bluuebunny/crossref_metadata_2025 huggingface dataset:
Anxiety Disorders
Authors: McFarland Daniel , Pirl William , Watson Maggie
Published: January 2023

Pathological anxiety is common in cancer patients receiving palliative and end-of-life care and may extend to family members and those close to the patient. For patients, fear of death can be severe and physical comorbidities challenging. Anxiety makes it difficult to cope with impending death. Therefore, the management of anxiety disorders is an important part of end-of-life care. In this chapter, the characteristics, symptoms, and manifestations of anxiety disorders are described, along with information on how to make an accurate diagnosis. Once the symptoms are assessed, a plan to alleviate anxiety can be formed. Evidence-based methods, for individuals with advanced cancer and their extended family and social network, are briefly described. Professional issues, as they relate to anxiety management, are covered so that clinicians may follow clear pathways of care within the medicolegal structures in which they work. High-quality psychosocial care is the primary aim since alleviating anxiety disorders in the dying and their family members is a priority.
Adjustment Disorder and Demoralization
Authors: Kissane David W. , Grassi Luigi , Fang Chun-Kai
Published: January 2023

The diagnosis of metastatic cancer and subsequent disease progression, despite available treatment regimens, can signal closeness to the end of life. This can challenge coping and adaptation, resulting in the development of adjustment disorder and what has become known as demoralization. This chapter covers background models of adjustment disorder and demoralization, the way they overlap, and the notion that demoralization can be a richer diagnostic framework for palliative care because of its inclusion of key existential symptoms. The prevalence of adjustment disorder with demoralization is in the range of 15% to 25% of palliative care patients. Core symptoms include a sense of poor coping with low morale, entrapment by the illness, hopelessness, pointlessness, poor functioning, and the potential for suicidal thinking. The diagnosis requires differentiation from clinical states of anxiety and depression, and assessment may be aided by use of the Psycho-Existential Symptom Assessment Scale or short forms of the Demoralization Scale. Management is tailored to severity of presentation and includes psychoeducational, supportive, and meaning-centered therapies. Psychotropic medication will assist severe presentations. There are communication challenges in discussing existential symptoms and ethical concerns about decision-making toward the end of life. Much service development is still needed to optimize care delivery.
Diagnosing Dying and Assessing Death Wishes
Authors: Monforte-Royo Cristina , Porta-Sales Josep , Balaguer Albert
Published: January 2023

Recognizing the signs and symptoms of dying, especially in the days near death (i.e., imminent death), is key to tailoring treatments toward goals of care and avoiding futile interventions. In accompanying the dying, the palliative care team provides symptom management and support to sustain living until death intervenes. This chapter covers prognostic tools evaluating clinical signs such as functional status, anorexia-cachexia, dyspnea, cognitive decline, or delirium. Nevertheless, nothing can replace whether professionals are trained in diagnosis, with skills to control symptoms and effective communication. It is not uncommon for patients with advanced illness to experience a wish to hasten death (WTHD) (~25% in some studies). The WTHD is regarded as a response to suffering of multifactor origin (physical, emotional, spiritual, and social), and hence it may reflect a wish to put an end to this suffering rather than a genuine wish to die. The proactive exploration of a possible WTHD is therefore an opportunity to identify hidden sources of suffering and to address these as best one can. Faced with a patient who expresses a WTHD, health professionals have an ethical duty to listen and to do what they can to relieve the person’s suffering. Before interpreting the WTHD as a deliberate expression of personal autonomy, it is essential to rule out depression, demoralization, and other forms of existential distress, lack of social support, and uncontrolled symptoms, and to explore the roots of a patient’s suffering, both present and foreseen.
Spiritually Sensitive Care in Palliative and End of Life Settings
Authors: Deodar Jayita , Park Crystal , Lazenby Mark
Published: January 2023

This chapter describes the importance of spiritually sensitive palliative care for cancer patients. Typical symptoms and ways that patients present with spiritual distress are outlined, alongside clinical approaches to spiritual assessment and the common tools used to assist with this assessment, and the relevant differential diagnoses. The chapter reviews evidence-based psychotherapeutic and complementary therapies that address patients’ spiritual concerns. It discusses the influence of different cultural and religious traditions on decision-making and the unit of care. It considers the professional, legal, ethical, training, and service development issues that arise when clinical programs strive to deliver care that is aligned to be responsive to spiritual needs.
Staff Support
Authors: Kelly Brian , Trill Maria Die , Ntizimira Christian
Published: January 2023

Providing end-of-life care presents a range of professional and personal challenges for clinicians. These are often balanced against the personal rewards of providing care to the dying patient and their family. Symptoms such as depression, anxiety, demoralization, and what is referred to as “burnout” can occur among clinicians when demands overwhelm the rewards. Factors that can contribute to the emotional load of such work include: cumulative grief, coping with the limitations of curative treatments, refocusing of goals, and the often clinical and ethical complexity of care. Other relevant factors include risk and protective factors at the personal level for the clinician, through to organizational, cultural, and clinical workplace factors. This chapter describes interventions to support clinicians including those that ensure clinicians are appropriately prepared with the necessary skills and supported in their role. It also covers effective mentorship and supervision, strong leadership, and teamwork that promotes support and clinician well-being, and steps to promote a sense of meaning and purpose in this work. Cultural factors, and the varying models of care relevant to different settings globally are described, including the critical role of community workers in provision of appropriate and effective end-of-life care in diverse locations.
Preventing Falls by Integrating Functional Exercise into Habitual Daily Routines
Authors: Hu Yi-Ling , Liu Chiung-ju
Published: January 2023

This chapter reviews a three-arm clinical trial, which compared the LiFE (Lifestyle-integrated Functional Exercise) program to structured strength and balance exercise and gentle flexibility exercise. Older adults, aged 70 years and above, who had a history of falls were recruited from the community and randomly assigned to one of the three exercise programs. Older adults in the LiFE program successfully integrated strength and balance exercises into their everyday activities. Significant improvements in favor of the LiFE condition were observed for fall rates, static balance, ankle strength, function, and participation. The study shows that the LiFE program is an effective alternative fall prevention program compared to traditional structured strength and balance exercise.
Scoping Review of Occupational Therapy Interventions for Chronic Diseases
Authors: Siebert Carol
Published: January 2023

Chronic diseases may result in activity limitations and may negatively impact overall health, quality of life, and self-efficacy. The body of evidence for occupational therapy (OT) interventions to address chronic conditions is emerging. This study was a scoping review of randomized controlled trials of community-based interventions to improve occupational outcomes for individuals with arthritis, heart disease, chronic obstructive pulmonary disease, and depression. Sixteen studies, published between 1998 and 2008, all involving OT either alone or as part of a multidisciplinary intervention, were reviewed. Ten studies found significant differences between intervention and control groups in activity, quality of life, and/or self-efficacy outcomes. There was mixed evidence for the impact of such interventions on physical function and health. This study supports the role of OT in improving occupational outcomes of adults with chronic conditions. It also offers a basis for additional studies to further examine and identify OT intervention with this population.
The Integration of Occupational Therapy into Primary Care
Authors: Pyatak Elizabeth A. , Padilla Vega Daniel
Published: January 2023

This chapter outlines the findings of Donnelly et al.’s article describing the integration of occupational therapy on interprofessional primary healthcare teams. A case study approach was used to identify the structures and processes that support successful integration of occupational therapy within family health teams. The findings illustrate that key factors supporting integration include developing team members’ understanding of the role of occupational therapy in primary care, creating a culture of collaboration, and developing trust and understanding among team members. The chapter outlines key findings of the Donnelly et al. article, highlights related studies evaluating the role and outcomes of occupational therapy in primary care settings, and provides a descriptive case study relating the chapter content to current occupational therapy practice.
Return to Work after Spinal Cord Injury
Authors: Sleight Alix G.
Published: January 2023

Individuals across a variety of chronic conditions seek rehabilitation with a goal of returning to employment. The qualitative study outlined in this chapter explored the experiences of returning to work among adults 7–11 years after spinal cord injury. This study used in-depth interviews and observations and described the nuances and challenges of returning to work for this population. This study has implications for all practitioners working with patients seeking to return to work after illness or disability. Namely, persons who have no higher education or lack viable employment may be less likely to find work, suggesting that occupational therapists and other rehabilitation practitioners must be creative and attentive to the increased needs of these individuals. In addition, this study suggests that early and timely interventions tailored to patients’ interests and competencies are critical in successful return to work, and the rehabilitation team should have a distinct coordinating role in this arena.
Personal Medicine as a Recovery Tool
Authors: Scremin Tristan , Milman Tessa Z.
Published: January 2023

This chapter explores how people with psychiatric disorders use personal medicine, non-pharmaceutical personal coping tools, as a mechanism for their recovery from mental illness. Personal medicine involves engaging in activities that are meaningful or activities to support self-care. The study examined how individuals use personal medicine to cope with symptoms, to improve wellness, and to bring greater meaning and purpose to their lives. The study includes narratives illustrating how individuals use personal medicine, why they often do not share these experiences with their providers, and how experiences of personal medicine intersect with use of psychiatric medications. Suggestions are provided for how providers can support recovery by eliciting information about personal medicine and supporting individuals to identify and use it.
Optimizing Arousal to Manage Aggression
Authors: McIntyre Erin
Published: January 2023

This chapter presents the results of a study in which sensory rooms were utilized in four inpatient mental health units as an alternative or complementary approach to de-escalation of arousal and aggression. The use of sensory modulation techniques to reduce the incidence of violence and aggression focuses on adaptive regulation of arousal and emotion, as opposed to the more traditional, dominant model, which relies on verbal and cognitive techniques for de-escalation. This study utilized narrative analysis of interview and focus group data of service users and staff, which demonstrated that by modifying the environment and introducing soothing stimuli via a sensory room, arousal can be optimized to support emotional regulation. Findings are discussed in light of recent advances in the neurophysiology of emotional regulation and the General Aggression Model, which focuses on arousal and maladaptive emotional regulation as precursors to aggression.
Somatically Based Regulation Intervention for Adolescents Who Have Experienced Complex Trauma
Authors: De Brun Jessica
Published: January 2023

For adolescents who have experienced complex trauma and reveal developmental disruption in self-regulation or who have the inability to utilize language-based psychotherapy, a somatic regulation treatment model may be a useful intervention. This chapter describes a pilot study using a quasi-experimental research design to evaluate the efficacy of the Sensory Motor Arousal Regulation Treatment model as opposed to treatment as usual in two residential treatment facilities. Outcomes indicated a significant reduction of internalizing symptoms on the Child Behavior Checklist and the Somatic Complaints and Anxious/Depressed subscales. The study suggests that somatic regulation can positively impact stabilization and skill-building in complex trauma treatment for adolescents.
Hyporesponsiveness to Vestibular Input and Academic Performance
Authors: Blanche Erna I. , Cermak Sharon A.
Published: January 2023

This study examined the response to sensory integration therapy (SIT) in a group of children with learning disabilities. Ninety-two children were divided into two groups of 46. The control group received special education alone. The experimental group received both SIT and special education. Children in both groups were tested with the Southern California Postrotary Nystagmus Test (SCPNT) and language and academic tests. In the experimental group, children who tested below –1.0 standard deviation in the SCPNT (hyporesponsive to vestibular input) were better responders to SIT than children who were not hyporesponders. In the control group, fewer children with hyporesponsiveness to vestibular input benefited from special education compared to those without hyporesponsiveness. Hyporesponsiveness to vestibular input was also linked to language concerns. Children who were hyperresponsive to vestibular input exhibited more generalized sensory-motor problems than children who were hyporesponsive.
Autism during Infancy
Authors: Bodison Stefanie , Lane Alison E.
Published: January 2023

The chapter describes a study, “Autism during Infancy: A Retrospective Video Analysis of the Sensory-Motor and Social Behaviors at 9–12 Months of Age,” that used retrospective video analysis to identify several sensory-motor and social behaviors that discriminated between children with autism, children with developmental disabilities, and neurotypical children between the ages of 9 and 12 months. There were 19 boys and 13 girls whose families had taken high-quality home videos of them. Nine categories of behaviors were identified and coded: affective expressions, looking, gaze aversion, response to name, social touch responses, anticipatory posture, motor stereotypies, object stereotypes, and sensory modulation. This was the first retrospective study to identify early sensory-motor indicators of autism in children.
Exploring the Content Validity of the Pediatric Evaluation of Disability Inventory (PEDI)
Authors: Reinoso Gustavo , Park Karen
Published: January 2023

This chapter explores the content validity of the Pediatric Evaluation of Disability Inventory (PEDI). Rather than concentrating on developmental items (e.g., stacking blocks) that may not be relevant to each family and child, the authors set out to explore daily-level activities and items. The authors developed and defined 20 complex activities related to mobility, self-care, toileting, and social cognition. Similarly, they provided opinions about the appropriateness on three measurement scales (functional skills/behaviors, caregiver assistance, and modifications). These items and domains were reviewed by a panel of experts in the fields of occupational therapy, physical therapy, physiatry, speech and language therapy, and special education, who were not familiar with items or domains. Results were positive, with 80% of experts rating the overall PEDI as either good or excellent on the two major content validity issues including measuring functional disability in children and determining the comprehensiveness of the item sampling.
The Importance of Family-Centered Care
Authors: Como Dominique H. , Bodison Stefanie
Published: January 2023

Lawlor and Mattingly utilize data collected from three different studies to illustrate the need for a model of family-centered care that addresses the challenges, or “daily dilemmas,” that arise when attempting to create family–practitioner partnerships. Two macro-categories, Situating Family-Centered Care in Cultural Contexts and Daily Dilemmas within Family-Centered Care, were identified. Practitioners often have to overcome the expert model of treatment, the dilemma of “real work,” “turf battles,” and the blurring of professional boundaries while also recognizing the efforts that parents, often mothers, have to make to engage in these partnerships. To be implemented successfully, effective family-centered care requires a radical shift in traditional power dynamics.
Lifestyle Changes and Pressure Ulcer Prevention in Adults with Spinal Cord Injury
Authors: Diaz Jesus
Published: January 2023

This chapter presents findings from a study analyzing occupational therapy intervention outcomes to elucidate the relationship between lifestyle changes and pressure ulcer development. The complexities of lifestyle and behavior changes contributed to different patterns which impacted the development and progression of pressure ulcers. The four identified patterns included positive pressure ulcer changes accompanied by positive lifestyle and behavior changes, negative or no pressure ulcer changes accompanied by positive lifestyle and behavior changes, positive pressure ulcer changes accompanied by minor or no lifestyle or behavior changes, and negative or no pressure ulcer changes accompanied by minor or no lifestyle changes. Community-based occupational therapy practice provides an opportunity to comprehensively address important lifestyle factors impacting pressure ulcer development.
Energy Conservation Interventions for Multiple Sclerosis
Authors: Cunningham Rebecca
Published: January 2023

The chapter “Energy Conservation Interventions for Multiple Sclerosis” provides a detailed review of a randomized controlled trial studying the impact of an occupational therapy delivered 6-week energy conservation course on fatigue, self-efficacy, and quality of life for individuals with multiple sclerosis. Additionally, this chapter reviews related relevant literature, including 1-year follow-up data, energy conservation group delivery for individuals with progressive multiple sclerosis, teleconference delivery of the energy conservation protocol, and one-to-one implementation of the energy conservation protocol. The chapter concludes with clinical implications and a case study to demonstrate clinical decision-making recommendations for energy conservation programming in the multiple sclerosis population.
Development of a Client-Centered Occupational Performance Measure
Authors: Roberts Pamela
Published: January 2023

The Canadian Occupational Performance Measure is a standardized outcome measure that assists in structuring and focusing the occupational therapy assessment, reassessment, and intervention process. Using a semi-structured interview with patients who have a wide range of diagnoses in various practice settings, the information gathered by the Canadian Occupational Performance Measure reflects the importance of the skill or activity to the client in the areas of self-care, productivity, and leisure. The Canadian Occupational Performance Measure is designed to assist the occupational therapist in establishing occupational performance goals based on client perceptions of need and measures the change in defined problem areas.
A Practical Guide to Clinical Supervision in Genetic Counseling
Authors: Veach Patricia McCarthy
Published: January 2023

This book provides a comprehensive overview of supervision, with an emphasis on supervision of genetic counseling students. It draws from theory and research in genetic counseling, psychology, and counselor education and from supervision practice. It describes the infrastructure required for effective supervision; relationship dynamics inherent in supervision; and critical supervision processes, including goal setting, feedback, evaluation, culturally responsive supervision, and common clinical supervision challenges. It also reviews models of supervisor and supervisee development, strategies to promote student wellness, recognizing and addressing problematic performance, and models of supervision delivery. The content emphasizes student supervision, but basic concepts and skills presented are relevant for individuals engaged in supervision of all types of individuals. Each chapter begins with chapter objectives, provides illustrations of major topics with supervision vignettes and examples, and offers specific strategies for promoting self-reflective supervision practice. This title includes instructional tips for designing and conducting supervision training opportunities; and every chapter contains experiential activities to facilitate the professional development of current and future genetic counselor supervisors at all levels of experience.
Setting the Stage for Supervision
Authors: Veach Patricia McCarthy
Published: January 2023

This chapter discusses the importance of the supervision working alliance and ways supervisors can begin establishing a strong working relationship with students. It suggests ways to anticipate and address critical elements of the supervision experience that promote positive supervision processes and outcomes. It includes examples of common student and supervisor questions about beginning a supervision relationship and the structure of fieldwork experiences. It describes anticipatory guidance strategies to structure supervision, including supervision information statements and agreements. The chapter explains the purpose and use of information statements and agreements and includes a sample information statement and supervision agreement. The chapter presents learning activities that provide reflection about and practice in initiating supervision relationships.
Recognizing and Addressing Student Problematic Performance
Authors: Veach Patricia McCarthy
Published: January 2023

This chapter defines problematic performance and identifies different types of performance issues and their sources. It includes cues that student performance is problematic and notes common barriers to addressing problematic performance. It describes a deliberate process that supervisors can engage in with program leadership to report, review, document, and remediate problematic performance. It describes specific strategies that provide support and guidance for following this deliberate process, including ways to engage in difficult conversations. Learning activities presented in this chapter promote self-reflection about what constitutes problematic performance and barriers to addressing it (e.g., personal biases and subjectivity) and provide opportunities to practice addressing student problematic performance.
Systematic Review of the Efficacy of Cilostazol, Naftidrofuryl Oxalate, and Pentoxifylline for the Treatment of Intermittent Claudication
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study on the efficacy of medications for the treatment of intermittent claudication. This systematic review of the efficacy of cilostazol, naftidrofuryl oxalate, and pentoxifylline assessed the role of these three medications in improving walking distance. It concluded that both naftidrofuryl oxalate and cilostazol appeared to be effective treatments. This chapter describes the basics of the study, including funding, how many studies were included, inclusion and exclusion criteria, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Safety of Stenting and Endarterectomy for Asymptomatic Carotid Artery Stenosis
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery assessing whether carotid stenting improved outcomes compared to carotid endarterectomy in patients with asymptomatic carotid artery disease. This meta-analysis of randomized controlled trials demonstrated that stenting is associated with a significantly higher rate of any periprocedural stroke and periprocedural minor stroke than carotid endarterectomy. This chapter describes the basics of the study, including funding, year range for searches, inclusion and exclusion criteria for studies, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
General Anesthesia Versus Local Anesthesia for Carotid Surgery (GALA)
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery assessing whether local anesthesia improved outcomes compared to general anesthesia in patients undergoing carotid endarterectomy. The General Anesthesia Versus Local Anesthesia (GALA) trial demonstrated that no difference in outcomes between general and local anesthesia for carotid surgery. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Outcomes of 3,309 Thoracoabdominal Aortic Aneurysm Repairs
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery reporting on the outcomes of open surgery for patients with thoracoabdominal aortic aneurysm repairs. The study, which involved a retrospective data analysis, demonstrated that repair of thoracoabdominal aortic aneurysms, when performed at an experienced center, can produce respectable outcomes. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Long-Term Results of Endovascular Repair for Descending Thoracic Aortic Aneurysms
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery assessing the long-term outcomes of thoracic stenting for the repair of descending thoracic aortic aneurysms. The study, which involved a retrospective observational analysis, demonstrated that endovascular repair should be considered the treatment of choice for patients with this pathology. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Multicenter Aneurysm Screening Study (MASS)
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery assessing whether screening for abdominal aortic aneurysm was beneficial and cost-effective. The Multicenter Aneurysm Screening Study, a randomized controlled trial from the United Kingdom, demonstrated benefit from ultrasound screening for abdominal aortic aneurysms in men aged 65 to 74 years. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Stenting and Medical Therapy for Atherosclerotic Renal Artery Stenosis
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery assessing whether renal artery stenting improved outcomes compared to medical management in patients with atherosclerotic renal artery stenosis. The Cardiovascular Outcomes in Renal Athero-sclerotic Lesion (CORAL) study, a randomized controlled trial, demonstrated that renal artery stenting did not confer a significant benefit. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Splenic Artery Aneurysms
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery reporting on the natural history and surgical outcomes of splenic artery aneurysms. This observational study, a review of two decades of experience at the Mayo Clinic, demonstrated that the growth rate of these aneurysms is slow, so selective management is safe. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Open and Laparoscopic Treatment of Median Arcuate Ligament Syndrome
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery reporting on the outcomes of open and laparoscopic surgery for patients with median arcuate ligament syndrome. The systematic review conducted in this study demonstrated that both laparoscopic and open release of the median arcuate ligament may provide sustained relief of symptoms. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Absence of Long-Term Benefit of Revascularization in Patients with Intermittent Claudication
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery assessing whether endovascular therapy improved walking distance compared to supervised exercise in patients with intermittent claudication. The Invasive Revascularization or Not in Intermittent Claudication (IRONIC) trial demonstrated that revascularization did not result in any long-term improvement in health-related quality of life or walking capacity. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Is Duplex Surveillance of Value After Leg Vein Bypass Grafting?
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery assessing whether duplex surveillance improved outcomes compared to clinical surveillance following bypass surgery. The findings of the Vein Graft Surveillance Randomized Trial (VGST) demonstrated that duplex surveillance did not result in any benefit for patients undergoing vein bypass graft operations. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Risk of Death Following Application of Paclitaxel-Coated Balloons and Stents in the Femoropopliteal Artery of the Leg
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery reporting on the risk of death following the use of paclitaxel-coated balloons and stents. The meta-analysis performed in this study demonstrated an increased risk of death following application of paclitaxel‐coated balloons and stents in the femoropopliteal artery of the lower limbs. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many studies were included, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
A Prospective Study of Risk Factors for Diabetic Foot Ulcer
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery reporting on the effects of diabetes characteristics, foot deformity, behavioral factors, and neurovascular function on the risk of developing a foot ulcer. This large prospective cohort study demonstrated a multifactorial etiology for diabetic foot ulceration. The most notable risk factors were found to be sensory neuropathy, Charcot deformity, and history of amputation. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Long-Term Results of Compression Therapy Alone Versus Compression Plus Surgery in Chronic Venous Ulceration
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery assessing whether surgical treatment of superficial venous reflux reduced the risk of recurrence in patients with open or recently healed leg ulcer. The Effect of Surgery and Compression on Healing and Recurrence (ESCHAR) trial demonstrated that surgery led to a reduction in the recurrence of ulcers at 4 years and resulted in a greater proportion of ulcer-free time. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
A Randomized Trial of Early Endovenous Ablation in Venous Ulceration
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery assessing whether early endovenous ablation improved ulcer healing in patients with a leg ulcer. The Early Venous Reflux Ablation (EVRA) trial, a randomized controlled trial, demonstrated that endovenous ablation resulted in faster healing and more time free from ulcers. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Multiple Preoperative and Intraoperative Factors Predict Early Fistula Thrombosis
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery reporting on the effects of preoperative and intraoperative factors as predictors of early fistula thrombosis. The study demonstrated that early thrombosis was associated with female gender, forearm fistula, smaller arterial size, and draining vein diameter of 2 to 3 mm. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Prostatitis
Authors: Mufti Uwais , Ali Ased
Published: January 2023

Prostatitis is a broad clinical entity and men with this condition can present with a wide range of symptoms based on the type. The acute presentation is usually easy to diagnose and straightforward to treat but the management can be challenging in the chronic type. Classification into acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and asymptomatic prostatitis has simplified the diagnostic pathway to some extent but the understanding of CP/CPPS is poor and consequently the management remains challenging. The case presented below is a complication of an inadequately treated urinary tract infection. However, the different types of prostatitis, the challenges, and the management strategies for consideration are also described.
Newly diagnosed metastatic prostate cancer
Authors: Ali Adnan , Clarke Noel W.
Published: January 2023

In unscreened populations, approximately 16% of men with newly diagnosed prostate cancer have metastatic disease. The optimal treatment for such patients is combination therapy with androgen deprivation combined with either docetaxel, abiraterone, enzalutamide, or apalutamide. In patients with low metastatic burden (only non-regional lymph node metastasis or fewer than four bone metastases and no visceral metastasis), prostate radiotherapy combined with systemic treatment improves survival. Selection between these treatments depends on patient comorbidity and preference, availability of drugs, side effects, and metastatic burden. Eventually, disease progression occurs in the majority and treatment sequencing thereafter depends on patient comorbidity and preference, previous therapies, drug availability, side effects, sites and extent of metastases, and, now, the presence of genomic alterations. Bone metastases are the most common secondary site and timely management is required to prevent skeletal complications. Despite optimal treatment, most cases will require palliative support in the disease’s later stages. This case presentation of a man with newly diagnosed metastatic prostate cancer highlights some of the key decisions required in managing this condition.
Upper urinary tract urothelial carcinoma
Authors: Nobrega Richard , Sullivan Mark
Published: January 2023

Upper tract urothelial carcinoma (UTUC), although rarer than urothelial carcinoma of the bladder, is more aggressive with 60% of patients presenting with invasive disease. Bilateral synchronous UTUC is scarcer still, with much literature quoting a 2% lifetime risk of recurrence in the contralateral upper tract. This case aims to discuss and reinforce the key evidence supporting current guidance and management algorithm in managing a patient with UTUC and examines the role of renal autotransplantation in the patient with bilateral UTUC; a principal that could also apply to invasive UTUC in a solitary kidney.
Benign prostatic enlargement and acute urinary retention
Authors: Papworth Emma , Jelski Joseph , Hashim Hashim
Published: January 2023

This is a case of mixed lower urinary tract symptoms in a male managed initially with medical therapy, and subsequently investigated with urodynamics. Following this, a transurethral resection of the prostate was performed. After surgery, further treatment was required for ongoing lower urinary tract symptoms. The case reviews important considerations, patient factors, and possible outcomes relating to this common presentation in urology.
Urge urinary incontinence
Authors: Ravindra Pravisha , Parkinson Richard
Published: January 2023

Urge urinary incontinence is the involuntary loss of urine associated with a sudden, compelling desire to pass urine. Successful treatment is dependent on an accurate initial diagnosis, especially in patients with complex or mixed symptoms. Differentiation from other complaints, such as stress incontinence, bladder pain syndrome, or urinary tract infection, is achieved by careful clinical assessment. A 3-day bladder diary, urine dipstick, and post-void bladder scan are useful initial investigations, with more invasive tests used on a selective basis. Bladder retraining, weight loss, caffeine reduction, and fluid management can produce significant improvement. Pharmacotherapy in the form of vaginal oestrogens, antimuscarinics, and beta-3 agonists can be initiated if conservative measures fail. The management of refractory overactive bladder syndrome is challenging; options include intravesical botulinum toxin, percutaneous tibial nerve stimulation, sacral neuromodulation, or augmentation cystoplasty.
Stress urinary incontinence
Authors: Barratt Rachel , Biers Suzanne
Published: January 2023

Stress urinary incontinence (SUI) is a common condition accounting for around 50% of all female urinary incontinence. Diagnosis includes robust history taking, clinical examination including cough stress test, urinalysis, and post-void residual measurement. For uncomplicated primary SUI, guidelines advise that urodynamic studies are not required, although clinicians may offer this test to assist with patient counselling. Management of primary SUI includes conservative measures with bladder training, supervised pelvic floor muscle training, and weight loss. Surgical options comprise urethral bulking agents, mid-urethral tapes (currently on ‘pause’ in the UK), autologous fascial slings, and colposuspension. Approximately 20–30% fail primary treatment for SUI with recurring incontinence which can be more difficult to treat. Urodynamics is essential in this setting. All surgical options can be offered again, and insertion of an artificial urinary sphincter. For end-stage complex SUI, surgical management is limited to artificial urinary sphincter or urinary diversion. Clear patient counselling on the treatment options and associated risks is essential.
Bladder pain syndrome/interstitial cystitis
Authors: Mangera Altaf
Published: January 2023

Bladder pain syndrome/interstitial cystitis is a condition that is poorly understood, poorly researched and poorly managed. This typical case discusses assessment and evidence for the management of bladder pain syndrome/interstitial cystitis with an expert commentary and clinical tips for those who may encounter such patients. It is important to be aware of how patients may present, the investigations which are indicated, the natural progression of the symptoms and how to exclude red flags and other diagnoses. We find, it is essential to have good communication with your patients and explain the understanding of the condition and work through a stepwise approach to management.
Vesicovaginal fistula
Authors: Malde Sachin , Sahai Arun
Published: January 2023

Vesicovaginal fistula (VVF) is uncommon in well-resourced countries and is usually as a result of pelvic surgery such as hysterectomy. In poorly resourced countries, VVF usually occurs as a result of obstructed labour. Evaluation of VVF includes cystoscopy and examination under anaesthetic, and select imaging to assess the pelvis and the upper urinary tract. The timing of surgery typically is within the first week or delayed at 3–6 months. Surgery can be performed through either the vaginal or abdominal routes. This case describes a VVF repaired through the vaginal route with the use of a Martius fat pad interposition graft. Expert comments, clinical tips, evidence bases, and learning points in managing VVF are provided.
Erectile dysfunction
Authors: Tracey James , Shabbir Majid
Published: January 2023

Erectile dysfunction is a common and difficult concern for patients to address. It can be an early indicator of systemic illness that may require treatment before more significant complications occur. It is important for both urologists and general practitioners to ask their male patients about erectile dysfunction and use the opportunity to treat their symptoms while addressing and managing any underlying cause. This holistic approach to men’s health will ensure an improvement in their longevity as well as their quality of life.
Peyronie’s disease
Authors: Prattley Sarah , Rees Rowland
Published: January 2023

Peyronie’s disease and penile deformity is an uncommon but significant problem which can lead to a notable impact on a patient’s physical, mental, and emotional well-being. Medical intervention, while abundant, currently lacks the evidence base and proven efficacy in therapeutic management. Surgical intervention is reserved for the stable phase of the disease, and includes penile shortening, penile lengthening, and penile prosthetic interventions. We present the case of a 51-year-old gentleman with significant curvature of 70° who underwent assessment and surgical intervention with a Lue procedure. The case highlights the importance of thorough assessment and selection of the most appropriate form of management, and provides intraoperative tips to aid outcome.
Ejaculatory orgasmic disorders
Authors: Satchi Maria , Ralph David
Published: January 2023

Ejaculation is the physiological process that refers to the expulsion of semen from the penis, whilst orgasm refers to a state of climax from sexual excitement. Disorders of ejaculation and orgasm, either lifelong or acquired, can pose both a diagnostic and management challenge. Although linked and typically occur during sexual excitement, ejaculation and orgasm are different neurophysiological processes, where some patients may reach orgasm without ejaculation and some ejaculate without orgasm. Different hormonal and neurotransmitter pathways have been found to influence the ejaculatory and orgasmic pathway. These symptoms can cause significant patient and partner distress. An understanding of the different symptoms and specific patient concerns is needed to streamline investigations and is pivotal to planning subsequent management.
Renal trauma
Authors: Lee Hack Jae , Anderson Christopher , Sharma Davendra M.
Published: January 2023

Kidneys are commonly injured organs in trauma and account for approximately 1–5% of all trauma patients. The way renal trauma is managed has changed over the years and conservative management is favoured to prevent iatrogenic nephrectomies. In unstable, high-grade renal injuries, patients occasionally require arterial embolization or surgical exploration. This case presents a 16-year-old male who sustained penetrating injury to his kidney. The case discusses the role of imaging in diagnosing renal trauma, current management strategies, surgical procedures, and complications.