bluuebunny/crossref_metadata_2025 huggingface dataset:
Model dynamo may solve Mercury mystery
Authors: Smart Ashley G.
Published: August 2014

Simulations suggest that the planet’s top-heavy magnetic field derives from the unusual chemistry of its core.
Charged polymers form unusual nanostructures
Authors: Miller Johanna L.
Published: August 2014

A hybrid theoretical description provides a roadmap to designing better battery electrolytes.
Are the makings of a dirty bomb in your neighborhood?
Authors: Kramer David
Published: August 2014

Although regulators say that current protections are adequate, the US government continues to pay for extra security features for facilities that hold radiological materials.
Super fracking
Authors: Turcotte Donald L. , Moores Eldridge M. , Rundle John B.
Published: August 2014

Injecting large volumes of low-viscosity water helps energy producers extract oil and gas from shales that tightly confine those fossil fuels. But the technique also confronts technical and environmental issues.
Molecular analysis of NAD+-dependent xylitol dehydrogenase from the zygomycetous fungus Rhizomucor pusillus and reversal of the coenzyme preference
Authors: Yamasaki-Yashiki Shino , Komeda Hidenobu , Hoshino Kazuhiro , Asano Yasuhisa
Published: August 2014

The zygomycetous fungus Rhizomucor pusillus NBRC 4578 is able to ferment not only d-glucose but also d-xylose into ethanol. Xylitol dehydrogenase from R. pusillus NBRC 4578 (RpXDH), which catalyzes the second step of d-xylose metabolism, was purified, and its enzymatic properties were characterized. The purified RpXDH preferred NAD+ as its coenzyme and showed substrate specificity for xylitol, d-sorbitol, and ribitol. cDNA cloning of xyl2 gene encoding RpXDH revealed that the gene included a coding sequence of 1,092 bp with a molecular mass of 39,185 kDa. Expression of the xyl2 in R. pusillus NBRC 4578 was induced by d-xylose, and the expression levels were increased with accumulation of xylitol. The xyl2 gene was expressed in Escherichia coli, and coenzyme preference of the recombinant RpXDH was reversed from NAD+ to NADP+ in the double mutant D205A/I206R by site-directed mutagenesis.
Frontotemporal Dementia
Authors: Miller Bruce L.
Published: August 2014

Frontotemporal Dementia provides an in-depth look at the history, various types, genetics, neuropathology and psychosocial aspects of one of the most common but least understood causes of dementia, frontotemporal lobar degeneration, from one of the world's leading centers for the study of dementia. Aided by the latest research in diagnosis, mechanism and treatment, this resource captures the rich and quickly changing landscape of a devastating neurodegenerative disease, and offers up-to-date clinical advice for patient care. Frontotemporal dementia, in particular, raises psychological and philosophical questions about the nature of self, free will, emotion, art and behavior - important topics for practitioners and families to appreciate as they care for the sufferer. It includes case studies, photographs and figures from the leaders in the field and personal communication from the researchers driving these developments.
The anatomical basis of the neurological examination
Authors: Samandouras George
Published: August 2014

Chapter 1.1 cover the anatomical basis of the neurological examination, including the cerebral cortex, the cranial nerves, motor system examination, sensory system examination, reflexes, gait, and the cerebellum.
Neurology for neurosurgeons
Authors: Samandouras George
Published: August 2014

This chapter on neurology for neurosurgeons covers headache, neuro-otology, neuro-urology, immune-mediated disease, Motor Neuron disease (MND), and neurological complications of systemic cancer.
Ultrasound
Authors: Samandouras George
Published: August 2014

Chapter 2.2 covers the basic concepts of ultrasound, including types of ultrasound image display and clinical applications.
Computed tomography
Authors: Samandouras George
Published: August 2014

Chapter 2.3 covers the basic concepts of computed tomography (CT), CT angiography (CTA), and CT perfusion (CTP).
Functional imaging
Authors: Samandouras George
Published: August 2014

Chapter 2.5 covers functional imaging, including functional MRI (fMRI) and positron emission tomography (PET).
Cardiovascular monitoring
Authors: Samandouras George
Published: August 2014

Chapter 3.3 discusses cardiovascular monitoring, and covers clinical cardiovascular physiology, blood oxygen content, and invasive monitoring,
The ventilated patient
Authors: Samandouras George
Published: August 2014

Chapter 3.4, The Ventilated Patient, covers clinical respiratory physiology, oxygen therapy, abnormal respiratory patterns, mechanical ventilation, ventilators, ventilator settings, setting up a ventilator, complications of ventilation, and ventilator weaning.
Operating theatre and neurosurgical instruments
Authors: Samandouras George
Published: August 2014

Chapter 4.1 covers the operating theatre and neurosurgical instruments, including the operating table, skull fixation, the operating microscope, monopolar diathermy (MD), bipolar diathermy (BD), the ultrasonic aspirator, drills, brain retractors, forceps, dissectors, suction, and sutures.
Advanced technologies in the operating theatre
Authors: Samandouras George
Published: August 2014

Chapter 4.2 covers the stereotactic frame, image-guided technologies for brain surgery, image-guided technologies for spinal surgery, neuro-endoscopy, and intraoperative MRI (iMRI).
Multimodality monitoring
Authors: Samandouras George
Published: August 2014

Chapter 5.2 covers multimodality monitoring, including ICP monitoring, cerebral metabolism monitoring, cerebral oxygenation monitoring, and monitoring of cerebral blood flow.
Critical surgical spinal anatomy
Authors: Samandouras George
Published: August 2014

Chapter 6.1 covers critical surgical spinal anatomy, including spinal bones, spinal joints and ligaments, intervertebral discs, spinal muscles, and spinal nerves.
Spinal cord anatomy
Authors: Samandouras George
Published: August 2014

Chapter 6.2 covers spinal cord anatomy, including gross anatomy, ascending tracts, descending tracts, major motor and sensory spinal cord nuclei, and lesions and spinal cord syndromes.
Pathology, pharmacology, and management of spinal injuries
Authors: Samandouras George
Published: August 2014

Chapter 6.5 covers pathology, pharmacology, and management of spinal injuries, including basic concepts, pathology, spinal cord injury assessment scales, and principles of management.
Thoracolumbar and sacral injuries
Authors: Samandouras George
Published: August 2014

Chapter 6.7 covers thoracolumbar and sacral injuries.
Paediatric spine injuries
Authors: Samandouras George
Published: August 2014

Chapter 6.8 covers the paediatric spine, SCIWORA, and specific spine injuries.
Introduction to neurosurgical infections
Authors: Samandouras George
Published: August 2014

Chapter 7.1 covers basic concepts of neurosurgical infections, prophylactic measures, antibiotic penetration into the CSF, and postoperative infections.
Meningitis and encephalitis
Authors: Samandouras George
Published: August 2014

Chapter 7.2 covers meningitis (bacterial and viral) and viral encephalitis.
Tuberculosis
Authors: Samandouras George
Published: August 2014

Chapter 7.4 covers intracranial tuberculosis (TB) and tuberculosis of the spine.
Spinal infections
Authors: Samandouras George
Published: August 2014

Chapter 7.9 covers spinal infections, including vertebral osteomyelitis, discitis,arachnoiditis, epidural abscess, and spinal instrumentation.
Oligodendrogliomas and mixed gliomas
Authors: Samandouras George
Published: August 2014

Chapter 8.4 covers oligodendrogliomas (OII)and mixed gliomas, including anaplastic oligodendroglioma (OIII), and oligoastrocytoma (OA).
Ependymal tumours
Authors: Samandouras George
Published: August 2014

Chapter 8.5 covers ependymal tumours, and includes information on ependymoma, anaplastic ependymoma, myxopapillaryependymoma (MPE), and subependymoma (SE).
Choroid plexus tumours
Authors: Samandouras George
Published: August 2014

Chapter 8.6 covers choroid plexus tumours, including choroid plexus papilloma (CPP) and choroid plexus carcinoma (CPC).
Other neuroepithelial tumours
Authors: Samandouras George
Published: August 2014

Chapter 8.7 covers other neuroepithelial tumours, specifically gliomatosiscerebri (GC).
Neuronal and neuronal-glial tumours
Authors: Samandouras George
Published: August 2014

Chapter 8.8 covers neuronal and neuronal-glial tumours, including ganglioglioma (GG) and gangliocytoma (GC), dysembryoplasticneuroepithelial tumour (DNET), and central neurocytoma (CN).
Pineal parenchymal tumours
Authors: Samandouras George
Published: August 2014

Chapter 8.9 covers pineal parenchymal tumours, including pineoblastoma (PB), pineocytoma (PC). It also covers the approach to the patient with a pineal tumour
Embryonal tumours
Authors: Samandouras George
Published: August 2014

Chapter 8.11 covers embryonal tumours, including medulloblastoma (MB), supra-tentorial primitive neuroectodermal tumour (PNET), and atypical teratoid tumour (AT/RT).
Haemopoietic system tumours
Authors: Samandouras George
Published: August 2014

Chapter 8.13 covers haemopoietic system tumours, including primary CNS lymphoma (PCNSL) and histiocytic tumours.
Germ cell tumours
Authors: Samandouras George
Published: August 2014

Chapter 8.14 covers germ cell tumours, including germinoma, embryonal carcinoma, yolk sac tumour, choriocarcinoma, and teratomas.
Peripheral neuroblastic tumours
Authors: Samandouras George
Published: August 2014

Chapter 8.16 covers peripheral neuroblastic tumours, including olfactory neuroblastoma and peripheral neuroblastomas (PNs).
Tumours of cranial and peripheral nerves
Authors: Samandouras George
Published: August 2014

Chapter 8.17 covers tumours of cranial and peripheral nerves, including vestibular schwannoma (VS), neurofibroma, and malignant peripheral nerve tumours (MPNSTs).
Familial tumour syndromes
Authors: Samandouras George
Published: August 2014

Chapter 8.18 covers familial tumour syndromes, including neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), von Hippel-Lindau (VHL) disease and capillary haemangioblastoma, tuberous sclerosis and subependymal giant cell astrocytoma (SEGA), and Lhermitte-Duclos disease.
Cysts and tumour-like lesions
Authors: Samandouras George
Published: August 2014

Chapter 8.19 covers cysts and tumour-like lesions, including arachnoid cysts (ACs), colloid cysts (CCs), dermoid and epidermoid, and porencephalic cysts.
Stroke basics
Authors: Samandouras George
Published: August 2014

Chapter 9.3 covers stroke basics, including basic concepts, management, imaging, specific ischaemic syndromes, treatment, the role of surgery in acute ischaemic stroke, and thrombosis of dural sinuses (DST) and cerebral veins.
Intracerebral haemorrhage
Authors: Samandouras George
Published: August 2014

Chapter 9.4 covers intracerebral haemorrhage, focusing on basic concepts such as epidemiology, imaging, monitoring, and management.
Subarachnoid haemorrhage II: management
Authors: Samandouras George
Published: August 2014

Chapter 9.6 covers the management of subarachnoid haemorrhage, including treatment, rebleeding, vasospasm, and other SAH-related complications.
Arteriovenous malformations
Authors: Samandouras George
Published: August 2014

Chapter 9.11 covers the arteriovenous malformations, includingbasic concepts, surgical pathology, diagnosis, classification schemes, treatment, and principles of surgery.
Dural and cavernous arteriovenous fistulas
Authors: Samandouras George
Published: August 2014

Chapter 9.14 covers dural and cavernous arteriovenous fistulas, including duralarteriovenous fistula (DAVF), carotid cavernous fistula (CCF), and vein of Galen malformation (VOGAM).
Vascular lesion of the spinal cord
Authors: Samandouras George
Published: August 2014

Chapter 10.2 covers vascular lesion of the spinal cord, including haemangioblastoma, spinal cavernous malformation (CM), spinal aneurysms, and spinal arteriovenous fistulas and malformations.
Introduction to skull base tumours
Authors: Samandouras George
Published: August 2014

Chapter 11.1 provides an introduction to skull base tumours, including mesenchymal tumours, and epithelial tumours.
Anterior skull base
Authors: Samandouras George
Published: August 2014

Chapter 11.2 discusses the anterior skull base, including basic concepts, meningiomas, olfactory groove meningiomas (OGMs), surgical technique, and tuberculumsellameningiomas (TSMs).
Middle skull base and cavernous sinus
Authors: Samandouras George
Published: August 2014

Chapter 11.3 discusses the middle skull base, including the clivus and cavernous sinus (CS).
Classification, diagnosis, and management of hydrocephalus
Authors: Samandouras George
Published: August 2014

Chapter 12.3 covers the classification, diagnosis, and management of hydrocephalus, including presentation, imaging, and aetiological classification.
Preoperative assessment
Authors: Samandouras George
Published: August 2014

Chapter 14.2 covers the preoperative assessment of epilepsy, including basic concepts, EEG, MRI, mesial temporal lobe sclerosis, functional imaging, intracranial electrode monitoring, and the Wada (amobarbital) test.
Surgical techniques
Authors: Samandouras George
Published: August 2014

Chapter 14.3 covers surgical techniques relating to epilepsy, including critical surgical anatomy of the temporal lobe and surgical techniques for various operations.
Neurosurgical management of pain
Authors: Samandouras George
Published: August 2014

Chapter 15.1 covers the neurosurgical management of pain, including basic concepts, principles of treatment, intracranial procedures, spinal and peripheral procedures, trigeminal neuralgia (TN), and glossopharyngeal neuralgia (GPN).
Neurosurgical management of spasticity
Authors: Samandouras George
Published: August 2014

Chapter 15.2 covers the neurosurgical management of spasticity, including basic concepts, common medications used in spasticity, intrathecal baclofen pumps, selective peripheral neurotomies (SPNs), and selective dorsal rhizotomy (SDR).
Movement disorders
Authors: Samandouras George
Published: August 2014

Chapter 15.3 covers movement disorders, including basic concepts, Parkinson’s disease (PD), lesioning for PD, and deep brain stimulation (DBS).
Congenital spinal disease in adults
Authors: Samandouras George
Published: August 2014

Chapter 16.1 covers congenital spinal disease in adults, including basic concepts, caudal agenesis, congenital scoliosis/kyphosis, Klippel-Feil syndrome (KFS), craniovertebral junction (CVJ) abnormalities, basilar invagination (BIV), Osodontoideum (OO), assimilation of the atlas (AA), Down syndrome (DS), and achondroplasia.
Syringomyelia
Authors: Samandouras George
Published: August 2014

Chapter 16.3 covers syringomyelia, including definitions, clinical features, imaging, and treatment.
Cervical spondylosis
Authors: Samandouras George
Published: August 2014

Chapter 16.6 covers cervical spondylosis, including basic concepts, clinical presentation, treatment, surgical anatomy, and operative technique of cervical laminectomy.
Lumbar disc disease
Authors: Samandouras George
Published: August 2014

Chapter 16.11 covers lumbar disc disease, including basic concepts and areas such as epidemiology, natural history vs. surgery, clinical features, imaging, and surgical treatment.
Failed back syndrome
Authors: Samandouras George
Published: August 2014

Chapter 16.14 covers failed back syndrome, including basic concepts, imaging, management, and prognosis.
Cerebrospinal fluid leak
Authors: Samandouras George
Published: August 2014

Chapter 16.15 covers cerebrospinal fluid leak, including epidemiology, risk factors, diagnosis, imaging studies, and management.
Spondylolisthesis
Authors: Samandouras George
Published: August 2014

Chapter 16.16 covers spondylolisthesis, including basic concepts, clinical features, imaging, and managements.
Intradural-extramedullary spinal tumours
Authors: Samandouras George
Published: August 2014

Chapter 16.18 covers intradural-extramedullary spinal tumours, including schwannomas, neurofibromas, meningiomas, management, and surgical technique.
Intramedullary spinal cord tumours (IMSCTs)
Authors: Samandouras George
Published: August 2014

Chapter 16.19 covers intramedullary spinal cord tumours (IMSCTs), includes epidemiology, clinical presentation of IMSCTs, imaging, management, and surgical techniques.
Pathophysiology of nerve injuries
Authors: Samandouras George
Published: August 2014

Chapter 17.1 covers pathophysiology of nerve injuries, including normal nerve structure, classification of nerve injuries, types of nerve injury, reaction of nerves to injury, and regeneration.
Nerve injuries of the upper extremity
Authors: Samandouras George
Published: August 2014

Chapter 17.2 covers nerve injuries of the upper extremity, including brachial plexopathies and upper limb mononeuropathies.
Medical ethics, consent, and brain death
Authors: Samandouras George
Published: August 2014

Chapter 18.1 covers medical ethics, consent, and brain death.
Acute lower gastrointestinal bleeding
Authors: Marks Daniel , Harbord Marcus
Published: August 2014

Lower gastrointestinal bleeding

Initial management

Admission

Definitive investigations

Complications of endoscopy

Investigations if cause not identified

Treatment of specific conditions

Co-morbidity and lower gastrointestinal bleeding

Non-severe overt lower gastrointestinal bleeding

Lower GI bleeding is common but usually of only modest severity. Most can be managed on an outpatient basis, although unwell patients need admission (have a lower threshold for patients with severe co-morbidity). In total, ~35% of significant bleeds require transfusion and 5% urgent surgery (see the ...
Severe acute diarrhoea
Authors: Marks Daniel , Harbord Marcus
Published: August 2014

Definition and physiology of severe diarrhoea

Aetiology of severe diarrhoea

Initial assessment of severe diarrhoea

Who to admit?

Management of severe diarrhoea

Outcomes

Special situations

First presentation of chronic diarrhoea

Formally refers to passage of 〉250g stool/24h. From a practical perspective, better defined as an increase of three or more watery stools/day for up to 2wk. Stool consistency can be judged using the Bristol scale (...
Acute thoracic pain and dysphagia
Authors: Marks Daniel , Harbord Marcus
Published: August 2014

Differential diagnosis of acute thoracic pain

Oesophagitis

Oesophageal spasm

Mallory–Weiss tear

Oesophageal rupture

Dysphagia

Odynophagia

Foreign bodies

Caustic injury

The approach to acute thoracic pain should be to rapidly identify potentially life-threatening causes, then consider other sources.

● Acute coronary syndrome.

● Aortic dissection.

●...
Acute abdominal pain
Authors: Marks Daniel , Harbord Marcus
Published: August 2014

Differential diagnosis

Peptic ulceration

Gallstone disease

Acute pancreatitis

Peritonitis

Retroperitoneal haemorrhage

Retroperitoneal fibrosis

Bowel ischaemia and infarction

Volvulus

Bowel obstruction

Severe constipation

When to call the surgeon

Table 9.1 shows the main differential diagnoses of acute abdominal pain, according to site of presentation. Overlap between sites is common. Generalized abdominal pain may be caused by peritonitis or medical disorders. Ensure a pregnancy test is performed in all women of childbearing potential....
HIV disease and the gastrointestinal tract
Authors: Marks Daniel , Harbord Marcus
Published: August 2014

General principles

Luminal disease

Pancreatitis

Hepatobiliary disease

HIV-infected patients with low CD4 counts frequently develop acute GI and hepatobiliary disease. Whilst susceptible to the same disorders as immunocompetent patients, the differential diagnosis is broader. The aim is to identify treatable disorders. Clinical presentations are rarely specific, and patients usually require investigation rather than empiric treatment....
Jaundice
Authors: Marks Daniel , Harbord Marcus
Published: August 2014

Assessment and causes of jaundice

Viral hepatitis

Alcoholic hepatitis

Drug-induced hepatitis

Autoimmune hepatitis

Haemochromatosis

Wilson’s disease

Primary biliary cirrhosis

Ischaemic hepatitis

Obstructive jaundice

Acholuric jaundice

Sepsis

Jaundice refers to yellow pigmentation of the skin and sclera caused by elevated bilirubin levels. It is usually clinically detectable when serum bilirubin concentrations rise above 60...
Acute liver failure
Authors: Marks Daniel , Harbord Marcus
Published: August 2014

Definitions of acute liver failure

Aetiology

Presentation

Investigation

Initial management

Subsequent management

Markers of disease severity

Paracetamol overdose

Acute presentations of Wilson’s disease

Acute-on-chronic liver failure

Hepatic encephalopathy

Criteria for emergency liver transplantation

Acute liver failure (ALF) is defined as potentially reversible severe liver injury with impaired synthetic function (INR 〉1.5) and hepatic encephalopathy, developing within 28d from the onset of jaundice, in the absence of pre-existing liver disease or with well-compensated chronic liver disease (...
The liver in pregnancy
Authors: Marks Daniel , Harbord Marcus
Published: August 2014

Liver disease in pregnancy

Liver function tests in pregnancy

Hyperemesis gravidarum

Obstetric cholestasis

Acute fatty liver of pregnancy

Pre-eclampsia

HELLP syndrome

Spontaneous hepatic rupture

Gallstone disease

Pancreatitis

Budd–Chiari syndrome

Viral hepatitis

Pre-existing cirrhotic liver disease

A number of liver disorders are unique to, or more likely to occur in, pregnancy. These should be considered alongside the other causes of liver disease that occur in non-pregnant patients. Transient mild derangements of LFT are common and rarely require further assessment beyond repeat monitoring to ensure normalization. However, liver disorders in pregnancy often present non-specifically and, therefore. all patients merit formal clinical assessment....
Hepatic, neuroendocrine, and general oncological emergencies
Authors: Marks Daniel , Harbord Marcus
Published: August 2014

Emergency presentation of hepatic malignancy

Emergency presentations of neuroendocrine tumours

General oncological emergencies

Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide. It usually develops on the background of cirrhosis, most frequently as a result of chronic hepatotropic viral infection. Untreated, the majority of patients die within 1y of diagnosis. However, there are now a number of potentially curative options for patients diagnosed with early stage disease, and overall 5y survival is between 50–70% in specialist centres....
History of pain in children
Authors: Unruh Anita M. , McGrath Patrick J.
Published: August 2014

The problem of pain has likely concerned humankind from the beginning as pain is a compelling call for attention and a signal to escape from its source. Early efforts to understand pain, and its origins, features, and treatment reflected the duality between spiritual conceptualizations of pain and physiological explanations depending on the predominance of such views in a given culture in any given historical period (McGrath and Unruh, 1987). In the absence of physiological or behavioural explanations to explain persistent pain without obvious injury, when spiritual perspectives dominated, prayer, amulets, supplication, and religious rites dominated approaches to pain treatment. Herbal remedies were often part of such strategies and might themselves have had potent properties (Unruh, 1992, 2007). In ancient writings about pain and disease, treatments for children were often given alongside discussions about the health issues of women. In this chapter, we trace early approaches to pain in children to the modern era highlighting points of transition and improvements in paediatric pain management.
Prevention of the development and maintenance of paediatric chronic pain and disability
Authors: Pagé M. Gabrielle , Huguet Anna , Katz Joel
Published: August 2014

Understanding the predisposing factors that confer a greater risk of developing chronic pain is an essential step in pain prevention and management. This chapter focuses on current theoretical models that can inform prevention of paediatric pain and disability. We review the literature on known risk/protective factors, markers, correlates, and prognostic factors for the transition to chronic pain and disability across a variety of pain conditions. We distinguish between primary, secondary, and tertiary levels of pain prevention and discuss the clinical implications of this distinction.
Families and pain
Authors: Birnie Kathryn A. , Boerner Katelynn E. , Chambers Christine T.
Published: August 2014

The family has long been acknowledged as an important social context where children learn about and receive support for their pain. When a child is in pain, it is the family who is responsible for the initial pain assessment and seeking appropriate evaluation and care. Families may inadvertently encourage the expression of pain and play a critical role in influencing their children’s ability to cope with pain, both positively and negatively. Having a child in pain can also pose significant personal, familial, and economic strains. Therefore, consideration of the family is absolutely critical in the understanding of factors involved in children’s acute and chronic pain experiences (McGrath, 2008). A concentration of research has continued since the last comprehensive review on the topic was published (Chambers, 2003). This chapter considers relevant theoretical models and summarizes current major research themes regarding the role of the family in both acute and chronic paediatric pain. Two illustrative case examples are provided and key areas for future research are identified.
Pain, social relationships, and school
Authors: Forgeron Paula , King Sara
Published: August 2014

Although recurrent and chronic pain impacts the whole life of a child and or adolescent, little research has been conducted on social consequences of chronic pain for children and adolescents. Emerging research suggests that (1) peer relationships, including close friendships, of children and adolescents with chronic pain may be negatively impacted by pain and (2) social reactions from others can negatively impact the child or adolescent’s pain experience. School functioning may also be impaired as a result of chronic pain. Clinicians should understand the challenges experienced by children with chronic pain and should attend to the social and school consequences of pain when working with this population. Although little research has examined interventions to manage the effects of chronic pain on school and social functioning, researchers have identified helpful strategies that may mitigate the negative consequences to social and school functioning associated with chronic pain.
Pain in children with intellectual or developmental disabilities
Authors: Belew John L. , Barney Chantel C. , Schwantes Scott A. , Tibboel Dick , Valkenburg Abraham J. , Symons Frank J.
Published: August 2014

In this chapter, it is argued that it is time to bring the burgeoning work on pain together and develop a coherent clinically-informed research agenda addressing the problem of pain among children with intellectual or developmental disabilities (I/DD). The chapter starts with an introductory section providing a short overview of the problem of pain among children with I/DD including many definitional and historical issues. Subsequent sections include a review of the epidemiology and impact of pain in children with I/DD, followed by a review of pain assessment and then pain management in children with I/DD. The chapter ends with a summary and conclusions relevant for future research and practice.
Chronic pain syndromes in childhood: one trunk, many branches
Authors: Schechter Neil L.
Published: August 2014

Although this volume is replete with detailed discussions about specific pain problems, the focus of this chapter is on a discussion of the commonalities in aetiology, associated symptoms, and treatment of many of the frequent chronic pain problems. We will explore in brief the data that demonstrates the co-occurrence of many of the common chronic pain problems in children and the epidemiological similarities that exist between affected individuals. Then we will review the concept of central sensitization and the physiological evidence that supports its presence in many of the functional pain problems. We will briefly review some of the symptoms associated with these entities (orthostatic intolerance, sleep disturbance, depression, anxiety, hypermobility, family distress). Finally, we will discuss briefly a general approach to these problems emphasizing the collection of specific information in the history and physical examination, the critically important presentation of the formulation to the family, and the treatment modalities that appear to be effective for many of these conditions. In-depth discussion of each of these pain problems is available in chapters specifically designated to review them in detail.
Pain in sickle cell disease
Authors: Dampier Carlton , Barakat Lamia
Published: August 2014

Sickle cell disease (SCD) presents a complex pain disorder to clinicians. Pain from vaso-occlusion of sickle erythrocytes can occur in multiple musculoskeletal locations, several internal viscera such as the spleen, as well as the penis. Such pain is typically intermittent in childhood, shares features of acute pain with other pain disorders, and often responds to non-steroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics. Adolescents with SCD often experience more frequent pain, and those with bone disease in spine, hips, or shoulders may experience chronic pain. Like other chronic pain disorders, this pain often responds poorly to opioids, but there is limited current clinical or research data to support alternative medications. Many cognitive-behavioural strategies are helpful as part of multidisciplinary pain management, particularly in adolescents, who may also benefit from psychological support to treat coexistent mood disorders, to increase coping skills, and to support appropriate school and family functioning. Future advances in pharmacological and psychological therapies are needed to ameliorate the substantial burden of pain in children and adolescents with SCD.
Pain and gastroenterological diseases
Authors: Batra Akshay , Bevan Amanda , Beattie R. Mark
Published: August 2014

Pain is a common complaint in children with gastrointestinal tract pathology and it has significant consequences for patients’ quality of life. A thorough evaluation should be performed to determine the cause and severity. Understanding the pathophysiology of pain in various conditions is key to effective management. This chapter outlines the aetiology and general principles of the management of pain in gastrointestinal disease. The specific management of common gastrointestinal conditions associated with pain, e.g. inflammatory bowel disease, gastro-oesophageal reflux disease, pancreatitis, and gut dysmotility disorders are discussed.
Postoperative pain management
Authors: Howard Richard F.
Published: August 2014

Postoperative pain management begins prior to surgery and includes not only the prevention and pharmacological treatment of pain, but also a holistic and well-coordinated strategy that allays fears and anxieties, and allows children and their carers to participate in the selection and implementation of safe and suitable analgesia. Admission to hospital for surgery is a significant and potentially traumatic event. Coping with a strange and unknown environment, fear of separation, anticipation of painful procedures, and postoperative pain or adverse effects such as nausea are all prominent causes of anxiety and stress that can increase the perception of pain and impact on the quality of perioperative care. Therefore, a successful postoperative pain management programme will include: ongoing training of hospital staff, adequate preparation of children and families that provides timely verbal and written information, and the development and implementation of audited institutional analgesic protocols that ensure the safety and efficacy of pain management strategies in a child-friendly and secure environment.
Chronic pelvic pain in children and adolescents
Authors: Sager Susan L. , Laufer Marc R.
Published: August 2014

Pain due to pelvic pathology in children and adolescents is often described as abdominal pain, and frequently coexists with gastrointestinal symptoms due to neuronal cross talk and viscero-viscero or viscero-somatic convergence of sensory afferents. Dysmenorrhea is highly prevalent among adolescents yet is underreported. Like many chronic conditions where repetitive noxious stimuli are present, dysmenorrhea can be associated with central sensitization of pain pathways and visceral hyperalgesia. In this chapter the components of a menstrual history, the importance of obtaining a menstrual history in adolescents with abdominopelvic pain, and the indications for referral to an adolescent gynaecologist are discussed. Endometriosis should be considered in the differential diagnosis of all females with chronic abdominopelvic pain of undetermined aetiology once the benchmark of thelarche has been met. Other overlooked causes of abdominopelvic pain include intercostal or subcostal neuralgias, nerve compression, and abdominal cutaneous nerve entrapment. A multidisciplinary approach to treatment of the patient with chronic abdominopelvic pain is discussed.
Effective management of children’s pain and anxiety in the emergency department
Authors: (Bo) Kennedy Robert M.
Published: August 2014

Effective management of children’s pain and anxiety during emergency department (ED) visits facilitates medically necessary care and procedures and increases patient, family, and health care provider satisfaction. This chapter will review evidence-based techniques for achieving this goal. A significant focus is upon non-pharmacological strategies to relieve children’s anxiety because high levels of anxiety exacerbate sensitivity to pain and disrupt coping mechanisms of the child and parent. In addition, advances in techniques for pain relief for specific procedures will be detailed. Aspects of procedural sedation and analgesia that are especially pertinent to the ED will also be reviewed along with two recommended regimens for moderate and deep sedation.
The neurophysiological evaluation of nociceptive responses in neonates
Authors: Poorun Ravi , Slater Rebeccah
Published: August 2014

Human pain and suffering is most often communicated by language. The ability to communicate verbally puts adults and older children at a distinct advantage over our young counterparts. Infants and newborns cannot talk—which makes the reliable subjective measurement of pain difficult in this population. In neonates, we have traditionally relied on objective measurements of physiological and behavioural responses to noxious stimulation (Stevens et al., 2007), and research continues to search for the best measures of pain in neonates (Stevens and Franck, 2001; see also Lee and Stevens, Chapter 35, this volume).
Measurement of health-related quality of life and physical function
Authors: Tham See Wan , Wilson Anna C. , Palermo Tonya M.
Published: August 2014

This chapter reviews the measurement of health-related quality of life (HRQOL) and physical function in paediatric pain populations. We present available data on HRQOL and physical function in children with pain, methods of assessment, details about specific questionnaire and performance-based measures, and recommendations for the use of measures based on available evidence. Because many children and adolescents with pain report impairment in participation in physical activities such as walking, running, and sports, physical functioning is a core target and outcome for intervention, particularly for youth with chronic pain. However, the domain of physical functioning encompasses a number of constructs such as physical fitness, physical activity, and subjective disability, which are interrelated, but represent distinct aspects of functioning. Moreover, HRQOL is a broader concept that subsumes physical and psychosocial function. A wide variety of measurement tools are in use, but no guidelines for measurement have been established. A better understanding of measurement of HRQOL and physical function may enable researchers and clinicians to track children’s functional impact and changes in function over time, and to improve the design and testing of potentially effective interventions for children with pain.
The non-steroidal anti-inflammatory drugs and acetaminophen
Authors: Anderson Brian J.
Published: August 2014

The non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (N-acetyl-p-aminophenol, APAP) are the commonest analgesic drugs used in childhood. Although both drugs act through inhibition of prostaglandin H2 synthetase (PGHS), acetaminophen lacks the anti-inflammatory effects of the NSAIDs. Neonatal acetaminophen hepatic clearance is reduced in premature neonates (5–10% adult rates) and increases to 30% adult rates in neonates born at term; adult rates (approximately 16–20 L/h/70 kg) are reached within the first year of life. NSAID clearance maturation, mostly through cytochrome P450 mixed oxidases, is more rapid. Concentration–response relationships suggest a maximum pain reduction of 5 or 6 on a 10-point scale for both drugs. Combination therapy does not increase this maximum effect but does prolong duration of analgesia. While both drugs have good safety profiles, dosing of both drug groups is tempered by concerns about toxicity. Acetaminophen hepatotoxicity is associated with single doses (〉250 mg/kg in preschool children, 〉150 mg/kg in adults) and therapy duration longer than 3 to 5 days (〉90 mg/kg/day).The most common minor adverse events in NSAID recipients are nausea, dizziness, and headache. More concerning is the potential of NSAIDs to cause gastrointestinal irritation, blood clotting disorders, renal impairment, neutrophil dysfunction, and bronchoconstriction. These adverse effects are uncommon provided care is taken with drug dose, duration of therapy, and recognition of contraindications.
Interventional pain management techniques for chronic pain
Authors: Sethna Navil F. , Dinakar Pradeep , Boretsky Karen R.
Published: August 2014

As part of multidisciplinary management of paediatric chronic pain, interventional pain management techniques can play an important role when pain is unrelieved by conventional treatment modalities. Many procedures and indications are extrapolated from adult studies, and evidence for long-term efficacy in paediatric populations is limited. Interventions range from injection techniques with local anaesthetic and/or corticosteroids to neuraxial blockade with implanted catheters. Paediatric case series have reported benefit in selected patients with complex regional pain syndrome and cancer-related pain.
Hypnosis and relaxation
Authors: Liossi Christina , Kuttner Leora , Wood Chantal , Zeltzer Lonnie K.
Published: August 2014

This chapter discusses the current research literature and clinical practice regarding the use of hypnosis in paediatric pain management, first defining hypnosis and discussing theoretical conceptualizations. Next it presents our current understanding of the mechanisms of hypnotic analgesia, along with the research evidence for the efficacy of hypnosis in the control of acute and chronic paediatric pain; in both sections relevant clinical techniques are discussed. It also includes a description and discussion of different relaxation techniques and the evidence for their efficacy in acute and chronic pain management, and concludes with an attempt to summarize and evaluate the existing literature and make suggestions for future studies and clinical practice.
Physical therapy interventions for pain in childhood and adolescence
Authors: Tupper Susan M. , Swiggum Mary S. , O’Rourke Deborah , Sangster Michael L.
Published: August 2014

This chapter is divided into four sections. The first section provides an overview of the theoretical foundations that can be used as a framework for possible mechanisms of effect for physical therapy (PT) interventions and identification of PT interventions oriented towards maximizing participation of children with pain in valued roles and life activities. The second reviews the literature on active therapies as interventions for children with pain. The third section reviews the literature on passive therapies and safety and efficacy for manual therapy or therapeutic modalities for pain. The importance of the therapeutic relationship and pain education will also be discussed. The final section reviews the literature on procedural pain from a PT perspective and provides recommendations on procedural pain management. Although PT practice settings and the treatment needs of infants, children and adolescents with pain vary widely, this chapter provides a structure for development of a theoretical and evidence-based physical therapeutic approach for all children with pain.
Complementary therapy in paediatric pain
Authors: Zeltzer Lonnie K.
Published: August 2014

There is increasing paediatric use of complementary therapies (CTs), especially for paediatric pain. This chapter reviews the key literature on studies that pertain to CTs that impact pain in children. The research is still in its infancy with few studies that have been well designed and replicated. Likely the strongest of the studies is in hypnotherapy, which will have its own chapter, and in biofeedback for headaches. Acupuncture research is growing but there are few well designed studies in children compared to those in adults. Risks in CTs mostly relate to training of the practitioner and good clinical judgement (e.g. avoiding massage in children aversive to touch). Most are safe when used with clinical judgement.
Sociodemographic disparities in paediatric pain management: relationships and predictors
Authors: Ezenwa Miriam O. , Huguet Anna
Published: August 2014

The purpose of this chapter is to present a narrative review of research studies examining sociodemographic predictors of disparities in pain management in children and adolescents. Findings from this review are conflicting. In the majority of the studies, sociodemographic variables were not statistically significant predictors of disparities in pain management. However, some gaps remain. For the studies in which evidence of sociodemographic disparities exist, it is: (1) not clear whether the statistically significant sociodemographic disparities were also clinically meaningful and (2) in all of the studies reviewed, the goal was to determine predictors of disparities in pain management. Future studies need to focus on determining the clinical meaningfulness of other findings and systematically testing explanatory models for possible sociodemographic disparities in paediatric pain management. Adequately addressing these gaps will help to move forward the science of sociodemographic disparities in paediatric pain management.
The Integrated Nurse
Authors: Quinn Janet F.
Published: August 2014

The nurse and the healer are one and the same in the integrated, holistic nurse. Yet many of us have forgotten our heritage as healers as we have become immersed in the sick-cure paradigm that continues to dominate healthcare. This chapter explores the opportunity for integrative nurses to reclaim their roots as healers in the lineage of Nightingale, becoming instruments of healing in service to life. The way of the healer is explored as a potential spiritual path for nurses who wish to follow Nightingale in awakening the diving spirit of love within.
Creating Optimal Healing Environments
Authors: Zborowsky Terri , Kreitzer Mary Jo
Published: August 2014

Creating an optimal healing environment requires attentiveness to the built environment as well as care processes, culture, and competencies of care providers and leadership. There are over 1,000 studies that link the physical environment to outcomes such as health care quality, patient safety, reduction of stress and improvements in patient safety. Key design elements highlighted include access to nature, access to daylight, positive distractions, and the ambient environment.
Informatics and Integrative Healthcare
Authors: Delaney Connie W. , Westra Bonnie L. , Dean Patrick J. , Leuning Cheryl J. , Monsen Karen A.
Published: August 2014

This chapter explores the intersection of informatics and integrative healthcare and the synergy of possibilities that are rapidly emerging. Big data, information science, and network science are new tools for advancing interprofessional healthcare knowledge and wisdom. Integrative healthcare, nursing, and all healthcare professions can leverage the benefits of informatics to improve information management; support and document care; and capture outcomes. We invite conversation, creative practice, and contribution to the evolution of our research and science that boldly represents the healthy synergy between integrative informatics and integrative health.
Movement and Integrative Nursing
Authors: Masemer Susan , Farrell Mary , King Jayson , Koithan Matthew
Published: August 2014

This chapter provides information about the connections between physical activity or movement and well-being, emphasizing the importance of self-care and patient education for integrative nurses. This understanding will guide nurses to engage patients in collaborative discussions around the benefits of physical activity and steer them toward realistic strategies for successful implementation. Foundational to quality interactions with patients is the presence of physical activity as part of the nurse’s own self-care. Understanding basic exercise strategies as well as mastering the skills of engagement will increase the integrative nurse’s competence in promoting health and well-being within various patient populations.
Health Coaching
Authors: Anderson Jane
Published: August 2014

Health coaching, an emerging health care specialty, is a way of being-knowing-doing that facilitates lifestyle change and well-being. Coaching is client-centered and based on values of partnership, empowerment, authenticity, trust, self-reflection and openness. Using strategies that include motivational interviewing, nonviolent communication, reflective practice and appreciative inquiry, health coaches accompany clients along their health-seeking journey. Developing professional competencies, including presencing, active listening, education, self-discovery and change processes, form the basis for new credentialing/certification processes and educational programs. These competencies align with the principles of integrative nursing and nursing’s historical focus on patient-centered, relationship-based care that facilitates body-mind-spirit health and well-being.
Integrative Nursing Management of Nausea
Authors: Cutshall Susanne M. , Van Getson Lisa M.
Published: August 2014

Recently, there has been a renewed interest by nursing practice in the management of nausea and vomiting. The physiological mechanisms involved in the process of causing nausea and vomiting are better understood. Pharmacologic agents are being used in combination with integrative modalities in the treatment and ongoing management of nausea and vomiting. Most episodes of nausea and vomiting are preventable or at least manageable. Nurses trained in integrative nursing practice play an important role in patient education and assisting the patient in the treatment and management of nausea. This chapter will provide a brief overview of integrative health assessment and practices for managing nausea.