bluuebunny/crossref_metadata_2025 huggingface dataset:
Uveitis and medical ophthalmology
Authors: Hughes Edward , Stanford Miles , Qatarneh Dania
Published: November 2017

This chapter focuses on uveitis and medical ophthalmology. It details uveal anatomy, before discussing anterior uveitis, intermediate uveitis, and posterior uveitis. Next, it discusses posterior uveitis and then specific non-infectious posterior uveitides before moving on to infectious uveitis (viral, parasitic, fungal, and bacterial) and HIV-related disease. It continues by examining systemic associations with uveitis, including sarcoidosis, Behcets disease, multiple sclerosis, and the seronegative arthritides ankylosing spondylitis, Reiter syndrome, psoriatic arthritis, and inflammatory bowel disease. In addition, it discusses scleritis and episcleritis, ocular inflammatory disorders (systemic treatment, biological agents and periocular treatments, intraocular treatments), rheumatological disease, vasculitis, cardiovascular disease and the eye, and endocrine, respiratory, and skin diseases in ophthalmology.
Paediatric ophthalmology and strabismus
Authors: Barker Lucy , MacKenzie Kelly , Hancox Joanne , Kozlowska Wanda , Tatham Andrew
Published: November 2017

This chapter focuses on paediatric ophthalmology and strabismus. It details the embryology, anatomy, and actions of the extraocular muscles, along with clinical skills that include patient assessment and assessment of visual acuity, binocular vision, and stereopsis, assessment of binocular single vision, and retinal correspondence and suppression. It then discusses amblyopia, the measurement and assessment of ocular deviation, the assessment of ocular movements, Hess charts, and the field of binocular single vision. In addition, it discusses concomitant strabismus (the heterophorias, esotropia, and exotropia), incomitant strabismus, the principles of strabismus surgery, general paediatric development, retinopathy of prematurity, retinoblastoma, congenital cataract, paediatric glaucoma, uveitis in children, phacomatoses, and metabolic and storage diseases.
Orbit
Authors: Gupta Tarang , Ezra Daniel
Published: November 2017

This chapter focuses on the orbit. It starts off with an outline of orbital anatomy, including the orbital blood supply and neve supply. It continues by describing history taking for orbital disease, and examination of the orbit. It then goes on to describe orbital infections, including preseptal cellulitis, orbital (postseptal) cellulitis, and mucormycosis. Next, it discusses orbital inflammatory disease, including idiopathic orbital inflammatory disease, orbital myositis, Tolosa-Hunt syndrome, dacryoadenitis, and vasculitis. In addition, the chapter discusses vascular malformations, tumours, and thyroid eye disease. The chapter concludes with a discussion of orbital fractures and trauma, and orbital surgery.
Microsurgical skills
Authors: Kam Ronald , Sullivan Paul
Published: November 2017

Safe ophthalmic surgery requires the surgeon to have the ability to select the best instruments for a particular task, knowledge of the most effective way of using each instrument, and knowledge of the limitations and side effects of the use of each instrument. This chapter focuses on microsurgical skills. It begins with an introduction to the use of forceps and the way they are used to grasp tissues. It then goes on to discuss toothed forceps, sutures, suturing tissues, and tying a surgeon’s knot. The chapter also presents a number of surgical scenarios, such as suturing a leaking corneal wound, suturing skin during a lateral tarsal strip operation, repairing full-thickness corneal lacerations, and repairing scleral lacerations.
Nineteenth-century doctors and care of the dying
Authors: Clark David
Published: November 2017

The nineteenth century saw major demographic and social changes that began to transform how people died. As lives lengthened, so the manner of their ending was transformed. A preoccupation with what lay beyond death began to be replaced by a concern about the manner of dying. New modes of pain relief raised questions about whether if suffering could be relieved, might it also be avoided by hastening death? During the century, the meaning of ‘euthanasia’ was therefore transformed—from the medically supported ‘easeful death’, to the deliberate ending of life by the physician. This chapter explores the changing landscape of Victorian dying and considers in particular the foundational work of William Munk, whose book on ‘easeful death’ published in 1887 seems to lay the foundations for the modern speciality of palliative medicine.
Homes for the terminally ill: 1885–1948
Authors: Clark David
Published: November 2017

This period saw major growth for hospital institutions. Some of these were especially concerned with the care of the dying. This chapter examines in detail the practices and modes of care to be found in the terminal care homes, their religious and charitable foundations, styles of organization, and place in society. It shows that such homes—which were to be found in London, New York, and several European cities—had limited influence on the wider practice of medicine. They developed a particular philosophy of care, however, which did later inspire some doctors, from the middle of the twentieth century onwards. Indeed, some of the homes survived as institutions and made the transition into the world of modern hospice and palliative care.
Developing mental health interventions
Authors: Nadkarni Abhijit , De Silva Mary J. , Patel Vikram
Published: November 2017

Most mental health interventions are complex as they are made up of a number of interconnected components, acting both independently and interdependently. This inherent complexity makes the development and evaluation of such interventions a complex process. Following a structured approach to the development and evaluation of complex interventions helps ensure that the process is systematic, rigorous, and replicable. In this chapter we demonstrate how systematically conducted formative research, consistent with the MRC framework, will ensure that due consideration is given to the sociocultural and health systems context. We use the case study of an ongoing complex intervention development and evaluation program in India (PREMIUM) to illustrate the application of the development and feasibility/piloting phases of the MRC framework. We describe two complementary frameworks, the Normalization Process Theory and the Theory of Change that can be used to strengthen the MRC framework for the development of mental health interventions.
Trials of interventions for people with psychosis
Authors: Chatterjee Sudipto , Naik Smita , Dabholkar Hamid , Padmavati R. , John Sujit , Koschorke Mirja , Thara Rangaswamy
Published: November 2017

Schizophrenia is a severe mental disorder that causes serious and persistent disability in multiple domains. People with schizophrenia are also often exposed to widespread sigma, discrimination, and human rights abuse. There is a large and persistent treatment gap for people with schizophrenia and their caregivers globally and in LAMIC;To address this gap, emerging observational evidence from LAMIC suggests that a task-sharing strategy involving community health workers (CHWs) is a feasible option for delivering services to people with schizophrenia and their families . However, there is no RCT evidence from LAMIC that such an approach is more effective than usually available care. The community care for people with schizophrenia in India (COPSI) RCT tested the clinical and cost-effectiveness of a collaborative community-based care (CCBC) intervention with usual, facility-based care (FBC). The FBC + CCBC intervention was superior in reducing symptoms and disability associated with schizophrenia and in improving adherence with treatment.
Error and bias in observations
Authors: Elwood Mark
Published: November 2017

This chapter distinguishes error and bias, non-differential and differential misclassification distinguished. Non-differential misclassification almost always biases results toward the null, while differential misclassification can affect results in any direction. Methods to minimise observation bias include single, double and triple blind assessment. It discusses recall and other biases, with methods of assessment and avoidance, and practical issues on reducing error and bias. In part two, it shows how to measure and adjust for observational error and bias, including Kappa and adjusting for non-differential misclassification, and similar adjustments using continuous exposure measures. Effects with more than two categories of outcome or exposure, and of the misclassification of confounders are discussed. In assessing the accuracy of information, sensitivity, specificity, and predictive value are defined, and the calculation of the effects of misclassification using sensitivity and specificity are shown.
Chance variation
Authors: Elwood Mark
Published: November 2017

This chapter explains chance variation and statistical tests, including discrete and continuous measures, the concept of significance, one and two sided test, exact tests, precision and confidence limits. It shows tests of differences in proportions and chi-square tests, the Mantel-Haenszel test, and calculation of confidence limits, for simple tables and for stratified data. It covers heterogeneity tests, multiplicative and additive models, ordered exposure variables and tests of trend. It explains statistical tests for matched studies and in multivariate models. Multiple testing, the Bonferroni correction, issues of hypothesis testing and hypothesis generation, and subgroup analyses are discussed. Stopping rules and repeated testing in trials is covered. It explains how to calculate study power and the necessary size of the study. The chapter describes time to event analysis, including survival curves, product-limit and actuarial or life-table methods, and the calculation of confidence limits, relative survival ratios, the log rank test with control for confounding, and multivariate analysis.
Critical appraisal of a randomized trial of a preventive agent
Authors: Elwood Mark
Published: November 2017

This chapter presents an important, large, international randomised trial of prevention, the use of folic acid and multivitamins in preventing spina bifida and other neural tube defects. This shows the ethical and logistic issues involved, a factorial randomised design, a sequential analysis and early stopping example, and specificity of effect, and discusses the application to policy. The critical assessment follows the scheme set out in chapter 10: describing the study, assessing the non-causal explanations of observation bias, confounding, and chance variation; assessing time relationships, strength, dose-response, consistency and specificity, and applying the results to the eligible, source, and target populations; and then comparing the results with evidence from other studies, considering consistency and specificity, biological mechanisms, and coherence with the distribution of exposures and outcomes. The chapter gives a summary and table of the critical assessment and its conclusions; and comments on the impact of the study and research carried out since.
Critical appraisal of a large population-based case–control study
Authors: Elwood Mark
Published: November 2017

This chapter shows a large population-based case-control study, to address the quantitative relationship between alcohol consumption and breast cancer. It shows the logistic and design issues, and the assessment of dose-response, consistency and specificity. The critical assessment follows the scheme set out in chapter 10: describing the study, assessing the non-causal explanations of observation bias, confounding, and chance variation; assessing time relationships, strength, dose-response, consistency and specificity, and applying the results to the eligible, source, and target populations; and then comparing the results with evidence from other studies, considering consistency and specificity, biological mechanisms, and coherence with the distribution of exposures and outcomes. The chapter gives a summary and table of the critical assessment and its conclusions; and comments on the impact of the study and research carried out since.
Devising the items
Authors: Streiner David L. , Norman Geoffrey R. , Cairney John
Published: November 2017

This chapter discusses various sources for the items that make up a scale (e.g. existing item banks, patient interviews, research, clinical judgement, expert opinion, and theory). It then covers ways of ensuring content validity of the resulting items. This involves assessing whether all domains are covered, and each item maps onto one and only one domain. The chapter covers both subjective and objective ways of doing this. It reviews the arguments for and against disease-specific scales as opposed to generic ones. Finally, it discusses the issues that arise when a scale is translated from one language to another.
Scaling responses
Authors: Streiner David L. , Norman Geoffrey R. , Cairney John
Published: November 2017

This chapter presents various ways of presenting the response options to the respondent. It begins by discussing why dichotomous responses (e.g. yes/no, true/false) are often inadequate. Different alternatives are discussed, including direct estimation methods (e.g. visual analogue scales, adjectival scales, Likert scales), comparative methods (e.g. paired comparisons, Guttman scaling), and econometric methods. It reviews some of the issues that need to be considered in writing the response options, such as whether one should use a unipolar or bipolar scale, how many steps there should be, and whether all the response options need to be labelled. It also covers what statistical tests can legitimately be used with scales. Finally, it compares ratings with rankings, and introduces the method of multidimensional scaling.
Methods of administration
Authors: Streiner David L. , Norman Geoffrey R. , Cairney John
Published: November 2017

There are many different ways a scale can be administered. These include face-to-face interviews, questionnaires which are mailed to the respondent, those administered over the telephone, and those presented via the Internet. This chapter discusses the advantages and disadvantages of each, and how changes in technology, such as the increasing use of mobile phones, are affecting factors such as response rate. The chapter summarizes different techniques for increasing the response rate, such as rewards, advance notification, personalization of the covering letter, keeping the questionnaire short, and follow-ups. It also discusses new approaches to administering scales, such as the use of smart phones and video technology. Finally, it mentions some of the difficulties that may be encountered when paper-and-pencil scales are administered over the Web.
Ethical considerations
Authors: Streiner David L. , Norman Geoffrey R. , Cairney John
Published: November 2017

Although studies of the psychometric properties of scales do not have the same ethical challenges as those involving interventions, there are still areas that researchers need to be sensitive to. These include issues such as informed consent, especially with vulnerable populations, and deception. This chapter also discusses confidentiality, and when this can be breached for legal reasons. It also returns to the issue of consequential validity and the ethical issues that may arise when minority or disadvantaged groups attain scores that are different from those of the majority population. This chapter discusses these and other ethical problems that may arise within the context of developing and validating scales.
Quantitative electromyography
Authors: Fuglsang-Frederiksen Anders , Pugdahl Kirsten , Tankisi Hatice
Published: November 2017

Several quantitative electromyography (QEMG) methods are used for diagnosing and monitoring in patients with neuromuscular disorders. At weak effort of the muscle, motor unit potential (MUP) analyses as individual MUP, multi-MUP, and macro-EMG are diagnostically sensitive and well tested. At higher effort of the muscle, interference pattern analyses such as the turns amplitude analysis are also diagnostically sensitive. Other potential diagnostic methods are power spectrum analysis, muscle fibre conduction velocity analysis, and some surface EMG methods. In patients with myopathy, QEMG has an important role in the diagnosis as a supplement to blood tests, muscle biopsy, and genetic testing. In patients with neurogenic disorders such as anterior horn cell disorders, peripheral nerve lesions, or polyneuropathy, QEMG has important roles in characterizing the lesion and differential diagnosis. Furthermore, QEMG may be useful in the examination of patients with neuromuscular transmission failure, critical illness disorders, and in treatment of dystonic muscle with botulinum toxin.
Electroencephalography
Authors: Koutroumanidis Michalis , Sakellariou Dimitrios , Tsirka Vasiliki
Published: November 2017

This chapter concentrates on essential technical aspects of the electroencephalogram (EEG) and its role in the clinical and aetiological diagnosis of people with epilepsy. The technical subsection explores important stages of the largely ‘mystifying’ process from the generation of the abnormal signals in the brain to their final visualization on the screen, including digitalization of the signal and sampling rate, montages, and derivations, focusing on their clinical relevance. The second part reviews the behavioural attributes of the interictal and ictal discharges in the different epilepsy types and syndromes, discusses the optimal use of activation methods, including sleep deprivation and sleep, hyperventilation, photic, and other specific stimulation, and describes specific diagnostic tools like polygraphy and cognitive assessment during apparently subclinical discharges. It also discusses aspects of the clinical EEG interpretation and reporting and delineates indications and limitations of the EEG.
Disorders of single nerves, roots, and plexuses
Authors: Mills Kerry R.
Published: November 2017

The role of electromyography (EMG) and nerve conduction studies in disorders of single nerve, root, and plexus lesions are discussed. The motor and sensory anatomy underpinning diagnosis is described and a scheme presented showing the key muscles to be examined using EMG to differentiate nerve, plexus, and root lesions. The main causes of mononeuritis multiplex, of either axonal degeneration or demyelinative pathology, are covered, including diabetic neuropathy, vasculitic neuropathy, multifocal motor neuropathy with block, and the Lewis–Sumner syndrome. The confirmatory role of EMG and nerve conduction studies in the investigation of cervical and lumbar radiculopathies is highlighted as is the use of transcranial magnetic stimulation to differentiate cervical radiculopathy with myelopathy from amyotrophic lateral sclerosis. The neurophysiological hallmarks of traumatic cervical plexus lesions, including obstetric causes, inherited and acquired brachial neuritis, hereditary liability to pressure palsies, the cervical rib syndrome, and radiation plexopathy are also covered.
Clinical aspects of neuromuscular junction disorders
Authors: Sanders Donald B.
Published: November 2017

Disorders that primarily impair neuromuscular transmission (NMT) produce weakness that characteristically affects certain muscle groups and varies with activity. Acquired, autoimmune myasthenia gravis (MG) is the most common of these disorders. Much less common are genetic abnormalities of the neuromuscular junction (NMJ), the Lambert–Eaton myasthenic syndrome (LEMS), and toxic effects of various biological and chemical agents. The diagnosis of MG or LEMS is suspected from the history and clinical findings, and is confirmed in most patients by the presence of specific auto-antibodies. The precise diagnosis of most genetic myasthenic syndromes may require sophisticated DNA analysis. Impaired NMT can be confirmed in all of these conditions by repetitive nerve stimulation (RNS) testing and measuring the neuromuscular jitter. Treatment of MG requires selecting among several therapeutic options, taking into consideration the clinical characteristics of the individual patient. Treatment of LEMS and genetic myasthenic syndromes is more limited.
Paediatric conditions
Authors: Pitt Matthew
Published: November 2017

This chapter dedicated to the practice of paediatric electromyography starts with a consideration of some of the misconceptions under which this particular investigation labours. The relevant technical aspects and normative data are discussed along with the personal characteristics needed. Sections cover the investigative strategies that need to be employed, the hereditary and acquired conditions that are common reasons for referral for electromyography (EMG), following an anatomical template, and conditions in which EMG has a particular role. The use of stimulation single fibre EMG in the diagnosis of neuromuscular junction disorders in discussed in particular detail. This chapters highlights the changing role of EMG but emphasises that it still has an important role in the management of pediatric neuromuscular disorders.
EMG-guided botulinum toxin therapy
Authors: Misra V. Peter , Catania Santiago
Published: November 2017

This chapter explains the mechanism by which botulinum neurotoxin (BoNT) causes its neuromuscular paralytic effects, and reviews the developments that led these effects to be harnessed therapeutically. It specifically focuses upon the conditions of dystonia and spasticity. Within the spectrum of these diseases, it discusses those situations where BoNT injections are the treatment of choice. The very accurate targeting of BoNT into specific muscles in many situations is both desirable and crucial in some situations BoNT’s therapeutic neuroparalytic effect may need to be restricted to a single muscle fascicle.. In some cases, an inaccurately placed injection may be associated with unacceptable side effects. In order to achieve accuracy of BoNT injection delivery, intramuscular injections of BoNT aided by electromyography (EMG) guidance allows the very accurate targeting of specific muscles. The practical aspects related to the preparation of BoNT for injection and the methodology and techniques for injecting using EMG guidance are discussed. The importance of good anatomical knowledge and the relevant EMG techniques to target individual muscles are highlighted and applied to injection of muscles in different body areas. Finally, certain diagnostic neurophysiological tests, which may be useful for the management of some neurological conditions that are treated by BoNT are briefly discussed.
Focal epilepsy
Authors: Wehner Tim , Unnwongse Kanjana , Diehl Beate
Published: November 2017

This chapter examines the neurophysiology of focal epilepsy. It discusses the principles of EEG source localization. This is followed by a presentation of nonspecific and epileptiform interictal EEG findings and ictal EEG patterns seen in focal epilepsy, along with normal EEG variants that may be mistaken for epileptiform features. Seizure semiologies and ictal and interictal EEG findings in mesial and neocortical temporal lobe epilepsy, orbitofrontal, dorsolateral, and mesial frontal epilepsy, insular epilepsy, and parietal and occipital epilepsy are presented with illustrative case discussions derived from patients investigated for resective epilepsy surgery. A brief discussion of prognosis and treatment strategies for focal epilepsy follows.
Presurgical evaluation for epilepsy surgery
Authors: Elwes Robert
Published: November 2017

This chapter describes the preoperative electroclinical assessment of the various epilepsy syndromes and pathologies that are open to surgical treatment. Particular emphasis is placed on medial temporal epilepsy and frontal epilepsy. The assessment of cases considered for hemispherotomy, multiple subpial transection for Landau–Kleffner syndrome, anterior two-thirds callosotomy in symptomatic generalized epilepsy, neural stimulation, and cases with nodular hetertopia are summarized. Throughout the chapter, particular emphasis is placed on the need for multidisciplinary assessment, and the interpretation of the electroencephalogram (EEG) in the context of the clinical features, imaging, and neuropsychology. Evaluation pathways are suggested and the indications for intracranial EEG, the types of electrodes used and the operative complications are discussed in detail. Summaries of the key points in the electroclinical evaluation of temporal and frontal lobe epilepsy are given.
Therapeutics in older people
Authors: Stephen Jackson
Published: November 2017

Key points

• Pharmacokinetics in older people is different to that in younger people:

o renal clearance is lower (water-soluble drugs)

o hepatic clearance is lower (lipid-soluble drugs)

o half-life is further prolonged for lipid-soluble drugs because of the increased volume of distribution of such drugs

o in frail older patients, half-life is further prolonged

▪ by reduced hepatic enzyme activity (lipid-soluble drugs)

▪ by reduced protein binding and hence increasing the volume of distribution (very heavily protein-bound drug).

• Polypharmacy is common and reflects multiple pathology.

• Inappropriate medication should always be avoided.

• Methods of enhancing the quality of prescribing include

o regular medication review

o prescribing audit using proven indicators of appropriateness

o education of prescribers.
Dementia and memory clinics
Authors: Burns Alistair , Atkinson Richard , Page Sean , Jolley David
Published: November 2017

Key points

• Memory clinics provide a valuable service for the assessment and management of people with memory difficulties.

• They have also provided a focus for the initiation and monitoring of antidementia drug treatments.

• They have grown in number and range of services they provide over the years.

• A robust accreditation programme exists to assess the services and service standards.

• As the number of people coming forward for investigation of memory problems increases, memory clinics may need realigning more to community and primary care settings.
Frailty: challenges and progress
Authors: Crome Peter , Lally Frank
Published: November 2017

Key points

• Frailty in older people is characterized by deteriorating health and increasing need for support.

• Frailty has the features of a ‘geriatric giant’ as originally defined by Isaacs.

• The identification of frail older people is important for medical intervention and for strategic planning.

• The clinical definition of frailty is still being debated but may include the following aspects:

o a distinct phenotypical profile

o a frailty index defined by the accumulation of deficits

o genetic and biochemical predisposition.

• There is no specific treatment for frailty but there are treatments for the diseases that contribute to it.
Under-representation of older people in clinical trials
Authors: Mills Gary H.
Published: November 2017

Key points

• Older people, often with high levels of co-morbidity and polypharmacy, are increasing in number as the population ages.

• Study populations in clinical trials have often not mirrored the population that will consume the drugs or treatments being investigated.

• Regulators, ethics committees, and funding bodies must recognize the need for inclusion of older people and the complexities this imposes on investigators.

• Across all aspects of medicine, funding for research into how best to safely include older people in clinical trials is vital.

• Researchers should not be disadvantaged by designing studies to meet the needs of the age range of patients expected to receive the treatment being investigated; this should include provision for older people.
The patient within the critical care environment
Authors: Adam Sheila , Osborne Sue , Welch John
Published: November 2017

Both critical illness and treatment in the critical care unit are extremely stressful, presenting great physical and psychological challenges for patients and their families. There are a range of compensatory responses to stress which may be adaptive, but severe or prolonged stress can induce a destructive spiral of decompensation. The importance of a holistic approach to care cannot be overemphasized; this chapter sets out the priorities of care for critically ill patients, and the common needs and problems for both patients and their families. The issues discussed include the mechanisms of stress in critical illness, the promotion of sleep, use of analgesia and sedation, management of delirium, complications of immobility, mouth, eye, and skin care, infection control, requirements for safe transfer, and care of the dying patient.
Cardiovascular problems
Authors: Adam Sheila , Osborne Sue , Welch John
Published: November 2017

The cardiovascular chapter discusses the physiology, assessment, and treatment of cardiovascular disorders in the critically ill patient. It gives an in-depth explanation of non-invasive and invasive monitoring procedures (such as ECG, pulse oximetry, oesophageal Doppler, and pulmonary artery catheterization). It includes the measurement of oxygen delivery and consumption, and explains diagnostic techniques such as echocardiography. The chapter includes the management and optimization of goal-directed therapies for specific conditions including coronary heart disease (such as myocardial infarction and angina), shock, valvular heart disease, and heart failure. Interventional treatment and specific drug therapy are discussed, including percutaneous coronary intervention, cardiac pacing, and electrical conversion.
Cardiac arrest and cardiopulmonary resuscitation
Authors: Adam Sheila , Osborne Sue , Welch John
Published: November 2017

Critically ill patients are at high risk of cardiac arrest, and the critical care nurse needs to recognize early signs of deterioration, understand what can be done to prevent arrest, and understand the different functions of cardiac arrest team members. This chapter outlines the pathophysiology associated with cardiac arrest, reviews the management of arrest, the practicalities of the techniques and drugs used in cardiopulmonary resuscitation, and the care of the patient and family following both successful and unsuccessful resuscitation.
Gastrointestinal problems and nutrition
Authors: Adam Sheila , Osborne Sue , Welch John
Published: November 2017

The chapter includes the background gastrointestinal (GI) physiology and pathophysiology commonly seen in critical care, including the immune functions of the gut. Acute gastrointestinal bleeding, the acute abdomen, liver failure and dysfunction, liver support systems and transplantation, and the management of acute pancreatitis are covered. Physical examination techniques, diagnostic information, and history are reviewed. The rationale for the importance of nutritional support in critical care, the techniques and complications of enteral feeding tube placement , the types of parenteral intravenous (IV) access, including peripherally inserted central catheter (PICC) lines, and the monitoring of delivery of enteral and parenteral nutrition are detailed. The complications associated with enteral tube placement and management and parenteral intravenous access and management are also included.
Trauma and major haemorrhage
Authors: Adam Sheila , Osborne Sue , Welch John
Published: November 2017

This chapter discusses the medical and nursing management of trauma patients from their initial assessment in the emergency department to their subsequent management in the critical care unit. Each section of the chapter covers a specific area of trauma and describes its underlying physiology, management, and associated complications. Injuries discussed include spinal, head, chest, cardiovascular, genitourinary, renal, abdominal, pelvic, musculoskeletal, burn injury, hypothermia, and drowning. Major complications, such as fat embolism syndrome, compartment syndrome, and rhabdomyolysis, are described in detail. The chapter also discusses the management of major haemorrhage and the complications of massive blood replacement therapy.
The immune system and the immunocompromised patient
Authors: Adam Sheila , Osborne Sue , Welch John
Published: November 2017

This chapter discusses the physiology of the immune system and its related disorders in the critically ill patient. The causes, complications, and management of the immunocompromised patient is discussed at length, detailing the specific nursing management. It also discusses the management of autoimmune disease such as Wegener's granulomatosis and rheumatoid arthritis, and hypersensitivity reactions such as drug allergy and anaphylactic reaction. Cancer is explained in detail, including its complications, specific therapies such as stem cell transplant, and the role of the cancer patient within critical care.
Evaluating evidence and quality of care in the critical care unit
Authors: Adam Sheila , Osborne Sue , Welch John
Published: November 2017

Critical care nurses and the whole multidisciplinary team have a responsibility to ensure that they use the most appropriate treatments and care procedures, to continually evaluate the effectiveness and value of the interventions they perform and the care they give, and to aim for continuous improvement of their service. This chapter discusses how research should be applied in practice, key principles of audit, quality assurance and quality improvement, standard setting, illness severity scoring systems, and the prediction and measurement of patient outcomes. The challenges of managing long-term patients and ethical issues, such as treatment withdrawal, bereavement, and care of relatives, are also reviewed
Neurology
Authors: Beed Martin , Sherman Richard , Mahajan Ravi
Published: November 2017

Decreased consciousness

Seizures and status epilepticus

Stroke/thromboembolic stroke

Intracerebral haemorrhage

Subarachnoid haemorrhage

Traumatic brain injury

Raised intracranial pressure

Meningitis and encephalitis

Agitation/confusion/aggression

Alcohol withdrawal

Neuromuscular weakness and paralysis

Guillain–Barré syndrome

Myasthenia gravis

↓consciousness occurs in many diseases requiring admission to intensive care, and is often a cause for admission in its own right. Changes in neurological state may be related to intracranial pathology, or may occur in response to respiratory, circulatory, or metabolic disorders....
Obstetric and fertility patients
Authors: Beed Martin , Sherman Richard , Mahajan Ravi
Published: November 2017

Critical illness in pregnancy

Severe pre-eclampsia/eclampsia

HELLP syndrome

Anaphylactoid syndrome of pregnancy

Massive obstetric haemorrhage

Ovarian hyperstimulation syndrome

Any critical illness may complicate pregnancy, or the postpartum period; especially sepsis and thromboembolic disease. Pregnancy-related illnesses may also require critical care intervention, including: pre-eclampsia and eclampsia, the HELLP syndrome, major haemorrhage, and anaphylactoid syndrome of pregnancy (amniotic fluid embolism). As with any critical illness, life-threatening problems are identified and treated first....
Communication and organ donation
Authors: Beed Martin , Sherman Richard , Mahajan Ravi
Published: November 2017

Breaking bad news

Referral to the coroner

The potential organ donor

Communication with patients and their relatives should be part of ongoing care, and should, where possible, be provided at regular intervals or whenever the clinical situation changes.

Given the severity of illness and high probability of death of patients requiring critical care, communicating bad news with patients and/or their families is a common occurrence. Breaking bad news can be difficult and distressing for all concerned. Where possible, the breaking of bad news should be led by a consultant who has received training in how to do this, but the speed with which patients deteriorate may mean that this is not possible, and what follows is a simplified template for ensuring that this is done as professionally as possible. It may need to be adapted for certain situations and according to the individuals involved....
Putting Into Perspective the Use of the Fmr1 Knockout Mouse as a Model for Autism Spectrum Disorder
Authors: Paylor Richard , Thomas Alexia M. , Veeraragavan Surabi , Spencer Corinne M.
Published: November 2017

Chapter 7 is concerned with the presence of autism spectrum disorder (ASD) in individuals with Fragile X Syndrome (FXS). It is estimated that 21–50% of individuals with FXS meet the criteria for autism or autism with pervasive developmental delay not otherwise specified. Importantly, recent findings indicate that approximately 2–6% of individuals with ASDs have a mutation in the FMR1 gene, making it one of the most significant single genes associated with the presence of ASD.
Alterations of the Serotonin–Melatonin Pathway in Autism Spectrum Disorders: Biological Evidence and Clinical Consequences
Authors: Pagan Cécile , Delorme Richard , Launay Jean-Marie , Bourgeron Thomas
Published: November 2017

This chapter discusses the mechanisms of the alterations of the serotonin–melatonin pathway associated with ASDs, their relevance to autistic symptoms, and their therapeutic implications.
FOXP2: Linking Language and Autism
Authors: Konopka Genevieve
Published: November 2017

Identifying the genes involved in language not only is important for the understanding of disorders such as ASDs but also provides a window into understanding the evolution of the human brain. Spoken language is only present in humans. For example, while other animals have developed methods of vocal communication, none have the ability to convey recursive ideas (i.e., ideas embedded within other ideas), although the idea of human-specific recursion is still being debated (Hauser, Chomsky, & Fitch, 2002; Penn, Holyoak, & Povinelli, 2008; Pinker & Jackendoff, 2005; Premack, 2007). Other potentially human-specific features of language include teaching language, the use of language to teach an extrinsic skill, and the use of language to develop the theory of mind (Penn et al., 2008; Premack, 2007). It is therefore not surprising that inherently human-specific diseases such as ASDs are defined by disruption of spoken language (Abrahams & Geschwind, 2008).
Introduction—The Nature and Nurture of Stigma
Authors: Stuart Heather , Arboleda-Flórez Julio , Sartorius Norman
Published: November 2017

Chapter 1 introduces the concept and history of stigma, including its origins and meaning, and the consequenses of stigma of mental illness for those who are diagnosed, their families, and mental health systems and societies, and how anti-stigma initiatives are on the rise.
Paradigm 1: Developed Countries Have Eradicated Stigma Related Discrimination
Authors: Stuart Heather , Arboleda-Flórez Julio , Sartorius Norman
Published: November 2017

Chapter 2 discusses Paradigm 1 - that developed countries have eradicated stigma-related discrimination, and covers mental health development, employment inequity, NIMBYism (not in my backyard), homelessness, the inverse care law, media depictions, and public tolerance.
Lung Lesions, Skin Lesions, Brain Lesions … Oh My
Authors: Tang Patrick , Bociek R. Gregory
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each of these cases highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
A Budding Headache in a Patient with Hematological Malignancy
Authors: Jacobs Samantha E. , Soave Rosemary , Schuetz Audrey N. , Walsh Thomas J.
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each of these cases highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
Shocking Revenge of the Weak Gram-Positive Cocci
Authors: Beam Elena , Razonable Raymund R.
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each of these cases highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
The New “Red Tide”
Authors: Sampath Rahul , Razonable Raymund R. , Vasoo Shawn
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each of these cases highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
Wounds in Cancer Patients
Authors: Tandra Pavan Kumar , Shonka Nicole
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each of these cases highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
The Dangers of Dirt
Authors: Deziel Paul J. , Razonable Raymund R.
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each of these cases highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
A Red Hot Mess
Authors: Peetz Robbe , Freifeld Alison G.
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each of these cases highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
A Purplish Skin Lump
Authors: Durand Christine M. , Marr Kieren
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain the state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each of these cases highlight the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.