bluuebunny/crossref_metadata_2025 huggingface dataset:
Social norm feedback reduces primary care antibiotic prescribing in a regression discontinuity study
Authors: Bradley Declan T , Allen Sarah E , Quinn Helen , Bradley Brenda , Dolan Matthew
Published: May 2019

Background

Reducing antibiotic prescribing is a priority for health authorities responsible for preventing antimicrobial resistance. Northern Ireland has high rates of antimicrobial use. We implemented a social norm feedback intervention and evaluated its impact.

Objectives

To estimate the size and duration of the effect of a social norm feedback letter to GPs who worked in the 20% of practices with the highest antimicrobial prescribing.

Methods

The letter was sent in October 2017 to 221 GPs in 67 practices. To assess the effect of the intervention, we used a sharp non-parametric regression discontinuity (RD) design, with prescribing rates in the four calendar quarters following the intervention as the outcome variables.

Results

In the quarter following the intervention (October to December 2017) there was a change of −25.7 (95% CI = −42.5 to −8.8, P = 0.0028) antibiotic items per 1000 Specific Therapeutic group Age-sex Related Prescribing Units (STAR-PU). At 1 year, the coefficient was −58.7 (95% CI = −116.7 to −0.7, P = 0.047) antibiotic items per 1000 STAR-PU. The greatest change occurred soon after the intervention. Approximately 18900 fewer antibiotic items were prescribed than if the intervention had not been made (1% of Northern Ireland’s annual primary care antibiotic prescribing).

Conclusions

A social norm feedback intervention reduced antibiotic prescribing in the intervention practices. The diminishing effect over time suggests the need for more frequent feedback. The RD method allowed measurement of the effectiveness of an intervention that was delivered as part of normal business, without a randomized trial.
A smart decision: smartphone use for operative data collection in arthroscopic shoulder instability surgery
Authors: Mohr Jill , Strnad Gregory J , Farrow Lutul , Heinlein Kate , Hettrich Carolyn M , Jones Morgan H , Miniaci Anthony , Ricchetti Eric , Rosneck James , Schickendantz Mark , Saluan Paul , Vega Jose F , Spindler Kurt P
Published: May 2019

Objective

This study tested validity, accuracy, and efficiency of the Orthopaedic Minimal Data Set Episode of Care (OME) compared with traditional operative report in arthroscopic surgery for shoulder instability. As of November 2017, OME had successfully captured baseline data on 97% of 18 700 eligible cases.

Materials and Methods

This study analyzes 100 cases entered into OME through smartphones by 12 surgeons at an institution from February to October 2015. A blinded reviewer extracted the same variables from operative report into a separate database. Completion rates and agreement were compared. They were assessed using raw percentages and McNemar’s test (with continuity correction). Agreement between nominal variables was assessed by unweighted Cohen’s kappa and a concordance correlation coefficient measured agreement between continuous variables. Efficiency was assessed by median time to complete.

Results

Of 37 variables, OME demonstrated equal or higher completion rates for all but 1 and had significantly higher capture rates for 49% (n = 18; P < .05). Of 33 nominal variables, raw proportional agreement was ≥0.90 for 76% (n = 25). Raw proportional agreement was perfect for 15% (n = 5); no agreement statistic could be calculated due to a single variable in operative note and OME. Calculated agreement statistic was substantial or better (κ > 0.61) for 51% (n = 17) for the 33 nominal variables. All continuous variables assessed (n = 4) demonstrated poor agreement (concordance correlation coefficient <0.90). Median time for completing OME was 103.5 (interquartile range, 80.5-151) seconds.

Conclusions

The OME smartphone data capture system routinely captured more data than operative report and demonstrated acceptable agreement for nearly all nominal variables, yet took <2 minutes to complete on average.
American Bias in Global Security Studies Data
Authors: Colgan Jeff D
Published: May 2019

Three major datasets contain problematic interpretative judgments, arguably biased toward the United States: the Polity dataset; Reiter and Stam's data on war outcomes; and Singh and Way's data on nuclear proliferation. These examples raise the possibility that important datasets in global security studies, and in political science more generally, are systematically affected by an American bias. Bias means that, non-Americans might code the same observations differently, on average. The issue arises because Americans, on average, seem to have certain predispositions that non-Americans, on average, do not have. Other nationalities have their own predispositions. I also demonstrate that each of the three empirical examples has significant implications for causal inferences, altering certain statistical findings based upon them. For instance, I reexamine Haber and Menaldo's study of the resource curse, showing that alternative data coding casts substantial doubt on their inferences.
American Perspectives and Blind Spots on World Politics
Authors: Colgan Jeff D
Published: May 2019

Scholars of international relations (IR) from the United States, like any country, view the world with particular perspectives and beliefs that shape their perceptions, judgments, and worldviews. These perspectives have the potential to affect the answers to a host of important questions—in part by shaping the questions that get asked in the first place. All scholars are potentially affected by national bias, but American bias matters more than others. This special issue focuses on two issues: attention and accuracy in IR research. While previous scholarship has raised principally normative or theoretical concerns about American dominance in IR, our work is heavily empirical and engages directly with the field's mainstream neopositivist approach. The collected articles provide specific, fine-grained examples of how American perspectives matter for IR, using evidence from survey experiments, quantitative datasets, and more. Our evidence suggests that American perspectives, left unexamined, negatively affect our field's research. Still, the essays in this special issue remain bullish about the field's neopositivist project overall. We also offer concrete steps for taking on the problems we identify, and improving our field's scholarship.
Factual survey of the clinical use of deformable image registration software for radiotherapy in Japan
Authors: Kadoya Noriyuki , Kito Satoshi , Kurooka Masahiko , Saito Masahide , Takemura Akihiro , Tohyama Naoki , Tominaga Masahide , Nakajima Yujiro , Fujita Yukio , Miyabe Yuki
Published: May 2019

Deformable image registration (DIR) has recently become commercially available in the field of radiotherapy. However, there was no detailed information regarding the use of DIR software at each medical institution. Thus, in this study, we surveyed the status of the clinical use of DIR software for radiotherapy in Japan. The Japan Society of Medical Physics and the Japanese Society for Radiation Oncology mailing lists were used to announce this survey. The questionnaire was created by investigators working under the research grant of the Japanese Society for Radiation Oncology (2017–2018) and intended for the collection of information regarding the use of DIR in radiotherapy. The survey was completed by 161 institutions in Japan. The survey results showed that dose accumulation was the most frequent purpose for which DIR was used in clinical practice (73%). Various commissioning methods were performed, although they were not standardized. Qualitative evaluation with actual patient images was the most commonly used method (28%), although 30% of the total number of responses (42% of institutions) reported that they do not perform commissioning. We surveyed the current status of clinical use of DIR software for radiotherapy in Japan for the first time. Our results indicated that a certain number of institutions used DIR software for clinical practice, and various commissioning methods were performed, although they were not standardized. Taken together, these findings highlight the need for a technically unified approach for commissioning and quality assurance for the use of DIR software in Japan.
Imperial Rejuvenations: Youth, Empire, and the Problem of Accelerated Aging in “Tropical” Colonies, ca. 1800–1914
Authors: Pomfret David M
Published: May 2019

In recent years scholars have argued that “rejuvenation” took distinctively modern forms as a specific set of surgical procedures intended to realize sexual potency and libidinal enhancement, as well as anti-aging medicine and cosmetic body projects. However, this article underlines the earlier, imperial dimensions of rejuvenation as a set of modern, state-sponsored practices taking shape outside Europe. An important turning point in the modern history of rejuvenation was a shift around 1830 in thinking about “the tropics,” as scientists who identified heat as accelerating the process of aging rejected the possibility of acclimatization in hot zones. Because racial vitality supposedly diminished more quickly in the tropics, the older ideal of the grizzled, mature colonial soldier fell into decline, and rethinking the globe in racial-climatological terms made youth an essential corequisite of empire. Military commanders confronted the need to rejuvenate armies by recruiting soldiers at younger ages. Together with medical experts, they responded to fears of racial-climatological impotence by developing a range of strategies—from troop rotation to the development of hill stations—which scaled up rejuvenation to the level of entire population groups. Focusing on strategies elaborated in Asia to address this problem, this article shows how ideas about youth, time, geography, and modernity gave rise to spaces and networks designed to slow or reverse the aging process, or in other words to achieve “imperial rejuvenation” well before rejuvenation became a buzzword in late nineteenth-century Europe.
Prosecuting Procurement in the Russian Empire
Authors: Hearne Siobhán
Published: May 2019

Concern about the issue of forced prostitution reached its height in the Russian empire (as elsewhere in Europe and the Americas) at the turn of the twentieth century, as part of the wider international “white slave” panic. In 1909, new antiprocurement statutes were incorporated into the Russian empire’s Criminal Code to ensure that those who forced, coerced, or encouraged young women to enter the commercial sex industry felt the full force of the law. This article uses a case study of the Russian empire’s Estonian provinces (Estliand and Lifliand) to highlight the regional nature of Russian imperial experience. Prosecuting procurement was aligned with the priorities of local government, and the authorities in Revel’ (Tallinn) and Iu’rev (Tartu) used the issue of procurement to bolster their revenue. Here, the statutes gave the authorities additional tools for targeting individuals, such as managers of unlicensed brothels, who deprived the government of the income it generated from regulating the commercial sex industry. Drawing on court cases from the early 1910s, this article also examines the interaction of lower-class people with the state, their engagement with the legal system, their knowledge of the law, and the rhetorical strategies they employed to in their attempts to secure specific outcomes.
Introduction
Authors: Nicholson Nigel , Selden Nathan R.
Published: May 2019

The Introduction explores how the study of ancient Greek medicine can be of help to modern medical practitioners and other professionals as well as patients in navigating the complex arena of personal health and contemporary medical care. A history that focuses on scientific advances is rejected in favor of a history that focuses on issues of rhetoric, including professionalism, training, self-definition, and social standing. These issues can be accessed through the study of ancient statuary, monuments, poetry, and other writings. While ancient and modern medicine share a variety of elements and attitudes, they are also different in significant ways, meaning that the medicine of the late archaic Greek period will appear strange as well as familiar to modern observers. The introduction also provides a preview of each of the coming chapters and how they contribute to a broader and deeper understanding of the rhetoric of medicine and its practice in the modern world.
Body
Authors: Nicholson Nigel , Selden Nathan R.
Published: May 2019

Chapter 1 explores different conceptions of the human body and their effect on medical care and patient health. Ancient Greek texts offer opposed conceptions of the body, with athletic sources presenting the body as immune to injury and always operating at its full potential and the Hippocratic texts presenting it as weak and highly vulnerable. Similarly divergent narratives also affect modern evaluations of the body by both patients and physicians, interfering with positive health outcomes. Physicians must recognize the operation of these narratives, challenge them with data, and promote a more realistic vision of health and success for patients and healthcare organizations.
Money
Authors: Nicholson Nigel , Selden Nathan R.
Published: May 2019

Chapter 2 explores the commoditization of healthcare and how the intrusion of money into the relationship between physician and patient undermines trust in the physician. One of Pindar’s odes links a physician’s receipt of payment to a lack of connection to the patient and a failure to observe moral principles. The same distrust accompanies the circulation of money within the medical profession. A renewed focus on patient care offers one answer to this problem, although this approach creates challenges for proceduralists whose relationship to the patient is often brief. Regulatory efforts to bolster physicians’ relationships to their patients may not be as effective as promoting humanistic ideals.
Autosomal Dominant Optic Atrophy
Authors: Thurtell Matthew J. , Tomsak Robert L.
Published: May 2019

There is a broad differential diagnosis for bilateral optic neuropathies, including inflammatory, ischemic, compressive, traumatic, nutritional, toxic, and inherited causes. In this chapter, we begin by discussing the approach to the patient who has bilateral symmetric optic neuropathies. We next review the genetic basis, clinical features, and natural history of autosomal dominant optic atrophy. We list other deficits that can occur in up to 20% of patients with this condition, which can include sensorineural hearing loss, ataxia, myopathy, peripheral neuropathy, spastic paraparesis, and chronic progressive external ophthalmoplegia. Lastly, we discuss the evaluation and management approach for autosomal dominant optic atrophy.
Neuroretinitis
Authors: Thurtell Matthew J. , Tomsak Robert L.
Published: May 2019

Neuroretinitis is an inflammatory condition that results in acute painless monocular vision loss. It is characterized by unilateral optic disc edema with fluid extending from the peripapillary region into the macula. As the fluid resorbs, retinal exudates develop in a stellate configuration to produce a characteristic macular star. In this chapter, we begin by reviewing the clinical features of neuroretinitis. We next discuss potential causes of neuroretinitis, which includes infections (e.g., cat-scratch disease) and inflammatory disorders (e.g., sarcoidosis). We then discuss the laboratory workup of neuroretinitis. Lastly, we review the management options for neuroretinitis and factors influencing the prognosis for visual recovery.
Idiopathic Intracranial Hypertension
Authors: Thurtell Matthew J. , Tomsak Robert L.
Published: May 2019

Idiopathic intracranial hypertension is a syndrome of increased intracranial pressure of unknown cause that most often occurs in obese women of childbearing age, although it can also occur in children, men, and older adults. Papilledema is usually present and can cause irreversible vision loss if left untreated. In this chapter, we begin by reviewing the symptoms of this condition, which include headache, transient visual obscurations, and pulse-synchronous tinnitus. We next review the clinical signs and common findings on formal visual field testing. We then discuss the diagnostic evaluation and review the diagnostic criteria for this condition. Lastly, we review the goals and management of this condition, which must be tailored depending on the severity of symptoms, papilledema, and vision loss.
Homonymous Hemianopia
Authors: Thurtell Matthew J. , Tomsak Robert L.
Published: May 2019

Homonymous hemianopia is caused by unilateral lesions involving the retrochiasmal visual pathways or primary visual cortex. Common causes of homonymous hemianopia include stroke, tumor, and trauma. In this chapter, we begin by reviewing the clinical features that can help to localize the lesion and determine its cause. We next discuss the diagnostic evaluation of homonymous hemianopia, emphasizing the importance of formal visual field testing. We list causes of homonymous hemianopia that produce minimal or no abnormalities on neuroimaging, which include migraine, seizures, encephalopathies, and neurodegenerative disorders. Lastly, we discuss the implications of homonymous hemianopia for driving and strategies for rehabilitation.
Visual Auras, Hallucinations, and Illusions
Authors: Thurtell Matthew J. , Tomsak Robert L.
Published: May 2019

Visual hallucinations are perceptions that occur in the absence of a corresponding external visual stimulus, whereas visual illusions are misinterpretations of an external visual stimulus. Migraine visual aura is a common cause of transient visual hallucinations. Similar symptoms can occur in patients who have occipital lesions or as a manifestation of occipital seizures. In this chapter, we begin by reviewing the common causes of visual hallucinations and illusions. We next review the clinical features of migraine visual aura and discuss the approach to the patient who has aura without a subsequent migraine headache. We then review features that help to distinguish aura from retinal migraine and occipital seizures. Lastly, we discuss the management approach for migraine with aura.
Nonorganic Vision Loss
Authors: Thurtell Matthew J. , Tomsak Robert L.
Published: May 2019

Nonorganic vision loss is common but can be challenging to diagnose and treat. In this chapter, we begin by reviewing the clinical features that suggest nonorganic vision loss. We next describe the maneuvers that can be used to demonstrate intact visual function in the patient who reports decreased visual acuity in one or both eyes. We then describe strategies to evaluate the patient who has visual field constriction. We describe the features that help to distinguish organic visual field constriction from nonorganic visual field constriction. Lastly, we discuss the management approach, which includes reassuring the patient that there is no evidence of permanent damage to the visual system and a good prognosis for spontaneous recovery.
Third Nerve Palsy
Authors: Thurtell Matthew J. , Tomsak Robert L.
Published: May 2019

Acute painful pupil-involving third nerve palsy requires urgent investigation because it can be due to third nerve compression by a rapidly enlarging aneurysm of the posterior communicating artery. In this chapter, we begin by reviewing the clinical features of third nerve palsy. We next review the common causes of isolated third nerve palsy, which include microvascular ischemia, trauma, compression by neoplasm, and compression by aneurysm. We then discuss the workup of third nerve palsy and review the vascular imaging options to evaluate for aneurysm. Lastly, we discuss the management approach for third nerve palsy due to aneurysmal compression and microvascular ischemia.
Sixth Nerve Palsy
Authors: Thurtell Matthew J. , Tomsak Robert L.
Published: May 2019

Binocular horizontal diplopia with a unilateral abduction deficit is often due to sixth nerve palsy. However, it can also be caused by other conditions, such as medial rectus muscle restriction in thyroid eye disease. In this chapter, we begin by reviewing the differential diagnosis of an abduction deficit. We next list the common causes of an isolated unilateral sixth nerve palsy and bilateral sixth nerve palsy. We then discuss our approach to neuroimaging for sixth nerve palsy, as this remains a controversial topic. Lastly, we discuss the prognosis and management of sixth nerve palsy, with a focus on sixth nerve palsy due to microvascular ischemia.
Ocular Myasthenia
Authors: Thurtell Matthew J. , Tomsak Robert L.
Published: May 2019

Ocular myasthenia typically causes intermittent or fluctuating ptosis and diplopia yet can be difficult to diagnose definitively. In this chapter, we begin by reviewing the symptoms and signs of ocular myasthenia. We next discuss the laboratory workup for antibodies that are associated with ocular myasthenia and describe bedside tests that can helpful for confirming the diagnosis. We then discuss electrophysiology testing that can be helpful, including repetitive nerve stimulation testing and single-fiber electromyography. Lastly we review the management options for ocular myasthenia, which include symptomatic treatments (such as pyridostigmine), immunosuppression (such as corticosteroids and steroid-sparing agents), and surgical treatments (such as eyelid and strabismus surgery).
Supranuclear Ophthalmoplegia
Authors: Thurtell Matthew J. , Tomsak Robert L.
Published: May 2019

Supranuclear ophthalmoplegia results from an interruption of the saccadic, pursuit, optokinetic, or vergence inputs to the ocular motor nuclei. In this chapter, we begin by reviewing potential causes for difficulty reading. We next review the neuro-ophthalmic and neurologic features of progressive supranuclear palsy, which can include a vertical supranuclear ophthalmoplegia, convergence insufficiency, square-wave jerks, upper-eyelid retraction, reduced blink rate, apraxia of eyelid opening, and blepharospasm. We then discuss the differential diagnosis of progressive supranuclear palsy and point out clinical features that help to differentiate these conditions. Lastly, we present a practical approach to the management of the visual symptoms commonly caused by progressive supranuclear palsy.
Upbeat Nystagmus
Authors: Thurtell Matthew J. , Tomsak Robert L.
Published: May 2019

Upbeat nystagmus is a less common type of central vestibular nystagmus that is often transient. It is a vertical jerk-waveform nystagmus with downward slow phases and upward quick phases. In this chapter, we begin by reviewing the clinical features of upbeat nystagmus. Since it can be produced by lesions in a variety locations in the brainstem and cerebellum, we next describe the symptoms and signs that can help to localize the causative lesion. We list the causes of upbeat nystagmus. We then discuss the clinical and imaging findings in Wernicke encephalopathy, which is a common cause of upbeat nystagmus, and we review the management of Wernicke encephalopathy. Lastly, we briefly discuss the medical treatment options for persistent upbeat nystagmus.
Thyroid Eye Disease
Authors: Thurtell Matthew J. , Tomsak Robert L.
Published: May 2019

Thyroid eye disease is the most common cause of orbital disease encountered in clinical practice. It most often occurs in patients with Graves disease, but can also occur in the absence of thyroid dysfunction. In this chapter, we begin by reviewing the clinical features and natural history of thyroid eye disease. We next discuss the diagnostic evaluation of thyroid eye disease, including the roles of imaging and visual field testing. We then briefly review the differential diagnosis, which includes idiopathic orbital inflammation, orbital cellulitis, and carotid-cavernous fistula. Lastly, we discuss the management approach for thyroid eye disease. Many patients have only mild disease and can be managed with supportive treatments, such as artificial tears, prisms, and selenium supplementation. However, patients with moderate to severe thyroid eye disease often require more aggressive treatments, such as immunosuppression with systemic corticosteroids, orbital irradiation, and orbital decompression surgery.
Dorsal Midbrain Syndrome
Authors: Thurtell Matthew J. , Tomsak Robert L.
Published: May 2019

Lesions of the dorsal midbrain produce a characteristic and highly localizing constellation of neuro-ophthalmic signs, which is known as the dorsal midbrain syndrome. In this chapter, we begin by summarizing the clinical features of the dorsal midbrain syndrome, which include supranuclear vertical gaze palsy, skew deviation, convergence insufficiency, convergence-retraction nystagmus, upper-eyelid retraction, and light-near dissociation of the pupils. We then list common causes of the dorsal midbrain syndrome, which include hydrocephalus, shunt malfunction, stroke, intrinsic brainstem tumors, and compression by extrinsic tumors, such as pineal and third ventricular tumors. Lastly, we discuss the neuro-ophthalmic features, diagnostic evaluation, and management of ventriculoperitoneal shunt malfunction.
Family Caregiving as a Problematic Category
Authors: Chin Jacqueline
Published: May 2019

This is a composite case description developed with health and social care workers grappling with Singapore’s growing chronic disease burden. The case focuses on (a) a typical household with a typical housing arrangement in Singapore, the HDB flat; (b) a care plan consistent with healthcare staffing policies for an aging population, which relies heavily on foreign domestic workers to support frail older people with dependency for activities of daily living at home when family caregivers have left home or are in the workforce; (c) a common age-related chronic condition and its particular care requirements; and (d) care at home that typifies “aging in place” in accordance with healthcare planning policy.
Family Centeredness as Resource and Complication in Outpatient Care with Weak Adherence, Using Adolescent Diabetes Care as a Case in Point
Authors: Herlitz Anders , Munthe Christian
Published: May 2019

This case study illustrates how family members can assist in the care of teenagers with diabetes but that there are also serious risks actualized by such involvement. In particular, it highlights ethical complications that arise when the role of a family member is changed from ‘parent’ to ‘care provider’. The ‘counseling, self-care, adherence’ (CSA) approach offers a look at the role that family can play to improve these types of care.
Justice, Intimacy, and Autonomy
Authors: Lindemann Nelson Jamie , Woods Simon
Published: May 2019

The aim of this chapter is both (1) to provide an overview of the tensions among various specifications of justice and practices characteristic of families and (2) to explore in greater detail the sites where those tensions erupt into conspicuous problems. The overall goal is to get a firmer grasp on how justice bears on both relationships within families and relationships between families and what is clearly a significant social institution, healthcare. We consider how distributive, contributive, restorative, epistemic, and recognitional justice operate in families, and how these concepts are complicated by the patterns of intimacy that characterize many families.
Clostridioides difficile and Norovirus
Authors: Sandora Thomas J.
Published: May 2019

Clostridioides difficile and norovirus are common causes of healthcare-associated gastroenteritis and both organisms cause outbreaks in pediatric healthcare settings. The spores are resistant to routine environmental cleaning with detergents and can survive in the environment for months. C. difficile can easily be transmitted on the hands of healthcare workers, either from direct patient care activities or through contact with a contaminated environment. Norovirus is highly contagious, with an estimated infectious dose as low as 18 viral particles. Transmission occurs either person-to-person or through ingestion of contaminated food and water. This chapter outlines strategies to prevent transmission of healthcare-associated C. difficile and norovirus infections. It includes recommendations for surveillance, isolation, hand hygiene, environmental cleaning and removal of isolation precautions. Diagnostic methods are reviewed, highlighting the challenge of distinguishing between colonization and clinically significant C. difficile infection in young children.
Infection Prevention in Ambulatory and Emergency Department Settings
Authors: Linam W. Matthew , Honeycutt Michele D. , Vijayan Vini
Published: May 2019

Children receive care in a variety of outpatient settings, including ambulatory clinics, urgent care clinics, emergency departments, and ambulatory surgery centers. In general, the same infection prevention principles used in inpatient settings apply in ambulatory settings, but these locations also present unique challenges. This chapter provides infection prevention guidance in the ambulatory and emergency department settings, focusing on pediatric-specific issues in these healthcare settings. Basic infrastructure and processes needed to prevent HAIs in pediatric outpatient settings are outlined and strategies for implementation are reviewed. The use of standard precautions is emphasized. Specific guidance is described for the care of patients with cystic fibrosis.
The Moral Agency of Abortion Providers
Authors: Harris Lisa
Published: May 2019

Until very recently, only negative claims of conscience related to abortion provision were recognized; that is, conscience-based refusal to provide abortion care was recognized but conscience-based provision was not. In fact, to the contrary, abortion providers were and are routinely stigmatized as being devoid of conscience or moral principles. This chapter takes up the moral agency of abortion providers. It deepens understanding of the concept of conscientious provision and considers the intersection of stigma and conscience claims. In addition to stigma, deep social polarization on abortion prevents abortion providers from feeling that they can safely and freely speak about their work. This means that the lived experiences of abortion providers, including their openness to the moral ambiguities and complexities of abortion, remain hidden. Ultimately the chapter suggests that abortion providers’ capacities to live in contested arenas, to see the complexities of abortion, and to hold a “tension of opposites” are a manifestation of deep moral engagement, a potential path out of our current polarized state, and a model for civic engagement on any number of issues.
Women with Disabilities
Authors: Francis Leslie , Silvers Anita , Badesch Brittany
Published: May 2019

Women with disabilities face challenges related to their disabilities of access and accommodation for infertility care. This chapter explores the societal and structural barriers to infertility care these women experience, including legal issues, training and attitudes of physicians, ability to pay, lack of adaptive equipment, inexperience of providers in treating these patient populations, and lack of access to health insurance coverage for infertility care. Ethical arguments respond to providers’ concerns about offering reproductive care to women with disabilities, including concerns about physician competence, physician choice, risks to the woman, inability to consent, risks to any offspring, conscientious objection, and ability to pay. It concludes that there is at best limited and partial justification for many of these concerns, especially in the context of background injustice. The chapter ends with an account of reasonable modifications and accommodations to allow women with disabilities to enjoy reproductive services on equal terms with other women.
Healthcare and the Electronic Health Record
Authors: Misulis Karl E. , Frisse Mark E.
Published: May 2019

The cornerstone of clinical informatics is the Electronic Health Record. This is more than an electronic version of the paper medical record. The use of the electronic record is for more than point-of-care healthcare but rather includes analytics, gap analysis, decision support, and related purposes that would be almost impossible in a paper world. The electronic health record is the present preferred term for the digital systems that coordinate healthcare information. The term electronic medical record was used more prominently in the past. The chapter looks at the transition in this terminology and examines the future move to the personal health record. A case scenario is presented regarding use of the electronic health record system. The future of the system is examined.
Data Repositories
Authors: Misulis Karl E. , Frisse Mark E.
Published: May 2019

Data repositories are dynamic systems for storing, organizing, and retrieving clinical and administrative data. These repositories are used to support clinical care and clinical administration. Data may be retained in several data warehouses and data marts to support care, analysis, decision support, and process improvement and for a range of other purposes. This chapter focuses on data storage, retrieval, and database queries. The term database in the context presented in this chapter means the entirety of the data storage and retrieval system. This includes the physical data storage and the database management system. Data warehouses are secondary databases, meaning that they are not directly populated by data from the healthcare providers. A data mart is similar to a data warehouse but with a restricted focus, typically on a single issue.
Decision-Making
Authors: Misulis Karl E. , Frisse Mark E.
Published: May 2019

Decision-making consists of the logical application of information. Human decision-making and computer-based decision-making are different. Human decision-making relies on nuances and impressions that are not represented in recorded data, and they are subject to behavioral and other factors not represented in the sterile logic of computer algorithms. Computers are capable of analyzing large data collections, ensuring that important data are not overlooked, reacting instantly to critical events, and operating in ways that ensure consistent processes. Computers therefore assist in decision-making but rarely substitute for human judgment. This chapter concerns the logical aspects of decision-making, including statistics and logic theory.
Access and Access Controls
Authors: Misulis Karl E. , Frisse Mark E.
Published: May 2019

Evolution of healthcare systems and the constantly changing regulatory landscape continuously alter all facets of health information technology including access. Access to information systems must be controlled in order to protect privacy and confidentiality. Access systems must be flexible enough to be applicable regardless of device and location. While access must be secure, it cannot obstruct the efficient care of patients. Access controls depend on position because privileges and permissions depend on position. These controls are the method of enforcing authorization through mechanisms and policies. This chapter discusses some of the mechanisms of controlling access. Also discussed are some practical considerations for client and device strategy.
Security and Privacy
Authors: Misulis Karl E. , Frisse Mark E.
Published: May 2019

Security and privacy must be maintained in an information-rich environment. While information availability needs to be ensured, appropriate access also must be ensured. The complexity of this task is heightened in the presence of greater data sharing. Informatics professionals need a detailed understanding of security and privacy regulations and methods. Security and privacy have been extensively addressed in guidelines and regulations and are pivotal to the electronic health record (EHR). Informatics professionals should be familiar with security and privacy implications, especially those of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Meaningful Use programs, although these are not the limits of regulatory involvement or best practices regarding these issues. Among the issues commonly dealt with are data breaches: unauthorized access to protected health information. Mechanisms and implications are discussed.
Enabling Technologies
Authors: Misulis Karl E. , Frisse Mark E.
Published: May 2019

Enabling technologies are products and processes that complement more established techniques based on the electronic health record by broadening and easing the process of data collection. Often, these technologies are used to provide more effective means of communication among patients and providers, collect data from home and body sensors, and store data in more accessible ways, all seeking to improve the process or performance of our healthcare system. These include a host of devices and processes that connect providers, connect patients to providers, and add data outside the healthcare enterprise to the personal health record. This has the promise of further improving healthcare.
Patients and Families
Authors: Misulis Karl E. , Frisse Mark E.
Published: May 2019

Patients and families become part of the healthcare team in part by having a communication strategy between the healthcare system, patient, family, and community. In many instances, historical practices employing the telephone and conventional mail correspondence are not adequate for complex and rapidly changing care needs. Electronic health records, home healthcare records, other clinical systems, and consumer devices such as cell phones and other mobile devices are being adopted by patients and families to gain greater control over their care. Communication methods are changing. Advances in social communication are being applied to medical communication. Also, availability of online information has exploded, with some benefits and some detriments. Many patients and families are surprised to learn that websites and even mainstream press are not peer reviewed.
Preoperative Evaluation of the Cardiac Surgical Patient
Authors: Gerlach Rebecca M.
Published: May 2019

Patients undergoing cardiac surgery are at elevated risk for perioperative complications; however, certain risk factors may be modifiable. Preoperative evaluation performed in advance of surgery provides an opportunity for the perioperative anesthesiologist to intervene to reduce risk. Performing a focused history and physical examination informs the selection of appropriate preoperative tests. Risk assessment via tools specific to cardiac surgery provide a detailed risk profile. Certain diseases common to cardiac surgical patients deserve particular focus during assessment. Poorly controlled diabetes mellitus and resultant hyperglycemia are modifiable risk factors. Undiagnosed obstructive sleep apnea is common and associated with postoperative complications. Concurrent carotid artery disease presents a management conundrum requiring multidisciplinary planning. Preoperative anemia is common; when due to iron deficiency, it is easily treated to improve outcomes. In addition to gathering information about the patient, the goal of preoperative evaluation is to identify ways to reduce risk and improve outcome from surgery in a resource-efficient manner.
Cardiac Tumors
Authors: Kozarek Katherine , Hood Ryan
Published: May 2019

Cardiac tumors are rarely encountered in clinical practice; however, because they affect vital structures, they can have significant consequences. Cardiac tumors are categorized as either primary tumors originating from cardiac tissue or metastatic tumors migrated from other sites; they may infiltrate the atria, ventricles, valves, and coronary arteries, resulting in considerable changes to normal physiology. They may extend beyond the myocardium to the pericardium, great vessels, and mediastinum. Advances in the development of imaging modalities have allowed for expedited diagnostic evaluation of cardiac tumors. Prompt treatment, which often includes surgical intervention, is essential to both alleviate symptoms and prevent harmful sequelae. The intraoperative anesthetic management of a patient with a cardiac mass presents a number of challenges due to altered cardiovascular physiology. Because these tumors occur so infrequently, standardized, evidence-based diagnostic and treatment guidelines have not been developed. The existing data were derived mainly from small case series and case reports. The aggressive nature of the disease warrants further investigation to improve the accuracy of diagnostic modalities and the efficacy of treatment regimens.
Air Embolism on Cardiopulmonary Bypass
Authors: Hudson Aaron , Hood Ryan
Published: May 2019

The danger associated with air embolism in cardiac surgery has been well established for over 125 years. In the first volume of Annals of Surgery, published in 1885, long preceding the era of cardiac surgery and the use of extracorporeal circulatory techniques, Dr. Nicholas Senn alluded to the ensuing calamity caused by air embolism: “I intend on this occasion to call your attention to one of the most dreaded and, I may add, one of the most uncontrollable causes of sudden death—I allude to air-embolism.”1,2 Since the advent of modern cardiac surgery, much attention has been focused on the prevention of air embolism by cardiac surgeons, anesthesiologists, and perfusionists alike. Indeed, all three team members are critically responsible for the safe conduct of thousands of cardiac surgical procedures occurring on a daily basis worldwide. While the morbidity and mortality of massive air embolism is exceedingly high, most believe that with appropriate training and unwavering vigilance during clinical practice, almost all massive air emboli can be prevented.3
Cardiac Implantable Electronic Device Lead Extractions
Authors: Fitzmartin Kevin , Kacha Aalok
Published: May 2019

Cardiac implantable electronic devices (CIEDs) are used for an increasing range of indications. With a broader range of indications, CIEDs are being implanted in increasing numbers. They are being used in older patients as well as patients with more comorbidities. As expected with these trends, the need for device extraction for a variety of reasons has steadily grown as well. These leads can often be removed via simple traction, but other techniques have been developed for circumstances where removal is more complex. To perform this procedure safely, a team-based approach is required, as is the ability to anticipate consequences of complications for each of the different methods of removal. A gold standard method has not been identified for transvenous lead extraction, but rather one has a toolbox of methods at their disposal. In this chapter, indications for lead removal, extraction techniques and devices, as well as potential complications are reviewed.
Minimally Invasive Esophagectomy
Authors: Merling Brandon , Dupont Frank
Published: May 2019

Esophageal cancer is the eighth most common malignancy worldwide, producing a high morbidity and mortality rate around the globe. Minimally invasive esophagectomy (MIE) is most commonly performed on patients with this devastating disease. Esophagectomy is a high-risk procedure, and perioperative mortality remains around 5%–8%. Because esophageal cancer is associated with chronic alcohol and tobacco use, patients have serious comorbid conditions that affect anesthetic management and perioperative care. Among them, pulmonary complications and anastomotic failure remain the most common causes of perioperative morbidity and mortality. The anesthesiologist managing a patient during MIE must be able to reduce the effect of the patient’s multiple comorbidities intraoperatively while mitigating the factors that lead to adverse postoperative outcomes.
Anesthesia for Lung Transplantation
Authors: Roberts J. Devin
Published: May 2019

Since the first human procedure in 1963, lung transplantation has become the gold standard treatment of a variety of end-stage lung diseases. With over 4000 lung transplants performed in 2015 and steadily improving survival rates over the past three decades, anesthetic management of patients undergoing lung transplant can significantly contribute to patient outcomes. Anesthesia care for lung transplantation can be both complex and clinically challenging. Anesthesiologists taking part in these procedures need to have specific skills regarding thoracic and cardiac anesthesia. There are both technical and physiological challenges, such as achieving adequate lung isolation and oxygenation, interpretation and use of transesophageal echocardiography, and the management of respiratory and myocardial impairments. This chapter provides an overview of these perioperative anesthetic management considerations utilizing a problem-based format.
High-dose therapy (autologous transplant)
Authors: Eyre Toby
Published: May 2019

This chapter covers the principles of high-dose therapy, or autologous transplant. This includes stem cell priming, collection, and storage, as well as conditioning regimens used to prepare the autologous transplant recipient. Common indications for its use are explored, including myeloma, Hodgkin's disease, and non-Hodgkin's lymphoma. The chapter also covers links to common side effects, including mucositis and bone marrow suppression.
Bone marrow suppression
Authors: Eyre Toby
Published: May 2019

This chapter explores the main clinical problems that arise from bone marrow suppression and discusses, in turn, the nursing actions required to manage each of these. It briefly desribes the role of each of the main blood cell lines. It then explores anaemia management, summarizing common causes of anaemia, the symptomatic impact, and their management. Neutropenia is looked at in detail, with a focus on risk factors for infection, prevention of infection, and understanding early warning signs. The main focus is on management of febrile neutropenia and septic shock and the need for early intervention and support. The final section of the chapter looks at bleeding, covering the common causes of bleeding in patients with cancer. Management of thrombocytopenia is covered, along with management of terminal haemorrhage.
Sexuality and cancer
Authors: Taylor Bridget
Published: May 2019

Sexuality is unique to each person and includes physical, psychological, social, and cultural factors that influence sexual values, beliefs,, and behaviour. Cancer and its treatments can disrupt many aspects of the sexual lives of patients. Lesbian, gay, bisexual or transgender people (LGBT) may have particular needs as a result of cancer and its treatment. Cancer causes changes to body image through amputation, scarring, hair loss, drug side effects, and weight changes. Patients can be prepared in advance by providing images of how appearance may change. After treatment, the partner of the patient, support groups, or professionals, including sexual counsellors, may help them through a period of adjustment. Sexual problems, like changes to physical sensation, pain, loss of sexual response and impotence, infertility, and loss of confidence and intimacy, may be associated with cancer treatments. There is a range of resources available to individuals and couples, including written and Internet-based information. Despite the effects of cancer and its treatment, many couples adjust by re-evaluating the place of sexual activity in their lives, and some couples report becoming closer as a result. Patients report that they want nurses to provide information and initiate conversations about sexuality. However, many nurses find this difficult. Important principles of working with a patient’s sexuality include: letting them know it is acceptable to talk about sexuality, treating it as an element of health and quality of life, providing information about the sexual problems associated with cancer, addressing problems that are raised, and finding sources of additional support.