bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding Substance Use Problems
Authors: Daley Dennis C. , Douaihy Antoine
Published: September 2019

This chapter provides an overview of substance use, substance use disorders (SUDs), and co-occurring disorders (CODs, or SUDs combined with psychiatric illness). The authors address current trends in substance use, challenges for practitioners, the importance of a therapeutic alliance with clients, causes and effects of SUDs, classification of SUDs based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and specific symptoms of a SUD. A substance problem exists when an individual experiences any difficulty or adverse effect caused by the use of alcohol, tobacco, or other drugs. These include illicit street drugs and prescription drugs with addiction potential used for pain, anxiety, sleep, and attention deficit disorder.
Goal Planning in Recovery
Authors: Daley Dennis C. , Douaihy Antoine
Published: September 2019

Recovery is the process of managing a substance use disorder (SUD) and making changes in oneself and one’s lifestyle to improve the quality of life. Recovery involves four major dimensions: (1) health, (2) home, (3) purpose, and (4) community. The objectives of this chapter are to help the client learn that there are different paths to recovery, to help the client learn about the various domains of recovery, to help the client identify specific recovery goals, and to help the client develop strategies to reach the identified goals.
Managing Cravings and Urges to Use Substances
Authors: Daley Dennis C. , Douaihy Antoine
Published: September 2019

A craving or longing for alcohol, tobacco, or other drugs is common, especially in the early weeks and months of stopping substance use, regardless of how motivated clients are to stay substance-free. Cravings are mediated by brain activation in the amygdala region. Cravings can be activated by exposure to drug cues via classical conditioning. Memories associated with substance use can trigger a craving. Usually, cravings decrease in frequency and intensity as recovery progresses and the client abstains from substance use. The objectives of this chapter are to help the client identify and label a craving to use substances, to teach the client to monitor and rate the level of intensity of cravings, to identify internal and external factors that trigger cravings, and to teach cognitive, behavioral, environmental, and interpersonal strategies to manage alcohol or drug cravings.
Managing Thoughts of Using Substances
Authors: Daley Dennis C. , Douaihy Antoine
Published: September 2019

Helping clients to become aware of and challenge thoughts of using substances reduces the risk of relapse and raises the client’s level of self-confidence. Clients who experience a high-risk relapse situation and have positive thoughts of using are more vulnerable to taking a drink, smoking, or using other drugs. This is especially true if the client has little confidence in his or her ability to manage thoughts of using. The objectives of this chapter are to help the client become aware of how thoughts of using substances can contribute to relapse, to help the client identify common thoughts and apparently irrelevant decisions that precede substance use, and to help the client learn strategies to manage and challenge thoughts of using alcohol, tobacco, or other drugs.
Relapse Management
Authors: Daley Dennis C. , Douaihy Antoine
Published: September 2019

Even if clients are working toward total abstinence, they should be prepared to handle setbacks. Many clients who attempt to quit substance use will use again. Knowing how to interrupt a lapse or relapse can help clients minimize the damage associated with a return to substance use. Lapses and relapses can be viewed as opportunities to learn from mistakes. Clients can use them to get back on track, change their recovery plan, or focus on learning new skills. How a client responds to an initial lapse plays a significant role in whether the lapse leads to a relapse. Clients who lapse and then judge themselves harshly as failures or have strong feelings of demoralization are at risk for continuing to use substances. The objectives of this chapter are to help the client identify strategies to interrupt an actual lapse or relapse, to raise the client’s awareness of her or his emotional and cognitive reactions to a lapse and how these reactions may lead to a relapse, and to complete a “relapse debriefing” to help the client learn from a lapse or relapse.
Measuring Progress
Authors: Daley Dennis C. , Douaihy Antoine
Published: September 2019

Progress in recovery is measured according to the client’s goals. It is helpful for clients to periodically review their progress and check it against their goals. This helps clients see if they are making progress and to identify new goals and recovery strategies. Viewing progress realistically helps improve client motivation to continue working toward recovery and reinforces positive changes, no matter how small. In some cases, progress is significant and obvious. In other instances, it has to be measured in small changes. Progress can be measured in terms of cessation or reduction of substance use as well as in improvement in other areas of life or quality of life. The objectives of this chapter are to help clients evaluate progress against goals identified in their change plan, to help clients be realistic about ways in which to measure progress, and to help clients modify all-or-none beliefs about progress in order to appreciate small changes.
Advanced Genetic Counseling
Authors: Biesecker Barbara B. , Peters Kathryn F. , Resta Robert
Published: September 2019

Advanced Genetic Counseling: Theory and Practice addresses educational objectives for second-year genetic counseling students. Building on mastery of genetics principles and baseline clinical skills, this comprehensive textbook begins with the history of the profession as it relates to current practice definitions and goals. Characteristics of clients and counselors that may affect the counseling relationship are presented to guide strategies for achieving positive client outcomes. Throughout the text, a psychotherapeutic counseling approach is advocated. Steps to establishing a therapeutic alliance are outlined and the elements of relational counseling emphasized. The psychological counseling theories presented will help counselors identify interventions to address client needs. Students are encouraged to pursue research to address gaps in evidence needed to guide practice. Health behavior and social psychology theories offer models to assess health perceptions and behaviors. The book concludes with a look toward the future of genetic counseling in the genomics era.
History of Genetic Counseling
Authors: Biesecker Barbara B. , Peters Kathryn F. , Resta Robert
Published: September 2019

The history of genetic counseling as a clinical practice ultimately has its roots in eugenics. Although medical geneticists distanced themselves from eugenic ideology after World War II, that separation was sometimes more in name than practice. The history of the genetic counseling profession does not have direct connections to eugenics, although the profession has since its inception been intimately connected with medical genetics and medical geneticists. Key historical moments in the emergence of genetic counseling as an independent profession include the creation of specialized master’s-level training programs beginning in 1969 at Sarah Lawrence College, the formation of a professional society (the National Society of Genetic Counselors), a professional certification process governed by genetic counselors separate from medical geneticists, the establishment of a professional journal, and working affiliations with a wide range of clinicians beyond medical geneticists such as obstetricians, oncologists, surgeons, cardiologists, and neurologists.
Characteristics of Genetic Counseling Clients
Authors: Biesecker Barbara B. , Peters Kathryn F. , Resta Robert , Barbara Biesecker
Published: September 2019

It is readily apparent that not all genetic counseling clients are homogeneous. However, it is harder to appreciate the ways that client variability can impact the process, dynamics, and outcomes of genetic counseling. Some of the critical client characteristics that come into play during genetic counseling are religion, gender, sexuality, ethnicity and culture, language, health status, age, and family dynamics. These traits influence not only the way that we perceive and engage with clients, but also the way that clients perceive and engage with us. Failure to recognize the influence of these characteristics can result in poor counseling outcomes and frustration on the part of both clients and counselors. Awareness and management of transference and countertransference are critical to delivering competent and compassionate care.
Psychological Counseling Theories
Authors: Biesecker Barbara B. , Peters Kathryn F. , Resta Robert
Published: September 2019

Due to the diversity of clients’ needs, there is no central theory of genetic counseling. Psychological counseling offers an array of theories pertinent to the goals of genetic counseling sessions. These theories offer frameworks in which strategies emerge that may be most effective in meeting client needs. Person-centered theory was introduced at the origins of genetic counseling for its contribution of the concept of nondirectiveness. Yet Carl Rogers himself obliterated this from his person-centered theory once he came to appreciate that all human interactions have directive components. Since then, this theory has remained pertinent to genetic counseling because of its high regard for clients’ personal resources and their self-actualizing potential. Cognitive-behavioral and solution-focused theories can be applied to cases where decisions are being deliberated to help clients weigh potential consequences. Strength-based counseling leaves clients empowered to effectively cope with challenging circumstances. Such theories are contrasted to practical approaches that include bereavement and crisis counseling. In the latter, the counselor attends to clients’ need for safety and care from loved ones as they absorb devastating news.
Blister Aneurysm of the Internal Carotid Artery
Authors: Nakaji Peter , Levitt Michael R.
Published: September 2019

Abstract: Blister aneurysms are a rare cause of subarachnoid hemorrhage. They are easily overlooked on conventional imaging and catheter angiography due to their small size and unusual anatomic location. Whereas the medical management of subarachnoid hemorrhage is similar to that of saccular aneurysms, the surgical management of blister aneurysms is more challenging due to their unique pathology and higher risk of intraoperative rupture. Special consideration should be made for open management such as preparation of the option of bypass or the emerging use of endovascular techniques such as flow diversion. This chapter reviews the diagnosis and medical and surgical management of blister aneurysms.
Posterior Communicating Artery Aneurysm Presenting with and without Third Nerve Palsy
Authors: Corliss Brian M. , Hoh Brian L.
Published: September 2019

Abstract: Posterior communicating artery (PCOM) aneurysms are common and carry a higher risk of rupture than aneurysms at other locations in the brain. They arise from the ventral surface of the intradural internal carotid artery and often incorporate the posterior communicating artery itself. PCOM aneurysms are in close proximity to the oculomotor nerve and therefore can cause symptoms of oculomotor palsy from mass effect or hemorrhage. There are both open surgical and endovascular options for these aneurysms, which may be modified in the context of a third nerve palsy. This chapter discusses differential diagnosis and management strategies for patients presenting with third nerve palsy, placing emphasis on the management of PCOM aneurysms, both ruptured and unruptured.
Incidental Anterior Communicating Artery Aneurysm
Authors: Yaeger Kurt , Mocco J.
Published: September 2019

Abstract: Anterior communicating artery aneurysms are among the most commonly encountered aneurysms in neurosurgical practice. While many are treatable using modern endovascular techniques, because of their often complex anatomy, both ruptured and unruptured anterior communicating artery aneurysms often require microsurgical treatment. Pre-operative analysis of the collateral circulation, the aneurysm orientation, the aneurysm height, morphology, and the dome-to-neck ratio can all affect decision-making. For unruptured aneurysms, a careful analysis of the natural history of rupture risk versus the risks of surgery or endovascular treatment will determine if treatment is recommended and what modality. At surgery, perforating artery preservation is of utmost importance. This chapter discusses these issues as considered in the management of an incidental, unruptured anterior communicating artery aneurysm.
Ruptured Anterior Communicating Artery Aneurysm
Authors: Connolly E. Sander , Lavine Sean D. , Mandigo Grace K. , Altschul Dorothea , Satar Ahsan , Solomon Robert A. , Meyers Philip M.
Published: September 2019

Abstract: Anterior communicating artery aneurysms are among the most commonly encountered ruptured aneurysms. Both endovascular and microsurgical treatment should be considered. Their complex anatomy makes microsurgical treatment challenging, a concern that is amplified in the setting of subarachnoid hemorrhage. Nonetheless, many will still require microsurgical treatment. Small aneurysms and those with a broad neck are particularly likely to need microsurgical treatment. Posteriorly projecting aneurysms or those that present in patients who have high medical risk for surgery should be favored for an endovascular approach. This chapter reviews the diagnostic and therapeutic considerations in the management of ruptured anterior communicating artery aneurysms, including the selection of surgical approach based on aneurysm anatomy.
Small Incidental Internal Carotid Artery Terminus Aneurysm
Authors: Cole Tyler S. , Ding Dale , Almefty Rami O. , Baranoski Jacob F. , Ducruet Andrew F. , Albuquerque Felipe C.
Published: September 2019

Abstract: This chapter presents a case of a man with a history of previous subarachnoid hemorrhage from a ruptured basilar tip aneurysm and incidentally noted small, left, internal carotid artery bifurcation aneurysm that was unruptured. Preoperative assessment and decision-making for treatment are discussed for an unruptured aneurysm in the context of risk factors for hemorrhage, which varies by location. Relative indications for endovascular compared to open surgical treatment are presented, as well as comparative results of treatment with the different modalities. Procedure-related complications and management are also outlined. The presence of a large number of critical perforators around internal carotid artery terminus aneurysm that must be preserved presents a special risk of this aneurysm type, that must be considered for either open or endovascular treatment.
Giant Aneurysm of the Middle Cerebral Artery Presenting with Headache
Authors: Wicks Robert T. , Spetzler Robert F.
Published: September 2019

Abstract: This chapter reviews the diagnosis, preparation, and treatment options for giant middle cerebral artery aneurysms. Despite advancements in the techniques of microneurosurgery and the rapid technological developments in the field of neuroendovascular surgery, giant aneurysms of the middle cerebral artery remain a persistent management challenge. Due to the involvement and relation of multiple branching arteries, endovascular treatment options are often limited. The surgeon and surgical team must be well versed in the techniques of complex clip reconstruction as well as a number of possible variations of bypass options. In addition, they must be prepared with contingency plans for the varying intraoperative and postoperative complications that can occur. These larger aneurysms require both more complex decision-making and higher technical skills to treat successfully.
Incidental Medium-Sized Basilar Tip Aneurysm
Authors: Winkler Ethan A. , Rutledge W. Caleb , Lu Alex , Abla Adib A.
Published: September 2019

Abstract: Posterior circulation aneurysms, including those in the basilar tip location, are commonly seen in neurosurgical practice. They represent about 10% of aneurysms. Although posterior circulation aneurysms are often treated via endovascular means, microsurgical clipping of basilar tip aneurysms is still occasionally indicated. A thorough understanding of the natural history of unruptured aneurysms in all locations is needed to drive proper management, and the higher rupture risk of posterior circulation aneurysms must be considered. Endovascular management techniques for these aneurysms now employ a wide range of strategies to achieve complete occlusion. For those treated with open surgery, careful patient selection and excellent microsurgical technique are essential for effective treatment.
Wide-Necked Large Ruptured Basilar Tip Aneurysm
Authors: Baranoski Jacob F. , Przybylowski Colin J. , Cole Tyler S. , Almefty Rami O. , Ding Dale , Albuquerque Felipe C. , Ducruet Andrew F.
Published: September 2019

Abstract: This chapter reviews the clinical decision-making regarding ruptured basilar tip aneurysms. Basilar tip aneurysms can present formidable challenges for microsurgical clipping due to their less-accessible location, difficulties associated with proximal control, their variable height, and the presence of critical thalamoperforating vessels at their neck. Accordingly, ruptured basilar tip aneurysms are often treated using endovascular techniques. Because of the morphology of the origin of these aneurysms at the basilar bifurcation, adjunctive treatment with balloon or stent assistance is often required. Preservation of the major outflow branches in this region is also critical to a good outcome. Careful monitoring post-operatively is needed for complications of thromboembolism or late complications of coil compaction and regrowth.
Giant Cavernous-Segment Internal Carotid Artery Aneurysm Presenting with Cranial Neuropathy
Authors: Baranoski Jacob F. , Cole Tyler S. , Przybylowski Colin J. , Almefty Rami O. , Ding Dale , Ducruet Andrew F. , Albuquerque Felipe C.
Published: September 2019

Abstract: This chapter discusses issues surrounding the management of giant cavernous carotid artery aneurysms. These aneurysms most commonly present with symptoms of cranial neuropathy. They present a unique treatment challenge given their location and often large size. Endovascular flow diversion has emerged as the mainstay of treatment, although parent vessel sacrifice, high-flow bypass, and surgical trapping are important alternatives. Evaluation of the nature of collateral circulation and the tolerance of the intracranial circulation to carotid artery sacrifice should also be part of the work-up. The technical details of endovascular flow diversion strategy are described, as well as the management of known post-procedural complications.
Symptomatic Cervical Carotid Artery Stenosis
Authors: Dornbos David , Burnsed Brandon , Arthur Adam
Published: September 2019

Abstract: This chapter discusses the medical and surgical management of carotid artery disease, including both surgical and endovascular revascularization. Surgical treatment for symptomatic cervical carotid artery stenosis is one of the most effective means of preventing ischemic stroke. It has been validated through multiple high-quality prospective surgical trials. There is substantial reduction of stroke risk versus best medical management with treatment of carotid stenosis via carotid endarterectomy. Although endovascular management with carotid artery angioplasty and stenting has emerged as another high-quality treatment, carotid endarterectomy remains the treatment of choice for patients who are of acceptable medical risk for surgery. The details of the carotid endarterectomy procedure and its perioperative management are discussed.
Symptomatic Intracranial Arterial Stenosis
Authors: Sen Rajeev D. , Ghodke Basavaraj , Levitt Michael R. , Sekhar Laligam N.
Published: September 2019

Abstract: This chapter discusses intracranial artery stenosis (IAS). Intracranial artery stenosis is most often caused by atherosclerotic disease. Although often asymptomatic, if the degree of stenosis becomes severe enough or the atherosclerotic plaque becomes unstable, patients can suffer from transient or even permanent ischemic injury. In most cases, medical management is the mainstay of treatment. However, endovascular treatment offers additional options. This chapter discusses a case in which a male patient who presented with transient episodes of left-sided hemiparesis due to stenosis of the left distal internal carotid artery was treated with endovascular angioplasty and stenting. This case highlights the importance of understanding the pathophysiology of symptomatic IAS in determining when surgical management is indicated.
Moyamoya Vasculopathy Presenting with Transient Neurological Deficit
Authors: Brunozzi Denise , Amin-Hanjani Sepideh , Charbel Fady T.
Published: September 2019

Abstract: This chapter addresses the management of patients with moyamoya vasculopathy presenting with transient neurological deficit. Progressive occlusion of the major intracranial arteries at the intradural carotid bifurcation with collateral formation is the hallmark of moyamoya vasculopathy. This rare disorder can cause both hemorrhagic and ischemic stroke, and it is often encountered in younger patients. The radiographic stage of the disease can help estimate both the risk of stroke and the need for treatment, although decision-making must be considered in the context of the degree of clinical symptomatology. Surgical management includes revascularization with extracranial–intracranial bypass, and careful patient selection and surgical technique are required to improve patient outcomes.
Cerebral Venous Sinus Thrombosis Presenting with Altered Mental Status
Authors: Wali Arvin R. , Cheung Vincent , Santiago-Dieppa David R. , Pannell J. Scott , Khalessi Alexander A.
Published: September 2019

Abstract: Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke, but if left untreated, it can result in significant morbidity or mortality. Complications of CVST include cerebral infarction, cerebral hemorrhage, focal neurologic deficit, hydrocephalus, seizure, coma, and death. Therefore, prompt diagnosis and initiation of treatment is critical. Noninvasive imaging modalities can often readily identify CVST. Systemic anticoagulation is the mainstay of CVST treatment, even in cases associated with cerebral hemorrhage. For patients who are refractory to medical management, endovascular therapy may be used as an adjunctive treatment. After the acute phase, evaluation for underlying hypercoaguable disorders is necessary to risk stratify patients and determine their duration of anticoagulation. This chapter presents a case of a patient with symptomatic CVST. Relevant diagnostic and treatment strategies are discussed.
Unruptured Eloquent Arteriovenous Malformation Presenting with Seizure
Authors: Schmalz Philip G. R. , Gupta Raghav , Ogilvy Christopher S.
Published: September 2019

Abstract: Unruptured cerebral arteriovenous malformations often present with seizure. The mechanism of seizure can vary from effect of surrounding hemosiderin from subclinical hemorrhage, arterial steal, or venous congestion. Medical and surgical management should primarily focus on reduction of seizure symptoms and elimination or reduction of arteriovenous malformation rupture risk. Arteriovenous malformation treatment lowers seizure risk, and should be considered for patients in whom resection can be achieved with acceptably low morbidity and mortality. The exact approach chosen will depend on the size, location, and complexity of the arteriovenous malformation. This chapter discusses the pre-surgical evaluation and treatment by surgical resection (with adjunctive embolization) for patients presenting symptomatic with seizures from unruptured cerebral arteriovenous malformations.
Unruptured Eloquent Arteriovenous Malformation Presenting with Arm Weakness
Authors: Ilyas Adeel , Ding Dale , Shepard Matthew J. , Sheehan Jason P.
Published: September 2019

Abstract: Cerebral arteriovenous malformations are often located in regions of the brain that are not surgically accessible, or they are found in patients who are not candidates for microsurgery. If the expected neurological morbidity of surgical extirpation is unacceptably high, or if the patient’s medical condition presents an unacceptable risk for surgery, either conservative management or radiosurgery should be offered. Stereotactic radiosurgery provides a noninvasive treatment of such lesions and should be considered in the discussion of management of all arteriovenous malformations. Customization of treatment strategy to each arteriovenous malformation is necessary, as obliteration rates and complications share an inverse relationship depending on treatment volume and radiation dose. This chapter presents the key considerations in the work-up and radiosurgical management of patients with arteriovenous malformations.
Incidental Ethmoidal Dural Arteriovenous Fistula
Authors: Eli Ilyas , Kim Robert , Schmidt Richard H. , Taussky Philipp , Couldwell William T.
Published: September 2019

Abstract: Anterior cranial fossa (ethmoidal) dural arteriovenous fistulas are an important subtype of cranial dural arteriovenous fistulas. These fistulas transit the skull base between the ethmoidal artery feeding branch and the anterior inferior frontal lobe. They are most often considered high risk fistulas. Because of their location and almost exclusively cortical venous drainage, they often present with hemorrhage. Surgical clipping and resection is the mainstay of treatment, with a high rate of effectiveness and a low rate of complications. However, in certain cases, transarterial and transvenous embolization have emerged as important management alternatives. This chapter discusses the diagnosis and management of ethmoidal dural arteriovenous fistulas.
Small Cavernous Malformation Presenting with Medically Refractory Epilepsy
Authors: Williams John R. , White-Dzuro Gabrielle A. , Levitt Michael R. , Ko Andrew L.
Published: September 2019

Abstract: Cerebral cavernous malformations are a rare but important cause of medically refractory epilepsy. Although medical management is important in seizure control, surgical resection remains the most effective method of both reducing seizure frequency and eliminating hemorrhage risk. The prognosis for seizure control with resection is excellent. Adjacent hemosiderin-stained brain is resected unless the cortical location is highly eloquent. A key part of the management is the decision as to when to offer surgery. Radiosurgery is generally felt to be an ineffective treatment for cavernous malformations. This chapter discusses the diagnosis, presurgical workup, and operative nuances that should be considered when treating this disease.
Ruptured Brainstem Cavernous Malformation
Authors: Munich Stephan A. , Morcos Jacques J.
Published: September 2019

Abstract: Brainstem cavernomas represent approximately 15% of all intracranial cavernous malformations. Unlike their supratentorial counterparts, the risk of hemorrhage of brainstem cavernous malformations is approximately 3%, whereas the risk of rehemorrhage has been reported to be greater than 30%. Given their location deep in the brain and proximity to critical structures and fiber tracts, small lesions (particularly when ruptured) may cause significant morbidity. The management of ruptured brainstem cavernomas requires a thorough understanding of the fine balance between their natural history and the intricacies, efficacy, and morbidity associated with their surgical resection. Embolization and radiosurgery do not play a role in management.
Ruptured Spinal Arteriovenous Malformation
Authors: Liebelt Brandon D. , Lee Michaela H. , Nakaji Peter , Spetzler Robert F.
Published: September 2019

Abstract: Ruptured spinal arteriovenous malformations are a rare cause of spinal cord injury. They should be considered especially in the differential diagnosis of younger patients with sudden onset of both severe back pain and neurological deficit. They may present with abrupt onset of hemorrhage, spinal edema and progressive myelopathy, and sudden thrombosis. They may occur in any part of the spinal cord anatomically. The pathophysiology and natural history of these lesions are poorly understood. When feasible, microsurgical resection is the most effective treatment for prevention of further hemorrhage or neurological deficit. In distinction to cerebral arteriovenous malformations, spinal cord malformations can often be treated effectively by pruning the extramedullary vasculature without removing the entire lesion.
Central Nervous System
Authors: Brown Robert
Published: September 2019

Neurological critical illness presents a unique set of challenges for the perioperative intensivist. An understanding of the significance and management of this pathophysiology holds particular pertinence in the neurosciences intensive care unit but also in every type of surgical unit. Neurological disease is prevalent in nearly every intensive care unit environment, and in-depth knowledge of this system is necessary to provide excellent care. This chapter aims to cover disease processes and management that every intensivist should know as well as a few unique scenarios.
Hematology and Oncology
Authors: Ben-Jacob Talia K. , Behrens Danielle L. , Potestio Christopher P.
Published: September 2019

Hematologic and oncologic disorders pose unique challenges, particularly in the setting of chronic disease. Many of the pathological states in this chapter are seen in subspecialized practice settings but are required knowledge universally because of the frequency of such patients suddenly deteriorating as disease and age progress. The rise of novel oral anticoagulants and their reversal agents adds to the complexity of this topic. The surgical population in particular requires the application of this knowledge set for safe patient care. As result, coagulopathy is definitively in the wheelhouse of every perioperative physician and can be expected to have daily application in practice.
Critical Care Review
Authors: Cross James M. , George Tonya C. , Huzar Todd F.
Published: September 2019

Thermal and inhalational injuries pose unique challenges in critical care that extend far beyond volume resuscitation. The inflammatory nature of a burn injury, along with the unique ongoing management of such injuries from a wound care and pain control perspective, necessitate a precisely calibrated approach to this population. As thermal injury frequently involves compromise to the integumentary system and interaction with the extracorporeal environment, questions within this domain can easily span from dermatologic lesions and images to systemic inflammation. Therefore, this topic frequently tangentially spans cardiovascular, immunology, infectious diseases, renal and pulmonary disease. This chapter provides salient clinical insight into the management of these patients, the thought process involved with this type of clinical presentation and offers a well-rounded review for the certification examination.
Endocrinology
Authors: Grewal Navneet Kaur , Williams George W.
Published: September 2019

Endocrinology is a topic that is tightly aligned with neurological disease, infectious diseases, nephrology, and postoperative management; in fact, the endocrine system is a chemical version of the neurological system. In many respects, it is entangled with all of critical care and is a substantial topic even on the core anesthesiology examination. In the same vein, endocrinopathies of various types are an ideal method through which an examination board can generate material. When once considers the scope and breadth of endocrinopathies, this system generally effects every critically ill patient while also serving as an indicator for disease in other systems. These concepts are empowering when mastered and add tremendous clinical dexterity to the clinician when applied in the intensive care unit.
Pulmonology
Authors: Lytle Ted , Popovich Marc J.
Published: September 2019

The management of pulmonary disease and mechanical ventilation encompasses part of the core of critical care medicine. Because physician anesthesiologists routinely manage ventilators on a daily basis, functional elements of mechanical ventilation are not heavily emphasized in this chapter, though the authors seek to avoid taking knowledge of this topic by the reader for granted. On the converse, this chapter seeks to emphasize clinically realistic and testable concepts that address authentic management decisions for patients with respiratory failure or pathophysiology related to critical illness. Additionally, complications associated with ongoing mechanical ventilation and pertinent diagnostic processes are tested in this chapter with some questions that demand rote knowledge of mechanical ventilation. Pulmonary disease represents a significant component of all critical care examinations and is a key element of practice for the every intensivist.
Procedures
Authors: Grewal Navneet Kaur
Published: September 2019

Procedures are a significant part of what drives physicians to choose to practice critical care medicine. Intensivists from every background commonly describe the expectation to perform procedures under pressure and with accuracy as means through which they gain satisfaction from their profession. Understanding the myriad of possible indications and complications of the procedures that we are called on to perform as intensivists is clearly critical to the safe practice of intensive care medicine, and the reader can expect questions pertaining to this content of the examination. The authors strive to include clinical scenarios that could practically be seen at the bedside and on the examination. A healthy amount of humility is required to perform procedures as safely as possible; if the authors are successful, following reading this chapter, the readers will more likely exhibit such humility than afore.
Nutrition
Authors: Williams George W.
Published: September 2019

Nutrition is the second of two principal concepts (the first being infectious disease) in critical care not heavily emphasized in core anesthesiology training for reasons that are obvious. Optimal nutritional management is imperative to achieve positive outcomes in surgical patients. Wound healing, mobilization, and respiratory function are all particularly affected by nutritional status, and the optimal application assessment of nutrition directly affects surgical patients in the long term. Clinically, many physicians may take nutrition for granted and potentially conclude that it is not acutely important. Following consuming this content, the reader will be better equipped to educate their colleagues on the optimal assessment and application of perioperative nutrition. This chapter provides clinically useful and examination-oriented substrate to an equal degree, while being optimally digestible by the reader (no pun intended).
The Forensic Psychiatry Paper Chase
Authors: Rotter Merrill , Colley Jeremy , Cucolo Heather Ellis , Ford Elizabeth , Forman Howard
Published: September 2019

This chapter makes the case for teaching landmark cases through a stand-alone seminar, with particular focus on reviewing the cases chronologically. In making this case, the authors highlight important principles and themes that readers can look for in the specific cases to follow, including the relationship between psychiatry and broad social and legal trends, in areas such as civil rights, federalism, law enforcement, and the role of government in serving or supporting underserved populations with and without mental illness. In addition, legal understanding of and opinions about clinical issues including diagnosis, treatment and risk assessment are highlighted.
Duty to Protect
Authors: Kopelman Andrew M.
Published: September 2019

Chapter 3 examines cases that relate to a mental health clinician’s legal responsibility to protect citizens from danger caused by patients. The duty can be at the individual or institutional level and varies from state to state. Tarasoff v. Regents, described in this section, is probably the most famous landmark case of all. Other cases included in this section are Lipari v. Sears, Petersen v. Washington, Jablonski v. U.S. and Naidu v. Laird.
Child Abuse Reporting
Authors: Sidhu Shawn S. , Bath Eraka
Published: September 2019

Chapter 11 covers three cases involving child abuse: Landeros v. Flood, People v. Stritzinger, and DeShaney v. Winnebago. Although it is now common practice for individuals who care for, educate or treat children to be required to report child abuse, these cases highlight the evolution of that responsibility. Other themes include confidentiality of the reporting and the limits of state power in preventing child abuse.
Child Custody and Parental Competencies
Authors: Ryan Eileen P.
Published: September 2019

Chapter 12 contains only two cases, Painter v. Bannister and Santosky v. Kramer, but these cases are extremely important in having established the important principles of “best interest of the child” for determining child custody arrangements and terminating parental rights based on “clear and convincing evidence.” The former overturned the idea that parental preference should drive custody decisions and the latter recognized the serious and potentially traumatic effects of removing a child from his/her parents.
Juvenile Rights
Authors: Ryan Eileen P. , Ford Elizabeth
Published: September 2019

Chapter 13 includes three cases that have each shaped the way adolescents are treated in the justice system. In re Gault was a critical case in establishing due process rights for adolescents who have been charged with a juvenile offense. Graham v. Florida and Miller v. Alabama are recent Supreme Court cases that have defined the limits of punishment, specifically limiting life without parole, for adolescents charged in the adult system.
Civil Liability and Emotional Harm
Authors: Mehta Amar
Published: September 2019

Chapter 17 involves two California Supreme Court cases that relate to damages that can be recovered for emotional harm in negligence cases. Both cases involve the death of a child after being struck by a car and subsequent lawsuits filed by their mothers. The first, Dillon v. Legg, established that one need not be in the “zone of danger” to recover damages if emotional injury is “reasonably foreseeable.” The second case, over 20 years later, Thing v. LaChusa, was an attempt to further broaden emotional injury damages, but the court prevented such action and even reversed the “foreseeability” standard as too broad.
Sex Offenders
Authors: Lee Li-Wen G. , Cucolo Heather Ellis , Colley Jeremy
Published: September 2019

Chapter 28 includes cases related to the diagnosis and treatment of sexual offenders in the criminal justice system. Forensic practitioners may treat these individuals as part of their clinical work or may evaluate them to determine suitability for civil commitment upon release from prison or appropriateness for return to the community. The cases in this chapter are Specht v. Patterson, Allen v. Illinois, In re Young and Cunningham, Kansas v. Hendricks, McCune v. Lile, Kansas v. Crane and U.S. v. Comstock. The new cases (Does #1-5 v. Snyder and Millard v. Rankin)add a focus on legal challenges associated with sex offender registration.
Gun Ownership
Authors: Colley Jeremy , Cucolo Heather Ellis
Published: September 2019

Chapter 30 includes cases related to gun ownership. The first two cases (District of Columbia v. Heller and McDonald v. City of Chicago) focus on the Constitutional basis for gun ownership generally, while the others (Tyler v. Hillsdale County Sheriff’s Department and Wollschlaeger v. Governor of Florida) represent two examples of cases in which the national gun ownership debate is relevant to clinical care and the potential consequences of clinical treatment.
Primary immunodeficiency
Authors: Spickett Gavin
Published: September 2019

In general, immunodeficiencies are divided into those of the specific immune system (e.g. T cells or B cells or combined) or those of the innate or non-specific immune system (e.g. complement and neutrophils). Immunodeficiencies may also be divided into primary (usually genetic) and secondary, where the immune defect is caused by some other non-immunological disease. This chapter describes the classification and clinical features of primary immunodeficiencies, and then the cause, presentation, diagnosis, immunology, and treatment for a wide range of immunodeficiencies.
Secondary immunodeficiency and other host defence syndromes
Authors: Spickett Gavin
Published: September 2019

Many disease states have been associated with immune dysfunction of varying degrees of severity and significance. This chapter discusses individual immunological abnormalities, along with the classification of secondary immunodeficiency. Individual viruses, bacterial causes, fungal and parasitic infections, and oncological causes are all outlined, along with age, metabolic disorders, diabetes, drugs, and other injuries.
Autoimmunity associated with cardiac, respiratory, and renal disease
Authors: Spickett Gavin
Published: September 2019

This chapter covers autoimmunity associated with various cardiac, respiratory, and renal diseases. It features the clinical presentation, immunology, and testing for diagnosis and management. Myocarditis, cardiomyopathy, eosinophilic syndromes, recurrent pericarditis and rheumatic fever are all described, with over ten detailed topics on various respiratory and renal diseases.
Autoimmunity in liver disease
Authors: Spickett Gavin
Published: September 2019

This chapter covers the presentation, immunogenetics, immunopathology, diagnosis, treatment, and testing for a range of liver diseases. Primary biliary cirrhosis, autoimmune hepatitis, and primary sclerosing cholangitis are described.
Autoimmune haematological disorders
Authors: Spickett Gavin
Published: September 2019

This chapter covers the presentation, immunogenetics, immunopathology, diagnosis, treatment, and testing for a range of haematological disorders. Immune thrombocytopaenia, haemolytic anaemia, neutropenia, paroxysmal nocturnal haemglobinuria, aplastic anaemia, pure red cell aplasia, acquired haemophilia, and others are described.
Autoimmune eye disease
Authors: Spickett Gavin
Published: September 2019

The eye has a number of interesting immunological properties that alter the propensity for immune-mediated disease, including the curious feature that antigen injected into the anterior chamber induces tolerance rather than immunity. In addition, the eye has no true lymphatics, relatively poor vascularity, and, as the retina is an extension of the CNS, there is a blood–retinal barrier that limits passage of molecules in either direction. Ocular involvement is a common feature of many connective tissue and vasculitic diseases.
Miscellaneous conditions, including autoinflammatory syndromes
Authors: Spickett Gavin
Published: September 2019

This chapter covers the presentation, immunogenetics, immunopathology, diagnosis, treatment, and testing for a range of miscellaneous diseases not covered in other parts of the book.
Transplantation
Authors: Spickett Gavin
Published: September 2019

This chapter covers the indications, methods, immunological considerations, and monitoring of various types of transplantation. Covering stem cell transplantation, gene therapy, graft vs host disease, graft failure, and solid organ transplantation, the chapter provides an immunological overview of the subject.
Immunotherapy
Authors: Spickett Gavin
Published: September 2019

This chapter gives an overview of the complex area of immunotherapy. It covers the major mechanisms of immunomodulation, the generation of the immune response, modern approaches to vaccine development, and the basics of replacement therapy. It highlights immunosuppressive or immunomodulatory drugs and biologicals by type, as well as allergy interventions.
Quality and managerial issues
Authors: Spickett Gavin
Published: September 2019

Clinical and laboratory services do not operate in isolation but are integrated into the clinical and managerial framework of a hospital, and in the UK into a nationwide network (the NHS). This provides a constraint in both managerial and financial terms and also provides a legal framework in which services are delivered. It is essential that no matter where the patient is treated the right diagnosis is reached and the appropriate treatment is given. This chapter describes quality and managerial issues related to immunology and allergy, and gives an overview of the structure of the NHS.
Testing the warmness of dark matter
Authors: Kumar Suresh , Nunes Rafael C , Yadav Santosh Kumar
Published: September 2019

Dark matter (DM) as a pressureless perfect fluid provides a good fit of the standard Λ cold dark matter (ΛCDM) model to the astrophysical and cosmological data. In this paper, we investigate two extended properties of DM: a possible time dependence of the equation of state of DM via Chevallier–Polarski–Linder parametrization, wdm = wdm0 + wdm1(1 − a), and the constant non-null sound speed $\hat{c}^2_{\rm s,dm}$. We analyse these DM properties on top of the base ΛCDM model by using the data from Planck cosmic microwave background (CMB) temperature and polarization anisotropy, baryonic acoustic oscillations (BAOs), and the local value of the Hubble constant from the Hubble Space Telescope (HST). We find new and robust constraints on the extended free parameters of DM. The most tight constraints are imposed by CMB+BAO data, where the three parameters wdm0, wdm1, and $\hat{c}^2_{\rm s,dm}$ are, respectively, constrained to be less than 1.43 × 10−3, 1.44 × 10−3, and 1.79 × 10−6 at 95 per cent CL. All the extended parameters of DM show consistency with zero at 95 per cent CL, indicating no evidence beyond the CDM paradigm. We notice that the extended properties of DM significantly affect several parameters of the base ΛCDM model. In particular, in all the analyses performed here, we find significantly larger mean values of H0 and lower mean values of σ8 in comparison to the base ΛCDM model. Thus, the well-known H0 and σ8 tensions might be reconciled in the presence of extended DM parameters within the ΛCDM framework. Also, we estimate the warmness of DM particles as well as its mass scale, and find a lower bound: ∼500 eV from our analyses.