bluuebunny/crossref_metadata_2025 huggingface dataset:
Oral rofecoxib in postoperative pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Clinical bottom line. Rofecoxib is an effective analgesic in acute pain. The NNT for rofecoxib 50 mg for at least 50% pain relief over 6 h was 2.3 (95% confidence interval 2.0–2.6). The weighted mean remedication time was 1.9 h for placebo (126 patients), 7.4 h for ibuprofen 400 mg (97 patients) and 13.6 h for rofecoxib 50 mg (322 patients). Rofecoxib is a COX-2 inhibitor that has been shown to be an effective analgesic in osteoarthritis and rheumatoid arthritis at single daily doses of 12.5 or 25 mg. At these (and higher) doses it has also been shown to reduce the incidence of gastrointestinal bleeding on chronic use for arthritis compared with NSAIDs, in both a systematic review and a separate large randomised trial.
Transcutaneous electrical nerve stimulation (TENS) in acute postoperative pain and labour pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Clinical bottom line. TENS is not effective in the relief of postoperative pain. Patients should be offered effective methods of pain relief. TENS neither alleviates labour pain nor reduces the use of additional analgesics. Women should be offered effective interventions for relief of labour pain. TENS was originally developed as a way of controlling pain through the ‘gate’ theory. There is conflicting professional opinion about the use of TENS in acute postoperative pain. For example, the Agency for Health Care Policy and Research recommend TENS as effective in reducing pain and improving physical function, whilst the UK College of Anaesthetists’ working party states that TENS is not effective as the sole treatment of moderate or severe pain after surgery.
Other acute pain interventions with evidence of efficacy
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

This section looks at a number of other interventions for acute pain where there is some evidence that they work. What is not included are interventions that could come under the heading of complementary therapy, which are dealt within a later section. The format is a title, clinical bottom line, reference, and a brief commentary for each. Clinical bottom line. Incisional local anaesthetic is effective in relieving postoperative pain after inguinal herniotomy up to about 7 h. For hysterectomy, cholecystectomy and other major/minor surgical procedures, there was a lack of evidence for effectiveness. This may be due in part to inadequate trial design, and further trials are needed before recommendations can be made.
Introduction
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

This chapter is going to deal mainly with migraine, the most common form of headache apart from common headache or headache associated with other illness. Migraine is common. It affects about 1 adult woman in 5 and 1 adult man in 20. To investigate the prevalence of migraine, studies were looked for that used International Headache Society (IHS) criteria for migraine in large samples of adults. The results of individual studies are shown in Table 3.1.1 and Figure 3.1.1.
Paracetamol for acute Migraine
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Paracetamol is often recommended as the first line of treatment for acute migraine attacks, and patients frequently self-medicate with over-the-counter drugs. There is only a single study on paracetamol in acute migraine that fulfils IHS criteria for the diagnosis of migraine, and with useful outcomes. The study is described, and a brief review of additional studies on migraine from a systematic review added.
Ibuprofen for acute migraine
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Ibuprofen is sometimes recommended for treatment for acute migraine attacks, and patients frequently self-medicate. There is only a single study on ibuprofen in acute migraine that fulfils IHS criteria for the diagnosis of migraine, and with useful outcomes. The study is described, and a brief review of additional studies on migraine from a systematic review added. Inclusion criteria were: treatment of acute migraine with ibuprofen by any route; randomised allocation to treatment groups; double-blind design; adult population and headache outcomes.
Oral naratriptan for acute Migraine
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Comprehensive searches of the following databases were made: MEDLINE (1966–July 2001), EMBASE (1980–June 2001), Cochrane Library (Issue 3, 2001), PubMed (to September 2001) and the Oxford Pain Relief Database (1950–1994). A series of free text searches were undertaken, using generic and trade names. There was no restriction to language. Retrieved reports were searched for additional trials. Neither individual authors nor pharmaceutical companies were contacted for unpublished data.
Oral rizatriptan for acute Migraine
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Comprehensive searches of the following databases were made: MEDLINE (1966–July 2001), EMBASE (1980–June 2001), Cochrane Library (Issue 3, 2001), PubMed (to September 2001) and the Oxford Pain Relief Database (1950–1994). A series of free text searches were undertaken, using generic and trade names. There was no restriction to language. Retrieved reports were searched for additional trials. Neither individual authors nor pharmaceutical companies were contacted for unpublished data.
Oral eletriptan for acute Migraine
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Comprehensive searches of the following databases were made: MEDLINE (1966–July 2000), EMBASE (1980–June 2000), Cochrane Library (Issue 3, 2000) and the Oxford Pain Relief Database (1950–1994). A series of free text searches were undertaken, using generic and trade names. There was no restriction to language. Retrieved reports were searched for additional trials. Pfizer Inc provided data from seven unpublished trials, one of which has subsequently been published.
Topical capsaicin for pain relief
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Capsaicin is an alkaloid derived from chillies. It first entered European knowledge after Columbus’ second voyage to the New World in 1494. There is evidence that capsaicin can deplete substance P in local nerve sensory terminals. Substance P is thought to be associated with initiation and transmission of painful stimuli, as well as a number of diseases including arthritis, psoriasis and inflammatory bowel disease. Inclusion criteria were randomised, double-blind, placebo-controlled trials of topical capsaicin for pain relief; data extractable to show proportion of patients showing improvement. Reviewers calculated odds ratios. We have calculated relative benefits and NNT (with 95% confidence intervals) for some benefit with capsaicin. Reviewers noted that blinding may not be complete owing to the irritant effects of capsaicin when applied to the skin.
Back pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

The evidence from Britain and elsewhere is that back pain is becoming a bigger problem – not that there is any evidence of changing pathology, but rather due to changed attitudes and expectations. This trend has been particularly noticeable since the mid-1980s. The total number of days in Britain for back incapacity obtained through sickness and invalidity benefit has risen dramatically in recent years (Figure 4.7.2). The British experience is by no means unusual, with other countries seeing an even steeper rise to higher levels.
Intravenous regional sympathetic blockade for reflex sympathetic dystrophy
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Clinical bottom line. There is no evidence from existing trials that guanethidine used in intravenous regional sympathetic blockade (IRSB) reduces the pain associated with reflex sympathetic dystrophy (RSD). Based on a small number of patients, there is weak evidence that ketanserin and bretylium may provide some relief. Reflex sympathetic dystrophy describes the constellation of chronic pain conditions associated with hyperactivity of the sympathetic nervous system. Pain is usually constant, severe and unresponsive to conventional analgesics. Intravenous regional sympathetic blockade is an intervention where a drug known to block the sympathetic nervous system is given in high local concentration in the painful limb isolated with a tourniquet.
Treatments for intermittent Claudication
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Inclusion criteria were randomised controlled trials of exercise for intermittent claudication due to peripheral arterial occlusive disease in the lower extremities; walking distance as an outcome; use of treadmill for evaluations. Reviewers extracted data on pain-free or maximum walking times or distances, and used pre- and post intervention scores to calculate a percent change from baseline. All of the included trials were small, with group sizes ranging from seven to 25, and exercise interventions varied in intensity, duration and content. Five of 10 trials had an untreated control group (no intervention or placebo drug), and the remaining trials had an active intervention, either pharmacological, surgical or strength training of lower extremities only.
Arthritis and joints
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

There has been a major change in the conduct of clinical trials in arthritis with the advent of COX-2 selective inhibitors (called, for convenience, coxibs). Previously, trials were characterised by being small, short, and having uncertain outcomes. Subsequently they have become large, of long duration, and often have many outcomes measured, though few reported. A view of outcomes reported in trials before the late 1980s can be gained from a study of reporting outcomes up to 1998 [1]. A search was made for all randomised double-blind trials that compared two of the 22 NSAIDs available in Denmark published up to August 1998. The final sample was 144 trial reports.
Lifestyle and exercise
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

With many bone and joint problems, exercise or other lifestyle interventions are recommended. This is not a bad thing. There is abundant evidence that taking moderate exercise, like walking, improves wellbeing and reduces the risk of cardiovascular problems. A reasonably brisk walk of a mile a day is sufficient. Again, diet, including a reasonable amount of fruit and vegetables, whole grain bread or rice, and regular fish, protects both against cardiovascular disease, but also cancer. People who adopt a healthy lifestyle live longer and better. The Bandolier 10 tips for healthy living summarise the recommendations from the evidence, and are reproduced in section 9.3.
Topically applied non-steroidal anti-inflammatory drugs for chronic pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Inclusion criteria were randomised controlled trials of NSAIDs with pain outcomes; chronic pain conditions (arthritic and rheumatic); full journal publication and unpublished drug company trials. Trials in vaginitis, oral and buccal conditions, thrombophlebitis and experimental pain were excluded. Dichotomous data on pain outcomes were extracted from trials for analysis.At least 50% pain relief was regarded as a clinically relevant outcome. From the dichotomous data, information on the proportion, and then the number of patients who achieved at least 50% pain relief were calculated. A NNT for at least 50% pain relief and the relative risk and benefit of the treatment were then calculated. The review also included a meta-analysis of topical NSAID use in acute pain.
Adverse effects of NSAIDs and coxibs
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

A retrospective case-control survey of emergency admissions for upper gastrointestinal disease in two English general hospitals covering 1% of the UK population (in Rotherham and Stockport) gives some good estimates [3]. Records of all community deaths attributed to upper gastrointestinal disease were also surveyed. Matched controls were identified from emergency admissions for other causes. There were 620 emergency admissions over one year in 1990/91, with controls for 460 cases. Controls were matched for GP practice, sex, age and date of admission. Unmatched cases were retained in the analysis.
Sulfasalazine for rheumatoid arthritis
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

More patients on sulfasalazine discontinued because of adverse effects (rash, abnormal liver function tests) than on placebo, but lack of efficacy discontinuations were many fewer than with placebo. Morning stiffness, pain, the number of tender and swollen joints and patient global assessment were all significantly better with sulfasalazine. The majority of the studies used 2 g of sulfasalazine a day, and results are also given for 3 g a day in two studies. There are also comparisons with other treatments for rheumatoid arthritis (hydroxychloroquinine, penicillamine, and gold), but in few studies with limited numbers of patients.
Complementary and alternative therapies
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

This is a difficult topic for all sorts of reasons. Most importantly, it is different things to different people. For some, it is the one thing that seems to bring some relief in incredibly difficult situations. For others it is a sort of health fashion accessory. Most frustrating is the continual shifting of goal posts, as evidence for or against one variant of a therapy is talked down because of some slight difference in therapy delivery – different acupuncture points, or homeopathy dilution, or ways of doing massage. Most obviously is the blindingly obvious – that for most complementary or alternative therapies (CAT for convenience), or diagnostic procedures, there is absolutely no evidence whatsoever.
Acupuncture
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Acupuncture is commonly used as a routine treatment in many parts of eastern Asia, and is becoming more commonly available in western societies. It is often used for chronic painful conditions, and there are standards for using and performing acupuncture. There is more than one type of acupuncture technique, and this age-old method is now becoming technological, with different types of acupuncture needles, and stimulation (heat, electric current), as well as different acupuncture points representing different schools of thought.
Cancer and palliative care
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

For advanced cancer, pain control relies on morphine (though not necessarily alone). There is no systematic review of morphine clinical trials that we know of, and precious few trials. Therefore, in this introduction, two systematic reviews on morphine clinical pharmacology are offered. The first is a systematic review of factors affecting the ratios of morphine and its major metabolites. The second is a systematic review of the maximum plasma concentration of morphine (and the time at which the maximum occurs). The final section reviews the trials of oral morphine in the cancer pain setting. In the conclusion we set out the areas where we think there is a clear research agenda, and the lessons we have learned about the design and conduct of future trials in cancer pain management.
Non-steroidal anti-inflammatory drugs for cancer pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Clinical bottom line. Non-steroidal anti-inflammatory drugs (NSAIDs) are effective in relieving cancer pain. Single doses of an NSAID are effective at 6 h, and multiple doses of NSAID are effective at ten to 14 days. This review did not attempt to compare the efficacy of different NSAIDs. For single doses, NSAIDs appear to be as effective as intramuscular morphine 5–10 mg, weak opioids or opioid combinations and the same NSAID given at higher doses. For multiple doses, there was no difference between NSAIDs and weak opioids or opioid combinations. No other comparisons were possible. Upper gastrointestinal upset, dizziness and drowsiness were the most common adverse effects for single and multiple dose trials. In multiple dose trials, NSAIDs were associated with fewer adverse effects than intramuscular morphine 5–10 mg.
Radiotherapy for painful bone metastases
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Clinical bottom line. Radiotherapy can provide effective analgesia for painful bone metastases. Over 40% of patients can expect at least 50% pain relief, and just under 30% can expect complete pain relief at one month. There appears to be little difference in efficacy between the fractionation schedules and between different doses using the same schedule.

Radiotherapy is commonly used to provide pain relief for localised painful bone metastases. It is, however, difficult to provide accurate estimates of the proportion of patients achieving relief, and the extent and duration of relief owing to the variations within the condition and in the primary cancer itself. Contemporaneous interventions and supplementary analgesics further complicate the picture.
Better prescribing of NSAIDs
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Providing information to doctors about better prescribing, also called academic detailing, has been shown to be a good thing. A Cochrane review [1] of 18 randomised or quasi-randomised trials found positive effects on practice in all trials, but only one measured a patient outcome. A new study from Adelaide [2] demonstrates an apparent remarkable decrease in admissions for perforations, ulcers and gastrointestinal bleeding following detailing about appropriate use of NSAIDs.
Quality improvement by audit: Pain relief after day surgery
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

In an 8-week period in 1993, 150 adults having surgery in a day surgery unit in Cardiff (general surgery, gynaecology, ophthalmic or ENT) were audited using a postal questionnaire for pain at home after their operation. At 24 and 72 h they rated their pain as mild, moderate or severe, and recorded analgesic drugs used over three days. The hospital had an analgesic prescribing policy covering about half these patients.
Improving oral postoperative Analgesia
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

Successive initiatives in the 1990s at Stoke Mandeville Hospital had made progress in using new analgesic techniques like epidural, spinal, patient and nurse controlled analgesia. But management of subsequent ‘step-down’ prescribing of oral analgesics was not keeping pace. Patients’ postoperative care was not the best because of the inadequacy of the oral component. Prescribing at this stage was unstructured, with a wide range of oral analgesics in routine use, without any evidence base. Expenditure on oral analgesia was rising rapidly.
Do-it-yourself pain control
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry
Published: October 2023

The successful implementation of an acute pain service prompted questions about how pain control was managed for women after Caesarean section. Methods used there had evolved over time. Midwives and doctors thought it could be improved, but for different reasons, while no-one knew what mothers thought because they had not been asked. Two parallel paths of action were set in hand in 1996. One was a baseline audit to establish the nature of pain control being provided to mothers. The other was a review of the evidence about effective analgesic prescribing.
Providing health care: finance and regulation
Authors: Dolan Paul , Olsen Jan Abel
Published: October 2023

The previous two chapters set out the arguments for government intervention in the distribution of health care. This chapter turns the focus towards the supply side and discusses some key issues on the financing and regulation of health care provision. Market failures have implications for how a market should be regulated. The idea that an ‘invisible hand’ will take a market towards an efficient allocation of resources becomes untenable if that market is not capable of standing on its own two feet (that is, if it does not come close to satisfying the assumptions of perfect competition). Uncertainty about the incidence of illness, asymmetric information of various kinds between the providers and the users of health care, and externalities in consumption all mean that there is the need for extensive regulation of the provision of health care. Whilst private insurance markets can to some extent solve the problems associated with uncertainty, asymmetric information requires considerable government regulation to protect relatively uniformed users, and we have already seen that concerns for other people’s health have implications for how health services should be financed.
Discrepancies between diagnostic criteria and clinical practice
Authors: Wessely Simon
Published: October 2023

In this chapter I shall discuss the problem of classifying conversion disorders, and con- clude that there is a wide discrepancy between the official psychiatric classifications of conversion disorders and their use in clinical practice. This is partly a reflection of the dilemmas and ambiguities that underlie the concepts of conversion disorders, and partly because of the general problems of applying psychiatric thinking to non-psychiatric practice.
Hysterical conversion—a view from clinical neurology
Authors: Stone Jon , Zeman Adam
Published: October 2023

Symptoms which prove to be medically unexplained are ubiquitous for the clinical neurologist. Although they range throughout the domain of neurology, weakness, sensory disturbance, dizziness, and blackouts are particularly common presentations. A proportion of patients satisfy the following working definition of hysteria: They appear initially to suffer from a neurological disease.
Conversion hysteria: a legal diagnosis
Authors: Sprince Michael A Jones Alan
Published: October 2023

Conversion hysteria is not a diagnosis that has featured significantly in English law, at least in terms of reported decisions. Less than two per cent of civil claims come before the courts, the remainder being settled by the parties before trial, and not all cases that go to trial are reported. There is however very little direct reference to conversion hysteria in the legal electronic databases or the Law reports. This suggests that practising lawyers are unlikely to recognize it from their typical case-loads, though they will be more familiar with phrases such as ‘psychological overlay’, ‘functional overlay’, ‘illness behaviour’, and ‘litigation neurosis’.
Hysteria and hypnosis: cognitive and social influences
Authors: Mcconkey Kevin M
Published: October 2023

The cognitive and social factors that influence hypnosis seem to influence hysteria as well. Thus, investigating and understanding hypnosis is one way of investigating and under- standing the processes of hysteria. This has been recognized in both historical and contemporary links of hysteria and hypnosis, and I consider these links before turning to consider selected investigations of hypnotic phenomena (specifically blindness, anaes- thesia, and identity distortion), to then look at some major influences and interactions, and finally to make a concluding comment.
The future
Authors: Lindesay James , Rockwood Kenneth , Macdonald Alastair
Published: October 2023

As all investors are constantly warned, the future cannot be predicted from the past, but a better future can be facilitated by the careful use of history, and the bulk of this chapter is therefore autistic [wish-fulfilling, in Bleuler’s terms (1970)] rather than attempting too much in the way of crystal-gazing. However, a cautionary note must be sounded by what appears to be a waning of interest in delirium, judging by the numbers of references to empirical studies. In 1970, there were 203 MEDLINE (National Library of Medicine 2001) references to delirium (2.5% of all mentioning patients or subjects), but this had only risen to 243 references by 2000 (0.2% of all mentioning patients or subjects). The disorder’s claim to interest as a boundary issue (its rich basic science, clinical, psychiatric, physical, social, and health service importance) may also be responsible for it being considered as peripheral by many disciplines and central to none. Claims by any one discipline to a dominant role [e.g. old age psychiatry (Meagher 2001)] must – with the possible exception of geriatric medicine – be rejected, but this lack of clear ‘ownership’ also makes it difficult to obtain funding for high-quality, large-scale research. It seems to us self-evident that delirium is a perfect subject for interdisciplinary research, including the biological, psychiatric, psychological, medical (including palliative care), nursing, and social sciences. Our primary desire, then, is to see delirium research increase in volume and quality to match its importance and relevance, and the intellectual challenge it poses.
Harvard University and the American Red Cross
Authors: Tyrrell David , Fielder Michael
Published: October 2023

Common cold research, in spite of these distractions, was attracting considerable support in Britain, and this was largely due to the attention being given to it by certain groups in the United States. The Lancet reported in 1930 that $195 000 had been given to Johns Hopkins Medical School to create the John J. Abel Fund to support research on the common cold. And we have just seen how the study of colds in New York City impressed young Dr Andrewes and the senior MRC staff in Britain. But another important element was the contribution, in 1940, of Harvard University in Boston, Massachusetts—in a quite different but very practical and immediate way.
Uncertain beginnings
Authors: Tyrrell David , Fielder Michael
Published: October 2023

The CCU was set up so that the team could find out how to grow the cold virus in the laboratory. But catching and taming a virus is like stalking an animal. It has to be approached with extreme care and in a roundabout way. The initial result of their experiments would be a slightly cloudy fluid in a tube. But that could be anything. They had to be absolutely certain it had a live virus in it that would reliably produce colds. If they could achieve that it would be a major advance in cold research. Meanwhile their experiments with volunteers had to rely upon transfers from known sufferers.
Viruses and their targets
Authors: Tyrrell David , Fielder Michael
Published: October 2023

There has been much confusion concerning viruses and bacteria and what, if any, are the differences between them. This is not surprising since even the scientists who first studied them shared this confusion. But the differences are fundamental. A bacterium is self-sufficient. It can survive on its own without any exterior aid and multiply rapidly through cell division. A virus is essentially parasitic. It can do nothing on its own and becomes active only after it has penetrated a living cell. Once inside it produces more viruses, often destroying the host cell and then going on to attack adjacent cells. It is the type of virus and the type of cell it attacks which determines the nature of any disease which follows.

Viruses are very ‘clever’, being able to adapt rapidly to changing conditions, but so is the body. It is by no means a foregone conclusion that a virus attack will lead inevitably to some form of illness. We are involved with viruses all the time. Some viruses live inside our bodies from childhood to old age and either cause no illness or only occasional problems like cold sores. We swallow or breathe in other viruses, and more often than not they do us no harm. Even if they infect us for a while our immune system is very good at getting rid of them. Some people are attacked more than others, but our bodies win the battle on most occasions.
International cooperation
Authors: Tyrrell David , Fielder Michael
Published: October 2023

Diseases travel the world, taking no note of boundaries. They are the true internationals, and we have to deal with them accordingly. Some have a preference for a particular region, perhaps thriving in warmer climes, but the majority have no such limitations. And of these the common cold must surely be the most ubiquitous international of them all. We needed to pursue this experienced traveller as far as we could by having an international dimension to our own studies. For example, were the rhinoviruses found in Salisbury causing colds abroad?
Major rheumatic diseases
Authors: Li Suzanne C , Imundo Lisa F
Published: October 2023

The aims of this chapter are to discuss the major rheumatic diseases that may present with features similar to those seen in Juvenile Idiopathic Arthritis (JIA). These major systemic rheumatic diseases include systemic lupus erythematosus, neonatal lupus erythematosus, mixed connective tissue disease, dermatomyositis, scleroderma, and vasculitis. Some of the less common rheumatic diseases will also be discussed. Clinical characteristics and laboratory studies that can be used to distinguish between JIA and these other childhood rheumatic diseases will be discussed.
Disorders of bone and connective tissue
Authors: Peterson Karin S
Published: October 2023

The aim of this chapter is to provide an extensive review of the congenital and inherited diseases of bones and connective tissues that may present with musculoskeletal symptoms and may be potentially confused with Juvenile Idiopathic Arthritis. The clinical presentation of inherited and congenital disorders of bone and connective tissue is varied ranging from the fairly typical features of an adolescent with Marfan syndrome to the diagnostic challenge of a child afflicted by a mild form of osteochondrodysplasia where subtle disproportionate short stature may be noticed during the evaluation for arthritis.
Adolescent rheumatology services
Authors: McDonagh Janet E , White Patience
Published: October 2023

The aim of this chapter is to examine the specific issues that are pertinent to the care of adolescents with Juvenile Idiopathic Arthritis (JIA). In particular the importance of transition from childhood to adult rheumatology care is discussed in detail. All adolescents including those with chronic illnesses and/or disabilities have hopes and dreams. They want to be valued as human beings and treated with dignity, obtain education and job training, have opportunities for social experiences, community involvement, recreation and worship, and find meaningful work for reasonable pay.
Disease evaluation
Authors: Tucker Lori B
Published: October 2023

The aim of this chapter is to discuss the different components of the disease that must be evaluated in order to determine if a child with JIA is actually improving or not. The chapter details those instruments that are available to measure these different aspects of disease. In caring for the child with Juvenile Idiopathic Arthritis (JIA), the goals are elimination or decrease of active disease as much as possible, improvement in the disability, or impairment resulting from active disease, and an improved quality of life for the affected child and the family.
Pain assessment and management
Authors: Sherry David D , Varni, James W , Rapoff Michael A
Published: October 2023

The aim of this chapter is to discuss the assessment of pain in children, pain coping, cognitive behavioral management, and medical management in the context of arthritis pain, and painful procedures. Arthritis, conjures up images of joint pain and, as expected, most children with arthritis have significant pain and stiffness associated with their disease. Children, on the whole, experience as much pain as do adults under similar circumstances although we recognize that some children report either no pain or less pain than do adults [1,2]. Pain is subjective and personal which makes the communication and treatment of this experience in children especially challenging.
Nutrition
Authors: Rothman Deborah
Published: October 2023

The aim of this chapter is to discuss the importance of nutrition and nutritional deficits in the morbidity of children with JIA. Protein–energy malnutrition as well as obesity, poor linear growth, anaemia, and osteoporosis are all common problems in children with Juvenile Idiopathic Arthritis (JIA). Dietary intake is only one of many contributing factors including the disease process itself, malabsorption, side-effects from drug therapy, and decreased physical activity.
The Society of Northern Europe in the High Middle Ages 900-1200
Authors: Whitton Da Yid
Published: October 2023

In about 1175 a magnificent set of the Gospels was copied at the Saxon monastery of Helmarshausen. It was destined for another church, St Blasius, which had quite recently been founded at Brunswick by Henry the Lion, greatest of German nobles, who was duke of Saxony and Bavaria. Brunswick was his principal residence in Saxony-there he built a palace which outshone even those of his sovereign, the Emperor Frederick Barbarossa-and the new Gospels for his church were sumptuously illustrated. One of its illustrations featured the duke himself, with his English wife, Matilda. Each knelt in humility before Christ, who was in the act of placing crowns upon their heads.
The Civilization of Courts and Cities in the North 1200-1500
Authors: Vale Malcolm
Published: October 2023

The relation of the ecclesiastical and secular arms had always been a major theme in medieval European history, but during the later Middle Ages secularization was especially significant. The papacy’s attempt to control and consecrate the secular state had failed. By 1500 the secular power exerted a greater degree of control over the Church in northern Europe than its precursor had done in r 200. In Germany, princely and aristocratic influence was dominant; in France, the powers of the monarchy over ecclesiastical appointments and privileges had greatly increased, while in England a ‘national’ Church had already emerged in which papal influence was severely restricted. Rulers were still obliged to protect and support the Church within their lands; in return, the higher clergy confirmed and sanctified their authority. Both churchmen and laymen attached great importance to the elevation of secular power into something holier and greater than mere rule by brute force or even by consent. But the temporal ruler was no longer perceived as an instrument, even less as a servant, of the Church’s will because the Church had to a large extent been absorbed by the state.
Greece: The History of the Archaic Period
Authors: Forrest George
Published: October 2023

For most historians the characteristic and peculiar element in Greek political life has been the polis, the city-state, an institution of which any precise definition obscures the variety in size or shape or social and political organization. Very roughly, it was a community of citizens (adult males), citizens without political rights (women and children), and non-citizens (resident foreigners and slaves), a defined body, occupying a defined area, living under a defined or definable constitution, independent of outside authority to an extent that allowed enough of its mem¬ bers to feel that they were independent. The land at large may have been virtually empty of residents or occupied by farm¬ houses or villages or even small towns, but there had to be one focal point, religious, political, administrative, around which usually grew up (Sparta was. a notable exception) a city, the polis proper, usually fortified, always offering a market (an agora), a place of assembly (often the agora itself), a seat of justice and of government, executive and deliberative, in the early period monarchic or aristocratic in type, later usually oligarchic or democratic.
Hellenistic and Graeco-Roman Art
Authors: Ling Roger
Published: October 2023

Hellenistic art is an unfashionable field. To the aficionados of the Archaic and Classical periods it seems a bewildering farrago of divergent styles, at one extreme bloated and showy, at the other flaccid and derivative: it is almost as though Greek art, hitherto carried forward in a relatively comprehensible and consistent pattern of development, loses its way and threshes around without a sense of purpose. To the students of Roman art, with its clearer chronological framework and (in the main¬ stream at least) its firm political thrust, the Hellenistic age is the shadowy and half-understood background out of which emerge the technical know-how and many of the stylistic features which go into the making of the Roman state tradition. These attitudes of course do scant justice to the achievements of Hellenistic art. The period 323-31 BC saw the creation of some of the greatest of Greek masterpieces-masterpieces which have exercised considerable influence on the artists and art critics of recent centuries, especially the seventeenth and eighteenth.
The Expansion of Rome
Authors: Rawson Elizabeth
Published: October 2023

Polybius thought that no one could be so worthless or indolent as not to wish to know how, and under what sort of government, the Romans had succeeded in less than fifty-three years in subjecting almost the whole inhabited world to their rule (below, pp. 271 ff.). We are now to consider Rome’s expansion abroad from the beginning of the Punic Wars: but we will carry on the story after Polybius’ death to the end of the Republic.
Later Philosophy
Authors: Meredith Anthony
Published: October 2023

The period with which this section is concerned is bracketed by the lives of the two most interesting and important figures of later philosophy, Posidonius of Apamea in Syria (d. 51 BC) and Plotinus, an Egyptian by birth, who died in Rome in AD 270. The former of these two was one of the most widely travelled and deeply learned men of his age, who interested himself in a whole range of subjects including rhetoric, geography, and recent history, taking over in the latter field where Polybius had left off. He was also a philosopher and represents a tendency present in a good deal of the philosophy of the period, to harmonize the apparently conflicting views held by the main schools of the age.
Roman Life and Society
Authors: Matthews John
Published: October 2023

In the year AD 333 a Christian pilgrim set out from his home city of Bordeaux for the Holy Land. Measuring the early stages of his journey by the ‘leagues’ still at this late date in use in south-western Gaul, he travelled by land across the Alps and north Italy, through the Balkans to Constantinople, and from there through Anatolia and Syria until, 170 days and 3,300 Roman miles (about 3,100 modern miles) after his departure, he came to Jerusalem. The pilgrim’s journey is not merely testimony to the long-distance travel possible, and frequently undertaken, in all periods of the Roman Empire; it is also a challenge to the imagination. How did the pilgrim react to the different landscapes through which he travelled, the languages he heard spoken, the cities, towns, and way-stations in which he lodged as he passed from Bordeaux, penetrated by the Atlantic tides, to the edge of the Judaean wilderness? The modern historian, influenced perhaps by the Mediterranean perspective of his ancient informants and by his own knowledge of the future, tends to see the history of the Roman Empire in terms of the relationship between East and West, Greek and Latin; but a journey not much shorter than that of the Bordeaux pilgrim could be made from north to south, beginning at the militarized frontier region of Hadrian’s Wall and passing through Celtic.
Envoi: On Taking Leave of Antiquity
Authors: Chadwick Henry
Published: October 2023

The ancient classical world is a large entity to take leave of. How did it all end? Or should one ask how it survived so long? What principally distinguishes ‘ancient’ history from that which we label medieval or modern? One obvious difference is that the available sources, though massive enough, are on a far smaller scale, so that the writing of ancient history is a distinct operation from writing modern history where the quantity of documents overwhelms the student. But that is of the accidents rather than the substance of what makes ancient classical studies a special and unique discipline. The rock whence western civilization is hewn is the old Mediterranean world, beginning with high achievements at the eastern end in the Nile valley, in the Assyrian and Persian worlds, in Judaea, but then seeing the centre of gravity move westwards: first to the Greeks, with a high peak of excellence in the fifth and fourth centuries BC, then to the Romans, whose power ultimately yields to the energy of the despised, crude, bibulous barbarians of the north and northwest.
Ending the Revolution
Authors: Fitzpatrick Sheila
Published: October 2023

IN Crane Brinton’s terms, a revolution is like a fever which grips the patient, rises to a climax, and finally subsides, leaving the patient to resume his normal life-’perhaps in some respects actually strengthened by the experience, immunized at least for a while from a similar attack, but certainly not wholly made over into a new man’.
The Long War
Authors: Mulholland Marc
Published: October 2023

As poll evidence consistently indicated, Catholics broadly / % speaking were prepared to countenance a political settlement well short of a united, independent Ireland. Moreover, Catholics were confident that inexorable processes of demographic movement and the diminishing of borders in an integrated Europe would lead to communal Catholic victory. The relative moderation of Catholic political perspective was at odds with the widespread sympathy for armed struggle.
Towards One World?
Authors: Robbins Keith
Published: October 2023

In April 1961 the Soviet cosmonaut Yuri Gagarin became the first person in space. He was the first human being to orbit the Earth and thus look at ‘the world’ from ‘outside’. Even at this moment of triumph, however, there was a paradox. His achieve-ment has to be seen in the context of a ‘space race’ between the Soviet Union and the United States. Even as states thrust men beyond the world, they did so in competition with each other. Cost and other factors might lead to collaboration in the future, but in its early stages space exploration seemed to confirm division rather than unity. It was apparently only in the increas-ingly popular world of ‘science fiction’ that ‘Earthlings’ united to confront the aliens of outer space. It is the tension between creeping universalism and tenacious particularism which forms the central theme of this book.

Two decades before Gagarin, in August 1942, Wendell Wilkie, American publicist and presidential candidate, took off from an airfield in New York in a four-engined bomber to see what he could ‘of the world and the war’. Forty-nine days later, he landed in Minneapolis, Minnesota, having circled the globe on a route which crossed the Equator twice.
Turbulent Transition
Authors: Robbins Keith
Published: October 2023

The years 1973–5, as has just been noted, led many observers to conclude that the world economy was on the brink of fundamen-tal and perhaps frightening change. In addition to the shocks induced by the oil price rise, there was talk of a ‘third industrial revolution’ resulting from the application of electronic technolo-gies and the ‘automation’ of industrial processes through the use of robots. The structures and processes which had underpinned the immediate post-war decades were looking obsolescent in the computer age that was dawning. Apple II, launched in 1977, can be described as the first mass-produced personal computer, and in the years that followed improvements in capacity and function multiplied. Everything, and not merely the new French highspeed train (1981), seemed to be moving à grande vitesse. Scientific and technological breakthroughs could not be confined, in their applications, to one region of the world. People listened to music everywhere with their ‘Walkman’—launched by the Jap-anese company Sony in 1980. The telephone operator and the bank clerk—to name only two ‘safe’ occupations—suddenly had bleak employment prospects. Newspapers, on both sides of the Atlantic, trying to inform their readers about such matters, were themselves caught up in industrial disputes as technology transformed production.
Entrances and Deaths
Authors: Robbins Keith
Published: October 2023

Most literate and intelligent men in Europe during the summer of 1914 considered that, in the circumstances, it was rather sensible to go to war. There was a mood of high excitement, even of exultation. War had come at last and the moment was to be savoured to the full. Freud declared that for the first time in thirty years he felt himself to be fully an Austrian. He was prepared to give the Habsburg empire another chance and allow it to become the focus for his emotional cravings. Ignotus, a Hungarian writer, felt that the war had to be: ‘without it, we would have ended up like Turkey.’ No worse fate could be conceived in the civilized apartments of Vienna or Budapest. The Czech writer Hašek naughtily records an Austrian officer commanding his mistress to embroider ‘Gott strafe England’ on her suspenders. Of course, his own hero, the good soldier Schweik, adopted a rather less energetic approach to the ensuing conflict. Austrian poets were elated by the thought that with every shot Germany was on the way to establishing mankind’s ‘golden empire on earth’. Whatever their notional political convictions, they had no doubt that with cold blood and hot iron ‘wonderful work of man’ was being done.
The Experience of War
Authors: Robbins Keith
Published: October 2023

No man who took part in the First World War ever completely shook off the experience. Individuals struggled to come to terms with what they had seen and heard. For some, the only solution was silence. There was no way in which it was possible to communicate with those who had not been through it themselves. The inadequacy of language itself was exposed. Words gained fresh meaning in the context of war and vocabularies became hopelessly confused. Fathers who had every conventional reason for pride in their part in the conflict chose not to tell their children what they did in the war. The gap in experience could not be bridged by trite phrases or plain narrative. It was better to forget and resume ordinary life as though nothing had happened. For many that was never possible. Ivor Gurney, English poet and composer, died in a mental hospital in 1937, twenty years after he had been gassed in France. He had gone on writing, convinced that the war had not come to an end. Other men who appeared to retain their poise and composure were secretly scarred. Many years later they would wake up in the night, still unable to shake off some lingering horror. In general terms, it took many writers a decade before they were ready with an appropriate novel or memoir. And at that distance experience may be refined and embroidered so as to render it no longer authentic.
Caesar The Dictator
Authors: Syme Ronald
Published: October 2023

Ulla was the first Roman to lead an army against Rome.

Not of his own choosing-his enemies had won control of the government and deprived him of the command against Mithridates. Again, when he landed in Italy after an absence of nearly five years, force was his only defence against the party that had attacked a proconsul who was fighting the wars of the Republic in the East. Sulla had all the ambition of a Roman noble: but it was not his ambition to seize power through civil strife and hold it, supreme and alone. His work done, the Dictator resigned.