bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial and Ethnic Disparities in Maternal Morbidity and Obstetric Care
Authors: Molina Rose L. , Shah Neel
Published: February 2021

This article provides a summary of a landmark study describing racial and ethnic disparities in maternal morbidity and obstetric care practices. The article describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The article briefly reviews other relevant studies and information, and discusses implications. The article concludes with a relevant clinical case highlighting unconscious bias and how it affects the care providers deliver to their patients. Racial disparities are rampant in medicine, this article highlights the role of race in maternal outcomes.
Clomiphene, Metformin, or Both for Infertility With Polycystic Ovarian Syndrome
Authors: Kim Tana , Khan Zaraq
Published: February 2021

The PPCOS trial examines and compares ovulation induction treatments for infertile women with a diagnosis of polycystic ovarian syndrome (PCOS). Both clomiphene and metformin are pharmacologic therapies that have been utilized to promote ovulation and subsequent fertility in women with PCOS. However, it is uncertain if clomiphene, metformin, or a combination of both should be the first-line ovulation induction treatment option for women with PCOS. This study examines fertility and pregnancy outcomes for PCOS women by performing a double-blind, randomized study utilizing 3 different study arms: clomiphene, metformin, and clomiphene plus metformin. This study not only reviews differences in ovulation, pregnancy loss, live birth, and multiple gestation rates between the 3 different study arms, but it also concludes which treatment option is superior for infertile PCOS women seeking treatment.
A Randomized Clinical Trial to Evaluate Optimal Treatment for Unexplained Infertility
Authors: Rothenberg Stephanie , Sanfilippo Joseph
Published: February 2021

The treatment of unexplained infertility has traditionally been comprised of a stepwise treatment approach, first with ovulation induction combined with intrauterine insemination (IUI) and then with in vitro fertilization (IVF). Ovulation induction is first attempted with clomiphene citrate, and, if unsuccessful, injectable gonadotropins are used. The value of ovulation induction with injectable gonadotropins in couples with unexplained infertility has been questioned, however, given the high risk of multiple gestation and the increasing efficacy of IVF. To address this, the FASTT trial randomized couples with unexplained infertility to a treatment arm that either included or omitted gonadotropin/IUI. They found that an accelerated treatment approach that involved 3 cycles of clomiphene citrate/IUI and then progressed immediately to IVF resulted in a decreased time to pregnancy compared to the group who underwent gonadotropin/IUI for 3 cycles, as well as decreased cost per live birth. Therefore, it was concluded that treatment of couples with unexplained infertility with gonadotropin/IUI was of no additional benefit.
Biomarkers of Ovarian Reserve and Infertility Among Older Reproductive Age Women
Authors: Gadson Alexis , Kuohung Wendy
Published: February 2021

Biomarkers of ovarian reserve are being used as markers of reproductive potential. This use of ovarian reserve biomarkers has not been shown to accurate or beneficial when determining future fertility. The aim of this study was to determine the association of ovarian reserve biomarkers and fertility in women of late reproductive age. This was a prospective cohort study of 981 women ages 30 to 44 who had been trying to conceive for fewer than 3 months. A total of 750 women were included in the analysis. After adjusting for age, body mass index, race, current smoking status, and recent hormonal contraceptive use, women with low anti-Mullerian hormone (AMH) values (<0.7 ng/mL) or high serum follicle stimulating hormone (FSH) (>10mIU/mL) did not have a significantly different predicted probability of conceiving after 6 to 12 cycles of attempt. Women without a history of infertility with low AMH values or high serum FSH did not have reduced ability to become pregnant. Probability of conceiving naturally by 6 cycles or 12 cycles was not lower for women with low AMH or high FSH.
Leveraging Convergence Science to Address Global Mental Health Challenges
Authors: Smith Erin , Lavretsky Helen , Reynolds III Charles F , Berk Michael , Eyre Harris A
Published: February 2021

The world is in the throes of a global mental health crisis with severe physical, societal, and economic ramifications. This has only exacerbated by the COVID-19 pandemic. Modern mental health problems are characterized by their complexity, multisystemic nature, and broad societal impact, making them poorly suited to siloed approaches of thinking and innovation. To solve the unprecedented complexities and challenges associated with the current global mental health crisis, a paradigm shift is needed. Convergence science integrates knowledge, tools, and thought strategies from various fields and is the point where novel insights arise. In the context of mental health, convergence involves integration of scientists, clinicians, bioinformaticists, global health experts, engineers, technology entrepreneurs, medical educators, caregivers, and patients; synergy between government, academia, and industry is also vital. A convergence mental health approach will lead to improved outcomes for patients and healthcare systems. Predicate examples of convergence science in adjacent fields to mental health provide a model for the path forward. Further, within the field of mental health, there are examples of convergence science currently in action that include early-stage companies, neuroscience initiatives, public health projects, and unconventional funding mechanisms. The world has a historic opportunity to leverage convergence science to lead to a new era of innovation and progress in global mental health.
On the Road to Convergence Research
Authors: Wilson Niki
Published: February 2021

Climate change. Lack of food security. Limited access to basic healthcare. These are just some of the big, complex problems facing humanity. Solutions will require out-of-the-box innovation, which is why many governments, institutions, and entrepreneurs around the globe are beginning to embrace the concept of convergence research. The US-based National Science Foundation describes convergence as “a deeper, more intentional approach to accelerating discovery.” Following interdisciplinarity and multidisciplinarity, it is the next stop on a continuum used to describe approaches whereby scientists and experts learn from each other and collaborate across disciplines. It aims to integrate the natural, computational, social, economic, and health sciences in a humanities context, thereby transcending the traditional boundaries of those fields and creating unique opportunities for problem-solving. The concept of convergence research is taking hold, but how effectively is it being implemented? This chapter explores examples from research networks, research institutes, and the private sector to better understand how convergence research is addressing some of society’s most pressing issues. From disruptions in indigenous food systems to emerging issues in mental health, the author explores the benefits and challenges that arise from a convergence research approach.
The Use of Bioinformatics and Big Data for the In Silico Study of Psychiatric Disorders
Authors: Zhang Wei , Fries Gabriel R. , Quevedo Joao
Published: February 2021

Mental and behavioral disorders are becoming the leading cause of disability across the world. Along with the ongoing development of biomedical and computational technologies, more and more data are being constantly produced, including genomic, transcriptomic, metabolomic, proteomic, clinical, and imaging resources. As a consequence, scientists in the psychiatric field are actively changing their research ways from studies focused on individual investigators to large international consortia, which accelerate the data accumulation and increase its size. This chapter discusses the current publicly available data sets on psychiatry disorders and neuroscience, as well as their integrated analysis. The authors also list some studies using novel types of data, which will further extent the potential of big data in the study of psychiatric disorders.
Converging Technologies Between the Space Mars Mission and Earth Global Mental Health
Authors: Chang Donald D. , Abbott Ryan , Eyre Harris A.
Published: February 2021

The possibility of Space travel to Mars in our lifetime has reignited interest in aerospace medicine and mental health aspects of prolonged travel. The extended duration, tight quarters, and social aspect of Space travel have significantly but incompletely understood impact on the mental health of astronauts. As society looks to innovation to address mental health issues in Space, mental health on Earth remains a persistent and unmet need. There are ongoing efforts to advance technology to mitigate what is currently one of the largest burden of disease worldwide. How does one reconcile the challenges of mental health in long-term Space travel with that in the earthbound population? Fortunately, these apparently separate challenges are reliant on technologies that offer promising opportunities for cross-pollination and bidirectional sharing of ideas. In fact, there is a rich history of Space technologies helping to address challenges on Earth so there is a precedent for this translation.
Blockchain for Convergence Science in Mental Health
Authors: Charles Wendy
Published: February 2021

Blockchain is an innovative data management technology using distributed ledgers that has potential to achieve efficiency in data processing and greater control over healthcare record access. Interest is growing beyond uses for cryptocurrency, but blockchain technologies remain poorly understood in the general public and healthcare community. While there are many promising uses for healthcare and supply chain, most potential uses of blockchain for mental health are still in the pilot or development stage. This chapter presents blockchain to the mental health community with a detailed introduction to the unique facets blockchain with a few examples of current uses of blockchain in healthcare with promising proposed uses for mental health.
The Minds Behind the Technology
Authors: Carson Jessica
Published: February 2021

Over the past few years, there has been a surge of interest in entrepreneur mental health and well-being. Research has shown 72% of entrepreneurs self-report a lifetime history of mental health concerns (depression, substance abuse, attention-deficit/hyperactivity disorder, and bipolar), and countless others incur varying degrees of emotional, physical, and spiritual distress. While many have been quick to declare a mental health “crisis” or “epidemic” among entrepreneurs, the reality may not be so simple. Entrepreneurs with mental health challenges may in fact have a competitive advantage—they may self-select into entrepreneurial work as a result of the adaptive qualities conferred onto them by their diagnosis. This article explores the myriad reasons for these high rates (from self-selection to diathesis–stress), including the hypermasculinized nature of entrepreneurial culture, the high-stress nature of entrepreneurial work, and the hidden superpowers embedded in the genetics of entrepreneurs. To conclude, the ways in which the entire ecosystem can become healthier through self-understanding and self-care are discussed.
Anxiolytic (Antianxiety) Medications
Authors: Roth Andrew J. , Nelson Christian J.
Published: February 2021

Anxiety is common in cancer patients, but it is not necessarily predictable, tolerable, or inevitable. It can arise from the illness experience or as an exacerbation of a pre-existing anxiety disorder. Anxiety is commonly seen with a new cancer diagnosis, with complications of cancer treatment or medications, related to changes in body image, associated with fear of recurrence after treatment, when dealing with recurrence or progression of cancer after treatment, or when finding out that there is no further active treatment for the cancer and concerns about mortality must be engaged. Although understandable, these worries can intensify, causing severe panic or emotional paralysis, and interfere with completing cancer treatment. This chapter discusses the medical and psychiatric causes of anxiety, the medications used to treat anxiety, and the pros and cons of various choices. It is hoped that all practitioners can help educate patients about antianxiety medications, including fears about dependence, tolerance, and addiction, thereby improving outcomes.
Antipsychotics
Authors: Roth Andrew J. , Nelson Christian J.
Published: February 2021

Antipsychotics in a cancer setting are often used with different goals than in a general psychiatric setting. In a cancer population, antipsychotics primarily help manage delirium, confusion, agitation, and manic episodes, but they also treat anxiety, insomnia, and nausea and can improve appetite. The potential causes of delirium are many and variable, and must be identified and addressed. However, antipsychotic medication may be needed to facilitate a medical workup to allow appropriate treatment by helping to manage symptoms such as agitation, hallucinations, delusions, and disorganized thinking. This chapter discusses pearls for recognizing delirium because confusion may start insidiously or quickly, lethargically or turbulently, sometimes from an obvious trigger, and sometimes not, and at times in an outpatient setting. Non-prescribers who understand the features of delirium and appreciate the appropriate use of antipsychotics can help educate and support patients and their families to expedite and promote timely and appropriate treatment for a potentially dangerous entity. Non-prescribing clinicians will learn the indications for use of antipsychotics in cancer care, the reasons prescribers chooses different medications in different situations, and to recognize side effects such as akathisia or restlessness, muscle rigidity, and sedation so they can communicate their observations with prescribers.
Medications for Fatigue
Authors: Roth Andrew J. , Nelson Christian J.
Published: February 2021

Cancer-related fatigue is common, occurring in up to 80% of patients. Distressing fatigue can be related to psychiatric or medical causes such as significant depression, frequent intense anxiety, or panic attacks, as well as sleep disturbances, pain, and electrolyte or hormonal abnormalities. It is often caused by a wide range of medications and substances. This chapter presents the various causes of fatigue to help non-prescribing clinicians distinguish fatigue from other look-alike diagnoses such as depression and make appropriate referrals to prescribers. Identifying opportunities to supplement nonpharmacologic therapies with an activating medication can improve a patient’s quality of life and joy in living. This chapter will help all clinicians become more aware of medications used to boost energy, such as energizing antidepressants, wakefulness agents, and psychostimulants, as well as the potential side effects of these medications.
The Prevalence and Impact of Obstructive Sleep Apnea and Current Management Landscape
Authors: Motz Kevin , Patil Susheel P.
Published: February 2021

Obstructive sleep apnea (OSA) is characterized by repeated collapse of the upper airway during sleep that leads to reduced airflow and oxyhemoglobin desaturation. The disorder is highly prevalent, with obesity, male sex, and increasing age as risk factors. Consequences of untreated OSA include neurocognitive impairment, such as excessive daytime sleepiness, and an increased risk of cardiovascular and cerebrovascular disease. Positive airway pressure therapy remains the most common treatment for OSA. Over the last few decades, alternative nonsurgical and surgical treatments have been developed. Although surgical approaches are rarely curative, careful patient selection may benefit a subpopulation of people living with OSA. Selective hypoglossal nerve stimulation represents a new treatment strategy for the management of OSA in selected patients.
Criteria for Patient Selection
Authors: Liu Sara W. , Kominsky Alan
Published: February 2021

Patients with moderate to severe obstructive sleep apnea and body mass index <35 kg/m2 who are intolerant to positive airway pressure therapy should be considered for a hypoglossal nerve stimulator. Appropriate patient selection is essential to optimizing therapy response with device implantation. Important factors for consideration when patients present for initial evaluation in the outpatient setting include pertinent clinical history, body habitus, upper airway anatomy, and polysomnographic data. Patients who are identified as appropriate candidates should then undergo drug-induced sleep endoscopy to evaluate the pattern of airway collapse. These current recommendations have been validated in clinical trials as positive predictors of therapy success.
Special Considerations in the Acute Post-Implantation Period
Authors: Suurna Maria V. , Chang Jolie L.
Published: February 2021

The introduction of upper airway stimulation (UAS) implantation has offered a novel and effective therapy for patients with moderate to severe obstructive sleep apnea. Procedures for implantable devices are associated with unique risks and considerations. Specific attention should be given to individual factors such as gender, occupation, and medical and surgical history, which are important to consider for comprehensive preoperative counseling, preparation for implant surgery, and postoperative recovery management. This chapter discusses special considerations in the post-implantation period, including adverse events associated with UAS implant surgery and their management; postoperative considerations for patients with preexisting medical conditions; considerations in women; and considerations in patients with occupational requirements for a left-sided implant and other implanted medical devices.
Long-Term Follow-Up Considerations
Authors: Tucker Woodson B. , Sharma Abhay Varun
Published: February 2021

Upper airway stimulation is a powerful tool in the sleep surgeon’s arsenal for dealing with obstructive sleep apnea. With long-term data now available on patient outcomes, there is a greater understanding of the complications, long-term effects, and stability of the improvement in clinical parameters. As a result, we have improved our ability to recognize difficulties with the device and improve results. This chapter covers both routine follow-up (frequency of visits, device checks, criteria for repeat sleep studies, monitoring of patient subjective and objective parameters, monitoring of adverse events, and long-term device maintenance) and complexities that can arise years out from the original surgery (suboptimal clinical response to upper airway stimulation, weight gain, comorbid medical conditions, surgical complications in the long-term setting, device malfunction, complex device programming, complex polysomnographic titration, awake vs. sleep endoscopy for titration, and complex clinical profiles).
The Future in Upper Airway Stimulation Therapy
Authors: Kent David T.
Published: February 2021

Hypoglossal nerve stimulation therapy for obstructive sleep apnea was first approved by the U.S. Food and Drug Administration in 2014, but it has been under development through various research initiatives for the better part of the last three decades. Currently, multiple lines of research are directed toward optimizing patient selection and device adjustment with available neurostimulation therapies. Additional hypoglossal nerve stimulation devices are in trial or under active development. Future work will focus on iterative improvement of these devices and appropriate patient selection. Additional pharmacological and neurostimulation targets beyond the hypoglossal nerve in the upper airway exist, and current publications provide hints of what is yet to come.
Is Compassion Innate? A Physiological Perspective
Authors: Wong Agnes M.F.
Published: February 2021

Three interrelated biological subsystems subserve compassion: the autonomic nervous, neuroendocrine, and central nervous systems. The autonomic nervous system—the newly evolved ventral myelinated vagus nerve of the parasympathetic nervous system—allows moment-to-moment fine-tuning of physiological and emotional regulation to promote social engagement behaviours. The neuroendocrine system—the hormones and neurotransmitters vasopressin and oxytocin—facilitates kinship and clan emotional bonding. The central nervous system—an enlarged neocortex (including the prefrontal and cingulate cortices)—allows improved self–other differentiation and the ability to understand another’s emotion. The author reviews the first two subsystems in this chapter, showing that compassion is innate. However, it could be obscured by the adversity of individual experiences and by social context or conditioning. The author also shows that the physiological mechanisms that underlie the expression of compassion in the giver also elicit similar effects in those who receive and benefit from it.
What Are the Obstacles to Compassion?
Authors: Wong Agnes M.F.
Published: February 2021

In this chapter, the author examines the obstacles that impede the flow of compassion in three directions: for others, from others, and from self. Obstacles to compassion for others include insecure attachment style, personal identity, self-interests, social dominance orientation, moral judgment, confusing compassion with submissiveness or weakness, empathy fatigue, time pressure, and scale of suffering (including psychophysical numbing, pseudo-inefficacy, and prominence effect). Obstacles to receiving compassion from others include activation of grief responses, perceived weakness, and vulnerability. The author also looks at what inner compassion is and how self-criticism hinders it. Finally, the author also discusses the barriers to compassion that are unique to the healthcare environment, including self-recrimination and self-neglect, empathic distress and empathy fatigue, moral suffering, bullying, burnout, medical culture, and cognitive scarcity.
Echocardiography and stress echocardiography for coronary artery disease
Authors: Oh Jae K.
Published: February 2021

Echocardiography provides functional (systolic and diastolic), structural, and haemodynamic information about the heart at rest and with exercise using two- or three-dimensional Doppler, tissue Doppler, contrast, and strain imaging by transthoracic and transoesophageal approaches. These comprehensive imaging and haemodynamic data are essential in the diagnosis, management, and prognosis of patients with coronary artery disease. Moreover, echocardiography is frequently utilized intraoperatively during coronary artery bypass graft surgery and for clinical trials performed to establish optimal treatment strategies in coronary artery disease patients. These clinically indispensable roles that echocardiography plays in coronary artery disease are discussed in this chapter.
Ischaemia, hibernation, and viability
Authors: Ferrari Roberto
Published: February 2021

It was dogma for many years that if myocardial ischaemia persists for more than 30 minutes, necrosis will develop, resulting in myocardial infarction. The unavoidable extrapolation of that dogma suggested that chronic ischaemia, in reality, cannot exist, as it will inevitably evolve into structural changes (i.e. irreversible damage). These tenets were overturned in the early 1980s when Rahimtoola reviewed the results of coronary bypass surgery trials and identified patients with coronary artery disease and chronic left ventricular dysfunction persisting for months and even years that improved after revascularization. The rapid amelioration of myocardial function obtained by revascularization ruled out the hypothesis that the reduced function was due to histological modification of the myocardium and left the entire scientific community with the dilemma to explain and recognize hibernating myocardium.
Intravascular ultrasound
Authors: Räber Lorenz
Published: February 2021

Intravascular ultrasound represents the most established, well-validated, and widely used intracoronary imaging technology worldwide and was introduced approximately 25 years ago. Intravascular ultrasound enables the visualization of key anatomical structures of the coronary artery and saphenous or arterial grafts including the lumen, external elastic membrane, and adventitia and thereby provides the basis for the assessment of the degree of coronary artery stenosis, extent of atherosclerosis burden (i.e. global and local disease burden), and plaque composition. All this represents key information to plan and perform percutaneous coronary intervention procedures in native coronary artery disease or graft lesions and to estimate the risk for future cardiovascular events.
Comprehensive secondary cardiovascular prevention and cardiac rehabilitation after coronary artery bypass graft surgery
Authors: Lee Suegene K. , Khambhati Jay , Sandesara Pratik , Eapen Danny , Lundberg Gina , Margolis Basil , Gordon Neil , Franklin Barry , Sperling Laurence
Published: February 2021

Cardiac rehabilitation is a key component of secondary prevention for patients who have undergone coronary artery bypass graft surgery. Cardiac rehabilitation is a comprehensive, multidisciplinary, long-term provision of medical evaluation, prescriptive exercise, cardiac risk factor modification, and education. Not only does cardiac rehabilitation reduce cardiovascular mortality and hospital readmissions, but it also improves the functional status and quality of life for patients. Despite the strong evidence and recommendation for referral to and utilization of cardiac rehabilitation early in the postoperative period, it remains underutilized, especially in the elderly and women.
Quality metrics in coronary artery bypass grafting
Authors: Gaudino Mario , Zamvar Vipin , Prager Richard L.
Published: February 2021

Quality may be defined differently by different individuals and the objective measurement of quality is often challenging. In the United States Institute of Medicine’s 1990 report, Medicare: A Strategy for Quality Assurance, the definition of quality included ‘the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge’. The foundational definition of quality in medicine, and certainly in surgery, comes from Avedis Donabedian’s 1966 article utilizing the triad of structure, process, and outcome. Structure refers to the inherent characteristics of the setting where care is provided, process to the particulars and procedural details of the care, and outcome to the end results of the care.
Fast-track cardiac anaesthesia and early extubation
Authors: Martin Janet , Cheng Davy
Published: February 2021

‘Fast-track’ cardiac anaesthesia and recovery is the term given to a multicomponent intervention during cardiac surgery and postoperatively, with the ultimate goal of early extubation (within 1–6 hours) in order to reduce duration of mechanical ventilation, length of stay in the intensive care unit, and overall resource utilization. Key components of fast-track cardiac care include balanced anaesthesia (low-dose opioids together with inhaled or intravenous anaesthetics) and a time-directed extubation protocol. Fast-track cardiac care requires an interdisciplinary approach to anaesthesia during surgery, as well as a coordinated approach after surgery, in order to achieve early extubation and an overall streamlined approach to recovery and hospital discharge.
Harvesting arterial conduits
Authors: Benedetto Umberto , Buxton Brian F. , Taggart David P.
Published: February 2021

This chapter discusses harvesting of arterial conduits and compares skeletonized, pedicle, and semi-skeletonized methods with regard to internal thoracic artery, radial artery. and right gastroepiploic artery harvesting.
Pharmacology to prevent spasm in conduits
Authors: He Guo-Wei
Published: February 2021

The current incidence of coronary artery bypass graft spasm has been estimated at 0.43%. The first report of early postoperative graft spasm as a clinical entity was in the left internal thoracic (mammary) artery graft in 1987. Subsequently it was reported that spasm could be a localized phenomenon or a diffuse process, referred to as a ‘string sign’. These clinical reports promoted intense physiological and pharmacological studies on the biological characteristics of the internal thoracic artery to understand the nature of spasm.
Optimal use of instruments for off-pump coronary artery bypass grafting
Authors: Yanagawa Bobby , Halkos Michael E. , Puskas John D.
Published: February 2021

Off-pump coronary artery bypass grafting is a technically demanding procedure that allows for avoidance of the deleterious consequences of cardiopulmonary bypass and can facilitate a no- or minimal-aortic manipulation procedure. To ensure the construction of a precise and reproducible off-pump coronary anastomosis, adjunctive tools have been developed that, when used correctly, can create a near motionless and bloodless field, mimicking conditions of anastomosis on an arrested heart. These include cardiac positioning and stabilization devices, occlusive tapes and intracoronary shunts, and misted blowers. The chapter also discusses the use of a proximal anastomosis device to mitigate the risk of stroke and a transit-time flow meter for confirmation of graft patency. It offers practical suggestions on the correct use of each device as well as common pitfalls to avoid.
How to perform a distal coronary anastomosis
Authors: Glineur David , Grau Juan B.
Published: February 2021

The purpose of this chapter is to describe in detail the technical nuances and planning necessary to construct high-quality, long-lasting anastomoses during coronary artery bypass grafting. Issues to be covered include suture selection, needle manipulation techniques, correct exposure of the coronary target, and various types of anastomoses. These recommendations are intended to support and guide, rather than to dictate one or another approach, as every surgeon will develop their own preferred techniques. The chapter summarizes the technical approaches of two cardiothoracic surgeons from different academic backgrounds and training programmes who have developed their practices on two different continents. Modification of these recommendations is not only permitted but encouraged, as long as the fundamental principles of spatial proportion, quality, and sound technique are preserved.
Intraoperative graft assessment with transit-time flow measurement and epicardial ultrasound
Authors: Kieser Teresa M. , Giammarco Gabriele Di
Published: February 2021

Intraoperative bypass graft evaluation for coronary artery bypass graft surgery has now been recommended in three consecutive European guidelines for myocardial revascularization in 2010, 2014, and 2018. The two main modalities consist of transit-time flow measurement which assesses function of grafts and epicardial ultrasound to assess the anatomy of the anastomosis. Functional and morphological assessment are generally considered complementary, although transit-time flow measurement is the most commonly used. Transit-time flow measurement alone may have ambiguous values in 5–15% of grafts and this can lead to unnecessary graft revision. The addition of epicardial ultrasound aids interpretation of intraoperative graft assessment by allowing visualization of the anastomosis and correction of technical errors that, intuitively, will lead to improved patient outcomes.
Minimally invasive direct coronary artery bypass
Authors: Falk Volkmar , Holinski Sebastian
Published: February 2021

There are different minimal invasive approaches of coronary bypass surgery. Avoiding sternotomy and gaining access to the heart via an alternative route is one strategy. Another is to avoid cardiopulmonary bypass. Combining these two measures defines the classical minimally invasive direct coronary artery bypass (MIDCAB) procedure. While multiple grafts can be placed through a limited mini-thoracotomy on the beating heart, the classic MIDCAB procedure is usually limited to grafting of the left internal thoracic artery to the left anterior descending artery.
Coronary artery bypass grafting
Authors: Farkouh Michael E. , Fuster Valentin
Published: February 2021

The efficacy of coronary bypass surgery in special populations is an important topic, particularly in those with diabetes mellitus and those with chronic kidney disease. This chapter discusses the influence of diabetes mellitus and chronic kidney disease and the interaction between the two diseases.
Supportive Care During Treatment
Authors: van de Wetering Marianne , Phillips Robert S.
Published: February 2021

This chapter reviews the key physical aspects of supportive care for the child with cancer. Effective holistic supportive care is essential for the relief of cancer and treatment-related symptoms, leading to less morbidity and reduced mortality. The chapter covers the principles of the management of infection, preventing and treating nausea and vomiting, supporting nutrition, and dealing with mucositis. Aspects not covered include pain management, the use of complementary and alternative medicine (instead or alongside standard medical treatment), and the crucial areas of psychological support, social interventions, and clinican–family–patient communication. Major principles discussed include the use of effective risk-stratified prophylaxis, such as immunization and antiemetics, and patient-tailored responses to therapies.
Acute Lymphoblastic Leukaemia
Authors: Schewe Denis , Loh Mignon , Pieters Rob , Schrappe Martin
Published: February 2021

Acute lymphoblastic leukaemia (ALL) is the most common type of cancer in childhood. There have been continuous advances in the treatment of this disease in the last decades, mainly due to the unceasing development of cooperative international clinical trials. The identification of novel risk groups based on molecular genetic findings has added to improvements in risk stratification in many patients, but not in all. One of the main problems in paediatric ALL is relapsed and refractory disease requiring the evaluation of targeted agents and immunotherapies in clinical studies in children. Furthermore, the reduction of therapy intensity to avoid late adverse effects is a major focus in patients with low-risk disease. This chapter summarizes epidemiology, diagnostic modalities, prognostic factors, and therapy options, including allogeneic stem-cell transplantation, in paediatric ALL. It also focuses on controversial issues in specific patient subgroups defined by their age and molecular alterations.
Glial Central Nervous System Tumours of Childhood
Authors: van Vuurden Dannis , Hargrave Darren , Sturm Dominik , Jones David T.W.
Published: February 2021

Gliomas are the largest group of paediatric central nervous system (CNS) tumours and can affect any age and location. Currently, they are divided into low and high grade using the World Health Organization (WHO) classification but, increasingly, biology is being used to classify and stratify therapy, and this division may be challenged in the future. Outcomes vary greatly with some low-grade tumours being very indolent, requiring nothing more than careful observation, compared to aggressive high-grade gliomas of the brainstem that have a dismal prognosis. Current therapies are based on surgery, radiotherapy, and cytotoxic chemotherapy but, increasingly, biologically targeted therapies are being explored in an attempt to increase survival and decrease late effects and the burden of treatment.
Oxford Handbook of Gastrointestinal Nursing
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The Oxford Handbook of Gastrointestinal Nursing second edition commences with anatomy and physiology of the gastrointestinal tract and the accessory organs such as the liver. The subsequent chapters explore the diseases and conditions of these structures. This edition has built on the fantastic work of the previous authors. This new edition is restructured and updated to ensure that developments made in the last 10 years are included and outdated work is limited. The focus is on a diversity of bowel functions/diseases/investigations/surgery, which will assist the nurse in caring for people with issues related to their gastrointestinal tract.anatomy
Investigating the gut
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The investigating the gut chapter examines investigations used to diagnosis diseases of the gastrointestinal tract. The investigations need to be used in the appropriate settings as there are risks associated with some, such as the radiation used in scans. Investigating the gut includes the defaecating proctogram to explore the rectum as well as ultrasounds of the abdomen or endoanal. There are also investigations such as computer tomography, virtual colonoscopy, and magnetic resonance imaging. Simple X-rays can be used to examine the abdomen or monitor gut transit, and barium studies can be taken orally or via the anus. These investigations can be used to diagnose changes within the gastrointestinal tract, such as a colorectal cancer or a stricture. Succinct explorations on the different investigations used to examine the gastrointestinal tract, detailed within this chapter can be reviewed when necessary within clinical practice by the nurse.
Drugs in gastrointestinal care
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The chapter entitled drugs in gastrointestinal care explores the many drugs that are either used in the care of people with disorders and diseases of the gastrointestinal tract or affect the gut. Medications are often necessary to treat gastrointestinal issues but there may be side effects that should be managed by nurses, Pain might be treated by drugs, such as different types of analgesia; infections are treated by antibiotics, and nausea by antiemetics. Additionally treatment of constipation with the use of laxatives is explored as there are a variety of medications that have dissimilar methods of working. Upper gastrointestinal diseases may be treated by medications, such as proton pump inhibitors. Alternatively, there may be side effects of other drugs that affect the gastrointestinal tract that require nursing care. This chapter is tabulated for ease of use by the nurse in clinical practice, to include the indication for when to use the drug and any side effects.
Prejudice, ethnic discrimination, and double jeopardy in migrants
Authors: Watson Cameron , Tolentino Edgardo Juan , Bhugra Dinesh
Published: February 2021

Prejudice is a universal phenomenon and all human beings carry at least one prejudice in them, whether this is against individuals with mental illness or migrants. Often potential factors can also cause prejudice. In many clinical settings, migrants with mental illness can face double jeopardy, leading to facing further discriminations at a number of levels. Individuals with mental illness in many countries do not have the right to vote, marry, make a will or inherit property, or the right to employment. Migrants in many countries do not have full rights as citizens. Double or triple jeopardy means that migrants with mental healthcare needs often fail to get their needs met at a number of levels. Prejudice and discrimination are learned behaviours, whereas stigma is often a negative attitude. Racism is a form of discrimination, but it takes the form of xenoracism if the migrant is white, although shared whiteness does not exclude the possibility of racism.
The new face of exploited children in Europe
Authors: Peyroux Olivier
Published: February 2021

Children and young people are often trafficked for financial gains as a consequence of trafficking for physical and sexual abuse. The number of such refugees and asylum seekers is almost impossible to determine accurately. Children can be used to smuggle drugs across countries. Although small networks for local crime built around drug dealing, cigarette sales, or the resale of stolen goods use children and young people, there are also highly evolved and structured organizations specializing in drug and sexual trafficking. These challenges require new and different ways of approaching them so that mental health and well-being of children and young people can be maintained. Furthermore, it will be helpful to change the terms of child protection, strengthening structures of support, creating community and street teams with appropriate linguistic competencies, better links between countries of origin and European countries, and better cooperation between police, justice, social workers, and non-governmental organizations. Better approaches are indicated.
Vulnerability, psychopathology, and creativity of the children and adolescents of migrants
Authors: Moro Marie-Rose , Benoit Laelia , Lebozec Manon , Minassian Sevan , Rizzi Alice Titia , Radjack Rahmeth
Published: February 2021

Children and adolescents who grow up between two cultures (the culture of their parents, and the culture of the country where they live) are in a vulnerable transcultural situation. This chapter reviews three periods of vulnerability. At first, in the immediate postnatal phase, it describes the effects of migration on migrant women and their babies. Then, when the child enters school he/she is confronted for the first time by the outside world. It also questions the challenge of identity construction during the adolescent period. If this vulnerability is not an outcome, it can sometimes become a psychopathology. Some examples in connection with the transcultural context are detailed: suicidal risk, anorexia nervosa, addiction, and refusal to go to school. Finally, it describes some specific situations such as identity questions of the adopted children (international adoption) and the care of unaccompanied immigrant minors.
Effects of migration on women’s psychosocial health
Authors: Carta Mauro , Cossu Giulia , La Cascia Caterina
Published: February 2021

The scientific community and humanitarian organizations have produced a considerable amount of research on the mental health status of migrants. However, few studies have looked at the mental health of migrant women. This chapter is aimed to study this phenomenon, beginning with an examination of risks related to sexual and gender-based violence in the different steps of the migration process, and the psychological implications of the migratory process on Mediterranean African women in Europe. The migration and different forms of violence on women are associated with psychopathological manifestations such as post-traumatic stress disorder, depression, adaptation, and trauma- and stressor-related disorders. There is very limited knowledge on the lived experiences of migrant women and in future studies researchers should investigate the relationship between migration, gender, and mental health, in order to encourage the policies and prevention/treatment programmes for women and for psychosocial issues that may arise.
Micro-migration
Authors: Halbreich Uriel
Published: February 2021

The magnitude of migration across and within countries is immense and not new. The process of migration has caused significant strains and distress on all communities involved. Nations, cities, neighbourhoods, and individuals are affected, and remedies to reduce negative impacts should and are being taken, although not always very successfully. Micro-migration is the ‘Exodus of “modernized” youth from the bondage of the oppressing traditional cultural values of their parents, extended family and society’. It has been prevalent in orthodox cultures and currently it is apparent in Muslim countries, especially among young women. Exposure to the internet and social media substantially contribute to the attainment of information and ideas that are inconsistent with traditional environment and may entice youth to depart from their context even when they remain in situ. Micro-migration may be a force to change them in situ and from within. Changes in situ may well ease migration waves that are currently a burden on departure and receiving countries.
Managing relationships and psychotherapy
Authors: Po-Lun Fung Kenneth
Published: February 2021

Relationships are at the heart of all psychotherapies, as the therapeutic relationship serves as the bedrock for change and relationship issues are often the core concern of clients. Further, immigrants, refugees, and diverse clients often experience losses, changes, and conflicts in their relationship. Although attachment theory has empirical support and is clinically helpful, a much broader understanding of relationships can come from the application of cultural concepts (e.g. amae, jeong, yuan-fen, and familism); non-Western philosophies (e.g. Confucianism, Taoism, and Buddhism); and models that capture diverse cultural orientation and values (e.g. Horizontal and Vertical Individualism Collectivism model). A stepwise culturally competent approach, using RELATE (Relationship-building, Exploration of individual and sociocultural meaning, Laying off of cultural assumptions, Address sociocultural issues, Therapeutic use of culture, and Evaluation of impact), can help guide psychotherapy. Interventions may include pro-cultural or countercultural strategies. Ultimately, the use of a cultural lens can help the psychotherapist and the client to not only manage relationships, but also make them thrive.
Migration and mental health care in the European Union
Authors: Schininá Guglielmo , Lanneau Geertrui
Published: February 2021

This chapter analyses legal and factual aspects of the provision of mental health care for migrants in the European Union (EU), framing migrants’ access to mental health care within the wider contexts of migration in the EU, the EU’s policies for migrants’ integration and access to health care, and EU policies on mental health care for all. The rates of various psychiatric disorders may vary across migrant groups and host populations. The issue of how services can be made more accessible for migrants is to be considered within the context of the provision of mental health care for all in the EU, where mental disorders are a serious public health concern. Various gaps are identified, and various options are suggested that policymakers and healthcare professionals can take into account, bearing in mind facts and figures of migration in Europe—with a particular focus on migration from non-EU countries—and the consideration of mental health care as a right for all migrants.
Needs of child refugees and economic factors
Authors: Anagnostopoulos Dimitris C. , Triantafyllou Kalliopi , Christodoulou Nikos G.
Published: February 2021

Refugee families who move to a new country have a series of needs that have an impact on their well-being and adaptation process in the new community. Their main needs are easy accessibility to health services, access to education where appropriate, improvement of their socioeconomic position, access to their own social networks as well as those of the new community along with enabling of the acculturation processes. These needs are interrelated and interact with each other. A factor that impacts on these needs is the financial status of the individual as well as the economic state of the new country. This chapter initially discusses the global financial crisis as an economic factor that has an effect on refugees’ living conditions and subsequently considers the needs refugees have, and obstacles that they face in a new country.