bluuebunny/crossref_metadata_2025 huggingface dataset:
Adolescent and Young Adult Patients
Authors: Cheung Christabel K. , Santacroce Sheila J. , Zebrack Bradley J.
Published: February 2021

Adolescent and young adult (AYA) cancer patients are beneficiaries of technological advances, who are now living long enough to experience medical late effects and psychosocial challenges, as well as opportunities for personal growth and transformation, resulting from exposures to curative and life-extending biomedical innovation. This chapter first defines the AYA population and summarizes trends in the epidemiology, etiology, and prognosis of cancer in this population. Second, it describes prominent AYA developmental characteristics. Third, it characterizes the context in which AYAs experience a cancer diagnosis and its care. Fourth and finally, it discusses prevalent psychosocial developmental challenges for AYA cancer patients, including key clinical issues unique to this age-defined population, and what is considered reasonable recommendations for assessment, information, and intervention in psycho-oncology care to promote their health and well-being. Psycho-oncologists are called to utilize frameworks that explain human development and social ecology to inform the development of clinical recommendations that are relevant and responsive to the dynamic contexts in which AYA patients live beyond a diagnosis of cancer.
Cancer Caregivers
Authors: Applebaum Allison J. , Kent Erin , Litzelman Kristin , Ferrell Betty , Nicholas Dionne-Odom J. , Northouse Laurel
Published: February 2021

This chapter describes prevalence estimates of cancer caregivers in the United States and provides a comprehensive review of the effect of cancer on caregivers’ psychological, physical, and financial well-being. The unique burden faced by spouse caregivers versus adult child caregivers is clearly delineated. Four evidence-based interventions to assist cancer caregivers or patient-caregiver dyads are described: psychoeducational interventions (e.g., ENABLE), dyadic interventions (e.g., FOCUS), cognitive behavioral therapy (CBT), and Meaning-Centered Psychotherapy for Cancer Caregivers (MCP-C). The chapter also explores the ethical and legal issues faced by caregivers and concludes with important future directions including the need for (1) more comprehensive caregiver assessment, (2) more research on optimal intervention dose and delivery, and (3) more implementation of evidence-based interventions for caregivers in formal health care systems.
Latin American Critical Epidemiology
Authors: Breilh Jaime
Published: February 2021

This chapter presents a panoramic analysis of the roots and landmarks of the Latin American critical scientific tradition, explaining the historical conditions—from colonial times to 21st-century society—that determined the distinct periods of the Latin American social medicine/collective health movement, its philosophy, and its ethics. It explains how opposing perspectives and methodological differences arose during those periods, creating a paradigm clash that expresses the interests and views of scholars and decision-makers adhering to different philosophical and practical postures. It describes the fundamental influence in the conceptual and practical shaping of epidemiology of local specific conditions and pressures and also highlights the fundamental influence of and parallelism with outstanding contributions from the North. This chapter provides English-speaking audiences firsthand knowledge of an innovative scientific tradition, explaining its substantial contributions and potentialities for health transformative research, teaching, and community-based agency.
Why Critical Epidemiology?
Authors: Breilh Jaime
Published: February 2021

The exponential growth of a discriminatory and rapacious market economy in the 21st century, nurtured and reproduced by an unhealthy civilization, is analyzed in this chapter. Global problems that make critical epidemiology an imperative tool are condensed to provide a synthesis of the impacts of 21st-century health inequity. The chapter provides an epidemiological profile of socio-environmental contradictions that cause the failing results of big business applications of new fourth industrial revolution technologies. It illustrates how unparalleled wealth concentration is not only destroying the fundaments of wellness and healthy living but also causing the downfall of common good and the derailment of institutional ethos. As a call to reason for public and collective health advocates, it highlights the myths of “progressive” technocracy (aberration of health governance) and the “sins” of a regressive expertness. Planetary life and health are hanging by a thread in a civilization in which producing fast, living fast, and dying fast is the ruling logic.
Pediatric Airway Fundamentals
Authors: Sozzer Aisha , Anderson Jennifer
Published: February 2021

This chapter describes the important anatomic and physiologic differences between the child and adult pertinent to airway management. Equipment specific for pediatric airway management, including laryngoscopes, endotracheal tubes, and supraglottic airways, are described. It is critical that the pediatric anesthesiologist have specialized knowledge of and training for the pediatric airway as well as the correct equipment available for airway management. Many specialized options for airway management have become available in recent years, including Microcuff endotracheal tubes and new types of supraglottic airways. This chapter provides detailed step-by-step guidance on the basics of pediatric airway management. A useful reference feature included are charts on sizing of endotracheal tubes, laryngeal mask airways, the i-gel device, and the air-Q device.
Mask Ventilation, Direct Laryngoscopy, and Supraglottic Airway Placement Procedures
Authors: Anderson Jennifer
Published: February 2021

The basic skills required for competence in pediatric airway management include mask ventilation, supraglottic airway placement, direct laryngoscopy, and intubation. Although techniques used for children are similar to those used for adults, there are some nuances that pertain only to the pediatric patient. This chapter describes and illustrates these basic airway management procedures for pediatric patients. Bag mask ventilation is used extensively in the operating room, emergency department, and intensive care unit. Effective bag mask ventilation can save a child’s life in emergent situations.1 Respiratory assistance is provided to the patient through a mask on the patient’s face, held in a specialized way to maximize airway patency (described later), that is attached to a device capable of delivering positive pressure manually or automatically. Oxygenation is achieved by compressing air/oxygen through the delivery device into the lungs, and ventilation is ensured by maintaining airway patency as the patient exhales with chest wall recoil. Intubation is indicated in any patient who is unable to maintain adequate spontaneous respiration or who is at risk for aspiration. Examples are patients in respiratory arrest, those in cardiac arrest, or sometimes those experiencing neurologic issues such as seizures. Patients undergoing surgical procedures will often require intubation because of the apnea and risk for aspiration caused by the anesthetics and the surgical procedure itself.
Pediatric Intraosseous Placement
Authors: Seiden Samuel C.
Published: February 2021

Intraosseous access can be used to rapidly deliver fluids and medications when venous access is not feasible. The intraosseous space does not collapse (as can occur with large veins), making the intraosseous route particularly useful in a patient in whom venous access cannot be obtained readily by peripheral or central routes. In fact, the most recent American Heart Association/American Academy of Pediatrics guidelines for Pediatric Advanced Life Support state that in an emergency situation, “intraosseous (IO) access can be quickly established with minimal complications by providers with varied levels of training. Limit the time spent attempting to establish peripheral venous access in a critically ill or injured child.” Contraindications include underlying bone disease, infection at the site, or recent IO access in the same bone. Severe complications, including loss of bone or limb, have been reported; neonates are at higher risk for these complications. There are several options for devices for obtaining intraosseous access.
Infant and Pediatric Cardiopulmonary Resuscitation
Authors: Nizamuddin Sarah
Published: February 2021

High-quality cardiopulmonary resuscitation (CPR) in children with cardiac arrest is vitally important to increase the chance of survival. The rate of return of spontaneous circulation from in-hospital cardiac arrests has improved between 2001 and 2013, from 39% to 77%. In adults, cardiac arrest is most commonly due to primary cardiac causes. In contrast, the cause of pediatric cardiac arrest is often asphyxia resulting in hypoxia. Because of this difference, there is a greater level of importance given to ventilation during infant and pediatric CPR. After recognition of the loss of pulse or blood pressure, quick initiation of CPR is necessary to provide blood flow to vital organs. Ensuring high-quality cardiopulmonary resuscitation in pediatric patients requires knowledge of the appropriate equipment, medications, and procedures. Quick recognition of the loss of spontaneous circulation should trigger an immediate call for help and initiation of chest compressions. Ventilation should be supported, and defibrillation should be performed when the patient is in a shockable rhythm. Epinephrine and other medications may also be required.
Anesthesia for Tracheoesophageal Fistula
Authors: D’Mello Ajay , Raman Vidya T.
Published: February 2021

A tracheoesophageal fistula (TEF) is a communication that is congenital or acquired between the trachea and esophagus. The reported incidence of TEF or esophageal atresia (EA) is roughly one to two per 5,000 live births. The first successful surgery for TEF was in 1939. Presently, owing to progress in surgical techniques, neonatal intensive care, and neonatal anesthesia, the majority of neonates with a TEF/EA who do not have severe associated congenital anomalies are expected to have satisfactory outcomes. Coexisting congenital abnormalities occur in 30 to 50% of patients with TEF/EA. Congenital anomalies are more common in patients with isolated esophageal atresia (65%) compared with isolated tracheoesophageal fistula (10%).
First Trimester Hemoglobin A1 and Risk for Major Malformation and Spontaneous Abortion
Authors: Blake Rachel , Zera Chloe
Published: February 2021

This chapter summarizes a landmark study on the association of first trimester hemoglobin A1 values with risk for spontaneous abortions and major fetal malformations during pregnancy in women with pregestational diabetes. Is there a correlation between glycemic control during the first trimester and risk for spontaneous abortion and major malformations? Starting with this question, it describes the basics of the study, including study location, study population, amount of patients, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes
Authors: Belcher-Obejero-Paz Alexandra , Lee-Parritz Aviva
Published: February 2021

The ACHOIS Trial describes the treatment of gestational diabetes mellitus on pregnancy outcomes. Women between 16 and 30 weeks gestation who had a response between normal and diabetic on a glucose-tolerance test were randomized to either usual care or to an intervention that included dietary advice, glucose-monitoring and insulin therapy. The trial found that treating gestational diabetes is associated with improved maternal and fetal outcomes, including decrease is macrosomia, birth trauma, shoulder dystocia, and preeclampsia.
The Natural History of the Normal First Stage of Labor
Authors: Fox Karin
Published: February 2021

This article provides a summary of a landmark study on labor, in a large, multicenter modern cohort of women with singleton, vertex gestations. Emanuel Friedman published his original labor curve showing the expected progression of normal labor in 1955, and that for multiparous patients in 1956.2,3 He plotted the individual labor progression of 500 nulliparous laboring women from a single center to calculate the average progression of labor. In his cohort, 70% of whom were between 20 and 30 years old, many were Caucasian, and 55% of women were delivered via forceps. Dr. Friedman classically identified the second stage of labor starting at 4cm dilatation. Since the mid-20th century, many practice patterns have changed, and today’s population of women delivering in the United States is diverse and, on average, older and heavier than in 1955; therefore, use of the traditional labor curve has been questioned. The investigators in this study performed a secondary analysis of data from a multicenter cohort of 26,838 patients with singleton gestation, spontaneous labor, and normal outcomes. Using a sophisticated statistical approach Zhang et al. produced a modern labor curve.
An Intervention to Promote Breastfeeding
Authors: Sudhof Leanna , Golen Toni
Published: February 2021

This article summarizes the study that aimed to demonstrate the impact of the Baby-Friendly Hospital Initiative on breastfeeding duration and infant health. As it is not possible to randomize mothers to breastfeeding or formula feeding, the study randomized hospitals and their associated clinics to a breastfeeding promotion intervention or no intervention and followed the infants of breastfeeding mothers for1 year. The primary outcome was the rate of infant infections. The article reviews the most important components of the study, its strengths and weaknesses, and the implications for practice and presents a related clinical case at the end.
The Risk of Pregnancy After Tubal Sterilization
Authors: Chouinard Sujata , Espey Eve
Published: February 2021

The CREST Study, conducted from 1978 to 1986, used a prospective cohort design to determine the risk of pregnancy after different methods of tubal sterilization. This landmark study followed a cohort of over 10,000 women who underwent tubal sterilization via laparoscopic unipolar coagulation, laparoscopic bipolar coagulation, laparoscopic silicone rubber band application, laparoscopic spring clip application, or partial salpingectomy by laparotomy (postpartum tubal ligation) at 9 participating medical centers across the United States. Follow-up interviews identified women who subsequently became pregnant. The study demonstrated that rates of sterilization failure were higher than previously thought and that failure rates varied by method of tubal sterilization. More effective methods included postpartum partial salpingectomy and laparoscopic unipolar and band procedures. It further demonstrated that younger women and Black women were at increased risk of sterilization failure.
Effect of Screening Mammography on Breast Cancer Detection and Mortality
Authors: Jeudy Myrlene , Swain Monique , Pearlman Mark
Published: February 2021

This widely discussed study by Bleyer and Welch published in The New England Journal of Medicine (NEJM) “The Effects of Three Decades of Screening Mammography on Breast Cancer Incidence” concluded that screening mammography leads to a substantial overdiagnosis of early breast cancer (estimated 69% increase) while only having a small effect on late-stage breast cancer (estimated 8% decrease). In a population-based observational study, the authors utilized trend data from the Surveillance, Epidemiology and End Results (SEER) database to examine trends on the incidence and stage of early- versus late-stage breast cancer at the time of diagnosis. They compared 2 time frames: prior to widespread mammography screening (1976–1978) and after mammography screening was introduced in the United States (2006––2008). This article reviews this NEJM article and describes several methodological assumptions by the authors that have been soundly criticized and the associated limitations. As a result of these limitations, there was an exaggeration of the overdiagnosis of early-stage disease with mammography and, more importantly, a substantial underestimate of the impact of mammography on decreasing late-stage breast cancer.
Human Papillomavirus Infection of the Cervix
Authors: Mills Jacqueline M. , Stier Elizabeth A.
Published: February 2021

In 1992 Lorincz et al. were the first to evaluate the clinicopathologic correlation with 11 recently identified human papillomavirus (HPV) genotypes: 31, 33, 35, 42, 43, 44, 45, 51, 52, 56, and 58. Using cervical samples from 8 studies that included specimens from 2627 women, HPV genotypes were categorized by the likelihood of association with grades of cervical neoplasia (from normal to cancer). These findings were the basis of the determination that (a) HPV causes cervical cancer, (b) detection of the cancer associated HPV genotypes could identify women at risk for cervical pre-cancer and cancer, and (c) a prophylactic HPV vaccine should include protection against (at least) HPV 16 and 18.
The Accuracy of Endometrial Sampling in the Diagnosis of Patients With Endometrial Carcinoma and Hyperplasia
Authors: Chandler Chelsea , Olawaiye Alexander
Published: February 2021

This article provides a summary of a landmark study regarding the diagnosis of endometrial cancer. How accurate is endometrial sampling in women with endometrial carcinoma and hyperplasia? The article describes a meta-analysis in which the results of 39 studies using a variety of different endometrial sampling devices are compared by their sensitivity and specificity for diagnosis endometrial carcinoma and atypical hyperplasia of the endometrium. The article briefly reviews criticisms and limitations of the included studies, discusses implications, and concludes with a relevant clinical case.
Uterine-Artery Embolization Versus Surgery for Symptomatic Uterine Fibroids
Authors: Pepin Kristen , Cohen Sarah L.
Published: February 2021

This review highlights the work done on the REST trial in which women with symptomatic uterine fibroids were randomized to uterine artery embolization or surgery. Adult women with fibroid uterus were randomized to either surgery (myomectomy or hysterectomy) or uterine artery eumbolization. Both resulted in similar quality of life scores at one year after the procedure. UAE did result in lower pain scores 24 hours post-procedure, and had a faster return to work, but had a reintervention rate of 20% within the first year.
Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women
Authors: Beverly Rachel , Volkar Judith
Published: February 2021

In healthy postmenopausal women with a uterus, the unfavorable risk-benefit profile for combined estrogen plus progestin therapy makes this therapy a nonviable intervention for primary prevention of chronic disease. This study (part of the Women’s Health Initiative) evaluates hormone therapy in postmenopausal women. Patients are randomized to either combination therapy or to a placebo. The study concluded that risks of hormone therapy (including breast cancer and cardiovascular disease) outweighed the benefits of therapy, including a reduction of fractures. It is appropriate to initiate hormone therapy for women with bothersome vasomotor symptoms who are within 10 years of menopause and are healthy.1
Developing Convergence Neuroscience as a Model
Authors: Turnbull Marion T , Freeman William D.
Published: February 2021

This chapter on developing convergence neuroscience as a model examines the systems required to build and support a convergence oriented workforce. The future of the biomedical and life science innovation depends on its ability to integrate and cross-collaborate with other data-hungry and fast-progressing research domains such as bioinformatics, computer science, engineering, and the physical sciences. In the context of this chapter, convergence is the joining of forces between neuro-based life sciences with engineering and the physical sciences, in a transdirectional exchange—or intellectual cross-pollination. In this context, the chapter reviews three core objectives: (i) the need to focus on a common theme or scientific/medical challenge, (ii) how to encourage convergence through structural change such as personnel, infrastructure, and funding strategies, and (iii) the importance of expanding educational and training programs that teach convergence methodology alongside traditional opportunities for formal and informal discussion and collaborations.
Artificial Intelligence in Mental Health
Authors: Grzenda Adrienne
Published: February 2021

Artificial intelligence is devoted to developing “intelligent” software and machines capable of learning, reasoning, perception, and movement. The field frequently suffers from exaggerated claims as to its immediate promise or detriment to humanity. In practice, artificial intelligence is a set of powerful tools that facilitate a convergent approach to complex problems. Artificial intelligence—more specifically, machine learning—is critical to capitalizing on big data, the high-volume, high-dimensionality data sets generated by advanced biological, clinical, and mobile technologies. This chapter provides an overview to the key concepts of artificial intelligence as well as a primer to the field’s core methods. A discussion follows as to how these techniques may address notable challenges within mental health with select examples from the literature. The chapter concludes with a brief discussion of training, technical, and ethical considerations in implementation.
Global Mental Health and Technology
Authors: Ng Chee H. , Li Victor , Gratzer David , Lam Raymond W.
Published: February 2021

Globally, mental or neurological disorders are projected to be a leading cause of health and socio-economic burden, with the majority of the burden affecting low and middle income countries (LMICs). Although the growing mental health crisis is receiving greater attention worldwide than ever before, the high treatment gap and poor access to mental healthcare have persisted. Finding solutions to overcome barriers to treatment requires multisectoral and multidisciplinary partnerships as well as innovations that take advantage of new technology. The chapter will highlight the convergence of global mental health and digital technology by focusing on two regional initiatives, the Asia-Pacific Economic Cooperation (APEC) Digital Hub for Mental Health and the Enhanced Measurement-Based care Effectiveness in Depression (EMBED), to exemplify convergent approaches for targeting the treatment gap of mental illness in the Asia-Pacific region. To conclude, future directions in technology for mental health in LMICs are considered, while also recognizing some of its limitations.
NODE.Health Algorithm to Support Digital Mental Health Validation
Authors: Sheon Amy , Chan Steven , Winkle Brian Van , Rosner Benjamin
Published: February 2021

Over the last several years, there has been rapid growth of digital technologies attempting to transform healthcare. Unique features of digital medicine technology lead to both challenges and opportunities for testing and validation. Yet little guidance exists to help a health system decide whether to undertake a pilot test of new technology, move right to full-scale adoption, or start somewhere in between. To navigate this complexity, this chapter proposes an algorithm to help choose the best path toward validation and adoption. Special attention is paid to considering whether the needs of patients with limited digital skills, equipment (e.g., smartphones) and connectivity (e.g., data plans) have been considered in technology development and deployment. The algorithm reflects the collective experience of 20+ health systems and academic institutions that have established the Network of Digital Evidence for Health, NODE.Health, plus insights from existing clinical research taxonomies, syntheses, or frameworks for assessing technology or for reporting clinical trials.
Introduction
Authors: Doghramji Karl , Boon Maurits S. , Huntley Colin T. , Strohl Kingman P.
Published: February 2021

Respiratory devices have been the mainstay of treatment for obstructive sleep apnea for decades. However, despite significant technical advances in mechanisms of enhancing patient tolerance, many patients with severe disease have remained deprived of treatment. Alternative treatments for this population were largely unavailable until the introduction of upper airway stimulation therapy. By stimulating the hypoglossal nerve, this therapy activates muscles innervating the intrinsic and extrinsic muscles of the tongue, thus addressing inadequate neural activation. Since its commercial introduction, this innovative therapy has been adopted by multiple medical groups in North America and in Europe.
Drug-Induced Sleep Endoscopy
Authors: Kezirian Eric J. , Ravesloot Madeline J. L. , Hohenhorst Winfried , de Vries Nico
Published: February 2021

Drug-induced sleep endoscopy (DISE) is an upper airway evaluation technique in which fiberoptic examination is performed under conditions of unconscious sedation. Unique information obtained from this three-dimensional examination of the airway potentially provides additive benefits to other evaluation methods to guide treatment selection. This chapter presents recommendations regarding DISE technique. It presents the Velum, Oropharynx, Tongue Base, Epiglottis (VOTE) classification for reporting DISE findings, which incorporates the four major structures that contribute to airway obstruction in most patients. The authors review the evidence concerning DISE test characteristics and the association between DISE findings and treatment outcomes, including for upper airway stimulation.
Technical Considerations Following Implantation
Authors: Steffen Armin , Hasselbacher Katrin
Published: February 2021

The hypoglossal nerve stimulation system provides sleep apnea control and nightly usage when the stimulation is adjusted to meet the patient’s needs. During activation, respiratory sensing is checked and thresholds are set at standard electrode configurations. Follow-up contacts over the next few weeks are very important to ensure therapy adherence and to identify any treatment issues. Polysomnographic titration concentrates on therapeutic voltages, even in the supine position. In-lab polysomnography can be skipped as long as sufficient sleep apnea control is achieved and checked with a home sleep test in the setting of a good clinical response in terms of reduced daytime sleepiness and regular usage. If the latter is not achieved, even with the polysomnographic titration, advanced sleep lab adjustments are indicated in which the effects of modified electrode configuration and correct respiratory sensing are monitored.
Special Circumstances
Authors: Boon Maurits S. , Huntley Colin T.
Published: February 2021

Upper airway stimulation (UAS) has emerged as a viable alternative to treat obstructive sleep apnea in select patients who cannot tolerate continuous positive airway pressure. This chapter discusses special populations and circumstances that may impact care of patients using UAS. Topics addressed include women receiving implants, patients with Down syndrome, left-sided implants, replacement of an internal pulse generator, revision surgery, use of UAS with other implanted medical devices, and implants outside of indications approved by the U.S. Food and Drug Administration. Evidence is provided where applicable, but for many of the situations detailed, limited published data are available; the information provided represents consensus and expert opinion.
A brief history of the surgical treatment of coronary artery disease
Authors: Gaudino Mario , Head Stuart J. , Taggart David P.
Published: February 2021

The history of the treatment of coronary artery disease and of coronary artery bypass graft (CABG) surgery is a story of innovators, persistence in the face of ferocious criticism, disappointing failures, and serendipitous discovery. It is a story of giants and visionaries. Over almost 140 years, it can be divided into the following four different eras: the development of scientific background and extracardiac procedures (1880–1934), indirect revascularization procedures (1935–1953), non-CABG direct revascularization procedures and the first attempts at CABG (1954–1967), and the modern era of CABG (1968–present).
Epidemiology of ischaemic heart disease
Authors: Townsend Nick
Published: February 2021

Ischaemic heart disease (IHD) is the most common cause of death globally. However, the worldwide burden from IHD comes not only from the deaths attributable to it, but also from the disability it causes in those who survive with it. Both mortality and morbidity from IHD is greater in men than women, with large inequalities also existing between countries and global regions. This is particularly noticeable when comparing countries of different income classifications, with more than three-quarters of all IHD deaths occurring in developing countries and the lowest age-standardized mortality rates for IHD found in high-income countries.
Coronary endothelial function
Authors: Jay Widmer R. , Lerman Amir
Published: February 2021

The assessment of coronary endothelial function has profound importance in terms of diagnostic and prognostic significance in patients with both obstructive and non-obstructive coronary artery disease. Endothelial dysfunction may take place in both epicardial coronary arteries as well as in the coronary microcirculation. Epicardial coronary endothelial dysfunction can be detected in the catheterization laboratory with abnormal vascular responses to endothelial-dependent physiological or pharmacological stimuli, and is characteristically a precursor to the initial processes of atherosclerotic coronary disease. This chapter discusses coronary endothelial physiology, the prevalence of endothelial dysfunction, how to evaluate coronary endothelial function, and the prognosis for patients with endothelial dysfunction.
Differences and similarities between American and European myocardial revascularization guidelines
Authors: Milojevic Milan , Kolh Philippe , Fremes Stephen E. , Sousa-Uva Miguel
Published: February 2021

The development and update of clinical guidelines are based on an evaluation of the latest data from clinical studies. According to the National Academy of Medicine, clinical practice guidelines are ‘statements that include recommendations intended to optimize patient care that is informed by a systematic review of the evidence and an assessment of the benefits and harms of alternative care options’. These expert documents are intended to provide systematically developed statements that include recommendations on how to translate clinical knowledge from scientific evidence into best patient-centred, evidence-based practice. Supplementing the textbook, clinical guidelines are now being increasingly considered decision drivers, and are being used by healthcare providers to choose the most appropriate diagnostic or therapeutic managing strategy, standardize care, reduce variation, and improve outcomes. The core of each of the clinical practice guidelines are the recommendations developed according to an established scale of the hierarchy of evidence. Although randomized controlled trials are at the top of the pyramid of evidence as the preferred study design for assessing the effects of two or more interventions, in many instances, task force members must rely on findings from observational studies. This is particularly so as trial patients may not always be typical of routine clinical practice. Hence, valuable information can be obtained from both randomized controlled trials and observational studies, including subgroup analysis, cohorts, or case series; therefore, each type of scientific research can be a significant complement to the other and contribute to guideline developments.
Management of coagulopathy
Authors: Kornfield Zev Noah , Despotis George
Published: February 2021

Patients undergoing cardiac surgery with cardiopulmonary bypass are at increased risk for excessive perioperative blood loss and coagulopathy requiring transfusion. In a recent review of transfusion practices in cardiac surgical patients. it was noted that cardiac surgery patients utilize as much as 10–15% of the almost 15 million units of red blood cells transfused in surgical patients in the United States annually and more than half of cardiac surgical patients receive blood products during their hospitalization. Despite publication of blood conservation guidelines, blood product utilization continues to increase for all cardiac operations.
Early vein graft failure
Authors: Antonopoulos Alexios S. , Antoniades Charalambos
Published: February 2021

Coronary artery bypass grafting is a revascularization strategy that improves the clinical outcome of patients with coronary artery disease, but its clinical effectiveness may be hampered by graft occlusion. The mechanisms of graft failure are complex and multifactorial. Graft failure is defined as acute (<1 month), early (1–12 months), and late (>12 months) post surgery and the mechanisms are usually discreet. Graft manipulation and vein biology post engraftment may affect the risk of early acute graft failure. Activation of smooth muscle cell and adventitial fibroblasts, triggered also by the adaptation of the vein to arterial conditions, are involved in extracellular matrix remodelling and intimal hyperplasia development. Graft atherosclerosis can also result in late graft failure. This chapter summarizes the mechanisms of graft failure, provides an overview of the magnitude of the problem of early graft failure, and discusses potential therapeutic strategies.
Sequential coronary grafting
Authors: Grau Juan B. , Fortier Jacqueline H. , Glineur David
Published: February 2021

Sequential distal grafting is a surgical technique in which a single conduit has two or more distal anastomosis for a single proximal anastomosis; in situ sequential arterial grafts may have no proximal anastomosis. Proponents of this method suggest that there is increased total graft flow due to improved distal run-off in sequential grafts, which leads to better graft patency over time, and that sequential grafting is more efficient in terms of conduit use, and reduces the amount of aortic manipulation during surgery.
Anaortic coronary artery bypass grafting
Authors: Brent Keeling W. , Halkos Michael E. , Puskas John D.
Published: February 2021

Coronary artery bypass grafting (CABG) has evolved to become an incredibly safe and effective therapy for ischaemic heart disease. Despite advances in revascularization both with and without cardiopulmonary bypass, cerebrovascular events continue to occur following CABG. Many of these events have been directly related to aortic manipulation (cannulation, aortic clamping, proximal anastomotic devices), and this fact has led a number of surgeons to consider and implement a surgical revascularization strategy whereby the aorta is not manipulated at all. This ‘no-touch’ technique utilizes a number of conduits and orientations in order to achieve complete myocardial revascularization while eliminating aortic manipulation and significantly decreasing the risk of perioperative stroke. Outcomes of patients who suffer a permanent stroke after CABG are dismal. In-hospital mortality rates for patients suffering a permanent stroke after CABG have been reported to be as high as 13.5%. Following discharge from the hospital, patients who suffered a perioperative stroke have a significantly higher risk of mortality within the first year following surgery.
Management and impact of preoperative, intraoperative, and postoperative cardiogenic shock/cardiac arrest in coronary artery bypass graft patients
Authors: Lorusso Roberto , Toeg Hadi , Maltais Simon , DeRoo Scott , Takeda Koji
Published: February 2021

Cardiogenic shock and cardiac arrest due to acute coronary syndromes are almost exclusively approached, as first-line treatment, with percutaneous coronary intervention. In a few instances, however, coronary artery bypass grafting may be the procedure of choice or necessary in life-threatening scenarios based on the failure of percutaneous coronary intervention due to unfavourable/unsuitable anatomical features or for complications arising from percutaneous coronary intervention. Coronary artery bypass grafting in cardiogenic shock or cardiac arrest is frequently characterized by challenging and disadvantageous clinical and haemodynamic conditions.
Coronary artery bypass grafting in patients with ventricular dysfunction
Authors: Garatti Andrea , Castelvecchio Serenella , Parolari Alessandro , Menicanti Lorenzo
Published: February 2021

Ischaemic chronic heart failure represents one of the cardiovascular diseases with the worst degree of morbidity and mortality in the Western world, along with the highest healthcare costs. Despite several retrospective studies demonstrating that surgical revascularization (coronary artery bypass grafting), especially in the presence of viable myocardium, improves heart function and therefore survival in this subgroup of patients, the matter remains unclear and controversial. This chapter discusses the available evidence in the literature, from observational studies to randomized trials, including operative techniques and controversial issues, in order to clarify the role of coronary artery bypass grafting in the current management of patients with ischaemic left ventricular dysfunction.
Coronary artery bypass grafting with the maze procedure for atrial fibrillation
Authors: Javadikasgari Hoda , Marc Gillinov A.
Published: February 2021

Each year, approximately, 100,000 patients undergoing cardiac surgery also have concomitant atrial fibrillation (AF). The dangers of untreated concomitant AF are well known with a fivefold increase in the risks of stroke and mortality. Surgical ablation of AF has evolved in the last decades and surgeons can choose from a variety of ablation technologies. Therefore, most recent guidelines recommend concomitant AF surgery in all cases when feasible, although the choice of lesion set remains controversial. Based upon current data, patients undergoing coronary artery bypass graft surgery who have paroxysmal AF should undergo pulmonary vein isolation and left atrial appendage management (at a minimum), while those with persistent or long-standing persistent AF should undergo a biatrial maze procedure. The purposes of this chapter are to provide a thorough review of the pathogenesis of concomitant AF in patients undergoing coronary artery bypass grafting and to delineate the important technical aspects of concomitant surgical AF ablation.
Prior percutaneous coronary intervention and surgical revascularization
Authors: Luthra Suvitesh , Ohri Sunil K. , Taggart David P.
Published: February 2021

Surgical revascularization may be needed after a prior percutaneous coronary intervention (percutaneous coronary intervention) due to further progression of de novo disease or failure of percutaneous coronary intervention due to in-stent restenosis or stent thrombosis. The proportion of patients referred for coronary artery bypass grafting with prior percutaneous coronary intervention varies between institutions from 5% to 30%.
Radiotherapy in Paediatric Oncology
Authors: Gaze Mark , Boterberg Tom
Published: February 2021

Radiotherapy is an important part of the combined modality therapy used to cure many childhood cancers. Children should only receive radiotherapy in centres suitably equipped, staffed, and experienced in paediatric radiotherapy, supported by the necessary paediatric backup facilities. Many types of radiotherapy, including image-guided and intensity-modulated radiotherapy, brachytherapy, molecular radiotherapy, and proton beam radiotherapy, are available. Choice of the optimal type for an individual patient should result in the greatest chance of cure with least chance of adverse effects. Over the years, a better understanding of risk stratification, improved diagnostic imaging, research in technical developments, and clinical trials has refined decision making in paediatric radiotherapy. Fewer children now receive radiotherapy than previously, and doses and volumes irradiated have been safely reduced, which has improved the therapeutic ratio.
Psychosocial Care
Authors: Grootenhuis Martha , Jankovic Momcilo , van den Bergh Esther , Aarsen Femke
Published: February 2021

Children with cancer and their parents go through different phases of treatment which relate to different emotions and necessary psychosocial care. The stressors during the acute phase, the treatment phase, after treatment, long-term follow-up, or the palliative phase are described in this chapter. Consequences in terms of physical, social, emotional, and cognitive functioning are taken into account. Reactions of both children, parents, and siblings need to be considered, especially in relation to the age of the child. In terms of increased survival, it is important to acknowledge late effects and to teach survivors how to cope with a new normal.
Cancer in Adolescents and Young Adults
Authors: Jones Lucy J.W. , Saloustros Emmanouil , Ferrari Andrea , Stark Dan
Published: February 2021

Adolescents and young adults (AYAs) are a distinct group at the interface between children’s and adult’s cancer services. The distinctive pattern of cancers—biology, outcomes, psychosocial aspects, and late effects—mean they require specific clinical management and care. In the past, survival trends were stable or even deteriorating outcomes from AYA cancer. Then there was little research; treatment depended upon whether the managing clinician was accustomed to managing children or older adults, and was not tailored from specific knowledge and understanding. However, the last 20 years has seen greater interest, collaborative working; AYA-specific biology studies, clinical cohort and population-based studies; AYA-specific clinical services; and simultaneously improved survival. AYAs still pose significant challenges in care and treatment decisions, and in providing sufficient capacity and systems of care for all. Thus there remains much more to be done to further improve AYA cancer outcomes.
Non-Hodgkin Lymphomas in Children and Adolescents
Authors: Minard-Colin Véronique , Patte Catherine
Published: February 2021

Non-Hodgkin lymphoma (NHL) is the fourth most common malignancy in children, with an even higher incidence in adolescents, and is primarily represented by only a few histological subtypes. Dramatic progress has been achieved, with survival rates exceeding 80%. Most patients with Burkitt lymphoma and diffuse large B-cell lymphoma are cured with short, intensive, pulse chemotherapy. The benefit of the addition of rituximab has been demonstrated for high-risk B-NHL and primary mediastinal B-cell lymphoma. Lymphoblastic lymphoma is treated with intensive, semi-continuous, longer ‘leukaemia-derived’ protocols. Relapses in B-cell and lymphoblastic lymphomas are rare and infrequently curable, even with intensive approaches. Event-free survival rates of about 75% have been achieved in anaplastic large-cell lymphomas with various regimens, including generally a short, intensive ‘B-like’ regimen. The role of immunity appears important in prognosis and needs further exploration in therapy. Anaplastic lymphoma kinase (ALK) inhibitor therapeutic approaches are currently being investigated. For all these paediatric lymphomas, the intensity of induction/consolidation treatments correlates with a high rate of immediate toxicities, but due to low cumulative doses of anthracyclines and alkylating agents, minimal or no long-term toxicity is expected. Challenges that remain include defining the value of prognostic factors, such as early response on positron emission tomography (PET)/computed tomography (CT) and monitoring of minimal disseminated and residual disease, utilizing new biological technologies to improve risk stratification and the development of innovative therapies, both at frontline and relapse. non-Hodgkin lymphoma, NHL, European Intergroup for Childhood NHL, EICNHL, Burkitt lymphoma, anaplastic large-cell lymphoma, ALK, lymphoblastic lymphoma
Soft-Tissue Sarcomas
Authors: Bisogno Gianni , Merks Hans
Published: February 2021

This chapter discusses soft-tissue sarcomas (STS) in children and adolescents, which comprise approximately 8% of all paediatric malignancies. It highlights the clinical, pathological, and biological characteristics of this heterogeneous group of tumors derived from mesenchymal cells, and it describes the current management and the treatment results. The first part of the chapter is dedicated to the most frequent paediatric STS, rhabdomyosarcomas (RMS), while the second part covers the diagnosis and treatment strategies for non-rhabdomyosarcoma STS (NRSTS) including synovial sarcomas (SS), adult-type NRSTS, and other histotypes (infantile fibrosarcoma (IFS), desmoplastic small round-cell tumour (DSRCT), and malignant rhabdoid tumour (MRT)).
Wilms and Other Renal Tumours
Authors: Graf Norbert , Bergeron Christophe
Published: February 2021

This chapter discusses renal tumours in children and adolescents. Nephroblastoma or Wilms tumour (WT) is the most common childhood renal tumour, with an incidence of seven per one million children below 15 years of age. Diagnosis and treatment is done within prospective multicentre clinical trials conducted by large international study groups (International Society of Paediatric Oncology, SIOP; Children’s Oncology Group, COG). The outcome of WT is excellent, with around 90% survival rates, depending on age, stage histological subtyping, response to treatment, and molecular markers. Other renal tumours in childhood are clear-cell sarcoma of the kidney (CCSK), rhabdoid tumour of the kidney (RTK), renal-cell carcinoma (RCC), and congenital mesoblastic nephroma (CMN). Their treatment and outcome is different to WT.
Colon
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The colon chapter discusses the diseases and conditions of the colon. The diseases of the colon are explored with the common presenting symptoms detailed. The occurrence rates of these colonic conditions are listed and any potential causes defined. The investigations that are required to diagnose the condition are explained. Treatment options or preventative measures are also described with identification of any potential complications. There are many conditions and diseases that commonly occur within the colon such as appendicitis, diverticular disease, and irritable bowel syndrome. The polyposis syndromes such as familial adenomatous polyposis and juvenile polyposis syndrome are also included but colorectal cancer and inflammatory bowel disease are not included within this chapter, instead they are explored in a separate chapter each. Succinct descriptions of these conditions and diseases can assist the nurse in clinical care.
Pancreas
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The pancreas chapter explores the conditions and diseases of the pancreas. The common diseases of the pancreas are described with the identification of the more frequently presenting symptoms. The occurrence rates of these liver conditions are defined and any potential causes documented. The investigations that are used to diagnose the condition are described. Treatment options or preventative measures are also explored with a description of any potential complications. Conditions of the pancreas include pancreatitis which can be either acute or chronic. There is a more in-depth focus on pancreatic cancer. Concise explanations related to people with diseases and conditions of the pancreas will increase knowledge for the nurse that can be used in clinical practice.