bluuebunny/crossref_metadata_2025 huggingface dataset:
Enablers and barriers English secondary schools face in promoting healthy diet and physical activity behaviours
Authors: McHugh Camilla , Lloyd Jenny , Logan Stuart , Wyatt Katrina
Published: September 2021

This study sought to understand the current challenges mainstream secondary schools in England face in creating a health promoting school culture for diet and physical activity behaviours. An in-depth qualitative case study of two purposely selected state-funded schools, including interviews with teachers, observations of school activities including meal breaks and a qualitative survey with parents was done. Inductive thematic analysis was used to explore emerging themes. Additional interviews with the leadership team from four further schools were used to develop and refine emerging themes. Four main themes emerged from the data: competing pressures, school environment, personnel and policy. Results demonstrate that schools recognize they have role to play in promoting healthy lifestyle behaviours to pupils; however, several significant barriers were identified such as lack of government support and regulation, school structures and organization, focus on core subjects, business-run canteens and lack of family and community engagement. Given the importance of maintaining a healthy weight throughout the life course, schools have an important role to play in creating healthy environments in which students can easily make a healthy choice. Future school promotion initiatives need to consider addressing the barriers that schools face by working with them and the communities in which they are embedded.
Characteristics of Persons With Secondary Detection of Severe Acute Respiratory Syndrome Coronavirus 2 ≥90 days After First Detection, New Mexico 2020
Authors: Hicks Joseph T , Das Smita , Matanock Almea , Griego-Fisher Anastacia , Sosin Daniel
Published: September 2021

The New Mexico Department of Health (NMDOH) conducted a matched case-control study to compare 315 persons (cases) with and 945 persons (controls) without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) secondary detection (ie, positive SARS-CoV-2 test ≥90 days after first detection as of December 10, 2020). Compared with controls, cases had greater odds of higher SARS-CoV-2 testing frequency (adjusted odds ratio [aOR] = 1.2), being female (aOR = 1.6), being non-Hispanic American Indian/Alaska Native (aOR = 2.3), having diabetes mellitus (aOR = 1.8), and residing and/or working in detention and/or correctional facilities (aOR = 4.7). Diagnostic tools evaluating infectiousness at secondary detection are urgently needed to inform infection control practices.
The molecular basis for IL-31 production and IL-31-mediated itch transmission: from biology to drug development
Authors: Kunimura Kazufumi , Fukui Yoshinori
Published: September 2021

Atopic dermatitis (AD) is one of the most prevalent chronic inflammatory skin diseases in the world. It is characterized by recurrent eczematous lesions and intense itch, and many cytokines are involved in the pathogenesis of AD. Among them, much attention has been paid to interleukin 31 (IL-31) as an AD-associated itch mediator. IL-31 is mainly produced by CD4+ helper T cells and transmits the signals via a heterodimeric receptor composed of IL-31 receptor A (IL-31RA) and oncostatin M receptor (OSMR), both of which are expressed in dorsal root ganglion (DRG) neurons. However, the molecular mechanisms of how IL-31 is produced in helper T cells upon stimulation and transmits the itch sensation to the brain were largely unknown. Recently, by using original mouse models of AD, we have identified endothelial PAS domain 1 (EPAS1) and neurokinin B (NKB) as key molecules critical for IL-31 production and IL-31-mediated itch transmission, respectively. These molecules could be novel drug targets for AD-associated itch. This review highlights our recent findings, which show the functional significance of these molecules in the IL-31-induced itch sensation, referring to their application to drug development.
First case of imported Capillaria philippinensis in Israel
Authors: Kasher Carmel , Grossman Tamar , Vainer Julia , Yanovskay Anna , Okopnik Marina , Goldstein Lee Hilary , Schwartz Eli , Chazan Bibiana
Published: September 2021

This is the first case report of human Capillaria philippinensis imported from Thailand and diagnosed in Israel by PCR in biopsy material. Capillariasis can be fatal if untreated and should be suspected among returning travelers or foreign workers with protein-losing enteropathy and long standing diarrhea.
All-flesh fruit in tomato is controlled by reduced expression dosage ofAFFthrough a structural variant mutation in the promoter
Authors: Liu Lei , Zhang Kang , Bai Jinrui , Lu Jinghua , Lu Xiaoxiao , Hu Junling , Pan Chunyang , He Shumin , Yuan Jiale , Zhang Yiyue , Zhang Min , Guo Yanmei , Wang Xiaoxuan , Huang Zejun , Du Yongchen , Cheng Feng , Li Junming
Published: September 2021

The formation of locule gel is an important process in tomato and is a typical characteristic of berry fruit. In this study, we examined a natural tomato mutant that produces all-flesh fruit (AFF) in which the locule tissue remains in a solid state during fruit development. We constructed different genetic populations to fine-map the causal gene for this trait and identified SlMBP3 as the locus conferring the locule gel formation, which we rename as AFF. We determined the causal mutation as a 416-bp deletion in the promoter region of AFF, which reduces its expression dosage. Generally, this sequence is highly conserved among Solanaceae, as well as within the tomato germplasm. Using BC6 near-isogenic lines, we determined that the reduced expression dosage of AFF did not affect the normal development of seeds, whilst producing unique, non-liquefied locule tissue that was distinct from that of normal tomatoes in terms of metabolic components. Combined analysis using mRNA-seq and metabolomics indicated the importance of AFF in locule tissue liquefaction. Our findings provide insights into fruit-type differentiation in Solanaceae crops and also present the basis for future applications of AFF in tomato breeding programs.
Excoriation Disorder
Authors: Kim Hae-Joon , Luks Kelsey L. , Rabasco Ana , Jurska Justyna , Andover Margaret
Published: September 2021

Excoriation disorder, which is characterized by recurrent and impairing skin picking, has been included as a distinct diagnosis in the most recent version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The move to include excoriation disorder as a separate diagnosis in the DSM-5 was largely due to increasing awareness of its prevalence and the potential for significant impairment and distress. This chapter discusses the nature, clinical presentation, and potential etiological determinants of excoriation disorder. In addition to the nature of symptoms, contemporary approaches to assessment and treatment, including behavioral and pharmacological, are highlighted. The chapter concludes with a discussion of future directions for research.
Advances in Treating Obsessive-Compulsive Related Disorders Other than OCD?
Authors: Mathew Abel S. , Snorrason Ivar , Falkenstein Martha J. , Lee Han-Joo
Published: September 2021

The most recent version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders includes a new chapter on obsessive-compulsive and related disorders (OCRDs) that lists five main diagnoses: obsessive-compulsive disorder (OCD), hoarding disorder, body dysmorphic disorder, excoriation disorder (skin-picking disorder; SPD), and trichotillomania (hair-pulling disorder; HPD). While the latter two conditions share some characteristics with OCD, there are also important differences. This chapter reviews the clinical characteristics of SPD and HPD, presents cognitive-behavioral models of these disorders, provides an overview of core cognitive-behavioral therapy interventions and treatment packages, and reviews recent advances in the use of technology in the treatment of these conditions. The understanding and treatment of SPD and HPD represents a promising area of research with the hope of improving the lives of those who struggle with these debilitating disorders.
Community Mental Health Delivery
Authors: Shaw Ashley M. , Brown Renee L. , Ringle Vanesa A. Mora , Cobham Vanessa E.
Published: September 2021

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) is a modular, flexible intervention that has been applied in various community mental health settings by community clinicians to diverse adolescents across the United States and Australia. This chapter summarizes key adaptations that were commonly used by community clinicians across two effectiveness trials. For example, clinicians flexibly abbreviated the UP-A when they only had limited time with an adolescent. Many clinicians also referred to “module summary” outlines during their sessions to ensure they covered key take-home points. Lastly, the chapter summarizes intervention-level, clinician-level, and patient-level barriers for UP-A implementation in community settings and provides recommendations for clinicians, supervisors, and consultants about how to troubleshoot these barriers. Furthermore, the chapter describes the case of a community clinician who initially worried about deviating too far from UP-A content but was later able to flexibly apply the UP-A to her cases.
Evolution of the Palliative Team
Authors: Lookabaugh Britni , Gunten Charles von
Published: September 2021

Hospice and palliative care teams are inherently interdisciplinary to be able to assess and address all the domains of palliative care for patients with chronic, complex, and life-limiting illness. These domains include the physical, psychosocial, spiritual, and practical needs of patients and families, among others. The disciplines include, but are not limited to, physician, advanced practice provider, pharmacist, nurse, social worker, and chaplain, among others. Advanced practice providers are defined in the National Consensus Project Guidelines for Quality Palliative Care as physician assistants and advanced practice nurses utilized to expand the capacity of palliative care interdisciplinary teams to deliver complex care and provide direct care. The term advanced practice provider means either physician assistants or advanced practice nurses. The development of an interdisciplinary team in the midst of team and consult growth is essential to be able to provide high-quality palliative care. Team resilience should be supported and maintained as it is necessary to meet the high demand for specialty palliative care services throughout the care continuum.
Last Days and Hours of Life
Authors: Ackermann Richard
Published: September 2021

Most dying patients take a peaceful road to death, progressing from sleepiness to lethargy to coma to death, without substantial agitation. Although many dying patients experience fever, hypotension, and tachycardia, no combination of physical signs accurately predicts death. Noisy respiratory secretions should be prevented and treated by discontinuing artificial hydration and nutrition and by prescribing anticholinergic drugs such as glycopyrrolate or a scopolamine patch. Delirium at the end of life is not generally evaluated with blood tests or imaging but is treated with nonpharmacological measures or with haloperidol. Teach the family what to expect as death approaches. Be prepared with a systematic approach to declaring death and comforting families in the early stages of grief and bereavement.
Brains in bodies in the—social, built, and natural—environment
Authors: Arbib Michael A.
Published: September 2021

Each brain enlivens a body in interaction with the social and physical environment. Peter Zumthor’s Therme at Vals exemplifies the interplay of interior with surroundings, and ways the actions of users fuse with their multimodal experience. The action–perception cycle includes both practical and contemplative actions. The author analyzes what Louis Sullivan meant by “form ever follows function,” but more often talks of aesthetics and utility. Not only are action, perception, and emotion intertwined, but so are remembering and imagination. Architectural design leads to the physical construction of buildings—but much of what our brains achieve can be seen as a form of mental construction. A first look at neuroscience offers schema theory as a bridge from cognitive processes to neural circuitry. Some architects fear that neuroscience will strip the architect of any creativity. In counterpoint, two-way reduction explores how neuroscience can “dissect” phenomenology by showing how first-person experiences arise from melding diverse subconscious processes. This raises the possibility that neuroscience can extend the effectiveness of architectural design by showing how different aspects of a building may affect human experience in ways that are not apparent to self-reflection.
From libraries to wayfinding, waylosing, and symbolism
Authors: Arbib Michael A.
Published: September 2021

After demonstrating that a building is a system of systems, we examine the symbolism of certain libraries. A cognitive account of wayfinding uses the Seattle Public Library to analyze getting lost in buildings—which we contrast with waylosing as in exploration. Cognitive maps in the brain represent places and the means to find one’s way between them. Different “worlds” each have their own, modeled as a world graph (WG) with distinctive places represented by nodes, and paths represented by edges. Complementing this, a locometric map represents locomotor effort in getting from one place to another. Single-cell recording from rat hippocampus reveals place cells whose activity correlates with the place in which the animal finds itself. However, “place” here corresponds to location on a locometric map, rather than distinctive places of WG nodes. The taxon affordance model (TAM), models how one navigates without a cognitive map. Several brain regions are involved, but not hippocampus. The world graph model (WGM) makes essential use of the hippocampus in coordination with brain regions processing the relevant WG. Finally, we contrast symbolic form in buildings with the use of explicit signage. Oscar Niemeyer’s Brasilia Cathedral exemplifies how architects may achieve novel symbolic forms.
When buildings have “brains”
Authors: Arbib Michael A.
Published: September 2021

Neuromorphic architecture, buildings with “brains,” revisits Le Corbusier’s “a house is a machine for living in” in cybernetic terms. It relates to smart architecture and artificial intelligence and is informed by neuroethology. The interactive space Ada had sensors for vision, audition, and a sense of touch mediated by floor panels. Ada could use this information to interact with visitors. Ada had “emotions,” and this leads into analysis of how “emotion” in buildings and robots relates to the neuroscience of emotions. The chapter distinguishes the physical space of the building from the neural space that connects sensors and effectors to support homeostasis and social interaction between building and users. The example of a neuromorphic kitchen grounds discussion of how buildings may learn. Such buildings can be considered as inside-out robots or embrained bodies. Biophilia and the way humans flourish when they have a sense of community are exemplified in WOHA’s Kampung Admiralty project, which functions as a system of systems. After considering a building as a system of systems, one may assess which of those subsystems may be ripe for being cybernetically enabled.
The Language of Medicine
Authors: Fuks Abraham
Published: September 2021

The words that physicians use with patients have the power to heal or harm. The practice of medicine is shaped by the potent metaphors that are prevalent in clinical care, and military metaphors and the words of war bring with them unfortunate consequences for patients and physicians alike. Physicians who fight disease turn the patient into a passive battlefield. Patients are encouraged to remain stoic, blamed for “failing” chemotherapy and sadly remembered in heroic obituaries of lost battles. The search for disease as enemy shifts the doctor’s gaze to the computer and imaging technologies that render the patient transparent, unseen and unheard. Modern treatments save lives but patients can be the victims of collateral damage and friendly fire. In The Language of Medicine, Abraham Fuks, physician, medical educator and former Dean of Medicine, shows us how words are potent drugs that must be tailored to the individual patient and applied in carefully chosen and measured doses to offer benefits and avoid toxicity. The book shines a light on our culture that deprecates the skill of listening that is, paradoxically, the attribute that patients most desire of their doctors. Societal metronomes beat rapidly and compress clinic visits into stroboscopic encounters that leave patients puzzled, fearful and uncertain. Building on research about physicians in practice, the experiences of patients, stories of medical students as well as the history of medicine, Dr. Fuks promotes an ideal of clinical practice that is achieved by humble physicians who provide time and space for listening, select words with care, and choose metaphors that engender healing.
Things Get Rolling
Authors: Shorter Edward
Published: September 2021

The take-off of psychopharmacology in the mental-hospital world began in the vast asylum system of New York State in the early 1950s. Henry Brill ordered the state system to introduce chlorpromazine in 1955, which led to the first decrease in the census of the state asylum system in peacetime. Sidney Merlis and Herman Denber implemented chlorpromazine in their hospitals and, with Brill, began a series of publications on the drugs and their efficacy. Pharmacologist and psychiatrist Joel Elkes established the first department of experimental psychiatry in the world in 1951 at the University of Birmingham in England. Finally, the chapter examiunes the historical heft of the National Institute of Mental Health, which in 1953 opened the “intramural” (in-house) research program where much of the research in psychopharmacology done in the United States has occurred.
Science
Authors: Shorter Edward
Published: September 2021

There was a strong desire within psychopharmacology to find a firm scientific basis for the field, hoping to ensure that it was regarded as a science. This chapter explains how the pseudo-scientific proposition on drug efficacy has become the notion that patients are suffering from “chemical imbalances.” It also emphasizes the industry’s leaping on chemical imbalance from the very beginning, because it sounded so plausible and so scientific that patients could easily grasp it. The chapter refers to a 1976 ad for USV’s tricyclic antidepressant Pertofrane that promised higher norepinephrine levels through reuptake blockade. It explains how depressions are associated with an absolute or relative deficiency of catecholamines, particularly norepinephrine.
Trials
Authors: Shorter Edward
Published: September 2021

It is a great irony that none of the later drugs equaled those of the “golden years” of the 1950s, as though no subsequent generation of railway locomotives equaled the Iron Horse of the pioneers. Lithium remains the agent nonpareil for mood disorders but no subsequent “antidepressants” were ever the equal of imipramine and other tricyclics. The lack of progress in psychopharmacology was caused by the pharmaceutical industry’s taking over clinical trials. The 1962 Kefauver-Harris amendments triggered drug trials’ becoming so expensive that the incentive to try bold new experiments was minimal. The beginning of the great pivot of investigator-led to industry-led trials in the 1980s occurred as the “medical advisors” of pharmaceutical companies became responsible for collating the data as it came in from the various centers.
TMAP
Authors: Shorter Edward
Published: September 2021

The Texas Medication Algorithm Project (TMAP), which featured atypical antipsychotics, was considered more of a commercial scam than science. TMAP had its beginning in 1995, when it was granted $1.7 million by the Robert Wood Johnson Foundation and various officials and academics in Texas to develop a model mental health treatment program for incorporation into public mental health and prison systems. The Foundation was related to the Johnson & Johnson company, and what they funded was a “guidelines” project for schizophrenia. The TMAP subverted scientific integrity; it appeared to be a purely scientific venture when it was actually a marketing venture for Risperdal. The guidelines produced by TMAP became the basis for the TMAP algorithms, giving a market edge to the J&J products in Texas.
Conclusion
Authors: Shorter Edward
Published: September 2021

The psychopharmacologic model has led to the prescription of the wrong drugs for the wrong indications. This chapter cites Max Fink's judgment, which describes clinical psychiatry as an extraordinarily weak discipline that is split from clinical medicine, with its roots in unfounded psychological fantasies that disregard effective diagnostic and treatment practices. It also emphasizes how clinical psychiatry as a profession is unable to identify and treat most of the complaints of patients coming to the psychiatric clinics because it has floundered in its confusion of syndromes and studies of causes. The chapter analyzes how the psychopharmacologic model that started out with a promising future has become little more than an ad copy for the pharmaceutical industry. It mentions diseases that the system offers that are now considered wrong, because drugs cannot be discovered for ailments that don't exist.
Impact on Primary Care and Specialty Care
Authors: Goldenberg Don L.
Published: September 2021

Primary care practices (PCP) and specialty practices stopped most routine care and suffered major financial loss during the pandemic. Family practice, small PCP practices, and pediatrics were hit the hardest and are still having difficulty recovering. Increased use of virtual care, team management, and integration with community and public health were each utilized effectively during the pandemic and should continue to be incorporated in ambulatory medical practices.
COVID-19 Truths, Lies, and Consequences
Authors: Goldenberg Don L.
Published: September 2021

Misinformation and disinformation, most often propagated on social media sites, became rampant during the pandemic, contributing to myths and conspiracy theories. Such falsehoods resulted in inappropriate treatments, such as happened with hydoxychloroquine, and has contributed to vaccine hesitancy. Disinformation and political interference in institutions such as the Centers for Disease Control (CDC) and the World Health Organization (WHO) caused confusion for the American public and contributed to the poor pandemic performance in the United States. Anti-vaccine disinformation has interfered with the COVID-19 vaccine rollout. Healthcare providers need to take an active role in combating medical misinformation.
Persistent Medical Problems
Authors: Goldenberg Don L.
Published: September 2021

Persistent medical symptoms following COVID-19 infection may be related to chronic organ damage or dysfunction, primarily documented in the lungs, heart, and brain. This is more common in patients with severe COVID and who were treated in intensive care units. The atypical acute respiratory distress syndrome (ARDS) of COVID may lead to chronic pulmonary vascular disease and fibrosis. Myocarditis and cardiomyopathy may result in chronic cardiac disorders. Neurologic symptoms, including loss of taste and smell as well as mental and cognitive dysfunction, are common during acute COVID infection but may persist for months. In addition, 5%–10% of patients, including many with mild or moderate infection, report multiple unrelated symptoms lasting for months. These patients have been termed “long-haulers” or long-COVID syndrome and no significant laboratory or pathologic findings have been identified. The symptoms and clinical course are similar to chronic fatigue syndrome/benign myalgic encephalomyelitis and post-viral syndrome. In the general population, mental health issues have increased significantly, including depression and post-traumatic stress disorder (PTSD) and sleep disturbances.
Conceptualizing Psychological Problems
Authors: Lahey Benjamin B.
Published: September 2021

Psychological problems are simply aspects of human behavior—broadly defined to include ways of thinking, perceiving, feeling, and acting—that cause people distress or interfere with functioning in important areas of their lives. This straightforward and pragmatic definition of psychological problems is offered as an alternative to the current medical model view in the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases that dominates thinking about psychological problems in most of the world today. Psychological problems are not the result of terrifying illnesses of the mind. Although they can be very distressing and problematic for individuals, they are surprisingly commonplace variations in the natural continua of psychological problems that arise in perfectly ordinary ways. This perspective has the advantages of scientific validity and reducing the stigma inherent in viewing psychological problems as mental illnesses, mental disorders, or psychopathology.
Hierarchical Nature of Psychological Problems
Authors: Lahey Benjamin B.
Published: September 2021

All of the dimensions of psychological problem described previously in this book are positively correlated. This means that each dimension of psychological problems has some unique characteristics but also shares important things in common with all other dimensions. The patterns of varying magnitudes of correlations among psychological problems help identify causes and the best ways to prevent and reduce psychological problems. This chapter discusses a formal and testable causal taxonomy of psychological problems to stimulate future research. It is posited that all dimensions of psychological problems are correlated in a hierarchical manner because there is a hierarchy of causes of these problems—and a corresponding hierarchy of the psychological and biological mechanisms through which the causal influences operate. The first level of the proposed causal hierarchy is causal risk factors that are highly nonspecific in the sense of increasing the risk of having some kind of psychological problem but not which specific kind of problem. At the second level of the causal hierarchy, other genetic and environmental risk factors nonspecifically increase risk for any and all dimensions within only one second-order domain of psychological problems, such as only within the internalizing or only within the externalizing problems. Causal factors at the third level are unique to each specific dimension of psychological problems. This testable hypothesis of a hierarchy of causes and mechanisms represents a radical departure from the thinking underlying the putatively distinct diagnostic categories in the Diagnostic and Statistical Manual of Mental Disorders.
Ordinary Origins of Psychological Problems
Authors: Lahey Benjamin B.
Published: September 2021

This chapter summarizes the basic biology of inheritance, including chromosomes, genes, nucleotides, genotype, and gene expression. It uses these concepts and the logic of studies of the two kinds of twins—monozygotic and dizygotic—to define the concept of heritability as the proportion of differences on the dimension among people in the population that is attributable to genetic factors. The genetic variance in the phenotypes of psychological problems, such as depression, is never encoded in a single allele or genetic variant. Rather, every dimension of psychological problems is polygenic, meaning that many genetic variants have very small genetic influences on each dimension of psychological problems that must be combined to meaningfully measure the genetic component of risk at the molecular level. Often, single variations in individual nucleotides—the molecules arranged on DNA that serve as the letters of the genetic code—known as single nucleotide polymorphisms are summed to quantify the molecular genetic risk in a polygenic risk score. The nonspecific genetic influences at the top of the hierarchy of genetic influences result from some genetic variants being pleiotropic in the sense of directly or indirectly influencing essentially all dimensions of psychological problems. Identifying the specific genetic and environmental influences on dimensions of psychological problems at each level of the hierarchy is complicated because they operate together through the crucially important gene–environment correlations and interactions described in this chapter.
‘A certain physiologie and pathology of the brain and nervous stock’
Authors: Compston Alastair
Published: September 2021

Chapter 7: ‘A certain physiologie and pathology of the brain and nervous stock: Pathologiæ cerebri (1667–1678)’ provides a detailed bibliography, using the system described in chapter 4, of seven copies of Willis’s third published book in which are included two treatises: 6. De morbis convulsivis; and 7. De scorbuto. It is the first publication which includes the portrait of Willis, aged 45, engraved by David Loggan on which formed all subsequent images were based. These descriptions are preceded by a narrative highlighting the main bibliographic issues that characterize the various editions, states, and issues of these copies. Of these, some are already known but others newly identified. {107 words}
‘A great and difficult thing, and full of hazard’
Authors: Compston Alastair
Published: September 2021

Chapter 17, ‘A great and difficult thing, and full of hazard: the discourse of the soul’, provides an analysis of Pathologiæ cerebri (1667), Affectionum quæ dicuntur hystericæ et hypochondriacæ (1670) and De anima brutorum (1672). The chapter starts with Willis’s description of perverted activity of the particles in blood and the animal spirits which converts ordered movement into convulsion. The concept includes epilepsy and disorders of movement with preserved awareness, and extends to cough. An account is given of Willis’s concept of hysteria and hypochondriasis as organic brain disorders. His further work on comparative anatomy and animal behaviour as the basis for distinguishing the corporeal soul of brutes from the rational soul of man is described. The chapter provides an analysis of Willis’s writing on the human senses and passions followed by additional accounts of brain diseases and those affecting the mind, together representing a foundational work in psychiatry and behavioural neurology. {150 words}
‘To practice medicine with a safe conscience’
Authors: Compston Alastair
Published: September 2021

Chapter 18, ‘To practice medicine with a safe conscience: rational therapeutics’ summarizes both parts of Pharmaceutice rationalis (1674, 1675), The London practice of physick (1685), A plain and easie method for preserving those that are well from the infection of the plague (1691) and Dr Willis’s receipts for the cure of all distempers (1701). The analysis emphasizes that the theme running through these treatises is Willis’s concept that vitality is dependent on healthy nutrition, adequate respiration, fermentation and circulation of the blood, and excretion. His therapies target one or other of these processes, usually in combination. The point is made that although most of the ingredients are no longer favoured, Willis’s pharmacopoeia is rational in the context of his ideas. His advice on lifestyle with botanical remedies and the products of chemical laboratories are described. In addition to surgical manoeuvres such as bleeding and the cutting of issues and fontanels, details are provided of innovative procedures including oesophageal stenting and drainage of pleural fluid. {150 words}
The epidemiology of death and symptoms
Authors: Seah Davinia , Marco David , Philip Jennifer , Sands Megan B.
Published: September 2021

Despite the advances of medicine, many illnesses continue to evade cure. Chronic, progressive, incurable illness is a major cause of disability, distress, suffering, and, ultimately, death. This is true for many causes of cancer, AIDS, and other disorders of vital organs. Such progressive, chronic diseases are most common in late adulthood and old age, but they occur at all ages. Disease-modifying treatments and the relief of suffering through symptom management, care planning, and family support are central to care, and these four domains are core goals of palliative care. This chapter offers an overview of how epidemiological studies may be used to clarify the population/s of people who may benefit from palliative care, to assist the planning for how services may meet the needs of people towards the end of life. Symptoms associated with a series of common, progressive, chronic illnesses will be discussed, thereby further facilitating planning for individual patients and for services.
Social work in palliative care
Authors: Altilio Terry , Sumser Bridget , Laing Nina
Published: September 2021

Palliative social work is an evolving specialty which continues to be enriched by practitioners globally. Social workers practise in diverse settings and have the opportunity to extend palliative care values and processes beyond hospitals and hospices to home care, nursing homes, prisons, and senior centres. This chapter discusses social work values and core principles as a foundation upon which to integrate palliative care, creating a rich opportunity to serve patients, families, teams, institutions, and communities. It begins with an introduction to the history of social work in palliative care and moves on to discuss the convergence and synergy of social work and palliative care, and the need to create models of care to meet global needs. Assessment and interventions are introduced with attention to confidentiality, culture, family meetings, and the roles and responsibilities within team work. Finally, a patient family narrative is presented.
Physiotherapy in palliative care
Authors: Fettes Lucy , Maddocks Matthew
Published: September 2021

This chapter gives an overview of the role of the physiotherapist and their contribution within palliative care. Physiotherapy is a person-centred discipline working towards enhancing function and quality of life, irrespective of diagnosis or prognosis. Symptoms and disability are highly prevalent across all life-limiting conditions, especially in the 6 months before death. Physiotherapists help patients to self-manage and participate in meaningful activities, guided by comprehensive assessment and patient-centred treatment planning. They utilize expertise in movement analysis, functional assessment, and communication. Their scope of practice includes improving or maintaining function and easing the transition towards functional decline when deterioration is inevitable. Physiotherapy activities include guidance and education, symptom management, communication, and care coordination, each selected according to individual patient need. Physiotherapist interventions targeting function include task practice and adaptations, provision of mobility and assistive devices, exercise, and caregiver training and support. Measuring rehabilitation outcomes in the context of unpredictable disease and/or deterioration can be challenging but remains important. Personalized outcome measures, such as goal attainment, can complement standard measures to capture meaningful change.
Family dynamics in the context of serious illness
Authors: Lethborg Carrie , Kissane David W.
Published: September 2021

In considering cancer as an illness that affects not only the patient but their entire family, recent research offers further insight into the depth of this impact and the complexity of culture, specific family challenges, and the patient–carer dyad. This chapter offers a model of family-centred care to encourage an understanding of the impact of illness on the family, the family in the caregiver role, and the needs of family-based caregivers. From a clinical perspective, the authors offer a guide for assessing these families for interventions, including the use of open communication and information provision, the recognition of past patterns of relating, the encouragement of acceptance of support, discussions with the family as a whole, and support during unpreventable emotional suffering that families experience. Specific interventions described include preventive and supportive interventions, interventions that challenge dysfunction, and interventions with the family when a patient is dying. Family-centred care is challenging as a paradigm but a useful harness to improved quality of life, one that warrants the effort involved to ease the suffering of all.
Caregiver burden and distress
Authors: Nissim Rinat , Hales Sarah , Rodin Gary
Published: September 2021

Caregivers of patients with advanced disease can be seen as both care providers and as receivers of care. Family caregivers frequently face a wide range of their own psychological, spiritual, social, financial, and physical challenges, which may increase in duration due to longer survival and more ambulatory and home care of patients with advanced disease. While support for family caregivers is an integral component of quality palliative care, such support is often unavailable and there is a dearth of evidence-based interventions for caregivers. This chapter will provide an overview of the common issues faced by family caregivers of adults in palliative care, the factors that contribute to or exacerbate these problems, the interventions designed to address them and their supporting evidence, and the potential for personal growth in caregivers. Gaps in clinical practice and research are identified and future directions for clinical attention and research are discussed.
Pathophysiology of pain in cancer and other terminal illnesses
Authors: Dickenson Anthony H. , Gordon-Williams Richard
Published: September 2021

Cancer pain involves a myriad of peripheral changes in the function of tissues and nerves, at the site of the tumour growth, as well as a number of consequent changes in the processing of pain messages at the spinal cord level with implications for the pain experience at higher centres. This chapter reviews the changes in peripheral pain signalling, notes the likely prevalence of both inflammatory and neuropathic components, and describes the altered events at spinal levels and within the circuits of pain in higher brain areas that can help explain the ongoing pain, hyperalgesia, and allodynia that patients with cancer and other chronic illnesses, such as HIV/AIDs, experience. The mechanisms of action of therapies, both existing and potential novel approaches, are also described. The importance of these processes in the development and treatment of chronic pain is an emerging issue, particularly as the problem of persistent pain in cancer survivors increases in prevalence.
Management issues in chronic pain following cancer therapy
Authors: Paice Judith A.
Published: September 2021

Extraordinary innovations have led to the introduction of highly effective cancer treatments. These treatments include surgery, radiotherapy, chemotherapy, hormonal therapy, haematopoietic stem cell transplant, and, more recently, immunotherapy. Unfortunately, these remarkable treatments, and resultant improved rates of survival, can be accompanied by significant complications, including chronic pain. The prevalence of pain in the population of cancer survivors is estimated to be greater than 40%, with significant associated impairment of quality of life. It is important to note that cancer survivors may have received more than one of these therapies, considerably increasing the risk of developing chronic pain. The management of pain in cancer survivors requires thorough assessment of pain, function, and risk factors for misuse of opioids or other substances. Awareness of the types of cancer pain syndromes that may occur, along with treatment options, is crucial. Multimodal interventions should be incorporated into the plan of care, including pharmacological, non-pharmacological, cognitive behavioural, interventional, and integrative therapies. Despite the high exposure to these cancer therapies, and the significant prevalence of chronic pain that can occur, little research has been conducted to elucidate the resultant painful syndromes caused by these treatments clearly, much less develop effective management strategies for these disorders. Recent guidelines advance key treatment principles in this evolving population.
Paediatric pain control
Authors: McCulloch Renee
Published: September 2021

Our understanding of pain management in children has grown significantly in the past few decades; however, we still find reluctance to acknowledge and treat pain in children. Many myths prevail which, coupled with poor understanding, can undermine the effective treatment of pain in children. Understandably, many healthcare professionals are apprehensive and fearful about working with very sick and dying children; perhaps there is a sense of failure for being unable to ‘cure’. However, as pain is one of the most common symptoms in this group of children, relieving pain and distress can be an extremely rewarding experience. This chapter outlines the background and principles of understanding, evaluating, and treating pain in children with palliative care needs. It offers a basic overview of current understanding and practice and hopes to support healthcare professionals working in this challenging discipline.
Skin problems in palliative care
Authors: Probst Sebastian , Gethin Georgina
Published: September 2021

Nursing aspects of palliative wound care are driven by patient and family goals integrated with three components of wound management: the management or palliation of the underlying cause of the wound, management of wound-related symptoms, and management of the wound and peri-wound skin. Wounds most commonly encountered include pressure ulcers, fungating malignant wounds, and fistulae. Patients with blistering skin conditions, inherited and acquired, have extensive long-standing wounds and palliative care needs. In addition, meticulous skin care for patients of all ages with debilitating long-term conditions is crucial to prevent unnecessary skin breakdown. The symptoms and local problems associated with broken skin and wounds include odour, exudate, excoriation, maceration, bleeding, pain, and pruritus. Key clinical interventions include the application of wound dressings and skin care products. Unless these are managed effectively and consistently, body image and feelings of self-worth are affected together with the ability to socialize and maintain function, including, for some people, employment.
Sleep disorders
Authors: Mystakidou Kyriaki , Parpa Efi , Tsilika Eleni
Published: September 2021

In populations with serious chronic illness, sleep disturbances represent frequent distressing symptoms. The more common disorders include insomnia, excessive daytime sleepiness, and circadian rhythm sleep disorders. Primary sleep disturbances are thought to be a disorder of hyperarousal. Hypothalamic–pituitary–adrenal axis dysfunction has also been confirmed. Secondary sleep disorders may occur as a result of the advanced disease or its treatments. It has been associated with a large number of potential causes, both physical and psychological. Chronic medication use, neurological or psychiatric disorders, and environmental factors can also contribute. This chapter discusses the diagnosis of sleep disturbances, and both pharmacological and non-pharmacological treatments.
Integrative oncology in palliative medicine
Authors: Ben-Arye Eran , Samuels Noah
Published: September 2021

Patients with cancer frequently suffer from symptoms related to their disease or its treatment. Many seek out non-conventional medical treatments, often in an alternative setting and with an expectation that ‘natural’ remedies are both safe and effective in providing a ‘cure’ for their disease. While some non-conventional therapies can alleviate symptoms and improve quality of life, they may have adverse effects or herb–drug interactions, compromising treatment outcomes. Many cancer centres today have integrative oncology (IO) services which provide evidence-based guidance on the safe and effective use of complementary and integrative medicine (CIM) for symptom relief, improving quality of life and function. IO settings are headed by integrative physicians, with CIM treatments administered by a multidisciplinary team of medical, paramedical, and non-medical practitioners. CIM treatments are an effective adjunct to conventional supportive and palliative care, using a patient-centred approach to promote trust and better communication between patients and oncology healthcare professionals, including in palliative care. This chapter reviews the current state of IO as it is being provided in the conventional oncology setting, and suggests ways in which further integration can take place. An update on research-based evidence for CIM modalities relevant to palliative care will be presented, with an algorithm-based approach to the implementation of IO in conventional palliative oncology setting.
Interventional radiology in the palliation of cancer
Authors: Sabharwal Tarun , Fotiadis Nicos I. , Adam Andy
Published: September 2021

Interventional radiology uses image guidance to perform minimally invasive therapeutic and diagnostic procedures. It is an integral part of the multidisciplinary team managing patients with cancer. Interventional radiology is involved in all stages of the cancer patient’s journey starting from performing image-guided biopsies for the diagnosis of cancer, venous access procedures, and therapeutic procedures, and focuses on the palliation of symptoms and improvement in the quality of life. All interventional procedures carry some risk, which is related to the underlying condition, the nature of the procedure, and the experience of the radiologist. Therefore, it is important in patients with advanced malignant disease receiving palliative care to contemplate only those procedures that will alleviate symptoms, and in which the potential benefits outweigh the risks. This chapter presents the drainage, stenting, feeding, embolization, ablation, and supportive interventional radiology procedures which could potentially benefit patients undergoing palliative care. The focus will be on the indications, contraindications, and likely outcomes, rather than on detailed technical descriptions.
Neurological disorders other than dementia
Authors: Voltz Raymond , Lorenzl Stefan
Published: September 2021

The significance of a palliative care approach for patients with neurological disorders other than dementia, such as patients with amyotrophic lateral sclerosis, was recognized by Dame Cicely Saunders in her conceptualization of hospice and is increasingly supported by scientific evidence. From the clinical perspective, the need for palliative care is underscored by the high rate of requests for hastening death. This chapter describes palliative care approaches for a number of neurological disorders other than dementia. For amyotrophic lateral sclerosis, the literature has focused on the management of respiratory insufficiency and malnutrition. For patients with multiple sclerosis, the first randomized controlled trials of palliative care show positive effects on symptoms and healthcare utilization. For populations with parkinsonian syndromes, the literature discusses many interventions that can reduce suffering and improve quality of life. This literature is summarized and specific recommendations for symptom management are presented.