bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic aspects of diabetic nephropathy
Authors: Bilous R W , Mauer, S M , Viberti G C
Published: November 2023

Both insulin and non-insulin dependent diabetes mellitus (IDDM and NIDDM) are recognized as having a large genetic component in their pathogenesis. Identical twin studies (Barnett et al. 1981) and later HLA analysis in IDDM patients provided early evidence (Cudworth and Festen stein 1984). More detailed genetic analysis has demonstrated specific abnormalities in some NIDDM patients (Leahy and Boyd 1993).Because diabetic nephropathy is known to affect a minority (albeit sizeable) of IDDM and NIDDM patients (approximately 25% cumulative incidence after 25 years duration in both types of diabetes) (Ballard et al. 1988; Hasslacher et al. 1989), there has been a considerable interest in trying to identify genetic factors in the individual predisposition to renal complications.
Sickle cell anaemia and renal disease
Authors: Morgan Stephen H
Published: November 2023

Human single-gene disorders have been the subject of intense genetic research for almost a century and have resulted in many hostorical advances leading to the evolution of ‘molecular genetics’ as a science. In 1949, Pauling suspected that an abnormal haemoglobin was the cause of sickle-cell anaemia (Pauling et al. 1949) and this was subsequently confirmed by Ingram (1956) who found a single amino acid substitution (valine for glutamic acid at position 6 of the beta globin chain) altering the haemoglobin polypeptide sequence. This was the first demonstration, in any organism, that a mutation in a structural gene could produce such an alteration in an amino acid sequence.
Cystinuria
Authors: Jaeger Philippe
Published: November 2023

Cystinuria is an inherited disorder characterized by defective renal and intestinal transport of cystine as well as of arginine, lysine, and ornithine, the dibasic amino acids. Save the fact that cystine is the least soluble amino acid, cystinuria would have remained an experimental model to study transepithelial amino acid transports in man. Because of poor solubility of cystine, how ever, it is one of the disorders to look for in patients with renal stone disease (Halperin and Thier 1980; DeFronzo and Thier 1986 a, b).
Wilms’ tumour
Authors: Mitchell Christopher D
Published: November 2023

Wilms’ tumour, the most common genito-urinary malignancy of childhood, is a triphasic embry onal neoplasm consisting of varying proportions ofblastema, stroma, and epithelium. It develops from proliferation of the metanephric blastema, possibly in the absence of normal stimulation from the metanephric ducts, to produce differentiated tubules and glomeruli. Although the specific histological appearance was described by Max Wilms in 1899, the eponym is now loosely applied to virtually any malignant tumour arising in the kidney in childhood, some of which are pathologically, clinically, and probably genetically distinct.
Emergency department discipline
Authors: Montague Alan , Hopper Andrew
Published: November 2023

One way of valuing an institution is to consider its cost and what it produces. An emergency department’s only enduring ‘product’, beside its treated patients, is its notes.
Writing reports
Authors: Montague Alan , Hopper Andrew
Published: November 2023

Criminal proceedings are the commonest occasion for a medico-legal report in the form of a factual description of injuries, requested by the police. Victims, their solicitors, and others may approach doctors for reports to aid civil claims for compensation. These too are usually essentially factual, but the opinion of the doctor may also be required making the report an ‘expert’ report.
Mouse models of polycystic kidney disease
Authors: McDonald Ruth A , Avner Ellis D
Published: November 2023

Experimental studies in a variety of model systems have identified three major factors of potential pathophysiological significance in tubular cyst formation and enlargement: (1) tubular epithelial hyperplasia in response to a variety of physical or chemical stimuli, or cell cycle control abnormalities; (2) altered tubular epithelial cell metabolism and transport leading to intratubular fluid accumulation; and (3) extracellular matrix abnormalities leading to increased tubular wall compliance or alteration of the tubular microenvironment (Avner 1993; Avner et al. 1990).
Tuberous sclerosis complex
Authors: Torres Vicente E
Published: November 2023

Tuberous sclerosis complex (TSC) is an autosomal dominant disease that affects all tissues with the possible exception of the peripheral nervous system, meninges, and skeletal muscles. The term ‘tuberous sclerosis complex’ is preferred to tuberous sclerosis because it emphasizes the multiplicity of organs involved. Some of the lesions are so characteristic that they are considered diagnostic for the disease.
Von Hippel-Lindau disease
Authors: Michels Virginia
Published: November 2023

Von Hippel-Lindau (VHL) disease is an autosomal dominant disorder character ized by central nervous system (CNS) and/or retinal haemangioblastomas, visceral cysts, renal cancer and, less frequently, pheochromocytoma, and pancreatic cancer. Patients with VHL disease usually present with CNS or visual symptoms (Melmon and Rosen 1964). However, as physicians become more aware of the value of family screening and as diagnostic technology advances, a greater number of asymptomatic patients will be detected. In clinical series the age of onset of symptoms has ranged from 4 (Fill et al. 1979) to 65 years (Melmon and Rosen 1964).
Cloning strategies and genetics of type 1 autosomal dominant polycystic kidney disease
Authors: Germino Gregory
Published: November 2023

It has been nearly 40 years since Dalgaard concluded his landmark study with this observation. Sadly, renal failure remains a common outcome for those inheriting the disease gene. Despite the development of diagnostic tools that now allow identification of such individuals long before they become symptomatic, our therapeutic armamentarium is limited to treatments for the associated complications (hypertension, infection, pain). Aggressive control of blood pressure has many laudatory benefits, possibly including the delay of renal failure in hypertensive individuals, but there are no data proving that it significantly affects the underlying disease process.
Progression to renal insufficiency
Authors: Ritz Eberhard , Zeier Martin , Waldherr Rudiger
Published: November 2023

Since the reputed first description of polycystic kidney disease post-mortem by Eustachio Fine in 1986, the disease was viewed, until recently, as leading inexorably to end-stage renal failure. This view may have to be modified, however, in the light of recent observations that indicate that previous estimates have been too negative as a result of ascertainment bias (Churchill et al. 1984). In the seminal paper of Dalgaard (Dalgaard 1957) all the 173 patients who had come to autopsy had suffered fromuraemia unless they had died as a result of subarachnoid haemorrhage or urological complications.
How will I know if I have kidney disease?
Authors: Cameron Stewart
Published: November 2023

When the patient dies the kidneys may go to the pathologist, but while he lives the urine is ours. It can provide us day by day, month by month, and year by year with a serial story of the major events going on within the kidney. The examination of the urine is the most essential part of the physical examination of any patient with Bright’s disease.
Artificial kidneys and dialysis
Authors: Cameron Stewart
Published: November 2023

If your kidneys fail, fortunately it is possible to replace their function. One treatment for long-term kidney failure, a new kidney in the form of a kidney transpiant, is dealt with in Chapter 8. This chapter concerns the methods of substituting for absent kidney function in other ways, usually called dialysis, which includes the use of an ‘artificial kidney’. We are fortunate to have such treatments: a number of famous figures of the past, including Disraeli, Brunel, Jean Harlow, and possibly Mozart, died prematurely of renal failure.
Kidney transplantation
Authors: Cameron Stewart
Published: November 2023

By the end of 1993, about 140 000 patients owed their lives to kidney trans plants world-wide, including 64 000 in Europe (12 000 in the UK) and 50 000 in the USA. Every year, 11 000 transplants are done in Europe and almost 10 000 in the USA, of which some 3200 are from living related donors. In addition an unknown number of living donor transplants are done in developing countries-probably another 5000. Despite all the problems which remain unsolved, a successful renal transplant is the most satisfactory treatment for end-stage kidney failure from the medical, psychological, social, and economic points of view. It is now an established form of medical treatment for what was formerly an inevitably fatal condition. This chapter gives you the background to having a kidney transplant, and tells you what you may expect from being considered as a recipient of such a graft, through to the long-term outcomes.
The future
Authors: Cameron Stewart
Published: November 2023

Attempting to predict the future is always a faulty exercise, since the greatest changes are wrought by events, ideas, and especially techniques which are unforeseen, and often unforeseeable. Progress in medicine, which is an art b-ased upon science, always arises from a combination of ideas and techniques. Both transplantation and dialysis are examples of ideas which were present long before the techniques to make them practicable became available (see Boxe,.s 3 and 4 in Chapters 6 and 8). Finally, even when both ideas and technique are present, practical, financial, or political difficulties may stand in the way of application. However, the greatest barrier to progress is often that health professior,.als are unable to unwilling to see things in a new light, or to behave in a new way. Thus progress may sometimes have to await a change in generations.
Responding to changing healthcare systems: adapting prescribing in the new NHS
Authors: Bradley Colin , Blenkinsopp Alison
Published: November 2023

Given that the NHS reforms detailed in the preceding chapter have been implemented and are unlikely to be reversed by any subsequent administration, it is imperative that GPs adapt their practices to take account of these changed circumstances. It is no longer possible for GPs to prescribe for patients as they see fit without regard to the economic consequences of their actions. A major thrust of the new environment created by the reforms is to make doctors bear some financial, as well as clinical, responsibility for their prescribing.
Head Injury
Authors: Gronwall Dorothy , Wrightson, Philip , Waddel Peter
Published: November 2023

The authors, of this book have had many years experience working with head - injured people in both research and rehabilitation roles. The effects of injury are explained in non-technical terms and, where possible, practical ways of overcoming these effects are described. Because they also have many years experience working with organisations formed to help the families of the head-injured, the authors know the main areas of concern that these families have. Beginning with the injury itself, the stages that the patient will go through are described, and the procedures and techniques that will be used to chart progress are explained. As well as these direct effects of the injury on the victim, the book also examines the ways that head trauma can affect families and friends.
Leaiting hospital—what happens now?
Authors: Gronwall Dorothy , Wrightson, Philip , Waddel Peter
Published: November 2023

After the first dreadful days or weeks when you did not know whether your friend or relative was going to live or die, all you wanted was to have him well enough to leave hospital and come home. During that time you spent every waking minute that you could at his bedside, even at first when he was still unconscious, and it was important both for him and for you that you were able to do this. However, it had been a pace that no one could keep up for long. The strain of perhaps rushing home from work, rustling up a quick meal, maybe getting children to bed or finding a babysitter, the long drive to the hospital and the struggle to find a car park, were begillling to take their toll, and you thought it would all be so much easier when he was home again. But now that the time has come for him to leave hospital you realize that it may not be as simple as you tl-10ught, you wonder if it is right for him, and whether or not you will be able to cope. Firstly we need to look at the reasons for the move from hospital and how it works, and secondly, at possible alternatives.
Back to work and study
Authors: Gronwall Dorothy , Wrightson, Philip , Waddel Peter
Published: November 2023

For months everyone involved in the head-injured person’s rehabilitation has been working towards getting him fit enough to go back to work, school, or college. Unfortunately return to work is sometimes botched, in spite of the very best of intentions. There are several ways in which this can happen. The person can be returned to work or school before he has recovered sufficiently to cope with it, often because neither the family nor the employer or school teacher want to hurt his feelings by telling him that it is too early. He can be returned to an inappropriate work or school environment because there has not been sufficient communication between the rehabilitation team, the employer or school, and the head-injured person and his family. Finally, things can go very wrong if there is no system for monitoring the success of the return to work or school trial. By looking at the ways in which return to work or school can go wrong, we can arrive at some general principles which we can use to set up a better system. Remember, however, that in this section we are talking about returning the head-injured person to the employment or study which he was doing at the time of the accident. This is not always possible.
Theory and practice: the special features of psychiatric ethics
Authors: Dickenson Donna , Fulford Bill (Kwm)
Published: November 2023

Psychiatry is something of an ethical paradox1• It is deeply value-laden, so much so that its critics, like the American professor of psychiatry, Thomas Szasz, have argued that it is a moral rather than a medical discipline (Szasz 1960, 1987). Even some supporters regard it as a primitive or pre-scientific branch of medical science (Boorse 1975, 1976). Despite being so value-laden, however, psychiatry has been largely the ‘blind spot’ of bioethics, as one of us has described it elsewhere (Fulford 1993). There are important exceptions, of course, notably the sister volume to this book, Sidney Bloch, Paul Chodoff, and Stephen Green’s Psychiatric Ethics (1999). The first edition of Psychiatric Ethics, published in 1981, was a trail-blazer for the subject.
Diagnosis: rationality, responsibility, and values in psychiatric classification
Authors: Dickenson Donna , Fulford Bill (Kwm)
Published: November 2023

In the last chapter we were concerned with the overall concept of mental disorder. We found that mental disorder is understood in a number of different ways in the context of everyday practice, and that among these different ‘models’, it is important to strike a balance between medical and moral conceptions. In this chapter we move from the general to the specific, from the broad concept of mental disorder to three particular aspects of it which are ethically significant in psychiatric diagnosis: rationality (in Case 4.1, Martin McKendrick); respon sibility (in Case 4.2, Delia Jarrett); and descriptive psychopathology (in Case 4.3, Simon Greer).
The three Rs of research ethics
Authors: Dickenson Donna , Fulford Bill (Kwm)
Published: November 2023

Although this book is primarily a clinical casebook, we felt it important to include a brief consideration of research ethics for two reasons. First, the problems raised by ethics of research illustrate and help to draw together many of the issues that are important in clinical ethics. Second, the gap between clinical work and research is narrowing day by day. More and more clinical training schemes include a research component; and those working in ordinary clinical practice are increasingly expected to carry out research projects. These factors, combined with the growing importance of evidence-based practice, mean that even someone who is not directly involved in research, either as a researcher or as a member of a research ethics committee, must be able to assess the quality of a research proposal in its ethical as well as technical aspects.
Introduction
Authors: Wrightson Philip , Gronwall Dorothy
Published: November 2023

This chapter describes the development of the present concepts of the mechanisms and results of mild head injury. The sequence of organic changes, cognitive impairment, and the reaction to disability is outlined. Early management is important and there is a need for a service that can deal with problems before they become entrenched.

Mild head injury can be defined in a number of ways. Lay people see it as a minor event followed by rapid and complete recovery. In fact in the acute stage there is the possibility of life-threatening complications, and later disabling somatic and cognitive problems may persist and behavioural problems develop. In both cases there is the paradox of an apparently trivial event resulting in an illness with major consequences.
Special cases
Authors: Wrightson Philip , Gronwall Dorothy
Published: November 2023

In a previous chapter we described the general principles of management of the later effects of mild head injury. Some groups of patients have special needs, and it is essential to understand what these are if the patients are to be properly cared for.

Children have special problems with mild head injury. Younger children may not lose consciousness at the time of the injury but may go into a drowsy state later. Rarely they may suffer temporary cortical blindness. In the first few weeks older children may experience symptoms like those seen in adults, with disturbed behaviour and difficulty with school work. In both instances there is the possibility that mild injury can result in long term cognitive and behavioural problems.
Introduction
Authors: Hannan Kieran , Conlon Peter J
Published: November 2023

Access to the circulation for repetitive hemodialysis has been recognized as the Achilles’ heel of chronic dialysis. If access to the circulation is not possible for more than a couple of days, the effects of uncontrolled uremia will result in the rapid death of the patient. The importance of vascular access in the long-term provision of hemodialysis was apparent at the dawn of the dialysis era.
Cuffed tunneled catheters for long-term vascular access
Authors: Blankestijn Peter J
Published: November 2023

Temporary access for hemodialysis can be provided by bedside inserted catheters. Cuffed tunneled central venous catheters were originally described in the mid-l 980s for prolonged temporary access. Shortly thereafter their role as a method for long-term vascular access was explored in selected subgroups of patients. In subsequent years, they have gained popularity. At present, several designs are on the market. This review focuses on tunneled cuffed catheters for long-term hemodialysis, and will deal with the possibilities and limitations.
Options for restoration of thrombosed vascular access: thrombolysis
Authors: Beathard Gerald A
Published: November 2023

A patient with a thrombosed dialysis vascular access is a major problem. It is a problem for the patient who must cope with the inconvenience, pain and dis¬ comfort. It is a problem for the staff of the hemodialysis facility who must rearrange the dialysis schedule, arrange for transportation, interface between the patient and the physicians involved and assist the patient in coping with the problem. It is a problem for the nephrologist who must deal with an unhappy patient and their family and oversee the logistics of getting the problem solved. If the patient also has fluid or metabolic abnormalities that make a delay in dialy¬sis impossible, the problem is magnified for everyone. In the past the immediate management choices have been either immediate surgery or a central venous catheter and delayed surgery. All too often even immediate surgery entailed hos¬pitalization and delayed or missed treatments. A central venous catheter allowed for immediate dialysis, but carried with it a new set of problems.
Hormone replacement therapy and non-breast cancers
Authors: Lavery Bernadette
Published: November 2023

Family doctors and cancer specialists are often faced with the situation of advising a woman who has had a cancer about the pros and cons of hormone replacement therapy (HRT). In addition to the discussion about general risks and benefits which would be undertaken with any woman considering HRT, the questions most often asked are: (1) will taking HRT cause my cancer to come back? and (2) will HR T cause any other cancer to develop? In many cases the principal concerns relate to breast cancer, and this is covered in Chapter 5. The other area where there is often a high level of anxiety is in the woman with a personal or family history of gynaecological cancer.
The role of the nurse in women’s health
Authors: Brockie Janet
Published: November 2023

About 80% of menopausal women will experience uncomfortable symptoms. Hormone replacement therapy (HR T) has been shown to have many benefits for the menopausal woman, abolishing the troublesome menopausal symptoms and protecting her from the long-term metabolic problems, including cardiovascular disease, osteoporosis, Alzheimer’s disease, and bowel cancer. Despite all these advantages, only 17% of women aged between 40—65 years will take HRT (Hope et al. 1998), and it is during these years that the majority of women are most symptomatic. Continuation of therapy is also poor: 31% will discontinue therapy within six months, 51% within the first year, and 74% before three years (Hope and Rees 1995).
Genetic counseling and the laws of probability
Authors: Young Ian D
Published: November 2023

Since the first introduction of genetics clinics approximately 50 years ago many attempts have been made to devise a universally acceptable definition of genetic counseling. As the subject has expanded and moved from its origins in the eugenics movement, a consensus has gradually emerged that genetic counseling should be viewed as a non-directive communication process which addresses an individual’s needs and concerns relating to the development and/or transmission of a genetic disorder. From this rather complex definition it is apparent that the process of genetic counseling involves many important components, such as the gathering of family information, the establishment of a diagnosis, the communication of information, and the provision of on-going support. To this expanding list can be added the mathematical assessment of risk and it is with this particular aspect of genetic counseling that this text is concerned.
Sex-linked recessive inheritance
Authors: Young Ian D
Published: November 2023

In sex-linked recessive disorders the condition is manifest in the male who is described as being ‘hemizygous’, whereas, by definition, the heterozygous carrier female is not affected, although careful examination or appropriate investigations may occasionally reveal subtle abnormalities. When a female is known to be a carrier, each of her sons runs a risk of 50 per cent for inheriting the disorder in question whilst each daughter is at 50 per cent risk for being a carrier. When an affected male reproduces, all of his daughters will be carriers as they will all have inherited his X chromosome and all of his sons will be unaffected as they must have inherited his Y chromosome.
The use of linked DNA markers
Authors: Young Ian D
Published: November 2023

Developments in molecular genetics have greatly enhanced the diagnostic repertoire of the clinical geneticist. If a specific disease-causing mutation can be identified in a family then carrier detection, preclinical detection, and prenatal diagnosis become relatively straightforward. However, many situations still arise in which a specific mutation cannot be identified, possibly because a sample cannot be obtained from an affected individual or because the relevant gene has not been isolated even though the disease has been mapped to a particular chromosome region. In both of these situations, a compromise solution involves the use of polymorphic DNA marker loci which have been shown to be genetically linked to the disorder in question. Genetic linkage is a complex subject and the use of linked DNA markers can generate some very difficult calculations. Sometimes these are best resolved with the help of one of the computer packages which have been developed (Lathrop and Lalouel, 1984).
Other mechanisms of inheritance
Authors: Young Ian D
Published: November 2023

It is conventional to consider genetic disorders under the headings of chromosomal, single gene (autosomal dominant, autosomal recessive, sex-linked recessive), multifactorial, and acquired. Whilst most disorders encountered at a genetics clinic can be classified under one of these headings, there is increasing recognition that occasionally an alternative genetic mechanism should be considered, which will often have significant implications for genetic counseling. In this chapter some of these more unusual genetic mechanisms will be discussed and, where appropriate, due attention given to the relevant implications for risk calculation.
Defining and Classifying Disorder
Authors: Farmer Anne , McGuffin Peter , Williams Julie
Published: November 2023

Apart from the use of the old-fashioned term ‘insanity’, these comments, made over 100 years ago by an academic psychiatrist from St Georges’s Hospital in London, sound shockingly up to date and familiar. In this chapter, we will describe and review the evolution of current international psychiatric classifications, namely the International Classification of Diseases, tenth edition (ICD 10), produced by the World Health Organization (WHO 1992), and the Diagnostic and Statistical Manual, fourth edition (DSM IV) produced by the American Psychiatric Association (APA 1994). We will examine how far we have progressed in overcoming the problems of defining and classifying disorder.
Personality and Personality Disorders
Authors: Farmer Anne , McGuffin Peter , Williams Julie
Published: November 2023

In this chapter, we tackle personality and personality disorders, a subject seen by some as the most difficult and contentious area of measurement in psychopathology. The term ‘personality’ refers to the behavioural attributes that characterize individuals and differentiate them from others. Terms to describe personality, such as ‘extraverf (being outgoing and gregarious) or ‘neurotic’ (being anxious and worried), have entered everyday language. The notion that personality can cause problems for the individual or others, or deviate from what is considered normal, underpins the concept of a ‘personality disorder’. For example, an extremely perfectionistic individual may be so preoccupied with the details, rules, lists, order and organization of their daily life that they become unable to complete any tasks or do their job effectively. The anankastic or obsessional features of their personality are so extreme as to cause impairment of function, and the subject is then diagnosed as having ‘anankastic personality disorder’ (WHO 1993).
Coping with illness in late life
Authors: Melding Pamela , Cook Andrew J
Published: November 2023

Of all life events, physical illnesses are the most common occurrences that significantly affect older people and represent the most significant losses in late life. Understanding how an older person perceives the personal significance of the illness is essential to the liaison clinician’s own appraisal of the patient’s problems. The chapter discusses not only how an illness may influence the individual, but also how the person’s response may affect an illness. For the patient, the important aspects of primary appraisal include acuity and timing of events, their impact on social roles, the person’s perception of illness, their emotional and physical health status, perceived social support, personality traits, sense of personal control, and perception of any stigma attached to the illness. The ageing person’s primary appraisal of their illness influences the secondary appraisal process that assesses their ability to cope with the stressor. Aspects of coping discussed in this chapter are self-efficacy, outcome expectancy, focus for coping, and strategies employed.
The assessment
Authors: Draper Brian , Melding Pamela
Published: November 2023

Assessment is the linchpin of quality service delivery in geriatric liaison psychiatry. Assessment commences at the time of referral when urgency is established through a triage process. The reasons for referral, which may be overt and covert, should be established. The medical record should be read before the patient interview to obtain a more detailed understanding of the issues. While it is critical that collateral information be obtained from family, caregivers, and nursing staff, circumstances may determine whether this occurs before, during, or after the patient interview.
Specific Patients and Problems
Authors: Shah Ajit , Ames David
Published: November 2023

A range of special patients and problems are encountered in liaison geriatric psychiatry settings. Some examples include patients labelled as ‘difficult to like’, ‘undesirable’, and ‘bed blockers’. These patients may have specific problems, such as behaviour disturbance, suicidal ideation, poor compliance with treatment, refusal to eat, mental incapacity, squalor, neuropsychiatric complications of prescribed and non-prescribed drugs, and alcohol misuse. Case studies are used to illustrate some typical cases.
Ethical issues in geriatric psychiatry liaison
Authors: Perkins Christine J
Published: November 2023

This chapter begins with a general discussion of the principles of medical ethics and their particular relevance to older people with psychiatric illness. The focus there- after is on practical problems encountered in the liaison situation. These include: assessment of capacity including the ability to give informed consent: end-of-life issues such as truth-telling, denial, disagreements over treatment, depression, and treatment refusal and euthanasia. The section on confidentiality discusses how to deal with the family, non-psychiatric staff, third parties, and writing the ward notes. The chapter covers the old age liaison psychiatrist’s role as an advocate for the individual patient and family, and the wider issue of advocacy for the mentally ill elderly patient. Advocacy involves ensuring optimal treatment for the hospitalized older person, balancing patient and family needs, deciding on long-term care, elder abuse and the use of restraint, and the rationing of healthcare resources on the basis of age.
Overview of complementary therapies in cancer care
Authors: Barnett Mandy
Published: November 2023

Mandy Barnett is Consultant in Palliative Medicine at Walsgrave Hospital, Coventry and Myton Hamlet Hospice, Warwick, and Honorary Senior Lecturer at the University of Warwick. Mandy obtained a degree in psychology prior to qualifying in medicine in London in 1982. Her postgraduate training included general medicine, clinical oncology, and general practice in addition to clinical and research work in palliative medicine. She has undertaken introductory studies in aromatherapy, reflexology, shiatsu, homoeopathy and massage applied to palliative care, and courses at the Bristol Cancer Help Centre. She is a long-term member of the British Psycho-Oncology Society. In her work she actively supports the development and evaluation of complementary therapies.
Casting off the spell
Authors: Ross Robert
Published: November 2023

55-year-old Robert Ross has had four careers—as a town planner, lecturer, student counsellor, and careers advisor. On being diagnosed with terminal cancer of liver and lungs, he consulted the Bristol Cancer Help Centre, took early retirement from Oxford Brookes University and reinvented himself as an author and playwright. One book and five stage plays later he is in remission, living positively and creatively, one day at a time.
Health service planning issues: the UK perspective
Authors: Worth Chris
Published: November 2023

Chris Worth was formerly a Director of Public Health in Huddersfield, West Yorkshire. For several years he has been an advocate for the NHS to explore the wider integration of complementary therapies more thoroughly. A number of complementary therapies (notably homoeopathy, acupuncture, osteopathy) have been available within the National Health Service (NHS) since its establishment in 1948. There has been an increasing understanding and usage of these therapies since the 1970s. Equally, there has been an expansion in the number and range of therapies covered by such practitioners (Fulder and Munro 1981). However, a clear distinction between an orthodox medical profession and a ‘fringe’ of alternative practitioners, which was first given legislative force in the 1858 Medical Registration Act, still exists (Mercer et al. 1995). This has been repeatedly confirmed, particularly with the almost complete exclusion of unorthodox, ‘alternative’ practitioners from the publicly-funded healthcare system when the NHS was established.
Aromatherapy and massage
Authors: Hallissey Sheila
Published: November 2023

Sheila Hallissey writes: ‘The decision to specialize in oncology nursing led me to look at medicine in a different way. The importance and necessity of true holistic care became evident very quickly. Realizing this I undertook a combined counselling certificate, a diploma of holistic aromatherapy, and the study of kinesiology. I firmly believe that treating the whole person is the best medicine.’ For many patients the diagnosis of cancer is received with a dread and fear akin to being given a death sentence (Mclntosch 1974). In spite of huge advances in treatment, many people still regard cancer as a fatal disease. The diagnosis of cancer, combined or not with treatment, produces a vast range of emotions which affect well-being and quality of life. Intense emotional responses to threatening news are entirely natural. Each person has to cope with cancer in their individual way, mobilizing individual coping strategies according to their personality type. Cancer can produce varying physical symptoms but let us never forget that the human being is more than a physical being, thus cancer and its diagnosis also affects the psychological, social, and spiritual aspects of the patient’s life. In order to address cancer and its effects, both the psychological and physical problems must be considered. An integrated package of care, stemming from a thorough initial assessment together with constant reviews, is vital if we are to improve the quality of life of cancer patients.
Patient heal thyself
Authors: Goodare Heather
Published: November 2023

Formerly an academic editor, Heather Goodare was treated for breast cancer in 1986/7 and subsequently trained as a counsellor. She is particularly interested in consumer issues, complementary medicine, and psycho-oncology. When I was diagnosed with breast cancer in 1986 I knew almost nothing about complementary medicine, except that my husband had been greatly helped by an osteopath to overcome a recalcitrant back problem. Coincidentally I had had lower back pain only two months before my cancer diagnosis, and in view of my husband’s experience decided to go straight to an osteopath rather than my GP—and the problem was solved in three sessions. I was also given exercises to do, which have kept my back relatively trouble-free ever since.
Nursing perspectives
Authors: Stevensen Caroline
Published: November 2023

Caroline Stevensen is a private Holistic Healthcare Consultant and Practitioner, Senior Lecturer in Clinical Aromatherapy at Oxford Brookes University, and Director of Services for the Haven Trust. Her background includes a degree in social work and she is a registered nurse. She specializes in body therapies and is qualified in acupuncture, shiatsu, aromatherapy, massage, reflex zone therapy, and iridology. She has published research on the effects of aromatherapy massage on post cardiac surgery patients. She is deputy editor of Complementary Therapies in Nursing and Midwifery: An International Journal. Cancer nursing care has benefited from the expertise of specialist nurses world-wide. Generally, specialist cancer nurses assist patients receiving surgery, chemotherapy, radio therapy, needing pain relief, suffering from lymphoedema, those requiring psychological support, and they support patients who are dying and their carers. These roles are vital for patients to receive optimum care with conventional treatments. In recent years there has been a new breed of nurse specialist emerging in the field of cancer care. These nurses are specializing in the use of complementary therapies or are incorporating the use of complementary therapies into their existing practice with patients (Stevensen 1996; Corner et al. 1995). This chapter will explore issues surrounding the inclusion of complementary therapies into cancer nursing practice.
The patient’s path to integration
Authors: Bishop Beata
Published: November 2023

Beata Bishop is a psychotherapist working along Jungian and transpersonal lines. Her interests include the mind-body connection in sickness and health, and its therapeutic use in working with cancer patients. What I have to offer is based on two kinds of life experience. One is personal, for I am a former cancer patient myself, having recovered from metastasized malignant melanoma in 1983; the other is professional, gleaned from working with cancer patients as a psycho therapist ever since. My personal experience is a valuable asset in my professional work. It enables me to establish instant rapport with cancer sufferers, since they know that I know what they are going through, having travelled along that path myself. They need not be coy about the subject, use euphemisms or present a brave front. Cancer has a sinister aura of its own. The best way to dispel that is to handle the subject openly, calmly, and without fear, pointing out that cancer need not equal a death sentence. As a long-term survivor, I am in a good position to do that.
Assesment of the severity and extent of prostate cancer
Authors: Mason Malcolm , Moffat Leslie
Published: November 2023

The process of defining the extent of a cancer is called ‘staging’. The most widely used system to classify the spread of prostate cancer is the TNM staging system. This stands for tumour, nodes, and metastases.
Risks and benefits of screening and radical treatment - a guide
Authors: Mason Malcolm , Moffat Leslie
Published: November 2023

Almost any lifestyle has associated risks. It is not perhaps surprising that parachuting in the USA carries a risk of 19 000 times that of playing Association Football in England and Wales. Climbing in England and Wales carries 130 times the risk of playing football. Surgical anaesthesia in England in 1986 had a risk of death of 5.4 cases per million operations.
Treatment and management options
Authors: Mason Malcolm , Moffat Leslie
Published: November 2023

This chapter considers the different ways of treating the prostate gland. Deciding which of these options is the most appropriate can be one of the most difficult aspects of managing prostate cancer, and is often bewildering for doctor and patient alike. The reason for this difficulty is simple we do not know the best treatment for prostate cancer. For a number of reasons, not the least of which may be technical, not every patient is suitable for every form of treatment. This important aspect is something that should be discussed with the specialist.
Renal disease and transplantation
Authors: Fortune Farida
Published: November 2023

The main role of the kidney is the elimination of waste material and maintainance of the composition of body fluid. It receives about 25% of cardiac output every minute. Sixty to 80% of the filtered water and sodium are reabsorbed in the proximal tubule along with almost all the bicarbonate, potassium, glucose, and amino acids. In the distal tubule more water and some sodium are reabsorbed. The latter process is controlled by aldosterone. The total urine volume in health is 1–2 litres a day.
The respiratory system
Authors: Fortune Farida
Published: November 2023

The function of the respiratory system is to take in oxygen and remove carbon dioxide from the body. The physiological mechanisms that control ventilation, tissue perfusion, and gas exchange are multifaceted. Ventilation is controlled by chemosensory receptors in the carotid, the aorta and spinal cord which detect carbon dioxide tension and hypoxia.
Haematology
Authors: Fortune Farida
Published: November 2023

Blood is a complex fluid containing multiple cellular elements derived from bone marrow and thymus proteins, including clotting factors, derived from liver, and antibodies derived from plasma cells.
Dermatology
Authors: Fortune Farida
Published: November 2023

The skin is the largest organ in the body and makes up 15–16% of body weight. It plays an important role in maintaining the body’s homeostasis.
Influence of mental processes on health
Authors: Taylor Ross J , Smith Blair H , Teijlingen Edwin R van
Published: November 2023

consciousness is said to be lowered. A hallucination is the perception of an external stimulus in the absence of any appropriate stimulus. Perceptual abnormalities like hallucinations and illusions occur commonly in severe types of mental illness. However, the boundary between ‘healthy’ and ‘unhealthy’ perceptual abnormalities is indistinct.
Influence of age on health
Authors: Taylor Ross J , Smith Blair H , Teijlingen Edwin R van
Published: November 2023

Homeostasis is defined as ‘a tendency to stability in the normal body status (internal environment) of the organism’. Homeostatic reserve tends to increase during development, reach a plateau in adult life, and decline thereafter. Indeed, one of the definitions of ageing is a progressive loss of adaptability as time passes. As we grow older, we become less able to react adaptively to challenges from the external or internal environment (Evans & Williams 1992). Because of impaired homeostasis, very young and very old individuals may be overwhelmed by stressful situations that would lead to more minor problems in younger adults.
Promoting our well-being–young views: a study of young people aged 13–19 in Britain
Authors: Katz Adrienne
Published: November 2023

This chapter is in two parts. The first part gives an overview of research involving children and the expression of their views. The second part reports on some key findings from two national studies that have been undertaken by Young Voice, a national charity which aims to listen and respond to young people, together with Ann Buchanan and her associates at Oxford.
Do intervention programmes for parents, aimed at improving children’s literacy, really work?
Authors: Baillie Catherine , Sylva Kathy , Evans Emma
Published: November 2023

In 199 7 the Literacy Taskforce argued that parents have a key role in promoting literacy. In this chapter we review the research evidence which supports calls for increased parental involvement in the first years of their children’s formal education. We go on to speculate about which elements of intervention programmes aimed at supporting parents to assist their children’s reading are necessary for success.
Improving children’s long-term well-being by preventing antisocial behaviour
Authors: Capaldi Deborah M , Eddy J Mark
Published: November 2023

Antisocial behaviour in childhood (e.g. failure to comply with adult requests, aggression toward peers, and stealing) frequently is not a temporary developmental phase, but prognostic of problems which will continue in adolescence and adulthood. In the Oregon Youth Study (OYS), early adolescent antisocial behaviour predicted a wide variety of adjustment problems in late adolescence and early adulthood, including substance use, a poor relationship with parents, rejection by normal peers, association with deviant peers, poor educational outcome, unemployment, arrests, driver’s licence suspensions, and early fatherhood (Capaldi and Stoolmiller 1999). Each of these outcomes is related to other failures that can strongly affect not only the individual, but also their friends, family, co-workers, and subsequent children.
Living with Haemophilia
Authors: Jones Peter
Published: November 2023

Living with haemophilia has established itself as the complete guide to haemophilia and related disorders. Written primarily for affected families, the. book also provides a useful and up-to-date guide for doctors, paramedical staff, including nurses and physiotherapists, and teachers. It explains the inheritance of haemophilia, bleeding episodes and how to control them, safe treatment including home therapy and prophylaxis, and the prospects for a genetic cure. Other coverage includes · Sex and family planning · Childhood with haemophilia · Education and employment · Sports and travel · Previous side effects of treatment including HIV and AIDS Sensitively and clearly written at an appropriate level for those with haemophilia, their families and friends. This book aims to dispel the myths and raise awareness of the realities of haemophilia. It takes a positive approach to physical development and encourages the pursuit of healthy, active and fruitful living. Peter Jones shows how, with the right care, the person with haemophilia can live an active and normal life. He addresses all the questions that those with haemophilia or those caring for them need to know the answers to, with humour and genuine concern. He has worked with those affected by it for over 30 years and this book contains his wealth of experience. “All of those who come into contact with haemophilia should read this book” Journal of the Royal College of Physicians Features include · Bullet pointed lists of dos and don’ts for those caring for haemophilic children · Boxes containing key information · Clear simple drawings showing treatments and exercises.
Side-effects of treatment, including transfusion-transmitted infection
Authors: Jones Peter
Published: November 2023

All medicines have more than one effect. The primary effect, the reason we take the medicine in the first place, is usually sufficiently beneficial to outweigh the other results or side-effects, but this may not always be so. Aspirin may well cure a headache but at the same time it is reducing platelet stickiness, and it may provoke bleeding. Codeine dulls pain but at the same time it reduces the motility of the bowel, causing constipation. Often these secondary effects are dose-dependent and easily relieved, but the more powerful the drug the more serious the other effects are likely to be. Every time a doctor prescribes a drug he weighs up the potential benefits against the potential costs to his patient. If the benefit could be life, for instance in cancer chemotherapy, then even drugs with very marked and potentially lethal side-effects are worthwhile.
Systemic sclerosis
Authors: Denton Christopher P , Haddock Jamanda , Black Carol M
Published: November 2023

Systemic sclerosis (SSc) has the highest case-specific mortality of any of the autoimmune rheumatic diseases and forms part of the scleroderma spectrum of disorders. These conditions are characterized by the development of excessive and inappropriate connective tissue fibrosis, most frequently in the skin. There have been substantial advances in the management of systemic sclerosis in recent years, largely related to the identification and appropriate treatment of organbased complications. In part this has been due to the development and refinement of imaging methodologies, and the validation of new assessment tools based upon these methods.