bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Psychologist, 4 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter addresses the experience of a Clinical Psychologist who has worked in acute medical settings and on inpatient wards for several years, and has encountered people with a wide range of symptoms and presentations. Unfortunately, in acute medical settings, people who experience Non-Epileptic Seizures (NES) often receive substandard or inappropriate care and have negative interactions with staff as a result of stigma. When someone presents with NES, the situation can be difficult for medical professionals to understand. They can be just as frightened, confused, and unsure about what to do as the person experiencing the seizures. Moreover, it can be difficult for doctors to admit that they do not know what is happening. They can feel under pressure to do or say something—maybe to refer for a test that is not really needed, to prescribe unnecessary medication, or to refer to another specialist for a second opinion. As such, people often go through a seemingly never-ending journey of uncertainty, anxiety, and rejection as they try to find some understanding about what is causing the seizures they cannot predict or explain.
Neurologist, 26 years’ experience, Turkey
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter explores the experience of a Neurologist who has seen many different types of Non-Epileptic Seizures, from very hyperactive and even aggressive movements to dissociative-like symptoms. It specifically considers the stories of three patients at different ages with different manifestations. The first patient was an older lady whose seizures seemed to be aggravated after menopause. Her past history revealed a serious infection during her first pregnancy, which had resulted in the loss of her baby. During her visit with the Neurologist, she had a seizure in which she was not able to speak, her eyes were deviated upward with eye blinking, and her face looked pale. The second patient was a teenage girl who had started to have seizures diagnosed as status epilepticus after she had been involved in an accident. Later, the Neurologist found out that she had not suffered any serious physical injuries in her head associated with the accident and that she was undergoing psychiatric treatment because of her behavioral problems. The third patient was in her twenties and had had seizures for several years, which always happened at night during sleep. The seizures were described as involving excessive movement and were happening three to four times a month.
Neurologist and Psychoanalyst, 40 years’ experience, Germany
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter details the experience of a Neurologist who had only just started to train as a Psychotherapist and Psychoanalyst. At this time, there was no established knowledge, let alone evidence-based guidelines, for the treatment of patients with Non-Epileptic Seizures or for their psychotherapeutic treatment. The Neurologist’s psychotherapeutic training familiarized him with a way of perceiving conversations not commonly encountered in Neurology. The Neurologist further realized that, apart from serving to transmit information, conversations can also be a stage on which established ways of relating to others are re-enacted (transference), and that the clinician can learn to access his own resonant or dissonant affective reaction to this through introspection (countertransference), thereby gaining personal insights into relationships patients have previously experienced themselves. These processes allow a person engaged in conversation to absorb potentially challenging affects, detoxify them, and present them, in a processed form, to the patient by offering so-called interpretations.
Provision of Sexual Health Support
Authors: Ussher Jane M , Hawkey Alexandra , Perz Janette
Published: March 2020

Changes to sexuality and intimacy are a common consequence of cancer and cancer treatment. Such changes are multifaceted and associated with a range of negative physical and emotional outcomes for both people with cancer and their partners, as well as changes to roles and intimate relationships. This chapter examines cancer treatment side effects and their impact on sexuality and sexual functioning, risk factors for experiencing sexual difficulties, and the clinical management of sexual changes. We also address barriers to effective communication about sexuality and sexual changes and explore specific cultural or ethical challenges when providing support to people with cancer and their partners. Clinical management and effective communication, by providing general sexual health information and advice, as well as intensive therapy, are outlined, following the PLISSIT and BETTER models. The potential impact of information and advice, in terms of renegotiated sexual practice, is examined, illustrated through case examples.
Lesbian, Gay, Bisexual, and Transgender Issues
Authors: Lisy Karolina , Hulbert-Williams Nick , Ussher Jane M. , Alpert Alison , Kamen Charles , Jefford Michael
Published: March 2020

People identifying as lesbian, gay, bisexual, or transgender (LGBT) often experience unique issues and needs in the context of cancer care. These include experiences and fear of discrimination within heteronormative healthcare environments, assumptions of cisgender/heterosexual identity, exclusion of same-sex partners from care, and a lack of relevant supportive care and information resources. There are also unique impacts of cancer and treatment on LGBT sexuality and fertility. To provide the best possible care for LGBT people living with and after cancer, providers must understand the specific needs of LGBT people and be aware of strategies to deliver inclusive healthcare services. This chapter presents key background information to contextualize the needs of LGBT people with cancer before discussing specific challenges that LGBT people may face when accessing cancer care. We provide guidance for general cancer care, as well as specific concerns regarding the sexual health and fertility needs of LGBT patients. Finally, we outline issues for consideration by healthcare services seeking to advance LGBT awareness and improve care for this patient group.
Couple Therapy for Sexual Dysfunction
Authors: Zaider Talia I. , Kissane David W.
Published: March 2020

Relational strain can be activated by cancer or the effects of its treatment, reducing couple communication and marital satisfaction over time, especially when sexual intimacy declines. Meta-analyses show a modest benefit from couple therapy, with some evidence suggesting better outcomes for couples where one or both partners have greater distress or cancer-related concerns. Presenting problems can include role or transition challenges, communication failure, loss of mutual consensus and conflict, boundary violations, fractures and frustration with sexuality or intimacy. Assessment of the couple includes understanding their experience of the oncology diagnosis and its treatment, their family-of-origin and relational background, coping styles, impact on communication, cohesion, and sexuality alongside any agendas they bring. Behavioral couple therapy strategies can facilitate constructive communication and problem solving to restore intimacy and connectedness during and after treatment. In the advanced cancer setting, existentially oriented models examine grief, death talk, caregiving, and preparation for dying. A search for continued meaning and purpose can empower the couple to live life out to the full, while also preparing for a good death and considering bereavement needs for the survivor.
The history of psychiatry as a medical specialty
Authors: Pichot Pierre , Goodwin Guy M.
Published: March 2020

This chapter was edited from Professor Pichot’s contribution to the last edition. It presents a history of psychiatry from the perspective of doctors. It is not a historigraphy of mental illness, that is a history of how it has been described or written about by other groups or individuals. Nor is it a history of the people who have suffered with mental illness over the centuries. It describes the evolution of what is sometimes called the medical model of severe mental illness, starting with the founders of humane care, such as Pinel, and moving to the idea of an objective psychopathology, the confounding by psychological explanation, and the continuing conflicts between those favouring biological opposed to social approaches to aetiology and treatment.
The connectome
Authors: Sporns Olaf
Published: March 2020

The connectome refers to a comprehensive network map of the connectivity of the nervous system. Such network maps are composed of sets of neural elements, which may correspond to individual neurons or brain areas, and their interconnections, which may correspond to synaptic links or inter-areal pathways. Connectome maps, at a given level of scale, provide a complete and systematic account of brain connectivity that portrays a complete set of anatomical or physiological relationships. This chapter provides an overview of the origins and definitions of the concept and its application to structural and functional brain connectivity, brief surveys of the major findings on the topology of the human connectome and how its connectivity structure shapes dynamic brain activity, and a selection of current themes in the study of individual differences in development and clinical populations.
Functional genomics
Authors: Webber Caleb
Published: March 2020

Functional genomics seeks to understand the dynamic genome, considering how concerted actions by groups of genes operating together within biological pathways vary across different tissues, development, and disease. Driven by continuously advancing technologies, the generation or collation of information on genomic scales enables the study of how the genome is being co-ordinately utilized to direct cellular functions. This chapter provides an overview of the key types of functional genomics data, from epigenetic regulation and the transcriptomic and proteomic manifestations of a cell’s gene expression programme, through to the many systematic efforts to collect and organize our amassed knowledge of the function of genes. For each type of information, the chapter illustrates how this knowledge is advancing our understanding of the molecular aetiologies underlying neuropsychiatric disorders.
Aetiology of intellectual disability and its clinical features
Authors: Rapoport Judith L. , Zhou Dale , Ahn Kwangmi
Published: March 2020

Intellectual disability, in its more common mild form and its more severe form, is the consequence of highly interactive genetic and environmental causes. It is an important area for psychiatrists, as comorbidity with psychiatric disorders is frequent. This chapter presents the causes and clinical features of the best characterized syndromes associated with intellectual disability. Common environmental causes, such as fetal alcohol or lead exposure, and common genetic causes, such as trisomy 21 (Down’s syndrome), are briefly summarized. Classic syndromes, such as tuberous sclerosis, are also presented, though new research identifying many syndromes makes some of these classifications less useful. Prenatal and newborn screenings are fast-developing areas.
Core dimensions of autism spectrum disorders
Authors: Volkmar Fred R. , Jackson Scott L.J.
Published: March 2020

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that manifests during the early developmental period of childhood. Behaviourally characterized by impairments in social interaction and communication, in combination with stereotyped and restricted patterns of behaviour and/or interest, it is currently believed that ASD occurs in approximately 1–2% of individuals. ASD is more prevalent among males than females (4–5:1), but the mechanisms resulting in this discrepancy are still unclear. This chapter will serve as an introduction to ASD, covering the topics of disorder history, prevalence rates, demographics, diagnostic criteria, differential diagnosis, and discussions on current and future diagnostic classification systems. The remaining chapters within Section 4 will then provide detailed discussions on more specific topics related to ASD, including current understandings of treatment planning, prevention and epidemiology, genetics, imaging, and disorder management.
Genetics of substance use disorders
Authors: Strat Yann Le , Ramoz Nicolas , Gorwood Philip
Published: March 2020

The literature on the existing evidence for a genetic component is reviewed for substance use disorders (SUD), formerly known as substance abuse and substance dependence. The chapter provides a historical perspective of the evolution of genetic understanding in the field. It also discusses the most recent methods of studying genetic factors in SUD, as well as the related discoveries of genes involved in SUD. It concludes on the possible role of genetics in the evolution of the concept and the mechanisms of SUD.
Stimulants, ecstasy, and other ‘party drugs’
Authors: Winstock Adam R. , Flechais Remy
Published: March 2020

Stimulant drugs are the most commonly used illicit drug group in the world after cannabinoids. While their shared neurobiology is responsible for inducing the sought-after effects of euphoria and energy, subtle differences in their precise action, potency, and route of use mean their main functions and the risks associated with their use are diverse. Acute intoxication, often in combination with other substances, remains the most common risk that users face. High-risk behaviours associated with intoxication and the development of dependence are seen among a minority and require specialist assessment and treatment. Clinically, psychiatrists are most likely to see those who have developed problems with cocaine and methamphetamine, though some of the new psychostimulants that have appeared in recent years may increasingly provide patients for treatment. MDMA (3,4-methylenedioxymethamphetamine), on the other hand, may, in the lifetime of this edition, move from being seen solely as a recreational drug to one that may have significant therapeutic benefits, for those with post-traumatic stress disorder, for example.
Schizoaffective and schizotypal disorders/acute and transient psychotic disorders
Authors: Stone William S. , Faraone Stephen V. , Tsuang Ming T.
Published: March 2020

This chapter focuses on three disorders that demonstrate similarities to schizophrenia, including schizoaffective disorder, schizotypal personality disorder and acute and transient psychotic disorders (also known as brief psychotic disorders). These conditions typically include positive psychiatric symptoms such as psychotic or attenuated psychotic symptoms in at least some stages of the disorder, though they vary considerably in the extent to which they persist. Similarly, these disorders differ in other dimensions such as their clinical outcomes, relationships to each other, and heterogeneity of their presentations, among others. This chapter reviews the current clinical classifications of these three disorders by emphasizing their (DSM-5) diagnoses, differential diagnoses, clinical features, courses, epidemiology, and treatment/management options.
Treatment and management of patients with schizophrenia
Authors: McEvoy Joseph P. , Asuzu Kammarauche , Bradford Daniel W. , Freudenreich Oliver , Moyer Katherine
Published: March 2020

In schizophrenia, the years before psychosis are morbid, not premorbid. Widespread, low-grade corruption of circuitry (brain damage) occurs, resulting in enduring deficits in cognitive, social, and motor functioning and motivation. These deficits persist during patients’ lifetime and do not respond to medication or talking. Expectations of patients’ functioning must be modified (reduced); interactions and environments must be accommodated to support best residual functioning, and prostheses (mechanical or actions of others) must replace functions no longer available. One of the deficits—anosognosia—interferes with treatment efforts. When the circuits managing dopamine neurons in the ventral tegmental area are corrupted, storms of dopamine imbue random items of sensory experience and intrapsychic life with salience—psychosis appears. Early and uninterrupted dopamine antagonist medication results in sustained remission of psychosis but is rarely achieved because of the inadequacies of standard care. Enduring engagement by multi-disciplinary teams is the necessary response to the neurobiology of schizophrenia.
Management and treatment of bipolar disorder
Authors: Vieta Eduard , Pacchiarotti Isabella , Miklowitz David J.
Published: March 2020

This chapter surveys the literature on the pharmacological and psychological management of bipolar disorder. Lithium, valproate, and several dopamine antagonists/partial agonists—in monotherapy or in combination—are the first-line treatments for acute mania. For bipolar depression, lithium, lamotrigine, and quetiapine monotherapy remain the first-line options. The topic of antidepressants in bipolar disorder is controversial. Lithium, lamotrigine, valproate, olanzapine, quetiapine, aripiprazole, risperidone, and long-acting antipsychotic formulations represent the principal strategies for maintenance treatment of bipolar disorder. The use of medication in bipolar disorder may benefit from a combined psychological approach in stabilizing symptoms and preventing relapses. Three strategies have shown consistent empirical evidence: group psychoeducation, family-focused therapy, and interpersonal and social rhythm therapy. The evidence supporting cognitive behavioural therapy (CBT) as an adjunctive psychosocial intervention is inconsistent, although ‘third-wave’ CBT approaches are promising. There is preliminary evidence for functional remediation in bipolar disorder patients with neurocognitive impairment.
Basic mechanisms of, and treatment targets for, depressive disorders
Authors: Pereira Marcela , Andreatini Roberto , Svenningsson Per
Published: March 2020

The diagnosis of major depressive disorder (MDD) relies on the presence of a certain number of signs and symptoms, including feelings of guilt, hopelessness, dysphoria, cognitive dysfunction, persistent sleep, and appetite abnormalities. These signs and symptoms overlap with other conditions such as anxiety, bipolar, and seasonal affective disorders. This chapter provides an overview of the basic neurobiological mechanisms underlying MDD and its treatment. There are several alterations in the molecular pathways and neuronal networks associated with MDD. The chapter focuses here on: gene × environment interactions, dysfunctional brain circuitries, neurotransmitter alterations, maladaptation in neurotrophins and neuroplasticity, hypothalamus–pituitary–adrenal (HPA) axis dysfunction, abnormal immune system responses, circadian arrhythmicity, and sleep disturbances. The chapter briefly describes the mechanisms of actions for approved antidepressant therapies and also discusses recent insights into the pathophysiology of MDD and future possible therapy targets.
Genetic epidemiology of depression in the molecular era
Authors: Merikangas Alison K. , Merikangas Kathleen R.
Published: March 2020

Familial aggregation of major depressive disorder has been well established, but identification of specific genetic markers underlying this condition has been challenging. The aims of this chapter are to: (1) provide an overview of the results of twin, family, and adoption studies, which have demonstrated that both genetic and environmental factors contribute to the aetiology of depression; (2) discuss studies of depression in the molecular genetics era, including linkage, association, genome-wide association, sequencing, polygenic, and pharmacogenetic studies; and (3) review challenges in identifying genetic factors underlying depression. The next phase of research in the genetic epidemiology of depression will require integration of research on genetic and environmental risk factors and increased recognition of the role of biologic and genetic vulnerability factors for depression.
Imaging of depressive disorders
Authors: Goodwin Guy M. , Browning Michael
Published: March 2020

Neuroimaging techniques have been used extensively to compare brain structure and function between patients with, or at risk of, depression and control subjects. The goal of this work has largely been to identify pathophysiological processes in depression. However, progress in this field has been limited by the heterogeneity of patient populations, the use of small sample sizes, and an overreliance on case-control studies. These limitations have increasingly been acknowledged with recent work collecting much larger samples and employing a variety of study designs, including those able to stratify patient populations. This chapter reviews imaging studies in depression, highlighting both outstanding questions and promising recent findings.
Imaging of stress-related disorders
Authors: Kaur Navneet , Hinojosa Cecilia , Russell Julia , VanElzakker Michael B. , Shin Lisa M.
Published: March 2020

Great advances have been made in understanding the neurocircuitry of stress disorders such as post-traumatic stress disorder (PTSD) and, to a lesser extent, acute stress disorder (ASD). Studies using structural and functional magnetic resonance imaging (MRI and fMRI, respectively) and positron emission tomography (PET) have revealed brain abnormalities consistent with a fear conditioning model. These abnormalities include hyperactivation in brain regions that are associated with the learning and expression of fear, as well as hypoactivation in structures that are associated with safety learning and fear inhibition. Although much progress has been made in our understanding of the neurocircuitry of PTSD, many questions remain unanswered. Future research will be needed to clarify the factors that affect neurocircuitry abnormalities, the origin of such abnormalities, and the role of neuroimaging in assessing and predicting treatment response.
Bereavement
Authors: Raphael Beverley , Wooding Sally , Dunsmore Julie
Published: March 2020

The human experience of loss and grief will touch us all. Grief is a deeply personal experience that will be influenced by culture, spiritual belief, the nature of the loss, gender, and the relationship with the deceased, whether it be as an individual or within a family setting. Grief has been of particular focus in the literature, given the increasing incidence of terrorism and subsequent loss via violence and trauma. Research in this area has a long history and is still evolving, with recent focus on the pathology of ongoing grief and its inclusion within the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). The majority of individuals demonstrate resilience and do not require intervention. This is less so when suffering and distress are acute and ongoing, and there are significant health impacts or functional impairment. This chapter discusses the phenomenology of ‘normal grief’ and prolonged or complicated grief, risk and protective factors that may influence the course and outcome such as trauma and the nature of the loss, and possible physical and mental health consequences in the context of current assessment and models of management.
Basic mechanisms of, and treatment planning/targets for, obsessive–compulsive disorder
Authors: Burguière Eric , Mallet Luc
Published: March 2020

Despite the range of conventional treatments available for obsessive–compulsive disorders, generally based on pharmacological and behavioural therapy, a significant number of patients receive no benefit from them. Clearly, further work is required to develop alternative therapeutic approaches to improve the treatment of the dysfunctional cognitive processes in obsessive–compulsive disorders and to better understand the neural networks involved. Some innovative tools have recently been developed in the fields of anatomical and functional imaging, neuromodulation, and animal models. These novel approaches offer opportunities to improve our understanding of the functional and pathophysiological basis of obsessive–compulsive disorders.
Body dysmorphic disorder
Authors: Kelly Megan M. , Phillips Katharine A.
Published: March 2020

Body dysmorphic disorder (BDD) is a common and unusually severe mental illness, characterized by distressing or impairing preoccupations with non-existent or slight defects in one’s physical appearance, as well as compulsive behaviours, that aim to examine, improve, hide, or obtain reassurance about the perceived defects. BDD is associated with poor quality of life and marked functional impairment, as well as high rates of suicidal ideation and behaviours. Although BDD is often under-recognized in clinical settings, both pharmacotherapy and psychosocial interventions are effective at reducing BDD symptoms and distress. This chapter presents information on the phenomenology, clinical characteristics, diagnosis, epidemiology, pathogenesis, course, and treatment of BDD.
Gender dysphoria
Authors: Elaut Els , Heylens Gunter
Published: March 2020

Gender dysphoria (GD) refers to persistent discomfort stemming from an incongruence between assigned and experienced gender, as stipulated in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Estimates of prevalence state 4.6 in 100,000 individuals suffer from GD, although referrals to gender clinics worldwide are rising. While GD often co-occurs with affective disorders, severe psychiatric problems, such as schizophrenia and bipolar disorder, are not more prevalent. GD is the result of a complex interaction between multiple genetic and environmental factors, and the exact aetiological mechanisms are largely unknown. Clinical management of adolescents, but especially children, with GD solicits a different approach from management of GD in adults. After gender-confirming treatment, most report significant improvement in GD, psychological symptoms, quality of life, and sexual function. While guidelines for treatment have been outlined, clinical practice will evolve significantly in the light of increasing diversity of treatment requests and greater client autonomy.
Personality disorders
Authors: Alarcón Renato D. , Palmer Brian A.
Published: March 2020

The clinical assessment of personality disorders (PDs) has been gaining increasing relevance in the pursuit of a comprehensive evaluation of every nosological entity in contemporary psychiatry. This section includes pertinent epidemiological data and emphasizes sociodemographic variables, family history, and comorbidities as eventual indicators of clinical course. After reviewing basic methodological issues, general prevalence figures, based on community studies and different clinical populations, are discussed. A subsection on ‘special epidemiology’ proceeds to examine specific aspects of each PD in Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), as well as additional types and personality changes due to other conditions. The heterogeneity of findings, the complexity of clinical conditions and comorbidities, the uneven patterns of clinical evolution, and the impact of genetic, socio-environmental, and cultural issues configure a multi-faceted source of knowledge, applicable to a global diagnosis and treatment of PDs and related psychiatric conditions.
Impulse-control and its disorders, including pathological gambling
Authors: Black Donald W.
Published: March 2020

Impulse-control disorders (ICDs) are conditions, the hallmark of which is difficulty with emotional and behavioural self-regulation. Acknowledged in Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) as ‘disorders of impulse control not elsewhere classified’, the category was reorganized in DSM-5 as ‘disruptive, impulse-control, and conduct disorders’. This chapter discusses oppositional defiant disorder (ODD), intermittent explosive disorder, kleptomania, pyromania, and gambling disorder. Several non-DSM conditions are also included: compulsive shopping, Internet addiction, and compulsive sexual behaviour. The latter conditions are often referred to as behavioural addictions, a category for disorders that appear to share commonalities with traditional substance use disorders but are not associated with the use of drugs or alcohol.
Domestic violence and abuse and mental health
Authors: Howard Louise M. , MacManus Deirdre
Published: March 2020

Domestic violence and abuse (DVA) is a global public health problem, accounting for up to 7% of the overall burden of disease among women, mostly due to its impact on mental ill health. It includes partner violence and violence perpetrated by other family members on adults, and may involve mutual violence or can involve coercive and controlling behaviours. Women are at greatest risk of serious physical and sexual assaults, including being victims of domestic homicide. There is growing evidence that men and women with mental disorders, particularly severe disorders, are at increased risk of being both victims and perpetrators of DVA. Despite barriers to disclosure, psychiatric services are well placed to identify and reduce the risk of future DVA and treat the mental health consequences.
Assessing and managing the risk of violence to others
Authors: Buchanan Alec
Published: March 2020

Assessing and managing the risk of patient violence is integral to the clinical practice of psychiatry. This chapter reviews the principles governing the assessment of violence risk in psychiatry, discusses clinical practice in this area, and examines the limits of psychiatric violence risk assessment. Assessment involves both the identification of risk and protective factors and a cause-based analysis based on an understanding of the case. Good practice involves the use of multiple sources of information and the integration of information gleaned from the identification of correlates of violence and a cause-based analysis. Empirical data on the limits to the predictive accuracy that can be achieved suggest that information concerning risk will usually be one of many pieces of information governing the management of a case.
Diagnostic studies
Authors: Peacock Janet L. , Peacock Philip J.
Published: March 2020

This chapter describes how statistical methods are used in diagnostic testing to obtain different measures of a test’s performance. It describes how to calculate sensitivity, specificity, and positive and negative predictive values, and shows the relevance of the pre- and post-test odds and the likelihood ratio in evaluating a test in clinical practice. The chapter also describes the receiver operating characteristic curve and shows how this links with logistic regression analysis. All methods are illustrated with examples.
F
Authors: Ainsworth Sean
Published: March 2020

This chapter presents information on neonatal drugs that begin with F, including use, pharmacology, adverse effects, fetal and infant implications of maternal treatment, treatment, and supply of Fentanyl, Fibrin sealants and cyanoacrylate tissue adhesives, Flecainide, Flucloxacillin (also cloxacillin and dicloxacillin), Fluconazole, Flucytosine, Fludrocortisone, Folic acid (pteroylglutamic acid), Formula milks for babies with intolerance/allergy, Formula milks for preterm babies, Fosfomycin, Fresh frozen plasma and cryoprecipitate, and Furosemide = Frusemide (former BAN)
G
Authors: Ainsworth Sean
Published: March 2020

This chapter presents information on neonatal drugs that begin with G, including use, pharmacology, adverse effects, fetal and infant implications of maternal treatment, treatment, and supply of Ganciclovir (and valganciclovir), Gentamicin, Glucagon, Glucose (dextrose), Glyceryl trinitrate = Nitroglycerin (USAN), Glycine, and Glycopyrronium = Glycopyrrolate (USAN)
I
Authors: Ainsworth Sean
Published: March 2020

This chapter presents information on neonatal drugs that begin with I, including use, pharmacology, adverse effects, fetal and infant implications of maternal treatment, treatment, and supply of Ibuprofen, Imipenem with cilastatin, Immunization, Immunoglobulin, Influenza vaccine, Insulin, Ipratropium bromide, Iron, Isoniazid, and Ivermectin
K
Authors: Ainsworth Sean
Published: March 2020

This chapter presents information on neonatal drugs that begin with K, including use, pharmacology, adverse effects, fetal and infant implications of maternal treatment, treatment, and supply of Ketamine
Re: AB (Termination of Pregnancy) [2019] EWCA CIV 1215: ‘Wishes and Feelings’ Under the Mental Capacity Act 2005
Authors: Cherkassky Lisa
Published: March 2020

In Re: AB (Termination of Pregnancy), the Court of Appeal was asked to consider an assumption made about the future living arrangements of a pregnant patient, and the weight to be ascribed to her wishes and feelings when she had no real understanding of her predicament. This commentary explores the importance of taking into account the perspective of the patient, even if suffering from a mental disorder, and it will analyse the existing common law to show that the weaker the ability of the patient to form her own wishes and feelings, the more appropriate it would be to rely on the remaining evidence.
On the angular momentum history of galactic discs
Authors: Renzini Alvio
Published: March 2020

The stellar mass, size, and rotational velocity of galactic discs all grow from redshift ∼2 to the present by amounts that are estimated from observationally derived scaling relations. The product of these three quantities, the angular momentum of stellar discs, is then estimated to grow by a remarkably large factor, between ∼20 and ∼50, whereas other evidences suggest a more moderate increase. This requires that the specific angular momentum of the accreted gas should systematically increase with time while remaining corotational with the disc over most of the last ∼10 Gyr. Thus, the baryonic gas vorticity of the circumgalactic medium appears to emerge as a major driver in galaxy evolution, and this Letter is meant to attract attention on the sheer size of the angular momentum increase and on the need to explore to which extent this can be observed in nature and/or in simulations.
Quark mass function at finite density in real-time formalism
Authors: Tanaka Hidekazu , Sasagawa Shuji
Published: March 2020

Chiral symmetry restoration of quarks is investigated at finite density in quantum chromodynamics. The critical chemical potentials at zero temperature, in which the chiral symmetry is restored, are calculated with the Schwinger-Dyson equation in the real-time formalism without the instantaneous exchange approximation. We present some properties of the quark mass functions and the quark propagators.
How Important Are Inflation Expectations for the Nominal Yield Curve?
Authors: Gomez-Cram Roberto , Yaron Amir
Published: March 2020

Macrofinance term structure models rely too heavily on the volatility of expected inflation news as a source for variations in nominal bond yield shocks. We develop and estimate a model featuring inflation nonneutrality and preference shocks. The stochastic volatility of inflation and consumption govern bond risk premiums movements, whereas preference shocks generate fluctuations in real rates. The model accounts for key bond market features without resorting to an overly dominating expected inflation channel. The estimation shows that preference shocks are strongly negatively correlated with market distress factors and that real rate news is the dominant driver of nominal yield shocks.
Quality metrics of screening colonoscopies performed by PAs
Authors: Fejleh M. Phillip , Shen Ching-Chieh , Chen Jacqueline , Bushong Joseph A. , Dieckgraefe Brian K. , Sayuk Gregory S.
Published: March 2020

Background:

Many communities face a shortage of qualified endoscopists. Training physician assistants (PAs) to perform colonoscopies can expand the availability of colorectal cancer screening. This study examined screening colonoscopy metrics and quality indicators among gastroenterologists, supervised PAs, and gastroenterology fellows.

Methods:

Consecutive patients undergoing average-risk screening colonoscopy were stratified into one of three groups by endoscopist type. Procedure and pathology reports were reviewed for the technical performance and quality metrics of the providers.

Results:

PAs performed comparably to gastroenterologists in technical performance and quality metrics, and demonstrated higher cecal intubation rates than their gastroenterologist colleagues. Comparisons of attending physicians and PAs grouped by years of experience also did not show notable differences in performance.

Conclusions:

In a supervised practice, PAs performed on par with their gastroenterology colleagues on established colonoscopy quality indicators. Following proper training, PAs can be employed in the provision of screening colonoscopy.
Predatory Publishing Is Alive and Well
Authors: Kennedy Maureen Shawn
Published: March 2020

We need to be vigilant against fake journals.
Olaparib Approved for Metastatic Pancreatic Cancer
Authors: Aschenbrenner Diane S.
Published: March 2020

Olaparib (Lynparza) is now approved for maintenance treatment in adults with deleterious or suspected deleterious germline BRCA-mutated metastatic pancreatic adenocarcinoma.
CE: Acute Care for Patients with Dementia
Authors: Zonsius Mary C. , Cothran Fawn A. , Miller Joanne M.
Published: March 2020

Among adults ages 65 and older, dementia doubles the risk of hospitalization. Roughly one in four hospitalized patients has dementia, and the prevalence of dementia in the United States is rising rapidly. Patients with dementia have significantly higher rates of hospital-acquired complications, including urinary tract infections, pressure injuries, pneumonia, and delirium, which when unrecognized and untreated can accelerate physical and cognitive decline, precipitating nursing home placement and death. The authors discuss the unique needs of patients with dementia who require acute care, highlighting evidence-based strategies for nurses to incorporate into practice.
Women Surveyed on their Abortion Decision
Authors: Rosenberg Karen
Published: March 2020

According to this study:

In the five years after having an abortion, a majority of women said they felt abortion was the right decision.

Both negative and positive emotions about abortion declined over five years; relief was predominant.
A New Normal
Authors: Reed Andrew Dwight
Published: March 2020

A badly injured young man and his family take an important step toward acceptance.
Social Mission Metrics: Developing a Survey to Guide Health Professions Schools
Authors: Batra Sonal , Orban Julie , Guterbock Thomas M. , Butler Leigh Anne , Mullan Fitzhugh
Published: March 2020

The social mission, which is focused on advancing social justice and health equity, has gained recognition as an important aspect of health professions education. However, there is currently no established method to measure a school’s commitment to these activities. In this Perspective, the authors describe the development of a new tool to measure the social mission at dental, medical, and nursing schools across the United States, and they reflect on the implications of using this tool to deepen discussions around the social mission and strengthen progress toward health equity.

From 2016 to 2019, the authors created and field tested the online social mission metrics survey for health professions schools to identify their level of engagement in social mission activities, track that level over time, and compare their progress with that of other schools. The survey measures a school’s social mission values, programs, and activities across 6 domains and 18 activity areas. The authors also developed a scoring system based on stakeholder priorities, which they used to provide customized, confidential feedback to the schools that participated in the field tests.

Going forward, the authors recommend that schools complete the survey every 3 to 5 years to track their social mission over time, and they plan to expand the survey process to additional dental, medical, and nursing schools as well as to schools in other health professions. The social mission metrics survey is meant to be a useful tool for improving the level and quality of social mission engagement at health professions schools, with the goal of improving the awareness, skills, and commitment of health professionals to health equity.
Statistics for the Practicing Spine Surgeon
Authors: Goyal Dhruv K.C. , Stolz Katharine , Lee Thomas J. , Thomas Alexander , Grandhi Nikhil , Galetta Matthew S. , Divi Srikanth N. , Fang Taolin , Schroeder Gregory D. , Kepler Christopher K. , Vaccaro Alexander R.
Published: March 2020

There are vast numbers of evidenced-based clinical trials produced each year, making it increasingly difficult to stay up to date with new treatments and protocols designed to provide the most optimal patient care. A physician’s ability to combine existing knowledge with new data is limited by a basic understanding of the background statistics used in these studies. Our goal is to not only define the basic statistics commonly used in clinical trials but to also ensure that practitioners are able to have a working understanding of these statistical measurements to effectively make the most informed and efficacious decisions regarding patient management. On the basis of the recent growth of empirical spine literature, it is becoming more important for spine surgeons to have the basic statistical background necessary to efficiently interpret new data, which may affect clinical decision making regarding patient care.
A Novel Arthroscopic-assisted Repair of Palmer 1B Triangular Fibrocartilage Complex Tears: Early Results
Authors: Kelsheimer Alexander J. , Timmermann Anne P. , Howard Richard F.
Published: March 2020

Introduction:

Ulnar-sided wrist pain is a common and complex complaint. One common diagnosis is an injury to the triangular fibrocartilage complex (TFCC). An essential and stabilizing component of the TFCC is the foveal insertion. Multiple open, arthroscopic, and combination techniques have been described with successful outcomes. Our novel technique refines previously described techniques and takes advantage of modern technology.

Materials and Methods:

All patients underwent the novel technique, which was performed by a fellowship-trained hand surgeon. A retrospective chart review was performed and 13 patients met the inclusion criteria. Information on patient age, sex, surgery side and preoperative and postoperative Quick-Disability of the Arm, Shoulder, and Hand (DASH) scores were collected.

Results:

Patients averaged 39.69±13.95 years and were followed for a mean of 15.38 weeks. The mean preoperative Quick-DASH scores were 20.38±8.23 and postoperatively were 16.85±10.33. There was no significant improvement in Quick-DASH scores postoperatively.

Discussion:

Our arthroscopic-assisted ulnar tunnel repair offers a novel technique for foveal TFCC repairs that avoids some of the traditional complications of an open repair or knotted suture repair, is reproducible and offers the added strength of modern suture anchors with ligament to bone healing. The lack of significant improvement in postoperative outcomes was limited by the small population and short postoperative follow-up.
Outcomes and the Role of Primary Histology Following LINAC-based Stereotactic Radiation for Sarcoma Brain Metastases
Authors: Sim Austin J. , Ahmed Kamran A. , Keller Andrew , Figura Nicholas B. , Oliver Daniel E. , Sarangkasiri Siriporn , Robinson Timothy J. , Johnstone Peter A.S. , Yu Hsiang-Hsuan Michael , Naghavi Arash O.
Published: March 2020

Objectives:

The brain is a rare site for sarcoma metastases. Sarcoma’s radioresistance also makes standard whole-brain radiotherapy less appealing. We hypothesize that stereotactic radiation techniques (stereotactic radiosurgery [SRS]/stereotactic fractionated radiotherapy [FSRT]) may provide effective local control.

Materials and Methods:

This single-institution retrospective analysis evaluated our experience with linear acceleator-based SRS/FSRT for sarcoma brain metastases. Time to event analysis was estimated via Kaplan-Meier. Univariable/multivariable Cox regression analyses followed to assess the impact of patient and disease characteristics on outcomes.

Results:

Between 2003 and 2018, 24 patients were treated with 34 courses of SRS/FSRT to 58 discrete lesions. The median age at first treatment was 57 years (range: 25 to 87 y). Majority of patients had concurrent lung metastases (n=21; 88%), diagnosed spindle cell sarcoma (n=15; 25%) or leiomyosarcoma (n=12; 21%) histology, and were treated with either SRS (n=43; median dose=19 Gy, range: 15 to 24 Gy) or FSRT (n=17; 3/5 fractions, median dose=25 Gy, range: 25 to 35 Gy). With a median follow-up after brain metastasis of 7.3 months, the 6 month/12 month local control, distant brain control, and overall survival of 89%/89%, 59%/34%, and 50%/38%, respectively. All local failures were of primary spindle cell histology (P<0.001), which was associated with poorer distant control (hazard ratio=25.8, 95% confidence interval: 3.1-536.4; P=0.003) on univariable analysis, and OS (hazard ratio=7.1, 95% confidence interval: 2.0-26.1; P=0.003) on multivariable analysis.

Conclusions:

This is the largest patient cohort with sarcoma brain metastases treated with SRS/FSRT, it provides durable local control, despite a reputation for radioresistance. Further prospective evidence is required to determine the impact of primary histology on control and survival following brain metastasis diagnosis.
The accuracy of ascites cytology in diagnosis of advanced ovarian cancer in postmenopausal women prior to neoadjuvant chemotherapy
Authors: Baransi Saher , Michaan Nadav , Gortzak-Uzan Limor , Aizic Asaf , Laskov Ido , Gamzu Ronni , Grisaru Dan
Published: March 2020

Objective:

To evaluate the accuracy of ascites cytology in the diagnosis of epithelial ovarian cancer among postmenopausal women.

Methods:

Ascites samples of women older than 51 years sent for cytology evaluation at our institution between 2010 and 2015 were retrospectively compared to final histology. The sensitivity, specificity, negative, and positive predictive values were calculated. Immunohistochemistry stain results were collected to determine diagnostic profiles.

Results:

A total of 551 patients, 51 years and over had both cytology and diagnostic histology samples. Of those, 161 patients had pathology confirmed ovarian tumors, 155 of which were malignant. Of the 155 cases of ovarian cancer, 125 patients had malignant cells on cytology examination (true positive); in 30 cases, ascites was negative for malignancy (false negative). In six cases both ascites and final pathology were negative for malignancy (true negative). There were no cases of positive cytology and negative final pathology (ie, no false-positive cases). The sensitivity, specificity, positive, and negative predictive value for cytology diagnosis of ovarian cancer were 80.6%, 100%, 100%, and 16.7%, respectively. Immunohistochemistry was done on cell blocks in 79 cases of ovarian cancer, 75 (94.9%) had profiles diagnostic for ovarian origin.

Conclusions:

Ascites cytology for postmenopausal women older than 51 years with immunohistochemistry is highly accurate in diagnosis of ovarian cancer. Neoadjuvant chemotherapy can be safely prescribed based on paracentesis evaluations.

Video Summary:http://links.lww.com/MENO/A570.