bluuebunny/crossref_metadata_2025 huggingface dataset:
Medication Overuse
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L.
Published: March 2022

Refractory daily headache is usually the result of misdiagnosis, inappropriate or inadequate pharmacotherapy, or failure to identify and treat coexisting exacerbating factors. Refractory daily headache commonly occurs in the setting of medication overuse. This chapter on medication overuse describes the phenomenon of headache worsening in frequency and severity when acute medications are taken too frequently. The chapter provides the definition of medication overuse headache, and it discusses management options when medication overuse is a concern. The chapter also shares the 2020 Quality Improvement headache updates from the American Headache Society and the American Academy of Neurology that provide new clinical recommendations on how to address medication overuse in the context of the underlying primary headache disorder.
Hemicrania Continua
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L.
Published: March 2022

Hemicrania continua is characterized by a unilateral, continuous headache of mild to moderate intensity. Patients usually describe this baseline discomfort as dull, aching, or pressing, and it is not associated with other symptoms. The pain is maximal in the ocular, temporal, and maxillary regions. Superimposed upon this background discomfort, exacerbations of more severe pain, lasting 20 minutes to several days, are experienced by the majority of sufferers. This chapter provides a description of this side-locked, continuous trigeminal autonomic cephalalgia. It presents details on the clinical presentation of this disorder and provides tips on how to distinguish it from other headache conditions. In addition, the chapter provides a summary of treatment options.
Occipital Neuralgia
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L.
Published: March 2022

This chapter assesses occipital neuralgia (ON), which can occur after posterior head trauma or whiplash, presumably due to the propensity for damage to the relatively superficial greater occipital nerve (GON), which can easily be compressed against the skull. It has been demonstrated that ON occurs more commonly in patients with other coexisting headache disorders. ON presents with stabbing pain in the occipital region as well as tenderness, dysesthesia, or allodynia over the affected nerve branch. Differential diagnosis includes pathology in the region of the upper cervical spine, craniocervical junction, or posterior fossa. The most useful initial treatment of ON is also diagnostic—anesthetic blockade of the GON. If local anesthesia of the GON is effective but pain returns, subsequent GON blocks may prove longer lasting.
Combined Hormonal Contraceptives and Migraine
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L.
Published: March 2022

This chapter on combined hormonal contraceptives and migraine focuses on the current discussions that revolve around prescribing hormonal contraceptives to women who have migraine. Because aura is a stroke risk factor, there is controversy regarding whether women who have migraine with aura may take estrogen-containing contraceptives. Aura is a positive focal symptom, spreading gradually over 5 minutes, lasting 5–60 minutes, and often followed by a headache within 60 minutes. Visual aura is the most common. A diagnosis of aura can double a woman’s baseline stroke risk; this risk can increase further if aura occurs frequently. This chapter discusses this topic in detail and leaves the reader well informed of the contemporary issues.
Abdominal Migraine
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L.
Published: March 2022

This chapter examines abdominal migraine, which is classified as an episodic syndrome that may be associated with migraine although headache is absent. This syndrome typically affects children aged 3–12 years. Another episodic syndrome that causes recurrent gastrointestinal disturbance is cyclical vomiting syndrome. These syndromes describe periodic symptoms in children who commonly have a family history of migraine, have co-occurrence of migraine, or have an increased risk of clinical evolution to migraine in later years. Abdominal migraine has been reported in adults; however, it is believed to be much less common. The diagnosis of abdominal migraine is made clinically, but if any red flags are raised—including failure to thrive, unexplained or recurrent fevers, chronic diarrhea, anemia, or family history of inflammatory bowel disease—concern should be raised for an alternative diagnosis and diagnostic evaluation should ensue. Treatment strategies are often extrapolated from migraine treatment and should include both pharmacological and nonpharmacological options.
Acute Treatment of Childhood Migraine
Authors: Newman Lawrence C. , Levin Morris , Halker Singh Rashmi B. , Michael Rebecca L.
Published: March 2022

This chapter discusses the acute treatment of childhood migraine. The diagnosis of migraine in children is slightly challenging because the features may differ from the standard definition in adults. Specifically, the headaches may be shorter, they are commonly bilateral, and auras are rarer. Treatment has typically centered on nonpharmacological measures such as sleep hygiene, regular mealtimes, and avoidance of triggers, with the judicious use of analgesics and antiemetics. However, this is not a satisfying approach when the child has very severe headaches that are disabling. Although only rizatriptan is approved for use in children, judicious use of triptans with open discussion with parents is common practice. Novel treatment modalities such as melatonin, neuromodulation, and calcitonin gene-related peptide receptor antagonists should be considered as well. Both acute medications and prophylactic agents may produce significant adverse effects in children that must be monitored closely.
Propaganda and Lone-Actor Terrorism
Authors: Drogin Eric Y.
Published: March 2022

There exists a critical symbiotic relationship between propaganda and lone-actor terrorism. Propaganda relies on the martyrdom of lone-actor terrorists as a symbolic factor in promoting militant political causes. Lone-actors terrorists are attracted, recruited, indoctrinated, radicalized, and operationalized by propaganda. Propaganda is the systematic dissemination of doctrine, rumor, or selected information to promote or injure a particular doctrine, view, or cause. With an exhaustively documented history that extends back many centuries, propaganda can usually be distinguished from other forms of persuasion such as religion, political campaigning, and advertising. “White” propaganda emanates from a known source and is typically neither deceitful nor false, whereas “black” propaganda emanates from an undisclosed source and purports to be the product of the very movement it seeks to undermine. Recently conducted analyses identify a number of legal, psychiatric, economic, personal, and other recognized vulnerabilities of lone-actor terrorists that leave such persons particularly susceptible to targeted propaganda. Propagandists, in turn, have managed—within the past decade in particular—to exploit specific examples of lone-actor terrorism in films, magazine articles, and a variety of internet-based incitements. The relationship between propaganda and lone-actor terrorism can be addressed by removing the causes for this relationship, removing the means of dissemination, imposing internet censorship, employing either “white” or “black” propaganda in response, or simply choosing to ignore this relationship in order to avoid inadvertently amplifying the messages it conveys.
Geographic Context
Authors: Jasparro Christopher , Levi-Sanchez Suzanne
Published: March 2022

The geography of lone-actor jihadist attacks and target preferences in the United States have changed since 2013, in step with the rise of the Islamic State of Iraq and al-Sham (ISIS) through 2019. From 1980 through 2012, the target geography of jihadist attacks (by all cell types) in and against the US homeland was largely consistent in terms of locale and target spaces and types. This chapter indicates that there was a shift to attacks on non-symbolic, everyday target spaces and places in which the attacker could use expedient methods. In order to examine which elements may be place-specific or ideology-specific, the geography of US lone-jihadist operations is compared and contrasted with those of European lone-actor jihadists and US right-wing lone-actor extremists.
Role of Forensic Mental Health in Lone-Actor Violence
Authors: VanDercar Ashley H. , Wagoner Ryan C. , Resnick Phillip J. , Farnham Frank , Corner Emily
Published: March 2022

Lone-actor terrorists are more likely than group-based terrorists to have mental health problems. When an alleged terrorist is arrested and prosecuted, there are a number of ways that their mental health can become pertinent: behavioral issues in the jail, competency to stand trial concerns, a plea of not guilty by reason of insanity, sentence mitigation, or psychiatric treatment in prison. Forensic mental health professionals provide assistance in such cases, either in treatment or evaluation roles. In a treatment role, a mental health professional provides treatment (e.g., medications) in a jail or prison. In an evaluation role, a mental health professional provides an opinion about the impact of a defendant’s mental health on competence to stand trial and/or criminal responsibility. These are legal decisions, ultimately decided by a judge or jury with consideration of forensic mental health professionals’ opinions. The legal standards and procedures for these decisions vary depending on the country and state.
US Legal Perspectives
Authors: Smith Jeffrey H. , Jeffress Amy , Beeler Christopher E. , Xin Tian Tian
Published: March 2022

In the post-9/11 world, violence perpetrated by lone individuals is increasingly being recognized as acts of terrorism by US policymakers, law enforcement authorities, and intelligence agencies. While federal and state prosecutors have been successful in prosecuting lone-actor terrorists in court, the surveillance programs intended to identify lone actors before they act have been fraught with challenges and friction points concerning privacy, free speech, and other constitutional implications. This chapter examines the laws applicable to lone-actor terrorists, the state and federal prosecutions that have occurred, and how the surveillance of social media and electronic communications in terrorism investigations has created a morass of civil liberties concerns that courts and policymakers alike have struggled to resolve. Although modern democracies all must grapple with the tension between security and freedom, the escalation of lone-actor terrorist attacks has created knotty challenges for all three branches of the US government and raised the stakes for getting it right.
Hatred and Grievance as Constructs in Lone-Actor Terrorism
Authors: Holzer Jacob C. , Shah Arya , Drogin Eric Y. , Granacher Robert P.
Published: March 2022

The concepts of “hatred” and “grievance: logically underlie much, if not all lone-actor terrorism cases, yet these socially based emotions cannot adequately explain the complexities of terroristic behavior. As reviewed in this book, numerous important variables, such as development, social factors, ideology, social media, clinical, weapons access, exposure to propaganda and rhetoric, and pre-incident stressors come together or “crystallize,” resulting in a terrorism incident. Many who are hateful and harbor a grievance do not commit violence, yet these concepts may be essential components of the complex disposition of lone-actor terrorists.
A Risk Analysis Framework of Lone-Actor Terrorism
Authors: Bouhana Noémie , Corner Emily , Gill Paul
Published: March 2022

In the rush to explain lone-actor terrorist radicalization and behavior, analyses highlighted a diversity of risk factors. This chapter organizes this knowledge into a general framework, the risk analysis framework (RAF). The framework incorporates theories that advance explanations about the role these factors play in producing the outcome of interest (e.g., radicalization). More specifically, the RAF draws on a well-developed general theory of crime causation known as situational action theory (SAT). The authors systematically articulate how the kinds of risk factors discussed in the prior literature review interact to produce one or the other. They differentiate between those factors which may act as indicators (needed for the design of detection and mitigation measures) of lone-actor extremist events and those which may be considered causes (needed for the design of prevention and disruption measures).
Case 6
Authors: Burri Haran , Johansen Jens Brock , Linker Nicholas J. , Theuns Dominic
Published: March 2022

A 64-year-old woman attended clinic following several episodes of short-lived, unprovoked palpitations. These had occurred several times per week since her device was implanted. She had a DDD PM implanted 3 months earlier due to syncope associated with sinus pauses on an implantable loop recorder.
Case 18
Authors: Burri Haran , Johansen Jens Brock , Linker Nicholas J. , Theuns Dominic
Published: March 2022

An ECG was recorded during implantation of a His lead while pacing at 2.5 V/1 ms unipolar in a patient with left bundle branch block at baseline.
Case 21
Authors: Burri Haran , Johansen Jens Brock , Linker Nicholas J. , Theuns Dominic
Published: March 2022

A patient in chronic AF with AVN ablation and HBP had programmed stimulation from the His bundle lead.
Case 30
Authors: Burri Haran , Johansen Jens Brock , Linker Nicholas J. , Theuns Dominic
Published: March 2022

A 32-year-old woman attends the device clinic following an episode of palpitations. She had a CRT defibrillator implanted 2 years previously due to dilated cardiomyopathy with severe LV systolic dysfunction, New York Heart Association class III. She has responded well to CRT and her biventricular pacing percentage is 98%.
Case 40
Authors: Burri Haran , Johansen Jens Brock , Linker Nicholas J. , Theuns Dominic
Published: March 2022

A patient with dilated cardiomyopathy and a CRT-D underwent lead revision due to fracture of the ICD lead. A new ICD lead was implanted.
Case 49
Authors: Burri Haran , Johansen Jens Brock , Linker Nicholas J. , Theuns Dominic
Published: March 2022

A 50-year-old man was scheduled for implantation of a S-ICD for secondary prevention of sudden death. After implantation, he experienced a shock without preceding symptoms at the ward.
Case 54
Authors: Burri Haran , Johansen Jens Brock , Linker Nicholas J. , Theuns Dominic
Published: March 2022

A patient with dilated cardiomyopathy and LBBB implanted with a CRT-D was seen at follow-up. The patient had no complaints. Percentage of VP was 98% (with LV pacing only).
Case 66
Authors: Burri Haran , Johansen Jens Brock , Linker Nicholas J. , Theuns Dominic
Published: March 2022

A 62-year-old man with ischaemic cardiopathy and LBBB had been implanted with a CRT-D for primary prevention of sudden cardiac death. An event classified as CRT pacing interruption was transmitted by remote monitoring.
Case 67
Authors: Burri Haran , Johansen Jens Brock , Linker Nicholas J. , Theuns Dominic
Published: March 2022

A patient with a CRT-D was seen at follow-up. The patient had no complaints.
Early Medical Abortion, Equality of Access, and the Telemedical Imperative
Authors: Parsons Jordan A. , Romanis Elizabeth Chloe
Published: March 2022

Telemedicine has recently become a key focus of healthcare systems globally, heavily influenced by the COVID-19 pandemic. Implementing telemedicine can bring myriad benefits for both patients (improved access and enhanced autonomy) and providers (improved service efficiency). One area in which telemedicine might have a huge impact is in improving access is abortion care. Telemedical early medical abortion encompasses a wide range of services, but fundamentally it involves remote provision of some or all aspects of the care pathway (confirmation of pregnancy/gestational age, consultation/counselling, provision of medications, and aftercare). We examine the safety, effectiveness, and acceptability of early medical abortion provided by telemedicine, alongside the access barriers created by the law in the UK and US. In doing so, we argue that there is a moral imperative to make the necessary regulatory changes to enable the provision of telemedical early medical abortion. In both the U K and US, abortion is heavily regulated—exceptionally so when compared to other routine healthcare. This law has had the effect of exacerbating the social circumstances and geography that can make access to abortion clinics difficult. Telemedicine might go some way to addressing these issues, but much regulation of abortion in these jurisdictions continues to limit the establishment of telemedical early medical abortion services. Whilst we focus on the legal and policy landscape in the UK and US, the case we advance in support of the telemedical provision of early medical abortion is broadly applicable.
Ketotherapeutics to Rescue Brain Energy Deficits
Authors: Myette-Côté Étienne , Castellano Christian-Alexandre , Fortier Mélanie , St-Pierre Valérie , Cunnane Stephen C.
Published: March 2022

Brain glucose uptake has long been recognized to be reduced in Alzheimer’s disease (AD) but was mainly assumed to be a consequence of reduced neuronal activity. More recently, several studies challenged this concept by showing that brain glucose hypometabolism was also present in individuals at high risk for AD before the presence of any cognitive symptoms. Thus, it is of great interest to know whether cognitive decline can be prevented or delayed if the glucose metabolism defect is at least partly corrected or bypassed. The ketones β-hydroxybutyrate and acetoacetate are the brain’s main alternative fuel to glucose, and their uptake in mild cognitive impairment (MCI) and mild to moderate AD is similar to that seen in healthy age-matched controls. Based on these findings, it is conceivable that ketones could be used to help rescue brain fuel supply during aging. Evidence from published clinical trials showed that increasing ketone availability to the brain via nutritional ketosis can have a beneficial effect on brain energy metabolism and cognitive outcomes in both MCI and mild to moderate AD. Nutritional ketosis can be safely achieved by a high-fat ketogenic diet or ketogenic supplements, such as medium-chain triglycerides containing the eight- and ten-carbon fatty acids, octanoate and decanoate. Given the acute dependence of the brain on its energy supply and the ineffectiveness of current therapeutic strategies aimed at AD, it seems reasonable that consideration be given to correcting the underlying problem of deteriorating brain glucose uptake observed with aging.
The Ketogenic Diet and the Gut Microbiome
Authors: Mu Chunlong , Shearer Jane , Scantlebury Morris H. , Marks Wendie N.
Published: March 2022

Over the past decade, a growing body of evidence has validated the essential role of the gut microbiome in regulating diverse physiologic processes, spanning gut-related disease to neural function. While many factors are involved, diet is the primary driver of global microbial composition and function. Studies from animal models and humans suggest that the ketogenic diet can reshape the gut microbiome. However, the relevance of the altered microbiota is still under investigation. Since the gut microbiome is implicated in modulating brain function via metabolic, immunologic, and endocrine pathways, a possible role of the microbiota–gut–brain axis in mediating the neural response to the ketogenic diet has been proposed. This chapter outlines how the ketogenic diet affects the gut microbiota and the implications of such ketogenic diet-induced phenotypes. Special attention is paid to interactions between the diet, gut microbiota, and neurodevelopmental disorders, including epilepsy and autism spectrum disorder.
Metabolic and Redox Alterations by Ketogenic Diets
Authors: Johnson Derek , Patel Manisha
Published: March 2022

When there is a shift from glucose utilization (glycolysis) resulting from carbohydrate-restrictive diets like the ketogenic diet, metabolic changes occur, and acetyl-CoA is instead derived from the alternative parallel processes of gluconeogenesis and fatty acid oxidation. Under these conditions, several antioxidant pathways are amplified, including the transcription factor Nrf2, the Forkhead box pathway, the NAD+:NADH ratio, and uncoupling proteins. Additionally, amino acid metabolism and synthesis are modified, with metabolomic analysis isolating tryptophan metabolism as a primary altered pathway. As the field of metabolism is revisited by epilepsy researchers, and animal models are guided by precision medicine, the connections between redox processes and metabolism will be further illuminated.
Antiseizure and Antiepileptic Effects of Glycolysis Inhibition with 2-Deoxyglucose
Authors: Stafstrom Carl E. , Shao Li-Rong , Sutula Thomas P.
Published: March 2022

Numerous metabolic approaches have been employed clinically for seizure suppression, including the ketogenic diet (KD). Inhibiting or bypassing glycolysis may be one way by which the KD suppresses seizures. 2-Deoxy-d-glucose (2DG) is a glucose analog that partially inhibits glycolysis and has antiseizure effects in seizure models. Acutely, 2DG diminishes the frequency of interictal bursts in hippocampal area CA3 induced by high Ko+, bicuculline, 4-aminopyridine, or Mg2+-free/4-aminopyridine. 2DG exerts an anticonvulsant effect in vivo in mice. 2DG also has acute anticonvulsant actions against status epilepticus evoked by pilocarpine in adult mice and in neonatal rats, and status epilepticus evoked by kainic acid in rats. Chronically, 2DG exerts disease-modifying antiepileptic effects in three kindling models and the posttraumatic epilepsy model, attenuates progression of the 6-Hz corneal kindling, and prevents traumatic brain injury-induced hyperexcitability. The mechanisms underlying the acute and chronic effects of 2DG are being investigated. Preliminary studies provide evidence that the acute anticonvulsant actions of 2DG involve activity-dependent presynaptic suppression of excitatory synaptic transmission during network synchronization. The chronic effects of 2DG entail reduction of the expression of brain-derived neurotrophic factor (BDNF) and its receptor, tyrosine kinase B (trkB). BDNF and trkB gene expression are required for kindling progression; by reducing glycolysis, 2DG modulates transcriptional repression of BDNF and trkB by neuron-restrictive silencing factor (NRSF) at the promoter regions of BDNF and trkB. Currently available preclinical efficacy and toxicity studies support 2DG as a novel first-in-class metabolic treatment for epilepsy with an antiglycolytic mechanism that is distinct from other anticonvulsants.
ECMO Configurations and Cannulation in Pediatric Patients
Authors: Vandewalle Robert J. , Clifton Matthew S. , Paden Matthew L.
Published: March 2022

Utilization of extracorporeal membrane oxygenation (ECMO) in the pediatric population requires consideration of numerous factors, including the size of the patient and indication. This chapter reviews several common indications for ECMO cannulation in pediatric patients, consideration for ECMO modality (i.e., veno-arterial [V-A] ECMO) versus veno-venous ([V-V] ECMO), and cannula placement site. ECMO is a well-established means to provide cardiopulmonary support in the neonatal/pediatric populations with select diagnoses, including respiratory failure, acute cardiac failure, and septic shock. Given the variability of patient size, diagnoses, and cardiopulmonary support requirements, various ECMO cannulation/configurations exist and each must be considered on a patient-by-patient basis. Three case presentations are followed by key point discussions and board-type multiple choice questions summarizing this chapter.
ECMO Configurations and Cannulation in Adult Patients
Authors: Prasad Amit , Singbartl Kai
Published: March 2022

Extracorporeal membrane oxygenation (ECMO), a form of extracorporeal life support (ECLS), represents a life-saving intervention in patients with cardiac and/or respiratory failure not responding to medical therapy. Blood is drained from a central vein (V), pumped through a membrane oxygenator for oxygenation and CO2 removal, and ultimately returned into a central vein or artery (A). Veno-arterial (V-A) ECMO is primarily used for patients in cardiogenic shock and provides both hemodynamic and respiratory support. V-A ECMO can limit or prevent secondary end-organ damage and allow time for myocardial recovery while a decision is made for the best definitive treatment. Conventional peripheral V-A ECMO, that is, return via femoral artery, carries the risks of differential oxygenation with upper body hypoxemia and extremity ischemia. Veno-venous (V-V) ECMO can rescue patients with the most severe respiratory failure but does not provide hemodynamic support. V-V ECMO allows for lung rest in patients who otherwise would receive potentially injurious ventilator support. Both V-A and V-V ECMO are invaluable, life-saving tools in patients who are failing maximum medical therapy.
ECMO for Neonatal Pulmonary Hypertension and Associated Disorders
Authors: Short Billie Lou
Published: March 2022

Pulmonary hypertension of the newborn (PPHN) has been a common finding in diseases that require extracorporeal membrane oxygenation (ECMO) treatment in the newborn population. This postfetal pathophysiologic condition can be either the primary cause for respiratory failure (i.e., idiopathic PPHN) or a secondary cause in such diseases as meconium aspiration syndrome (MAS), sepsis/pneumonia, and congenital diaphragmatic hernia (CDH) patients. Until recently, meconium aspiration syndrome (MAS) was the major cause of respiratory failure in the newborn infant requiring ECMO therapy. This disease is now surpassed by the CDH patient, as newer therapies, including inhaled nitric oxide, have come on the market for treating the MAS and PPHN patient prior to ECMO. There are still a large number of MAS infants requiring ECMO, and fortunately the outcome for these infants is good, with over 90% survival. A typical MAS infant will be on ECMO 6–8 days, so longer courses need to raise concerns that there may be an underlying disorder to consider, including surfactant protein deficiency, alveolar capillary dysplasia, or congenital heart disease. The MAS and PPHN infant’s courses on ECMO are discussed along with consideration for other disorders if improvement on ECMO does not occur.
ECMO in Pediatric Patients With Univentricular Physiology
Authors: Murphy Lee D. , Cooper David S. , Mah Kenneth E.
Published: March 2022

Patients with univentricular physiology or single-ventricle anatomy are unique. This population experiences an increased likelihood of needing extracorporeal membrane oxygenation (ECMO) during their lifetime. Due to the expansive nature of this topic, the chapter primarily uses patients with hypoplastic left heart syndrome who are status post–stage 1 palliation (Norwood with modified Blalock-Taussig shunt or right ventricle–to–pulmonary artery conduit) as an example. The chapter briefly mentions stage 2 (bidirectional Glenn) and stage 3 palliations (extracardiac Fontan). The chapter focuses on what univentricular physiology entails, management of patients with univentricular physiology on ECMO, and complications unique to this patient population.
ECMO in Pediatric Patients With Congenital Heart Disease
Authors: Desai Ajay , Hoschtitzky J. Andreas
Published: March 2022

Anomalous left coronary artery from pulmonary artery (ALCAPA) is a congenital coronary abnormality associated with high infant mortality. This chapter reviews the management of children born with ALCAPA from the prehospital setting to clinical management and cannulation of extracorporeal membrane oxygenation (ECMO) in the intensive care unit. Key factors for improved ECMO outcomes include having a structured ECMO program, multidisciplinary team approach, anticipation, protocolized approach, continuing education and training of ECMO staff, and research. A case discussion is followed by a critical review of the literature, as well as critical care board-type multiple-choice questions summarizing this chapter as a concise learning and study tool for the management of ALCAPA patients on ECMO.
ECMO in Middle Eastern Respiratory Syndrome (MERS-CoV)
Authors: Hassan Ibrahim F. , Zakhary Bishoy
Published: March 2022

Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic viral respiratory illness caused by a novel coronavirus. The virus exhibits high virulence, with affected patients at risk of acute respiratory distress syndrome with severe hypoxemia, septic shock, and multiorgan failure. While MERS-CoV outbreaks are difficult to predict, it is likely that novel viruses will present in a similar manner with severe respiratory failure and multiorgan dysfunction. The clinical experience and descriptive literature gained from applying extracorporeal membrane oxygenation to MERS will help form a framework to support patients with novel infections. This chapter reviews the utility of extracorporeal membrane oxygenation in the support of these patients. A case discussion is followed by a critical review of the literature, and board-type, multiple-choice questions are provided as a learning tool.
ECMO in Pregnancy and the Peripartum Patient
Authors: Agerstrand Cara , Saad Antonio F. , Maybauer Marc O.
Published: March 2022

Extracorporeal membrane oxygenation (ECMO) has been used with increasing frequency and acceptance in the treatment of adults with severe forms of respiratory, cardiac, or combined cardiopulmonary failure. Pregnant and postpartum women represent a unique group of patients that may be supported with this technology, resulting in successful maternal and fetal outcomes. However, limited information exists regarding optimal patient selection and management strategies in these unique populations. This chapter reviews the existing evidence and an approach to treating pregnant and postpartum women with ECMO in order to optimize clinical outcomes in these special groups of patients. Given the complexity of caring for pregnant women, proactive, multidisciplinary planning is critical to optimize outcomes for both the patient and fetus.
ECMO Support for Patients with Major Aortic Surgery or Dissection
Authors: Capoccia Massimo , Maybauer Marc O.
Published: March 2022

Extracorporeal membrane oxygenation (ECMO) is an established method of circulatory support in critically ill patients, although its role in acute aortic dissection remains not completely defined and rather controversial. The aim of this chapter is to review current thinking in the context of major aortic surgery, with particular reference to acute aortic dissection, and identify those patients who may benefit from the technique. Preoperative status, including organ malperfusion and cardiac tamponade, increase the surgical risk, which may affect patients’ outcome. The ability to identify specific risk factors with a view to ECMO support as an additional treatment option may give further insights about its role following major aortic surgery, particularly for acute aortic dissection. A stem case discussion also focuses on the related technical aspects.
ECMO Support for Pulmonary Embolism
Authors: Malfertheiner Maximilian , Maybauer Marc O.
Published: March 2022

Massive pulmonary embolism (PE) is associated with high mortality. Besides thrombolytic therapy and surgical embolectomy, extracorporeal life support (ECLS) can be a relevant therapy option. This chapter reviews the management of a complex patient from the onset of the event through extracorporeal membrane oxygenation (ECMO) cannulation and clinical management of serious and life-threatening complications. ECMO therapy has to be seen in conjunction with other available treatments in massive PE. A case discussion followed by a critical review of the literature and critical care board-type multiple choice questions summarize this chapter as a concise learning and study tool for the management of patients with PE on ECMO.
Health Equity in Palliative Care
Authors: Jones Tessa , Nedjat-Haiem Frances , Bullock Karen
Published: March 2022

This chapter explores health equity in the context of palliative social work, focusing on an understanding and commitment to reducing and eliminating health disparities in palliative care. Health inequities are experienced by socially, economically, and/or environmentally disadvantaged groups throughout the life course. They accumulate over time and too often culminate in the experience of serious illness. Despite a long history of substantiated recognition of the need to reduce disparities in health, racially and ethnically diverse populations continue to experience inequity in healthcare accessibility and utilization, suffering disproportionately from preventable and treatable conditions. As social workers in palliative care, it behooves us to consider such health inequities across our care systems. Social work, a discipline defined by its commitment to social justice, is well situated to provide evidence-based leadership in demonstrating strategies to eradicate health disparities and promote health equity in palliative care.
The Importance and Impact of Culture in Palliative Care
Authors: Becker Todd D. , Cagle John G.
Published: March 2022

Culture constitutes the lens through which we see ourselves, others, and the world around us. The diversification of the American population has prompted increased attention to the role of culture in healthcare systems. Medical advances increasing life expectancy have led to Americans living longer with serious illness, thereby accentuating the need to foreground culture in palliative care. On a structural level, such efforts have been reflected in initiatives emphasizing the delivery of person-centered and culturally effective care. Social workers are uniquely positioned to lead these efforts and integrate cultural considerations into health social work. This chapter provides an analysis of the impact of culture in palliative social work. Transcultural social work andragogy, clinical presentations of culture, and tools for cultural assessment are presented. Patient narratives illustrate how these issues may manifest in real-world contexts. This chapter concludes with resources for expanding our understanding of culture in palliative care.
The Power of Language
Authors: Altilio Terry , Kelemen Anne
Published: March 2022

Clinicians across healthcare settings make word choices that have attributed meaning and unintended consequences. We often respond with silence, reluctant to question or explore for want of time, for want of a way to respond respectfully, or for fear of wandering further into lands of uncertainty or suffering. Language, the words we choose and the words we hear, as well as the silence we observe, is an essential and basic instrument for social work. How we speak about our work informs the shared experience across disciplines, cultures, and hierarchy. This chapter is intended to raise consciousness, to consider judgments and biases often expressed by our words, and to highlight the unintended consequences of written and spoken words.
Walking across to Collaboration
Authors: Altilio Terry
Published: March 2022

This chapter’s crosswalk highlights, and adds to, a sampling of thoughts and perspectives from interprofessional colleagues who, in the inaugural edition of the Oxford Textbook of Palliative Social Work, coauthored chapters to capture the rich collaboration that is possible within relationships of respect and trust. Rather than competitors, colleagues become our partners in the discovery and response to caring for whole persons and in our shared work have the opportunity to support or undermine their experiences. This crosswalk is neither an exclusive, nor exhaustive, listing, but rather reflects an ongoing awareness of the rich experiences created when a “village” comes together to provide person-centered, family-focused, culturally congruent care and to mitigate the inequities which continue to infuse our systems.
Palliative Care for Veterans
Authors: Daratsos Louisa , Lopez Alba
Published: March 2022

This chapter discusses specific aspects of palliative care related to veterans who are living with serious illness and those at end of life. Veterans of any country can be considered a special population because of their sacrifice and service to their nation, regardless of whether they served after volunteering or being drafted. This chapter, however, concentrates on veterans of the United States Armed Forces and profiles Vietnam-era veterans, who are the largest living cohort of veterans over age 65. The end-of-life experiences of post-Vietnam veterans have not been systematically studied and therefore not discussed extensively except to make readers aware of the person’s potential veteran status and to alert social workers to remain informed of veteran-specific resources to help that individual. Similarly, the experiences of veterans and the COVID-19 pandemic have not been studied, but the authors offer learning from their experiences working with veterans and their families who have been affected by the virus.
Palliative Care in Chronic Kidney Disease
Authors: Anderson Elizabeth B. , Browne Teri
Published: March 2022

Kidney disease is a unique practice area for social work, as every dialysis and kidney transplant center is required to have a masters-level social worker on its interdisciplinary team. Chronic kidney disease is associated with significant pain issues and high mortality. People with kidney disease have the right to start, forgo, or discontinue renal replacement therapy at any time and have access to a full range of treatment options, including conservative care and palliative dialysis. As a result, people with chronic kidney disease may have many palliative care concerns. Nephrology social workers can integrate the eight domains of palliative care into their practice and assist patients and their families with palliative care issues.
Amyotrophic Lateral Sclerosis and Neurologic Disease
Authors: Mintz Judith Wood
Published: March 2022

Amyotrophic lateral sclerosis is one of a group of neurologic diseases that present with symptoms of gradual inevitable decline in the ability to function independently. It is rare, affecting a very small fraction of the population of the United States. Patients face a unique set of challenges that in turn profoundly challenge the interdisciplinary care teams. They are mentally, emotionally, and psychologically present as they progressively lose control of voluntary movement. The emotional and psychological experience of this disease, and other neurologic diseases, is one of progressive loss. Individuals frequently attempt to maintain control where they can, and this can complicate family dynamics and contribute to the level of stress in the home and may interfere with the provision of good medical care. These adaptations and losses along the continuum of illness invite the expertise of the social workers who contribute as members of interdisciplinary teams.
Palliative Care
Authors: Jagannathan Aarti , Juvva Srilatha , Thomas Priya Treesa
Published: March 2022

In India, palliative care is a specialized care provided at the tertiary health centers. The models of palliative care that provide either a continuum of care and/or end-of-life care services in the country include (a) hospice centers, (b) mobile home care palliative teams, (c) family-based care, and (d) neighborhood network palliative care programs. The role of the social worker is mainly to coordinate between health and social care agencies, advocate for the client/family with medical professionals and voluntary agencies, and provide psychosocial counseling and bereavement support to the family. In keeping with the cultural ethos of the country, working with the family, understanding collusion, and integrating spirituality are vital aspects in providing effective palliative care services.
Merging Research and Clinical Practice
Authors: Cadet Tamara
Published: March 2022

Despite ongoing efforts to encourage and translate the use of research into social work practice, there are still challenges that make it hard to integrate research and practice, particularly among palliative social workers. Among those challenges is what appears to be a lack of clarity about the importance of grounding our knowledge in research to provide the best care, and an inability to access research relevant to our work and the diverse populations we serve. The goal of this chapter is to help emerging and experienced palliative social workers take steps to ensure that the good work that we do is supported by evidence.
Connections and Context
Authors: Shermak Sheryl Lee , Cadell Susan
Published: March 2022

Positive aspects of the experience are not the first thought when working with people who are facing serious illness, death, and grief. Strengths, resilience, and growth can be important aspects to consider and facilitate. This chapter is a critical reflection on the synergy between social work as a person-in-context approach and palliative care philosophy and values. The chapter defines and explores the three aforementioned positive processes in palliative social work practice. Concurrently there is acknowledgment of how cultivating strengths and growth does not erase the pain and distress that are experienced. After definitions, to deepen engagement of what positive processes are and may be, the chapter has three sections. There is a discussion of the importance of situating our interest in the area. Then, the chapter addresses the need to be attentive to the timing of introducing positive processes. Finally, there is a call to action.
Holding On and Letting Go
Authors: Gerbino Susan , Raymer Mary
Published: March 2022

Palliative social workers will be attending to grief and bereavement in their respective settings. Palliative social workers combine humility and skill to provide impeccable assessment, which includes a working knowledge of widely held assumptions about grief that are not supported by empirical research. Awareness of other variables that influence grief include the quality of care proved over the continuum of illness, racism, culture, spirituality, disenfranchised and/or ancestral grief, gender/sexual identity, and COVID-19 pandemic issues helps inform assessment that seeks to understand each person’s unique experience. Appropriate and effective intervention also requires knowledge of current bereavement research and theory. The field of grief and bereavement is continuously evolving, and palliative social workers need to stay current and adjust their practice accordingly. Self-awareness and self-care are additional responsibilities that enable social workers to sustain effective practice over time.
The Integration of Technology
Authors: Campbell Katharine
Published: March 2022

Technology has infiltrated all aspects of healthcare, and palliative social workers are tasked with understanding the vast opportunities as well as the critical risks that accompany this evolution. The effects of technology range from access to care to the various processes and quality of that care. Implications for providers, patients, and families are explored from the areas of concern as well as the opportunities for enhanced care. Considerations include technological matters that impact care, ethical concerns, competency needs, and use of technology to meet emotional needs of support and knowledge. An overview bridging technology, healthcare, and ethics as a complex process is provided. Guidelines and future implications are offered for the reader to continue the journey of learning.
Interventions in Palliative Social Work Practice
Authors: Kelemen Anne , Remke Stacy S.
Published: March 2022

Social work intervention in palliative care is a key element of effective team-based practice and has significant implications for patients’ outcomes. Intentional integration of evidence-based and evidence-informed modalities that flows from a multidimensional assessment process is at the core of competent practice. With each clinical encounter, social workers make practice choices, selecting interventions that impact patient care, teamwork, and outcomes. This chapter provides a rationale for this practice, defines pathways to ensure accountability to diverse stakeholders, including patients and their families, and describes a logic model to guide social workers in the process of assessment and intervention. Taken together, these elements ensure ethical, effective and accountable social work practice in palliative care.
Acceptance and Commitment Therapy
Authors: Moore Kayla
Published: March 2022

Pain and suffering can be lonely and isolating experiences, and yet they are inextricably woven into daily life. Acceptance and commitment therapy (ACT) is a treatment modality that acknowledges the reality that pain and suffering are inescapable parts of humanity. Through the understanding of the relationship of language, cognition, and their influence on human behavior, Steven Hayes and colleagues have identified six core processes that can assist in enhancing psychological flexibility and empowering individuals to live life according to their truest sense of self. This chapter highlights the parallels between the six core processes of psychological flexibility and palliative care. These processes include mindfulness, acceptance, defusion, self-as-context, values, and committed action.
De-Escalating Highly Emotional or Potentially Violent Situations
Authors: Hurley Kathleen
Published: March 2022

Patients with serious illness and their families do not often become agitated or aggressive, but when they do, it is important to know how to intervene quickly and effectively. Skills such as active listening, empathy, attunement to nonverbal behaviors, fogging, the broken record technique, and a genuine apology may assist in successful de-escalation. The de-escalator’s emotional self-regulation and awareness are equally important in a charged encounter. After the de-escalation interventions have been implemented, it is important to offer space to process what has happened and repair any ruptures to the therapeutic relationship. Care must be taken during heightened encounters to intervene with cultural sensitivity and the awareness that anger can be a normal reaction to grief.
Eye Movement Desensitization and Reprocessing for Pain Management
Authors: Colón Yvette
Published: March 2022

In palliative care, there is a need to develop and use better tools for clinical assessment and intervention that address illness-related stressors. Eye movement desensitization and reprocessing (EMDR), originally developed as a psychotherapy treatment for posttraumatic stress disorder, has shown efficacy in pain and symptom management. Research studies indicate that EMDR, a culturally adaptable, evidence-informed treatment that targets emotional distress and associated physical symptoms, can reduce the physical and emotional distress of serious illness and side effects successfully. This chapter considers the development of EMDR and its use in the psychological support of people with trauma, including those living with or recovering from serious illness. It outlines the basic EMDR trauma protocol and eight phases of treatment, examining an exploratory process that may help palliative care patients further understand the relationship between body and mind. Additionally, the chapter will outline other EMDR protocols used with persons experiencing pain. Information about basic and advanced training, continuing education, and professional resources is included.