therapeutic relationships for patients, carers, and staff themselves.
Implementation of the Safewards model on inpatient wards
Authors: Attard Caroline
Published: July 2019

This chapter describes the development of the Safewards model for inpatient mental health wards, originally developed by Professor Len Bowers. There is an account of how the model was implemented locally by Berkshire Healthcare NHS Foundation Trust on their inpatient units for adults of working age and older adults and included in the prevention and management of violence and aggression training. It led to reduced conflict and ultimately reduced violence and aggression. The perceptions of patients on the impact of the Safewards project on their level of feeling safe are explored. Staff feedback and challenges encountered are also discussed.
Interventions for specific conditions
Authors: Barkataki Ian , Ross Louise
Published: July 2019

This chapter focuses on specific psychological interventions for disorders and conditions that commonly present within an inpatient environment. Three main psychological orientations (cognitive behavioural therapy, psychodynamic psychotherapy, and systemic therapy) are defined, along with their strengths and applicability for inpatient work. The importance of adapting psychological approaches in this setting is considered. Psychological theory, supporting evidence base, and specific techniques for mood disorders (including depression, bipolar affective disorder, and anxiety); psychotic disorders; and personality disorders are outlined in greater detail. The practical considerations of short-term and acute working, including the importance of staff support, in the delivery of effective psychological treatment on the ward are discussed.
Advocacy
Authors: Godwin Georga
Published: July 2019

This chapter takes as its starting point the lack of control felt by psychiatric patients who are detained against their will and who are forcibly medicated. It examines the principles inherent in the tension between inpatient psychiatry and mental health jurisprudence, including the European Convention on Human Rights and the Mental Health Act 1983 as amended by the Mental Health Act 2007. It explains by what methods those deprived of their liberty in psychiatric settings can challenge their detention. Finally, it outlines the roles of psychiatrists, lawyers, and non-legal advocates in ensuring that patients’ human rights are upheld. It is written for practising psychiatrists who are involved in the detention and treatment of patients.
Acute inpatient care in older adults
Authors: Murray Brian
Published: July 2019

Provision of specialist mental health services for older adults (previously referred to as ‘psychogeriatrics’) is recommended by the World Health Organization. In the UK, this extends to specialist wards for older inpatients with mental health problems. This chapter explores the rationale and provision of specialist older adult mental health beds in the UK and the different types of service offered. Beyond the macro level, it aims to provide a handbook for anyone wishing to set up such a ward from scratch: it explores what a ward designed with older adults in mind would look like (design) and what resources and staffing are necessary. The needs specific to this demographic of the population are explored, including issues such as physical health, frailty, and the most common mental health conditions one might encounter on such as ward (dementia, late-life depression, and late-life psychosis).
Eating disorders
Authors: Ayton Agnes
Published: July 2019

There is increasing demand for inpatient treatment of severe eating disorders, both in the UK and internationally. However, hospital treatment of severe eating disorders remains controversial, mainly because of poor long-term outcomes. This chapter provides a highly relevant and clinically focused review of the complex issues involved in inpatient care of people with severe eating disorders. The main guidelines and evidence base are critically reviewed from the point of view of a real-life clinical practice dealing with people with very low body mass indexes. Evidence, or lack of it, for a range of interventions is outlined, including artificial feeding and compulsory treatment. Practical issues regarding management of weight, physical morbidity, and psychological interventions are discussed.
Psychiatric assessment
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter explains how to conduct a psychiatric assessment. Starting with the basics of a clinical interview, including how to arrange a room and take a history, specific observations to look out for in the patient are described in detail. Methods of asking questions about specific psychiatric problems are discussed, including how to broach difficult topics. The physical effects associated with psychiatric disorders are defined, and some common assessment instruments are also featured.
Symptoms of psychiatric illness
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter defines the symptoms of psychiatric illness, from descriptive psychopathology and definitions of general terms to a dictionary of symptoms arranged alphabetically. Synonyms and older terms are cross-referenced with the modern descriptions.
Schizophrenia and related psychoses
Authors: Semple David , Smyth Roger
Published: July 2019

Covering schizophrenia and related psychoses, this chapter takes the reader through from historical views to diagnosis and differential diagnoses, as well as examination of a patient with psychotic symptoms, presentations, treatment, and management strategies. Also the chapter contains detailed tables of suitable drug choices and their associated indications and contraindications.
Bipolar illness
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter covers bipolar illness. Definitions of mania and a manic episode are defined, as well as hypomania and hypomanic episodes. Bipolar spectrum disorder and different forms of bipolar disorder are classified, clinical presentations and notes described, and management principles discussed. Treatment of acute manic episodes and depressive episodes are covered, including prophylaxis and psychotherapeutic and pharmacological interventions (lithium, valproate, carbamazepine, and lamotrigine).
Child and adolescent psychiatry
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter covers child and adolescent psychiatry. From assessment, develop, resilience, and attachment, normal infant mental health is discussed, followed by an approach to behavioural problems and conduct disorders in the older child. Parent management training is covered, followed by individual disorders and their management in the context of the adolescent and child, from attention-deficit/hyperactivity disorder to psychosis. Special focus is given to children and young people with intellectual disabilities, child maltreatment, and prescribing differences from adult psychiatry.
Forensic psychiatry
Authors: Semple David , Smyth Roger
Published: July 2019

Covering the role of the psychiatrist in forensic situations, from participation in the criminal justice system and legal definitions of crime (including homicide, violence, and sexual offences) to the relationship between mental disorders and offending, this chapter addresses secure hospitals and units, police and court liaison, and the role of the prison psychiatry. Legal provisions and how to give evidence in court are described, and an overview of pathways through the criminal health and justice system for mentally disordered offenders is provided. Fitness to plead and criminal responsibility are both explained.
Therapeutic issues
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter covers therapeutic issues in psychiatry, from medication adherence, off-label prescribing and associated legal considerations, negative side effects such as weight gain and sexual dysfunction in different forms of psychiatric medicines, potential interactions or contraindications for prescribing, and specific side effects. Special prescribing cases, such as psychiatric medicine in pregnancy and breastfeeding patients or those with heart, liver, or kidney disease, are explained.