bluuebunny/crossref_metadata_2025 huggingface dataset:
Pain Research
Authors: Edwards David A.
Published: March 2017

Research in pain requires not only that basic ethical standards for human studies research are followed but also that special consideration be given to the potential for human suffering. Following World War II, placebos as controls became widely used with the adoption of the randomized controlled trial. Other study designs have elucidated the risk factors for pain. The prevalence of pain in society is a measure of the burden of pain. Experimentation using animals in pain research has provided considerable insight into the pathophysiology of pain in humans. Historical abuses in human experimentation have driven the development of ethical guidelines for human subjects research. The Belmont Report serves as the modern standard of basic ethical principles on which institutional review boards judge human research studies.
Addiction and Pain
Authors: Lonergan Daniel F.
Published: March 2017

Patients who struggle with both pain and addiction present with some of the most challenging scenarios in clinical medicine. An understanding of the neurophysiologic basis of addiction is a key element in the proper management of acute and chronic pain. Physicians should appropriately screen for addiction and employ a comprehensive and safe approach to pain management, especially for patients with risk factors or a history significant for opioid addiction. Physicians should also understand the legal and regulatory issues governing the prescribing and dispensing of controlled substances in the course of treatment for acute pain, chronic pain, and addiction.
Musculoskeletal Pain
Authors: Hillegass M. Gabriel , Tucker Anthony A. , Quidgley-Nevares Antonio
Published: March 2017

This chapter on musculoskeletal pain is composed of a question-and-answer bank that encompasses the breadth of the fund of knowledge required for the evaluation and management of various chronic musculoskeletal pain syndromes. Not only do probing questions with concise and informative answer explanations challenge the reader’s knowledge base but also references for further reading and mastery of the subject are provided. Topics covered include epidemiology, disability, rehabilitation, anatomy and physiology (including neurophysiology and mediators of inflammation), and the musculoskeletal exam. The pathophysiology, diagnosis, and management of musculoskeletal pain conditions such as common orthopedic and occupational injuries, osteoarthritis, chronic tissue pain states, and various autoimmune diseases (e.g., rheumatoid arthritis) are also expertly reviewed. These high-yield questions correspond to the musculoskeletal pain section of the American Board of Medical Specialties Pain Medicine Content Outline.
Complementary and Alternative Medicine
Authors: Huntoon Elizabeth
Published: March 2017

Complementary and alternative medicine (CAM) is a broad area that has become popular with both patients and physicians alike. Most of the CAM practices are used together with conventional therapies and therefore have been called complementary to distinguish them from alternative practices. Most of the therapies under the heading of CAM are considered safe as adjuncts or alternative treatments by the medical profession for a variety of pain problems; however, one area deserves special consideration: herbal and vitamin preparations. Herbal supplement use has risen in the past few years and patients may fail to mention that they are taking these substances. This lack of disclosure (or our lack of inquiry about supplements) may put them at risk for herb–drug interaction. The popularity of CAM therapies may be due largely to their presumed safety, efficacy, cultural acceptability, and lesser side effects compared with prescription medications.
Cancer Pain
Authors: Gulati Amitabh , Hung Joseph C.
Published: March 2017

Cancer pain treatment is complex and requires a different and more encompassing focus than many pain processes. Not only can tumor or metastatic lesions cause various types of pain but also the medical, radiological, and surgical treatments of the cancer may eclipse the original cause in some cases. Although treatment is often palliative, the transition from curative to palliative therapies is rarely straightforward, and the influence of patient and family beliefs and sources of meaning may have implications for treatment. This chapter focuses on differentiation of various situations that a pain physician might encounter in clinical practice.
Headache
Authors: Dittrich Kurt F.
Published: March 2017

Having a solid grasp of headaches is essential for the pain provider. This required knowledge should include understanding the anatomy and physiology of headaches; knowing how to classify headaches using the second edition of the International Classification of Headache Disorders; recognizing the physical, psychological, and social factors that may contribute to headaches; and understanding the role of counseling and nonpharmacological treatment options. It is essential to understand the pharmacological aspects of headache management as well as some of the nuances of the specific medications most often used. A pain provider should be able to recognize when signs and symptoms of a headache warrant further investigation as well as when to offer alternative treatment options to patients. The questions in this chapter are designed to assist in gathering this knowledge base and assist the pain provider in analyzing the headache condition.
Complex Regional Pain Syndrome
Authors: Walters Jenna L.
Published: March 2017

Complex regional pain syndrome (CRPS) is a neuropathic pain condition classified as type 1 and type 2. The two classifications are distinguished by the presence of documented nerve injury in CRPS type 2. The symptoms of CRPS, including cold, blue, and painful extremities, are believed to occur from vasoconstriction caused by sympathetic dysfunction. Treatment in CRPS focuses on targeting neuropathic and sympathetically maintained pain. Traditional antineuropathic pain medications include membrane stabilizers and serotonin and norepinephrine reuptake inhibitors. Corticosteroids and nonsteroidals target the inflammatory process present in the initial stages of CRPS. Bone resorption has been treated with calcium-modulating drugs. Interventional therapies include sympathetic blockade of the affected extremity, spinal cord stimulation, and intrathecal drug delivery. All these therapies have been implemented in an effort to facilitate functional restoration of the affected limb. Physical and occupational therapies have demonstrated some of the most significant improvements in pain, mobility, and function.
Pediatric Pain and Development of Pain Systems
Authors: Rosenquist Ellen W. K. , Strickland Natalie
Published: March 2017

The diagnosis and treatment of pain in the pediatric population is challenging because there is still much that is not understood about the development of pain systems in the human body. Many common pain syndromes manifest unique characteristics in the pediatric population that vary greatly from those in adults. In addition, pediatric treatments vary greatly from those used for adults and typically rely to a far greater degree on physical therapy or other nonpharmacologic treatments before resorting to pharmacologic or interventional therapies. Furthermore, there are many factors that must be taken into consideration when treating children, such as the child’s stage of development, pharmacokinetic and pharmacodynamic variables, caregiver concerns, psychosocial considerations, ethical considerations, and the ability of the child to describe his or her pain. This chapter highlights important topics to be considered when managing pain in pediatrics.
Development Through the Life Cycle
Authors: Wurmser Rachel
Published: March 2017

In this chapter the essential aspects of personality development, developmental processes from infancy through adolescence and the environmental influences on growth and development are reviewed. Also, are topics on psychosocial influence on growth and development including deprivation. Additionally, issues related to personality adaptation during adulthood and late life along with developmental processes are reviewed. Furthermore there are reviews on psychosocial influences on adulthood and late life. Topics on acquisition and loss of specific capacities like menopause, cognition and endurance during adult will also be reviewed
Behavioral and Social Sciences
Authors: Akinsanya Adefolake
Published: March 2017

In this chapter topics on psychology including experimental and behavioral psychology, neuropsychology, cognitive psychology and social psychology will be reviewed. Additionally, essential topics in sociology including anthropology, culture, ethnicity and race will be reviewed. Other topics that will be reviewed in this chapter include ethology, psychoanalytic theory and spirituality
Clinical Aspects of Psychiatric Disorders
Authors: Gupta Neha , Shah Ajay , Roy Kamalika , Penumetcha Varma , Oldham Mark
Published: March 2017

In this chapter, clinical aspects of major psychiatric disorders listed in the DSM5 including intellectual-disability, attention-deficit and disruptive behavior disorders, substance-related and addictive disorders, schizophrenia spectrum disorders, bipolar and related disorders, depressive disorders, anxiety disorders, somatic symptom and related disorders are reviewed
Diagnostic Procedures
Authors: Zdanys Kristina
Published: March 2017

This chapter reviews topics on diagnostic procedures including clinical neurologic examination, biomedical laboratory testing, neuroimaging, neurophysiologic testing and neuropsychological testing
Clinical Aspects of Neuropsychiatric Disorders
Authors: Sinha Shirshendu , Zdanys Kristina
Published: March 2017

In this chapter clinical aspects of neuropsychiatric disorders including delirium, mild neurocognitive disorders, major neurocognitive disorders, major neurocognitive disorder due to Parkinson’s disease, major neurocognitive disorder due to multiple etiologies and sleep wake disorders will be reviewed
Diagnostic and Clinical Evaluation of Neurological Disorders and Syndromes
Authors: Zdanys Kristina , Roy Kamalika , Sinha Shirshendu
Published: March 2017

This chapter reviews the diagnostic and clinical evaluation of neurologic disorders/syndromes including infections of the nervous system, vascular diseases, neuro-oncology, trauma, birth injuries, cranial nerve disorders, peripheral neuropathies, ataxias, neuromuscular junction disorders and myopathies
Management and Treatment of Neurological Disorders
Authors: Barisic-Dujmovic Tatjana
Published: March 2017

In this chapter the management and treatment of neurologic disorders including topics on neuropharmacotherapy, cognitive rehabilitation, genetic counseling, neurosurgical procedures, ethical and legal issues, pain management will be reviewed
Substance-Related Disorders
Authors: Sinha Shirshendu
Published: March 2017

This chapter reviews topics on substance-related disorders including alcohol-related disorders, stimulant-related disorders, caffeine-related disorders, cannabis-related disorders, stimulant-related disorders, hallucinogen-related disorders, tobacco-related disorders, opioid-related disorders, phencyclidine-related disorders and sedative-, hypnotic-, or anxiolytic-related disorders
Schizophrenia and Other Psychotic Disorders
Authors: Singh Harvinder , Gupta Aarti
Published: March 2017

In this chapter topics that are reviewed include schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder, psychotic disorder due to a general medical condition, substance-induced psychotic disorder and unspecified psychotic disorder
Mood Disorders
Authors: Singh Harvinder , Frankel Brian
Published: March 2017

In this chapter the topics that are reviewed include major depressive disorder, persistent depressive disorder (dysthymia), unspecified depressive disorder, bipolar I disorder, bipolar II disorder, cyclothymic disorder and unspecified bipolar disorder
Anxiety Disorders
Authors: Ghori Ambreen , Gupta Aarti
Published: March 2017

This chapter reviews topics on anxiety disorders including panic disorder, specific phobia, social anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, acute stress disorder, generalized anxiety disorder, anxiety disorder due to a general medical condition, Substance/medication-induced anxiety disorder and body dysmorphic disorder
Sexual Disorders and Gender Dysphoria
Authors: Akinsanya Adefolake
Published: March 2017

In this chapter topics related to sexual and gender identity disorders including sexual desire disorders, sexual arousal disorders, orgasmic disorders, sexual pain disorders, paraphilias and gender dysphoria are reviewed
Impulse Control Disorders
Authors: Michna Isabella
Published: March 2017

This chapter briefly reviews the topic of impulse control disorders including oppositional defiant disorder, intermittent explosive disorder, conduct disorder, pyromania, kleptomania
Systems-Based Practice Issues
Authors: Challagolla Deepti
Published: March 2017

This chapter reviews topics of systems-based practice issues including public policy- parity & gender, and practice-based learning and improvements
Clinical Vignette
Authors: Oldham Mark
Published: March 2017

This chapter includes a clinical vignette on Psychosomatics (HIV), with accompanying questions.
Clinical Vignette
Authors: Jillani Sarah
Published: March 2017

This chapter includes a clinical vignette on Personality Disorders, with accompanying questions.
Clinical Vignette
Authors: Hussain Filza
Published: March 2017

This chapter includes a clinical vignette on Psychopharmacology (extrapyramidal symptoms), with accompanying questions.
Clinical Vignette
Authors: Maksimowski Michael
Published: March 2017

This chapter includes a clinical vignette on Schizophrenia, with accompanying questions.
Clinical Vignette
Authors: Sinha Shirshendu
Published: March 2017

This chapter includes a clinical vignette on Substance Use Disorders (alcohol), with accompanying questions.
Fundamentals of HIV Medicine 2017
Authors: HIV Medicine American Academy of
Published: March 2017

Fundamentals of HIV Medicine is the nation’s most frequently utilized HIV patient care and reference textbook. Authored by leading HIV care providers, researchers, and experts, the new 2017 edition provides a comprehensive review of all facets of the medical management of individuals with HIV. The following topics are discussed in the book: epidemiology and the spread of HIV, mechanisms of HIV transmission, transmission prevention strategies, immunology, HIV elimination strategies, linkage into care, retention in care and accountable care, complementary and alternative medicine approaches, coordination of care, antiretroviral therapy, antiretroviral therapy in special populations, comorbidities and complications, social and economic issues, and clinical research.
Epidemiology and the Spread of HIV
Authors: Bolduc Philip , Order Navix , Colgate Emily
Published: March 2017

Worldwide, approximately 36 million people are infected with HIV. The number of new infections has been declining in most geographic areas including sub-Saharan Africa due to a larger number of persons receiving antiretroviral therapy (ART) and the uptake of new prevention methods. Prevalence in many areas has either stabilized or gradually increased due to prolonged survival. The US epidemic has remained stable, with approximately 1.2 million persons living with HIV. There are fewer AIDS deaths and approximately 40,000–50,000 new infections yearly, leading to an overall increase in HIV prevalence in the United States. Globally, most new infections are via heterosexual transmission, with more than half of new infections occurring in women. In Europe and the United States, the largest number of new infections is occurring in men who have sex with men. Due to the progressive uptake of ART, mother-to-child transmission has declined significantly throughout the world.
The Origin, Evolution, and Epidemiology of HIV-1 and HIV-2
Authors: Kirchner Jeffrey T.
Published: March 2017

HIV-1 originated in the early 1920s in southern Cameroon and the Democratic Republic of Congo. From Africa, HIV rapidly spread in the late 1960s to the Caribbean and then the United States, Europe, and other areas of the world, leading to the global AIDS pandemic. Both HIV-1 and HIV-2 descended genetically from Simian immunodeficiency virus via cross-species transmission. HIV-1 group M was the first lineage discovered and represents the pandemic form of the virus. Group M consists of nine viral subtypes (A–K), has a widespread distribution, and accounts for approximately 95% of all HIV-1 infections. HIV-2 was not discovered until 1986 and makes up approximately 3% of cases worldwide. It is found mainly in West Africa. The genetic diversity of HIV does not appear to significantly affect viral response to antiretroviral therapy. However, viral diversity continues to present challenges for the development of an effective HIV vaccine.
HIV Transmission Prevention
Authors: Chu Carolyn , Bositis Christopher M.
Published: March 2017

The prevention of HIV transmission involves a number of behavioral, structural, and biomedical interventions. Behavioral methods include education about sexual health, drug use, and risk reduction, as well as specific messages for at-risk populations who are HIV positive. Needle exchange programs and consistent use of condoms have proven effective for prevention of HIV infection. Post-exposure prophylaxis against HIV with antiviral drugs is often recommended in occupational health care and non-occupational settings. Voluntary male circumcision also reduces the risk of HIV acquisition. The treatment of pregnant women who are HIV infected can effectively eliminate mother-to-child transmission of the virus. Recently, the use of antiretroviral drugs for pre-exposure prophylaxis has proven highly effective in preventing HIV infections in high-risk groups including men who have sex with men. Promising therapies that likely will be available in the future include injectable antiviral drugs, vaginal microbicides, and HIV vaccines.
Immunology
Authors: Hartigan-O’Connor Dennis J. , Brander Christian
Published: March 2017

The key factor in HIV pathogenesis is the decline in CD4+ T cells with resultant immunodeficiency and chronic inflammation. Depletion of CD4+ T cells from the gastrointestinal mucosa followed by microbial translocation and subsequent immune activation are components of disease progression in untreated patients. Symptomatic and occult opportunistic infections including cytomegalovirus contribute to chronic inflammation in persons infected with HIV. Antiretroviral therapy (ART) results in immune reconstitution, with increases in peripheral CD4+ T cell lymphocytes in most persons infected with HIV, although immune recovery is quite variable. A subset of patients with AIDS will develop immune reconstitution inflammatory syndromes after initiation of ART. Approximately 1% of persons with HIV are able to control infection without the need for ART (“elite” controllers). A variety of immune-based therapies, including hydroxyurea, growth hormone, and statins, are being studied in clinical trials and may ultimately play a role in treating persons with HIV infection.
The Medical History and Physical Examination of the HIV-Infected Patient
Authors: Martagon-Villamil Jose , Skiest Daniel J.
Published: March 2017

Fostering a strong and empathetic patient–physician relationship is essential for the success of the HIV therapeutic plan. A comprehensive understanding of all medical and psychiatric comorbidities, medication history, exposures, risk behaviors, and current state of health is fundamental in caring for the HIV-infected individual. All patients with HIV newly in care need a complete history and physical examination. The physical exam needs to be comprehensive both for the assessment of current complaints and for baseline comparison with future findings. Providers must be aware of the cultural, social, and sexual diversity of their patient population to help foster patient–provider communication.
Complementary and Alternative Medicine/Integrative Medicine Approaches
Authors: Shere-Wolfe Kalpana D.
Published: March 2017

Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not currently considered part of conventional medicine. If a non-mainstream practice is used together with conventional medicine, it is considered “complementary.” If a non-mainstream practice is used in place of conventional medicine, it is considered “alternative.” Many patients use CAM approaches to their care. Often, patients do not disclose what methods they are using, and providers may have little knowledge of the effects of alternative medications. Interactions with antiretroviral therapy and other medications are important to the care of the patient. Physicians need to routinely ask about CAM use, particularly herbal medicines and supplements.
Principles of Applied Clinical Pharmacokinetics and Pharmacodynamics in Antiretroviral Therapy
Authors: Pandit Neha Sheth , Heil Emily L.
Published: March 2017

Systemic concentrations of antiretroviral drugs (ARVs) are influenced by the pharmacokinetic properties of absorption, distribution, metabolism, and excretion. Pharmacokinetics and local drug exposure can differ significantly within anatomical sanctuary sites compared with the systemic compartment. High variability in interpatient ARV concentrations is common, which makes population pharmacokinetics for ARVs very difficult to interpret. HIV replication is dynamic and requires combination antiretroviral therapy with multiple active agents in order to achieve durable virologic suppression. Direct and indirect relationships between drug exposure, efficacy, and/or toxicity are common for most ARVs, which can be used to improve overall treatment success. Suboptimal adherence can result in inadequate concentrations, drug resistance, and virologic failure. Therapeutic drug monitoring can be considered in certain scenarios that should be evaluated on a case-by-case basis.
Managing the Patient with Multidrug-Resistant HIV
Authors: Thu Ye , Nassar Naiel
Published: March 2017

During approximately the past 15 years, HIV infection has been transformed into a chronic manageable disease primarily due to the effectiveness of antiretroviral therapy. Treatment guidelines emphasize the need for at least two or preferably three fully active medications in the salvage regimens of patients experiencing virologic failure. The new regimen should be started with as little interruption as possible because the structured interruption of treatment in patient with multidrug-resistant HIV infection is associated with greater progression of the disease. The new pharmacokinetic enhancer, cobicistat, is available as a fixed-dose combination product with antiretroviral medication that allows the treatment to be simplified and reduces the pill burden.
The Pharmacist’s Role in Caring for HIV-Positive Individuals
Authors: Cocohoba Jennifer
Published: March 2017

Medications for HIV have become more convenient but not less complex. For this reason, having a clinical pharmacist as a part of the health care team can greatly enhance the care of HIV-positive patients. HIV pharmacists are a diverse group of providers who work to improve the health of HIV-positive individuals via medication therapy management, quality assurance practices, research, and other avenues. HIV pharmacists may be particularly skilled at managing complex antiretroviral drug–drug interactions, recommending therapies for resistant HIV virus, and providing education and support with regard to adherence. If practicing with a physician under a collaborative drug therapy management agreement, an HIV pharmacist may be able to provide more direct management (e.g., prescribing and ordering lab tests) for HIV and its associated conditions.
Solid Organ Transplantation in HIV-Infected Individuals
Authors: Lopes Eurides , Husson Jennifer
Published: March 2017

End-organ disease has become a major cause of morbidity and mortality in HIV-infected patients due to increased life expectancy, increasing the demand for organ transplantation in these patients. The care of HIV-infected transplant recipients warrants a multidisciplinary team approach, including the transplant team, pharmacists, infectious disease specialists, nurses, and patients and their families. The immunosuppression of HIV-infected recipients post-transplant does not appear to further advance HIV disease. The post-transplant risk for HIV-infected recipients of opportunistic infections does not appear to be increased by immunosuppression. However, the overall rate of infections is high, and it is even higher in hepatitis C virus (HCV) co-infected transplant recipients. HIV/HCV co-infected recipients have worse outcomes compared to both liver and kidney HIV-infected recipients.
Antiretroviral Therapy in Pregnant Women
Authors: Short William R. , Schafer Jason J.
Published: March 2017

Research has demonstrated that proper prevention strategies and interventions during pregnancy, labor, and delivery can significantly reduce the rate of mother-to-child transmission of HIV. Antiretroviral drugs (ARVs) should be initiated in all HIV-infected pregnant women regardless of CD4+ T cell count or HIV-1 RNA level. ARVs should be given in combination therapy, similar to nonpregnant patients, with the goal of complete virologic suppression. Treatment changes during pregnancy have been associated with the loss of virologic control and independently associated with mother-to-child transmission. All cases of prenatal antiretroviral exposure should be reported to the Antiretroviral Pregnancy Registry, which collects data on HIV-infected pregnant women taking ARVs with the goal of detecting any major teratogenic effects.
Antiretroviral Therapy in Children and Newborns
Authors: Nielsen-Saines Karin
Published: March 2017

HIV-infected infants and children have a different, more progressive disease course compared to that of adults given that early infection leads to sustained, high-magnitude viremia with significant seeding of reservoirs in the first months of life. Early diagnosis of HIV infection is pivotal in the management of infants and prevention of HIV-associated morbidity and mortality. The availability of potent pediatric antiretroviral formulations encompassing different classes of drugs for infected infants and young children is limited. Significant advancements have been achieved in the area of infant post-exposure prophylaxis. Early antiretroviral treatment is still the mainstay of pediatric HIV infection, particularly for infants younger than age 12 months, but it is also highly recommended for older children. Early treatment of young infants diagnosed soon after birth appears to be the best approach to reduce the seeding of viral reservoirs and potentially attain prolonged periods of HIV remission off antiretrovirals.
Malignant Diseases in HIV
Authors: Oliver Nora , Chiao Elizabeth
Published: March 2017

Malignancies were one of the earliest recognized manifestations that led to the eventual description of the AIDS epidemic. Kaposi’s sarcoma was one of the first entities described in association with AIDS. Subsequently, intermediate-grade and high-grade non-Hodgkin’s lymphoma, invasive cervical cancer, and primary central nervous system lymphoma were defined by the Centers for Disease Control and Prevention as “AIDS-defining conditions.” Since the advent of combination antiretroviral therapy, several other cancers that are not AIDS-defining have been found to have an increased incidence in patients with HIV. These include, but are not limited to, Hodgkin’s disease and anal, liver, lung, oropharyngeal, colorectal, and renal cancers. They are generally referred to as “non-AIDS-defining cancers.” The increasing longevity of persons living with HIV as well as concurrent modifiable risk factors such as tobacco use may also influence the epidemiology of these malignancies.
Dermatologic Complications
Authors: Mutyambizi Kudakwashe
Published: March 2017

The hallmark of HIV infection is immune dysregulation and immunosuppression. As the immune system deteriorates, inflammatory dermatoses, metabolic dysregulation, adverse drug reactions, opportunistic infections, and cutaneous malignancies become more common, atypical in presentation, and recalcitrant to therapy. Both acute and chronic skin complaints contribute significantly to reduced quality of life for HIV patients. The Centers for Disease Control and Prevention recommends that individuals between ages 13 and 64 years be tested for HIV at least once in their lifetime, with increased screening of high-risk individuals and testing based on symptoms. The presence of dermatoses uncommon in the general population but concentrated in the HIV population, or dermatoses strikingly recalcitrant to therapy, should warrant suspicion and testing for HIV.
Endocrine Disorders
Authors: Sekhar Rajagopal V.
Published: March 2017

HIV infection is now a chronic disease, and it is associated with an increasing prevalence of metabolic and endocrine abnormalities. The underlying etiology of these disorders can be attributed to multiple factors, including, but not limited to, the effects of HIV itself, antiretroviral drugs, the effects of immune dysfunction, and other opportunistic infections. Any endocrine glandular system can be involved; hence, appropriate clinical suspicion, endocrinological dynamic testing for accurate diagnosis, and effective therapy are important in the identification and management of these disorders. HIV infection, antiretroviral drugs, and other factors play a role in the development of endocrine disease. For endocrine disorders in HIV, early referral to an endocrinologist is suggested.
HIV-Associated Neurocognitive Disorders
Authors: Hasbun Rodrigo , Dunham Richard , Kass Joseph S. , Das Rituparna , Nunez-Wallace Karen , Sharp Lydia J. , Kung Doris
Published: March 2017

HIV causes a chronic form of encephalitis (HIVE) that is clinically characterized by either dementia or mild neurocognitive impairment. Since the introduction of antiretroviral therapy in 1996, the incidence of HIV dementia has decreased by 50%, but the prevalence of mild neurocognitive disorder has increased up to 39%. HIVE is the result of direct microglial infection, interruption of trophic factors, or caused by inflammatory cytokines. HIV enters the brain primarily by the “Trojan horse mechanism”; it is carried by monocytes and lymphocytes that cross the blood–brain barrier. HIV has a predilection for the basal ganglia, deep white matter, and hippocampus, resulting in a subcortical dementia. HIV dementia is a diagnosis of exclusion and other co-infections, cerebrovascular disease, malnutrition, and drug abuse should be ruled out before making the diagnosis. In patients receiving antiretroviral therapy with immunological response, a novel condition termed CD8+ T cell encephalitis was recently described.
Dyslipidemia
Authors: Sekhar Rajagopal V.
Published: March 2017

Patients infected with HIV often develop dyslipidemia. Although lipid abnormalities have been described in HIV-infected patients from the pre-combination antiretroviral therapy era, they are most striking in patients treated with antiretroviral drugs and may even be present in those not exposed to these drugs. The dyslipidemic profile in HIV includes abnormalities in lipids and lipoprotein, including hypertriglyceridemia, elevated plasma total low-density lipoprotein cholesterol concentrations, and low levels of high-density lipoprotein cholesterol. Many patients also have the phenotypic appearance of lipodystrophy, with a variable combination of centripetal fat accumulation. The consequence of an abnormal dyslipidemic profile in the HIV lipodystrophic patient is an accelerated risk of developing myocardial infarction, cardiovascular disease, nonalcoholic fatty liver disease, and type 2 diabetes.
Immune Reconstitution Inflammatory Syndrome
Authors: Coppock Dagan , Short William R.
Published: March 2017

Immune reconstitution inflammatory syndrome (IRIS) is associated with either worsening of a recognized infection (paradoxical IRIS) or an unrecognized infection (unmasking IRIS), which occurs in the setting of improved immunologic function. Most patients presenting with IRIS should be maintained on antiretroviral therapy (ART) along with treatment for the associated infection. Screening for latent tuberculosis infection should be undertaken in all HIV-infected patients. In paradoxical IRIS, it is crucial to exclude alternate diagnoses and ensure the patient is receiving appropriate treatment for the condition. In the majority of cases, ART is continued, but on rare occasions cessation of ART is warranted in severe IRIS, particularly when it is life-threatening.
US Health Care Systems, HIV Programs, and Coverage Policy Issues
Authors: Packett Holly Kilness
Published: March 2017

HIV-related health care services have historically been covered or provided by a patchwork of federal, state, and local programs, such as Medicare, Medicaid, and the Ryan White Program, and state and local health programs. AIDS service organizations and private and charitable health organizations also provided services for HIV patients without coverage. These programs represent the long-standing pathways to insurance coverage, access to care, and access to treatment for people with HIV. Some of these programs also supply coverage for or access to medications that treat co-occurring conditions for people with HIV. Following the implementation of the Affordable Care Act, availability of health coverage for HIV patients was greatly expanded in the United States. However, challenges such as affordability and access to treatments still remain.
Ethical Conduct of Clinical Trials, Institutional Review Boards, Informed Consent, and Financial Conflicts of Interest
Authors: Ramers Christian B.
Published: March 2017

Ethics and conflicts of interest are important considerations when planning and carrying out research. It is the role of the institutional review board to weigh these against protection of the research subject when evaluating research proposals. The ethical considerations when performing research include basic ethical principles (e.g., autonomy, confidentiality, non-maleficence, informed consent, beneficence, justice, and utility), as well as nuances such as appropriate study designs, investigator conflict of interests, and bias in all its forms. To help guide clinicians, a number of professional and governmental organizations have published guidelines and recommendations on various aspects of clinical research (e.g., the American Medical Association, the National Institutes of Health, and the US Food and Drug Administration).
Regulation of Laboratory Genetic Testing
Authors: Zehnbauer Barbara , Andrew Faucett W.
Published: March 2017

Laboratory regulations provide rules to establish consistency and to evaluate performance. They also set out the qualifications and experience needed for laboratory staff to fulfill regulatory requirements and meet professional standards. Clinical genetic counselors play a significant role in determining which tests to offer patients, which laboratories to consider for testing, and which phenotypic information to provide to the clinical laboratory to improve the interpretation of test results. This chapter discusses laboratory regulations pertinent to the type of genetic testing offered and specimens received in the laboratory. The goal is to help the laboratory genetic counselor understand the regulatory oversight of genetic testing and the quality management of clinical laboratory operations.
Biochemical Technologies and Test Issues
Authors: Gaviglio Amy , Jack Rhona M. , King Lisa Sniderman
Published: March 2017

The biochemical genetics laboratory has seen rapid technological growth and progress in the past 25 years, which has greatly aided in the detection of inborn errors of metabolism. Result reporting and accuracy are influenced by preanalytic sample handling, sample type, and methodology. Differentiating normal from abnormal is the key to disease diagnosis, and the interpretation of results often depends upon the pattern of analytes and knowledge about the patient’s clinical picture. The biochemical genetics laboratory is a setting that benefits from the addition of genetic counselors on staff. Technologies may evolve, but the role of the laboratory genetic counselor will remain essential.
Genetic Counselor Role in Sales and Marketing
Authors: Schmitt Colleen Landy , Lazarin Gabriel A.
Published: March 2017

Sales and marketing functions may be a good fit for laboratory genetic counselors. Genetic counselors can use the technical and communication skills they learned during genetic counseling training to perform roles in marketing and sales and as medical liaisons for genetic testing laboratories. This chapter describes how genetic counselors in sales roles use their genetic counseling background. It discusses the challenges and limitations of such roles. Resources for thriving in sales and marketing roles are provided.
Genetic Counselor Communication and Counseling Skills for the Laboratory
Authors: Wain Karen E.
Published: March 2017

Laboratory genetic counselors need to use excellent communication skills when discussing genetic testing and relaying test results. Genetic counselors serve as key members of the patient’s circle of care. By using their counseling skills, they promote best practices in genetic testing. This chapter demonstrate the use of counseling skills in the laboratory setting. It outlines key factors to consider when communicating with other healthcare professionals, such as working without visual cues, building rapport, and gathering information.
Genetic Counselor Contributions to Medical Literature and Generalizable Knowledge
Authors: Dempsey Melissa , Rosenfeld Jill A. , Walther Susan E.
Published: March 2017

Laboratory genetic counselors are in a unique position to contribute to the medical literature on genetic testing and genetic conditions given their exposure to a wide variety and large volume of genetic tests and results. They have the opportunity to develop in-depth experience in a given area of genetic testing due to their proximity to laboratory directors and other colleagues with clinical and laboratory expertise. These experiences, coupled with advanced skills in verbal and written communication, enable them to contribute in many ways to the medical literature and generalizable knowledge of genetic testing. This chapter will describe the types of publications and research the laboratory genetic counselor may be involved in. It also outlines the ways in which this knowledge is communicated and translated into laboratory and clinical practice.
Lower limb
Authors: Harrison Mark
Published: March 2017

This chapter describes the anatomy of the lower limb as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the muscles, innervation, movements, vessels, and joints of the anterior thigh, medial thigh, posterior thigh, hip joint, gluteal region, popliteal fossa, anterior leg, lateral leg, calf, foot, and ankle. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Abdomen
Authors: Harrison Mark
Published: March 2017

This chapter describes the anatomy of the abdomen as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of regions, muscles, functions, blood supply, nerve supply, surface markings, and relations of the abdominal wall and cavity, inguinal region, testis, epididymis and spermatic cord, peritoneum, gastrointestinal tract, liver and biliary tract, pancreas, spleen, kidneys, ureters and bladder, pelvis, prostate, reproductive systems, and genital regions. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Cranial nerve lesions
Authors: Harrison Mark
Published: March 2017

This chapter describes the anatomy of the cranial nerve lesions as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the anatomy, signs, and causes of lesions of the olfactory, optic, oculomotor, trochlear, abducens, trigeminal, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, and hypoglossal nerves. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Principles of investigation
Authors: Harrison Mark
Published: March 2017

This chapter describes the principles of microbiology investigation as they apply to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of specimen types, culture and examination, serology, and molecular techniques. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Principles of immunization
Authors: Harrison Mark
Published: March 2017

This chapter describes the principles of microbiology immunization as they apply to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of immunization schedules for diphtheria, tetanus, pertussis, Haemophilus influenzae type b, polio, Pneumococcal infection, MMR, meningitis C, HPV, varicella, hepatitis B, and influenza, as well as further sources of information. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Clostridial infection
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of clostridial infection as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the source, clinical features, and principles of treatment and prevention of clostridial colitis, clostridial gas gangrene, and tetanus. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Neisseria
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of Neisseria as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of epidemiology, clinical features, diagnosis, management, and prevention of Neisseria meningitidis and Neisseria gonorrhoeae. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Klebsiella, Salmonella, Escherichia coli
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of Klebsiella, Salmonella, and Escherichia coli as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the epidemiology, sites of infection, clinical features, basis of diagnoses, and medical management and treatment of Klebsiella, Salmonella, and Escherichia coli. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Gram-negative gastrointestinal disease
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of Gram-negative gastrointestinal disease as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the background to infection, clinical features, basis of diagnosis, and principles of medical management of Helicobacter pylori and Campylobacter. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Chlamydia
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of Chlamydia as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of chlamydial genital infection and chlamydial ophthalmia neonatorum with Chlamydia trachomatis. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Gastrointestinal viruses
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of gastrointestinal viruses as they apply to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the epidemiology, pathological basis, clinical features, and diagnosis and management of rotavirus and norovirus. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Worms
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of worms as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the clinical features, basis of infection, diagnosis, and management of threadworm, tapeworm, roundworm, and hookworm. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Cardiovascular physiology
Authors: Harrison Mark
Published: March 2017

This chapter describes cardiovascular physiology as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter gives a systemic overview and outlines the key details of cardiac cycles I, II, and III, cardiac output, and peripheral vascular physiology I, II, and III. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Endocrine physiology
Authors: Harrison Mark
Published: March 2017

This chapter describes endocrine physiology as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of pituitary function, adrenal function, endocrine pancreas, thyroid physiology, and calcium and bone physiology. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Infections
Authors: Harrison Mark
Published: March 2017

This chapter describes the pharmacology of infections as they apply to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter lists notifiable diseases and outlines the key details of antibacterial drugs, penicillins, cephalosporins tetracyclines, aminoglycosides, macrolides, the management of tuberculosis, quinolones, urinary tract infections, antifungal preparations, herpes virus infections, and antimalarials. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Fluids and electrolytes
Authors: Harrison Mark
Published: March 2017

This chapter describes the pharmacology of fluids and electrolytes as they apply to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of oral preparations, parenteral preparations, and vitamin B. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Musculoskeletal system
Authors: Harrison Mark
Published: March 2017

This chapter describes the pharmacology of the musculoskeletal system as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of non-pharmacological measures, non-steroidal anti-inflammatory drugs, corticosteroids, and drugs used in gout and hyperuricaemia. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Cardiovascular system
Authors: Harrison Mark
Published: March 2017

This chapter describes the pathophysiology of the cardiovascular system as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the control of blood pressure and heart rate, cardiac output, blood flow, cardiac cycle, ECG, pharmacological manipulation of the heart, shock, oxygen delivery and consumption, body fluid homeostasis, crystalloid solutions, colloidal solutions, and exudates and transudates. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.