bluuebunny/crossref_metadata_2025 huggingface dataset:
Rheumatoid arthritis
Authors: Silman Alan J , Hochberg Marc C
Published: October 2023

Problems with criteria assignment in rheumatoid arthritis (RA) Agreement on the criteria for the inclusion of an individual as a case of RA has not been easily achieved. The problem in defining RA has been the lack of a distinct clinical, laboratory, or radiological marker. At one end of the spectrum there is an acceptance that the condition ‘benign self-limiting polyarthritis’-the occurrence of a short—lived episode of inflammatory polyarthritis with no obvious predisposing cause and which resolves spontaneously without sequelae—despite the similarity at presentation, should be distinguished from RA. In practice this is difficult given the lack of follow-up data. At the other end is the requirement to distinguish RA from those arthropathies which, in some individuals, may be similar but have an identifiable ‘cause’ such as ankylosing spondylitis and psoriatic arthritis. More problematic for epidemiological studies is that many individuals with RA, that has remitted by the time of study, can only be categorized on the basis of self-reported history or contemporary medical records. These approaches may not easily allow the application of criteria for current disease. Older criteria sets had different rules for ‘past’ arthritis (Kellgren 1962) but these tend not to be used currently.
Juvenile arthritis
Authors: Silman Alan J , Hochberg Marc C
Published: October 2023

Juvenile arthritis encompasses the universe of disorders which are associated with the presence and/or development of either axial or peripheral arthritis in children and adolescents aged 15 and below. These disorders can be classified into groupings including infectious arthritis, reactive arthritis, connective tissue diseases, and congenital and developmental diseases among others (Table 3.1). Prominent among these diseases is juvenile rheumatoid arthritis, a diagnostic classification reserved for children with idiopathic inflammatory arthritis. Numerous other terms including juvenile chronic polyarthritis, juvenile chronic arthritis, and Still’s disease have been used for this group of patients; Singsen (1990) has recently reviewed the historical evolution of the nomenclature and concluded that juvenile rheumatoid arthritis ‘... is the most widely used term, and the only one subjected to studies of criteria and classification’.
Osteoarthritis
Authors: Silman Alan J , Hochberg Marc C
Published: October 2023

Osteoarthritis, also referred to as osteoarthrosis and degenerative joint disease, is the most common form of arthritis (Kelsey and Hochberg 1988, 1992). Prior to 1986, no standard definition of osteoarthritis existed; most authors described osteoarthritis as a disorder of unknown aetiology in which articular cartilage and subchondral bone were primarily affected in contrast to rheumatoid arthritis which primarily affects the synovial membrane. A standard definition of osteoarthritis, developed by the Subcommittee on Osteoarthritis of the American College of Rheumatology Diagnostic and Therapeutic Criteria Committee, follows (Altman et al. 1986): A heterogeneous group of conditions that lead to joint symptoms and signs which are associated with defective integrity of articular cartilage, in addition to related changes in the underlying bone at the joint margins.
Gout
Authors: Silman Alan J , Hochberg Marc C
Published: October 2023

Gout is an ancient disease with a great deal known of both its pathophysiology and treatment. Clinically, it is characterized by: (1) recurrent attacks of acute arthritis involving one or more joints, (2) deposits of monosodium urate crystals in articular cartilage and/or synovial membrane which, when released into synovial fluid, provoke an acute inflammatory response, (3) elevation of serum and plasma concentrations of uric acid, and (4) the variable presence of renal disease including uric acid nephrolithiasis.
Back pain
Authors: Raspe Hans-Heinrich
Published: October 2023

There is a vast literature on the epidemiology of back pain but this chapter restricts itself to back pain in open populations. It concentrates mainly on investigations that have included both sexes, a broad range of age groups, all types of work (including housework), and work status including schooling, unemployment, and retirement. Thus studies of back pain in patient populations (for example Frymoyer et al. 1980) as well as ‘back pain in workers’ (for example Bombardier et al. 1985; Anderson 1981; Deyo 1988; Carey 1989) are virtually excluded. The subject of occupational back pain is so extensive as to be outside the scope of this book. Another area not considered in detail is that of ‘psychosomatic’ back pain, though many clinicians maintain that nonspecific back pain is often a result of psychological disturbances or conflicts. This neglect is due mostly to the fact that epidemiological studies have only very rarely included psychological variables. There is however sufficient common ground that this review will cover many relevant areas to those who are mainly interested in the epidemiology of occupational and psychosomatic back pain.
Neurosurgery
Authors: Walker D
Published: October 2023

The central nervous system is metabolically very active and is readily damaged by episodes of ischaemia which would not cause permanent injury to other organs. Already injured neural tissue is even more susceptible to further damage by otherwise minor episodes of hypoxaemia or reduced perfusion. The aim of neuroanaesthesia is therefore firstly to provide anaesthesia (analgesia and lack of awareness) to enable the surgical procedure to be performed, secondly to optimize operating conditions for the surgeon and thirdly to minimize the potential of adverse effects (particularly ischaemia) in the perioperative period.
Assistance In Maternity Hospitals
Authors: McNeil M
Published: October 2023

Anaesthesia for the pregnant woman poses a number of unique problems for the anaesthetist. Firstly, the presence of the fetus means that any intervention to the mother may have an effect on the fetus. Secondly, pregnancy is associated with profound changes in the mother’s cardiovascular and respiratory systems, which will alter her response to anaesthetic agents. Thirdly, childbirth is a highly emotional experience for the mother and her partner. A great deal of sensitivity and understanding will be required from those attending a woman in labour. These factors may also be compounded by religious or cultural factors which, although unfamiliar to the staff, must be respected.
Renal
Authors: Singer Mervyn , Webb Andrew R
Published: October 2023

Exclude a blocked catheter (common). An ultrasound is suitable to exclude obstruction. An intravenous urogram may be hazardous in renal failure due to nephrotoxic contrast.
Biological Rhythms And Exercise
Authors: Reilly T , Atkinson G , Waterhouse J
Published: October 2023

The effects of circadian rhythms on human performance in general and on response to exercise in particular are a well-known phenomenon. Often after a poor night's sleep or taking a "red-eye" flight into a different time-zone, one just doesn't feel like "themselves." This book aims to provide a comprehensive account of biological rhythms and how they affect exercise. Particular attention is given to sleep, its biological function, and the consequences for exercise performance of sleep loss. There are chapters devoted to the effects of disturbing the circadian body clock, such as when multiple time zones are crossed and jet-lag experienced. The effects of nocturnal shift work and seasonal variation are also covered. The interactions between exercise and the female menstrual cycle are explained and the issue of exercise during pregnancy discussed. Finally, there is a chapter devoted to research methods in chronobiology, the scientific discipline underpinning the content of the book.
The causes of epilepsy
Authors: Hopkins Anthony , Appleton Richard
Published: October 2023

One aspect of human nature is to search for causal links between events. The onset of epileptic seizures in a previously healthy child or adult results in great heart-searching in the family, and raking over past events in an attempt to find some reasons. Yet it has to be admitted that the most careful medical assessment of past events or current state allows a paediatrician or neurologist to assign a cause or causes of epilepsy in only a minority of subjects, and then often on the basis of circumstantial evidence.
Trauma
Authors: Armstrong R F , Aveling W , Grundy E M
Published: October 2023

After major trauma, mortality patterns can be divided into three groups: Inevitable. Victims so severely injured that even if medical treatment was immediately available, death would still occur within a few minutes. Salvageable. These victims have suffered injuries that are potentially recoverable, but are liable to die within a few hours with substandard treatment. Death is often due to blood loss. Late. Death occurs several days later from sepsis, head injuries, etc. The concept of the golden hour states that most victims in the salvageablegroup will survive if within one hour from the time of the injury the victimcan : (a) be transported to a hospital; (b) receive the ABC of resuscitation;(c)receive the DE of full clinical examination and evaluation; (d) betransferred for definitive treatment. With high-speed trauma it should be assumed that there is damage to thecervical spine until proved otherwise. Thus a hard cervical collar or manualin-line neck stabilization (MILNS) should be applied. If tracheal intubation is required in the presence of faciomaxillary traumaand a potential cervical injury, there is no consensus regarding idealtreatment. Several authors recommend cricoid pressure with MILNS andjudicious axial traction throughout the procedure. Gum elastic catheter,the use of the large Macintosh blade, or a McCoy laryngoscope may help.North American authors advise blind nasal intubation though this can bedifficult, causes bleeding, and may result in more cervical movementthan an oral approach. LMAs can be useful and allow the passage of an intubating bougie. Surgical or percutaneous tracheostomymay be needed. Two large-bore venous cannulae should be positioned in different limbs and2 litres of warm Hartmanns solution given. When these bags have beeninfused and further fluid is required, blood is recommended.
Anaesthetic emergencies
Authors: Armstrong R F , Aveling W , Grundy E M
Published: October 2023

This can result from (a) difficulty in positioning; (b) difficulty inlaryngoscopy; (c) difficulty in passing tracheal tube. If difficulty isanticipated in positioning the patient or in laryngoscopy, an alternativemethod of airway management such as fibreoptic intubation may be used. In the majority of cases, difficult intubation is synonymous with difficultlaryngoscopy. In a recent editorial it was pointed out that if the epiglottiscan be seen then with the aid of a gum elastic bougie successful intubationcan be anticipated. Thus difficult intubation means inability to visualizeeither larynx or epiglottis. Although there have been numerous methods suggested to predict difficultintubation none have gained universal clinical acceptance. The view seen ofthe pharynx (Mallampati classification) and the thyromental distance arecurrently accepted as giving the best indication of a difficult intubation(and even better if combined) but many false positives and some falsenegatives do occur. If there is a risk of aspiration, cricoid pressure should have been applied andmust continue. Some protocols recommend turning the patient on their sideand emptying the stomach with an orogastric tube. Currently enthusiasm forthis manoeuvre appears to be waning.
Depression and antidepressants
Authors: Lader Malcolm , Herrington Reginald
Published: October 2023

Of the three main groups of psychotropic drugs, the antipsychotics are useful in treating all forms of psychosis and the anti-anxiety compounds are really anti-arousal or anti-emotion compounds and therefore less specific than thelf names would imply. Only the antidepressants appear to exert a specific or selective action on a recognizable psychiatric entity. For this reason an outline of the features of depression is presented including some of the problems of classifying this condition.
Drug treatment in children
Authors: Lader Malcolm , Herrington Reginald
Published: October 2023

Child psychiatrists in the UK tend to be conservative in their use of psychotropic drugs (for review see Werry 1979; Campbell and Cohen 1981). This stems from several factors: the emphasis on social and educational manipulations as forms of treatment; the psychoanalytic or psychosocial background of many child psychiatrists; the realization that many disturbed children are reflecting tensions in the family rather than intrinsic difficulties; the reluctance to use drugs in a developing organism, in particular on a developing brain; a healthy and often well founded scepticism concerning the efficacy of drug therapy in psychiatrically disturbed children; and public controversy and anti-psychiatric postures by special interest groups. Also the ready use of drugs in children leads to the impression by child, parents, and by other medical attendants that the problem lies within the child and is amenable to drugs so that recourse to drugs in the future becomes too facile.
Epilogue: changing perspectives
Authors: Lader Malcolm , Herrington Reginald
Published: October 2023

The modern era of psychopharmacology dates back to about 1950, the extant physical treatments such as ECT a decade further still. The intervening period has seen increases in our understanding of the actions of these physical therapies and drugs although some crucial questions concerning them have not been answered. Thus, we still do not know the mechanisms by which they effect clinical improvement. For example, how does inhibition of monoamine oxidase result in alleviation of panic attacks!
Introduction to cardiopulmonary resuscitation
Authors: Skinner David V , Vincent Richard
Published: October 2023

In the United Kingdom approximately 160 000 deaths occur each year as a result of coronary artery disease; in the United States the annual mortality from this condition is around 650 000. Although trauma is the commonest cause of death in the first four decades of life, coronary artery disease rapidly overtakes trauma as a killer and, in later years, competes with malignancy as the leading cause of death. The incidence of coronary artery disease in the United Kingdom varies geographically, being about twice as common in the west of Scotland as in the south-east of England.
Cardiopulmonary resuscitation and the seriously ill child
Authors: Morton Rosemary J , Phillips Barbara M
Published: October 2023

1 Respiratory and/or circulatory failure are the usual causes of cardiac arrest in children.

2 Airway control and ventilation with 100 per cent oxygen are of prime importance.

3 Venous or intraosseous access must be gained as soon as possible for circulatory support and administration of drugs.

4 Earlier recognition and treatment of imminent respiratory and circulatory failure will improve outcome.

5 Overwhelming infection is a frequent precursor of collapse, especially in infancy. After initial resuscitation early consideration should be given to the use of intravenous broad-spectrum antibiotics.
Major trauma
Authors: Morton Rosemary J , Phillips Barbara M
Published: October 2023

1 The first priority is to ensure a patent airway and adequate ventilation with 100 per cent oxygen.

2 Intravenous access should be obtained with two large cannulae. A child can sustain a relatively large blood loss with initial compensation. Shock then develops rapidly.

3 A detailed history of the accident will help to anticipate the nature and severity of injuries.

4 Suspect internal chest injury if there is continuing hypoxia in a ventilated patient. Children may have severe chest cavity injuries despite intact ribs.

5 Abdominal and pelvic injury are particularly common and difficult to detect in children. Repeated abdominal examination, CT and ultrasound scans, and peritoneal lavage will all help in assessment. The patient with suspected abdominal injury who cannot be made haemodynamically stable with ventilation and transfusion must go for urgent surgical exploration. Exact pre-operative diagnosis is unnecessary.

6 The management of head injuries should focus on prevention of secondary damage from hypoxia, hypotension, and raised intracranial pressure.
Fractures and orthopaedic problems
Authors: Morton Rosemary J , Phillips Barbara M
Published: October 2023

1 Children’s injuries differ from those of adults. They are less likely to sprain a ligament and more likely to sustain a greenstick or avulsion fracture. Radiographs should be taken more readily than in adults.

2 Injuries which involve the growth plate must be treated carefully as later growth disturbance may occur. However, a greater degree of fracture angulation can be tolerated in children compared with adults as growth will remodel the bone.

3 A limp should be thoroughly assessed as there are several possible underlying causes which may lead to problems if untreated.
Gastrointestinal and genitourinary problems
Authors: Morton Rosemary J , Phillips Barbara M
Published: October 2023

1 Oral rehydration therapy is the mainstay of treatment in gastroenteritis.

2 Vomiting is a non-specific symptom of many illnesses, some of which are serious. A child should not be discharged with undiagnosed vomiting.

3 The concern in acute abdominal pain in childhood is whether appendicitis, or less frequently intussusception, is present.

4 There should be a high index of suspicion for urinary tract infections in infants and young children. All children with urinary tract infection or haematuria must be followed up.
Skin and infectious diseases
Authors: Morton Rosemary J , Phillips Barbara M
Published: October 2023

Children may be brought to the A & E department because of the sudden appearance, or worsening, of a rash or its poor response to treatment.

The diagnosis of a rash is based on its history, appearance, distribution, and associated physical signs. An ophthalmoscope set at about 8 dioptres is often helpful for close inspection of skin lesions.

1 Erythematous maculopapular rashes are usually due to an infectious disease or an allergic reaction.

2 Itchy skin lesions suggest eczema, scabies, or insect bites.

3 Vesicobullous eruptions are characteristic of chickenpox, herpes simplex, and hand, foot, and mouth disease. Staphylococcal infection, bullous erythema multiforme, and drug reactions are less common but potentially more serious causes of a vesicobullous rash.

4 A sore mouth may be due to primary herpes simplex, candida infection, scarlet fever, or rarer more serious diseases such as Stevens-Johnson syndrome or Kawasaki’s disease.
Computerized cognitive assessment
Authors: Wesnes Keith A , Hildebrand Kathleen , Mohr Erich
Published: October 2023

While many researchers in this field would reasonably believe that the automation of tests of mental capabilities would have started with the advent of the microcomputer in the late 1970s, this is by no means the case. Some may think the pioneering attempts of Gedye (1967) in the 1960s were the earliest attempts, or those with longer memories the introduction of the Continuous Performance Test in the 1950s (Rosvold et al., 1956). However, to the knowledge of the authors, Clark Hull was one of the true pioneers in this field. Hull, better known for his later work on Classical Conditioning, actually conducted his PhD thesis on the effects of tobacco smoking on mental efficiency. In a publication of his thesis, Hull (1924) described a remarkable apparatus which included a reaction time measurement system, accurate to 1/300 second, and a voice key to facilitate the measurement of reading reaction times! The purpose of this chapter is to shed some light upon the intriguing question of why, for decades, some researchers have worked diligently to harness the latest technological advancements of the day in order to automate tests of mental capabilities, while their colleagues have been perfectly happy to make such assessments simply using pencil, paper, and sometimes, a stopwatch.
Age-related memory and cognitive decline
Authors: Jones R W , Ferris S H
Published: October 2023

Memory and cognitive decline in normal ageing have been well documented. It is, however, extremely difficult to define what can be considered normal decline. The distinction between severe dementia and normal ageing is obvious but establishing the difference between, for example, early, mild Alzheimer’s disease and age-related cognitive loss is a much more difficult task. This is also complicated by those who suggest, with some—mainly clinical—evidence, that Alzheimer’s disease is on a continuum with normality and that, if we lived long enough, we would all eventually succumb. What is less clear is whether a disease entity exists which lies between dementing disorders on the one hand and normal age-related changes on the other.
Violence in society and in the family
Authors: Smith Lorna J F
Published: October 2023

Violence harms not only those upon whom it is inflicted but the communities and societies in which it takes place. Its effects are farreaching, going beyond the physical harm sustained to psychological and emotional suffering, which is often long-lasting. It diminishes the quality of our lives as social beings. What is meant by violence is problematic, as is defining the point at which violence is deemed to be crime. Most people would agree that ‘killing people is wrong’; but this statement is open to changing definitions.
Psychological causes of family violence
Authors: de Zulueta Felicity
Published: October 2023

It is useful to see family violence as a continuum-ranging from neglect and disregard of emotional and material needs, through lesser forms of physical aggression, such as slapping, hitting, kicking and beating, up to maiming or even murder. Gelles, a noted researcher in the field of domestic violence, defines it as an ‘act carried out with the intention, or perceived intention, of physically injuring another person’.
The future
Authors: Cloke Christopher
Published: October 2023

General practitioners and primary health care team members have a significant role to play in helping and supporting children and young people. This role derives not only from the provision of advice and health care but also from the way in which they treat and respect children, young people and their parents. Primary health care staff can promote the interests of children and young people by demonstrating to others, through their practice, how this group of patients should be treated and also, again drawing on their experience, by using their influence to change public policy.
Complications of long-term dialysis: bone disease
Authors: Cunningham John
Published: October 2023

Normal role of the kidney in the maintenance of bone and mineral homeostasis Divalent cation, phosphorus, and bone metabolism are critically dependent upon the fluxes of these mineral ions at the level of the kidney, the intestine, and bone itself. In the case of bone these fluxes are internal, and as such do not directly affect the overall balance of calcium, magnesium, or phosphorus whereas, in contrast, both the kidney and intestine are important sites of the regulation of their overall balance. Therefore, it is not surprising that disease of the kidney frequently leads to serious disturbances of mineral metabolism.
Guidelines for the patient with a pacemaker
Authors: Hwang Dr Nian Chih , Sinclair Dr Michael
Published: October 2023

Permanent pacemakers are implanted into patients with occasional or persistent bradyarrhythmias, including bifascicular or complete heart block, who have symptoms of low cardiac output (light-headedness, syncope, heart failure). In addition to the routine preoperative assessment of the cardiac patient, answers to the following additional questions are required. What is the pacing mode of the pacemaker? Is the pacemaker functioning properly?
Induction of anaesthesia, peroperative preparation, and investigations
Authors: Hwang Dr Nian Chih , Sinclair Dr Michael
Published: October 2023

In the induction room, the patient receives ECG and pulse oximetry monitoring while breathing oxygen via a clear facemask. Under local anaesthesia, venous access is gained with a 14 G (2 mm diameter) cannula and invasive arterial blood pressure monitoring is obtained via a 20 G (1 mm diameter) arterial cannula inserted into an artery, usually the radial artery. Two 14 G venous cannulas are inserted for surgery which may require massive blood transfusion. Central venous catheterization is necessary for the monitoring of right atrial filling pressure and the infusion of inotropes and vasopressors. The right internal jugular vein is usually used for catheterization because of its straight alignment with the superior vena cava. The left internal jugular and subclavian veins are acceptable alternatives if right internal jugular venous cannulation is difficult. If the ejection fraction is poor, a pulmonary artery catheter sheath can be inserted at the same time to facilitate the insertion of a pulmonary artery catheter. Unless the patient has an ejection fraction of less than 25 per cent, central venous catheterization can be performed after induction of anaesthesia. If the patient has angina, give sublingual or a nasal spray preparation of nitroglycerin.
Early postoperative management
Authors: Hwang Dr Nian Chih , Sinclair Dr Michael
Published: October 2023

Ventilatory and circulatory management during the postoperative period is an extension of the management which began after weaning from cardiopulmonary bypass. The transition from the operating theatre to the cardiac recovery unit or the intensive care unit can be a dangerous time because of alterations in the patient’s haemodynamic physiology. The patient’s heart rate, blood pressure, and pulse oximetry should be monitored during transfer. On arrival in the cardiac recovery unit, both the ventilatory and monitoring requirements of the patient must be managed simultaneously.
Induction of anaesthesia, peroperative preparation, and investigations
Authors: Hwang Dr Nian Chih , Sinclair Dr Michael
Published: October 2023

Induction of anaesthesia in a child can be via the intravenous, intramuscular, or inhalational route. The intravenous route is favoured but it depends on whether or not a vein is visible for cannulation. If venous cannulation is easy, thiopentone (3-7 mg/kg), fentanyl (30-50 µg/kg), and pancuronium (0.1 mg/kg) are administered through an appropriately sized cannula. As the majority of the patients have pulmonary-systemic communication(s), care should be taken to avoid the injection of air bubbles. For surgery not requiring cardiopulmonary bypass, the dose of fentanyl can be decreased (see Chapter 21). If several attempts at venous cannulation are anticipated, inhalational induction with halothane may be less traumatic. Alternatively, the intramuscular administration of ketamine (4-7 mg/kg) with atropine (0.02 mg/kg) can be used to anaesthetize the child and then venous access can be obtained. The child is then ventilated with 100 per cent oxygen and halothane.
Management of cardiopulmonary bypass
Authors: Hwang Dr Nian Chih , Sinclair Dr Michael
Published: October 2023

General anaesthesia is usually maintained with a volatile agent (such as halothane) in oxygen. Because of the presence of intracardiac shunts, nitrous oxide is not used as it is able to expand intravenous air bubbles if injected accidentally. Air can be added to decrease the inspired oxygen concentration. Normocapnia or, in the case of existing pulmonary hypertension, mild hypocapnia should be maintained by mechanical ventilation. Blood should be sampled for acid-base balance and blood glucose concentration. The blood glucose concentration should be more than 4 mmol/litre and hypoglycaemia can be corrected with a bolus dose of 0.3 ml/kg of 50 per cent glucose solution. The warming blanket is not switched on to allow cooling of the child to occur.
The hypothalamo-hypophysial axis (Physiology)
Authors: Laycock John , Wise Peter
Published: October 2023

is associated with neurones which terminate at the median eminence b is associated with its link to the hypophysis (pituitary gland) is to influence directly ‘higher’ centres of the brain is provided by neurosecretions released into the blood is to provide a link between the central nervous and endocrine systems
Spiritual help
Authors: Stoter David
Published: October 2023

Spiritual care as a concept has attracted growing attention in recent years, but still generates uncertainty for many carers and a range of often confusing definitions from writers. One thing is paramount, that whatever the approach, the nature of spiritual help required has to start from a consideration of the spiritual need of the person concerned whether that person is a patient, relative, or professional carer. It involves accepting each person together with all their attitudes, hopes, and fears and with all related feelings and emotions.
Complex interventional therapies
Authors: Krames Elliot S , Rohira Sunil K
Published: October 2023

In 1986, according to statistics from the American Cancer Society, there were 956 000 new cases of cancer reported; The prevalence of the disease was approximately 1991000 patients; and 478 000 patients died of their disease (Bonica 1990). According to Foley, approximately 50% of cancer patients with early disease will complain of pain, however, during the terminal phase of the disease, upwards of 75-80% of these patients will experience pain (Foley 1985). Because cancer pain is so prevalent, especially in the terminal phase of illness, leading to untold suffering of these individuals, it is imperative to address this problem and utilize all of the tools and therapies that are available to caregivers of patients with cancer. It is the intent of this chapter to present complex interventions, including intraspinal analgesic therapy for patients who do not respond to the pharmacological guidelines set out by the World Health Organization Committee on Cancer Pain Management (1986).
Chemotherapy and hormonal manipulation
Authors: Alison Dawn L
Published: October 2023

Chemotherapy can play an important part in the control of pain and other symptoms in cancer patients. Its use in the context of curable disease is not disputed but as part of a palliative approach to cancer care, chemotherapy has an unacceptable image in the eyes of many non-oncology health-care workers. It is often cited as a cause of significant symptoms due to the associated toxicities and side-effects. As a result the positive outcome for some patients may be overlooked. Lack of knowledge and of experience in caring for patients undergoing cytotoxic chemotherapy are both reasons why some clinicians fail to consider using chemotherapy as a method of symptom relief.
Diagnosis of the Orthodontic Patient
Authors: McDonald F , Ireland A J
Published: October 2023

This concise book provides a sound basis in orthodontic diagnosis for both dental students and general dental practitioners. Following an introductory chapter on the development of normal occlusion, this practical book provides a clear overview of the diagnostic process. It looks at how both local and general factors can affect the final treatment plan and the advantages of different management strategies. Diagnosis of the Orthodontic Patient includes over 150 illustrations five genuine clinical cases a chapter on evidence based practice a glossary of terms.
Dynamic occlusion
Authors: McDonald F , Ireland A J
Published: October 2023

The body is aware of each of its constituent parts, being able to relate them in three dimensions and this includes spatial awareness of the dentition and supporting tissues. The mechanism of recognizing spatial position and thereby coordinating muscle tone in particular, is known as proprioception. The mechanism consists of sensors (muscle spindles, Golgi tendon organs, Ruffini nerve endings, and free-ended fibres), afferent nerves, a central processing area of the central nervous system, efferent nerves (mostly motor nerves), and effectors, the striated muscles. When certain receptors are stimulated, the information is processed and physiological reflexes are activated.
Orthodontic records and diagnostic tests
Authors: McDonald F , Ireland A J
Published: October 2023

A number of different types of records and diagnostic tests are required for orthodontic practice, each of which serves different purposes. These include.

a written record of diagnosis, treatment planning, and treatment progress;
General practice
Authors: Leung Wai-Ching
Published: October 2023

Which of the following statements regarding treatment of asymptomatic adult patients with an abnormal blood pressure reading found on opportunistic screening is/are true?a patients with a single diastolic blood pressure reading of 110 mm Hg should be treated with an antihypertensive agent immediately b patients with three consecutive systolic blood pressure readings of 150 mm Hg should be treated with an antihypertensive agent asymptomatic elderly patients above the age of 80 should never be treated irrespective of their blood pressure readings patients with a single diastolic blood pressure of 135 mm Hg should have their blood pressure rechecked two more times within the next 2 weeks before commencing therapy patients with three consecutive diastolic blood pressure readings of 115 mm Hg should be treated with an antihypertensive agent.
Problems encountered during local anaesthesia
Authors: Illingworth Karen A , Simpson Karen H , Swales Sue
Published: October 2023

Never start an operation until adequate anaesthesia has been obtained Never exceed the maximum dose or volume of local anaesthetic when supplementing a failed block Everyone using local anaesthetics must be competent at managing the possible toxic effects Problems may be minimized by meticulous attention to technique Always believe a patient who says that the local anaesthetic is not working. She or he is likely to be correct even if the nerve block technique appeared to be perfect. Good surface analgesia may occur without anaesthesia of deeper tissues. A nerve block may fail for a number of reasons.
Clinical Trials in Cancer: Principles and Practice
Authors: Girling David J , Parmar Mahesh K B , Stenning Sally P , Stephens Richard J , Stewart Lesley A
Published: October 2023

Clinical Trials in Cancer provides concise, accessible and practical information on the practicalities of planning, designing, conducting, analysing, reporting, and interpreting phase III clinical trials predominantly, but also single-arm and randomized phase II trials. The book shows clearly how recent developments and current thinking can be implemented. Information on the need to decide and measure realistic target differences in trials, the conduct and interpretation of interim analyses, patient advocacy, good clinical practice, the study of quality of life, the role of meta-analyses, and informed consent and other ethical issues are also covered. This book will prove invaluable for medical, statistical, and biological cancer researchers, health care professionals, and researchers in the pharmaceutical industry. Trial sponsors, principal investigators, members of data monitoring and trial supervisory committees, specialists invited to provide independent assessments, and many others involved in all aspects of research related to clinical trials should also find this book helpful.
Introduction
Authors: Girling David J , Parmar Mahesh K B , Stenning Sally P , Stephens Richard J , Stewart Lesley A
Published: October 2023

With the best of intentions, medical interventions have the capacity to do harm as well as good, and before any new treatment is accepted into clinical practice it should pass through a series of pre-clinical and clinical evaluations to ensure that it is both safe and has some efficacy. Safety is usually first evaluated in laboratory studies followed by observations of either healthy volunteers or patients. Clinical effectiveness must be evaluated through some kinds of comparisons against no treatment or other competing therapies – on either a formal or an informal basis. Only rarely will an intervention be so obviously effective that formal comparison is not required: for example, defibrillation following cardiac arrest. The effects of most interventions are much more subtle and require careful evaluation to ensure that we are indeed measuring the effect of treatment rather than differences in the prognosis and potential responsiveness to treatment between the individuals being compared [1].
Principles of pharmacokinetics
Authors: Chatelut Etienne
Published: October 2023

Pharmacokinetics is the study of the fate of a drug between the time of its administration to an organism and the time it is eliminated from the body. Pharmacokinetic studies require an understanding of both the mechanisms and the kinetics of three main processes, absorption, distribution, and elimination, and it is mainly the last of these that will be addressed in this chapter. Pharmacokinetic information is accumulated during the development of a drug, and at each stage of drug development the collected pharmacokinetic data should be used to guide the design to the following phase.
Purine analogs and antifolates
Authors: Liliemark Jan , Peterson Curt
Published: October 2023

The first report on the synthesis and antileukaemic effect of cladribine [2-chloro-2e-dioxyadenosine (CdA)] (Fig. 6.1) was published in 1972. Owing to the absence of a confirmed patent, the development of the drug for clinical use was very slow. Thanks to the efforts of Dennis Carson and Ernest Beutler at Scripps Clinic, La Jolla, California, cladribine was eventually taken through preclinical and early clinical testing phases. Through the Orphan Drug Act, cladribine was licensed as Leustatin® in 1994 and has become an important drugs in the therapeutic armament against lymphoproliferative disorders. The use of cladribine in children was investigated independently at St Jude Children’s Hospital, Memphis, Tennessee. Although
Communication, psychiatric morbidity, access to information, and decision-making
Authors: Maslin A M
Published: October 2023

Considerable research has been carried out in relation to the psychiatric morbidity experienced by women diagnosed with breast cancer (Maguire 1988; 1990; Maguire et al. 1980; 1982; 1983; Watson et al. 1988). It is known that approximately one in four women with breast cancer will suffer from severe anxiety and or depression requiring psychiatric intervention (Maguire et al. 1980; Watson et al. 1988). It is also now known that the communication, or lack of it, between breast cancer patients and their clinicians has a psychological impact and affects the patients’ ability to adjust (Fallowfield et al. 1986; 1987; 1990^,b; 1994a,b). This chapter reviews the impact of communication on psychiatric morbidity and the role choice plays in adjustment to breast cancer diagnosis and treatment.
Surgical treatment options
Authors: Skene A
Published: October 2023

Contemporary diagnosis of breast cancer is based on clinical, imaging, and cytological assessments (triple assessment) of selected breast abnormalities. This initial evaluation in the majority of specialized breast clinics is led by surgeons; it is, however, their role as a surgical oncologist rather than a surgical operator that brings most influence to the surgical decision-making process.
Dialysis therapy in the cardiothoracic intensive care unit
Authors: Lacson Eduardo K , Owen William F
Published: October 2023

In the United States in 19961 there were over 300 000 patients with end-stage renal failure (ESRF), who, by definition, required a life-long course of dialysis. Cardiovascular causes (cardiac arrest, acute myocardial infarction, and other cardiac events) accounted for half the reported deaths in this population. This is unsurprising as cardiac disorders are present in a large fraction of patients when they begin dialysis. In one study, the investigators noted that 42% of patients had a previous myocardial infarction (MI) or coronary revascularization (also known as coronary artery bypass surgery, CABG) and up to 40% had a previous episode of congestive heart failure (CHF).
Prevention of Cardiovascular Complications in Chronic Renal Disease
Authors: Massy Z A , Kasiske B L
Published: October 2023

Cardiovascular disease (CVD) is common in patients with renal failure. Indeed, data from both the United States and Europe suggest that CVD is the most common cause of death in patients with end-stage renal failure (ESRF).In addition, risk factors for CVD may also be risk factors for renal disease and its rate of progression. In 1997 the National Kidney Foundation (NKF) convened a Task Force on CVD. The Task Force examined CVD and its risk factors in four groups: (1) patients with renal insufficiency, further divided into those with and without nephrotic syndrome (NS); (2) patients treated with hemodialysis (HD); (3) peritoneal dialysis (PD) patients, and (4) renal transplant recipients (RTRs).
Learning and memory in schizophrenia
Authors: Gur Ruben C , Moelter Stephen T , Ragland J Daniel
Published: October 2023

Disordered cognitive functioning has long been considered a hallmark of schizophrenia. Early work concentrated on impairment in attention, abstraction and other prefrontal domains. Recent studies have focused on memory processes in schizophrenia, implicating temporo-limbic systems. An immediate and important question that arises in this context is the issue of ‘differential deficit’as elucidated initially by Chapman and Chapman (1978). Is memory more impaired than other cognitive domains in schizophrenia? In order to establish differential impairment, it is necessary to show that patients are impaired in a specific domain more than other in domains on tasks in which normative samples perform equally (i.e. equivalent mean and true score variance). Demonstrating this can be a daunting task, yet is important prior to a more detailed examination of memory components in schizophrenia.
Information Processing and Attention in Schizophrenia: Clinical and Functional Correlates and Treatment of Cognitive Impairment
Authors: Cadenhead Kristin S , Braff David L
Published: October 2023

The study of information processing and attention abnormalities as core cognitive deficits in schizophrenia research has identified abnormalities in these domains and has clarified their relationship to neural substrate abnormalities and functional outcome in patients with schizophrenia (e.g. Braff, 1999). It has been hypothesized that the information processing and attentional deficits of schizophrenic patients are ‘central’to the disorder and are strongly associated with the clinical and functional impairments of the illness (McGhie and Chapman, 1961; Steronko and Woods, 1978; Green, 1996; Braff, 1999). In addition, the study of information processing deficits in human research and animal models has increased our understanding of the neural circuit dysfunction of schizophrenia and provided means of assessing new treatments that ‘normalize’these information processing deficits (e.g. Swerdlow et al., 1994; Braff, 1999) . If information processing abnormalities are core and enduring deficits of patients with schizophrenia spectrum disorders and their relatives, they may also be useful intermediate phenotypic markers in genetic studies (Freedman et al., 1997).
Formal Thought Disorder in Schizophrenia: Characteristics and Cognitive Underpinnings
Authors: Harvey Philip D
Published: October 2023

Abnormalities in communication have been noted on the part of patients with schizophrenia since the first definitions of the illness. Both Kraepelin (1919) and Bleuler (1911) noted these impairments and described them in detail. While Bleuler believed that these disorders and their cognitive causes were a fundamental feature of schizophrenia, Kraepelin’s perspective was that they were one of the important features of the illness but not necessarily pathognomonic. Regardless of whether disorders in communication are seen to be the central feature of the illness or only one its many symptoms, the importance of this symptom is not in question.
Cognitive functioning in schizophrenic patients with comorbid substance use disorders
Authors: Serper Mark R , Chou James C -Y
Published: October 2023

Substance abuse is a major health concern in schizophrenia because of the remarkably high comorbidity of the two disorders (Regier et al., 1990). Alcohol, cannabis and/or cocaine use disorders have been found to be present in almost half of all schizophrenic patients presenting for psychiatric treatment (Barbee et al., 1989; Galanter et al., 1992) and these are among the most frequently and heavily abused substances by schizophrenic patients (Regier et al., 1990; Herman et al., 1991; Cuffel et al., 1993). Moreover, schizophrenic patients with any substance use disorder are also two to three times more likely to be nicotine dependent (Ziedonis et al., 1997). Although the use patterns and the effects of smoking cigarettes are strikingly different from those of alcohol, cannabis or cocaine abuse, all these psychoactive substances have a significant impact on patients’symptomatic and cognitive functioning. In this chapter, we review the available research examining the effects that these substance use disorders have on schizophrenic patients’neurocognitive functioning and review methodological considerations needed for future research.
Epidemiology and pathology
Authors: Jennings Kevin
Published: October 2023

Coronary disease is the commonest cause of death in developed countries, being responsible for about 30 per cent of total mortality (Dwyer and Hetzel 1980). Annually approximately 270 000 patients experience myocardial infarction in the United Kingdom, from which the majority will die; there are about 180 000 deaths from this cause per year, and 60 per cent of these will occur, usually from ventricular fibrillation, within 2 hours, despite the fact that the median time to arrival in coronary care units is 4 hours. Coronary heart disease is responsible for the premature death of one person under the age of 65 years every 16 minutes in the United Kingdom.
Reducing the risk
Authors: Jennings Kevin
Published: October 2023

It is widely accepted that a combination of risk factors allows for a more accurate prediction of who will develop coronary disease than any isolated risk factor. The variables are: age, sex, cigarette-smoking, blood-pressure, resting ECG abnormalities, serum cholesterol, diabetes, exertional chest pain, and parental death from cardiac disease. These factors allow a degree of risk-stratification in an attempt to identify patients at excess risk of premature cardiac disease so that appropriate advice and therapy can be provided.
Hospital management of myocardial infarction
Authors: Jennings Kevin
Published: October 2023

The immediate in-hospital management of myocardial infarction is necessarily similar to early coronary care in the community. Once again a prompt diagnosis is desirable, and patients should not be allowed to stack up unseen by a physician, in the mistaken belief that their being in hospital is sufficiently protective.
Neuropsychological Assessment of Early Onset Dementia
Authors: Salmon David P , Hodges John R
Published: October 2023

Extensive clinical neuropsychological research over the past decade has characterized the various cognitive deficits associated with the dementias and identified the subtle cognitive changes that signal the onset of Alzheimer’s disease (AD). These advances have greatly enhanced the ability to diagnose AD in its early stages and to differentiate AD from other dementing disorders. This is particularly important given the development of disease modifying drugs and the fact that there are currently no biological markers for AD.