bluuebunny/crossref_metadata_2025 huggingface dataset:
Late-life depression
Authors: Fußer Fabian , Karakaya Tarik , Pantel Johannes
Published: November 2017

Depression is one of the most prevalent mental diseases in late life, and is a tremendous burden on patients, their families and carers, and the healthcare system. Late-life depression (LLD) often affects people with chronic somatic illnesses, cognitive impairment, and disability. In the elderly, core symptoms of depression are much less pronounced. Instead, unspecific somatic complaints and cognitive impairment may dominate the clinical presentation, and a significant proportion of individuals with LLD goes undiagnosed. This may lead to increased mortality rates, in part attributed to the deleterious consequences of LLD on comorbid somatic illnesses or increased suicide rates. In order to improve prognosis, general practitioners in primary care settings have a prominent but challenging role in recognizing LLD. The diagnostic challenge also includes the differential diagnosis between depression, dementia, and delirium. The optimal management of LLD may include antidepressant drugs, non-pharmacological interventions such as psychotherapy (e.g. cognitive-behavioural therapy), as well as physical exercise.
Untoward side effects of psychiatric drugs
Authors: Sharma Manu S. , Passos Ives Cavalcante , Carvalho André F.
Published: November 2017

Adverse effects are an unavoidable risk of medication treatment. Clinical trials alone do not adequately assess the entire side effect profile, and it is important to pay attention to post-marketing surveillance and long-term follow up studies. Psychotropic medications are responsible for a wide variety of adverse effects, which can affect almost any part/system of the body. Adverse effects can vary from mild nausea and vomiting to life-threatening blood dyscrasias and arrhythmias. A high number of adverse effects are associated with the action of the psychotropic medications on their primary targets outside the brain, and the additional action on the autonomic nervous system. In order to minimize the risk of adverse effects most psychotropic medications should be started with low-dose trials followed by slow titration. Care should be taken to look for drug-drug interactions and pre-existing medical and metabolic conditions which may pre-dispose a patient to certain adverse effects.
Drug interactions involving psychotropic drugs
Authors: Madhusoodanan Subramoniam , Tsoy-Podosenin Marina , Steinberg Leah R. , Tandan Nitin
Published: November 2017

This chapter covers the various drug interactions of psychotropic agents with other drugs, over the counter (OTC) medications, food substances, herbals, alcohol, and smoking. The basic mechanisms of pharmacokinetics, pharmacodynamics, and other interactions are discussed. The disease states and age-related changes underlying the drug interactions in the elderly are briefly addressed. Drug interactions discussed have been classified as severe, moderate, or mild, according to the severity of their anticipated clinical consequences. Serious complications including death may occur in severe interactions involving cardiovascular drugs. A thorough understanding of the basis of drug interactions, and patient participation in the treatment are vital. It is also particularly important to compile a list of medications, including OTC and herbal drugs, currently taken by the patient.
Evidence-based treatment of bipolar depression
Authors: Frye Mark A. , Croarkin Paul E. , Veldic Marin , Nassan Malik M. , Moore Katherine M. , Kung Simon , Tye Susannah J. , Bobo William V. , Voort Jennifer L. Vande
Published: November 2017

Despite the predominant illness burden, evidence-based treatment, and by extension regulatory approved, for acute bipolar depression is significantly less than evidence bases in acute mania and maintenance treatment. Complicating this deficit has been persistent use of unimodal antidepressant therapy without clear and convincing benefit. Successful regulatory-approved drug development has focused on atypical antipsychotic therapy. Evidence-based treatments also include lamotrigine and divalproex by meta-analyses and a number of manual-based psychotherapies. In contrast, unimodal antidepressants as a class for bipolar depressed patients as a group appear to provide substantial benefit and may pose risk for mood destabilization. Promising novel and neuromodulatory treatments while encouraging require further systematic investigation. Understanding unimodal antidepressant response and risk patterns in bipolar disorder has immediate clinical implications. Moreover, evidence-based guidelines will need to bridge more individualized or precision-based treatment interventions.
Psychological interventions for early stage bipolar disorder
Authors: Scott Jan
Published: November 2017

Clinical staging and early intervention models used in psychosis and depression have only recently been applied to individuals ‘at risk’ of bipolar disorder (BD), or experiencing a first episode of BD. This chapter briefly discusses the concept of staging and then reviews ongoing research into the adaptation and use of psychological interventions in ‘at risk’ and ‘first BD episode’ populations. Evidence indicates that the current interventions may not sufficiently target specific developmentally normal changes in cognitive–emotional and sleep–circadian regulation systems that may act as triggers for mood episodes. So the chapter discusses how to tackle these ‘dysregulations’ and how to ensure any ‘early stage’ therapy is sufficiently flexible to tackle the range of problems experienced, including mood symptoms, harmful alcohol or substance use, and/or co-morbid physical ill-health and that the therapy models must take into account that not all individuals in high-risk populations actually develop BD.
Psychotherapeutic interventions for bipolar disorder
Authors: Reinares María
Published: November 2017

The recurrent nature of bipolar disorder (BD), and the high morbidity and mortality associated with the illness advocate for an integrative treatment in which medication is complemented with psychological approaches. This chapter explores the role of adjunctive psychotherapy in BD. The most commonly tested psychological treatments have been cognitive-behavioural therapy, psychoeducation, interpersonal and social rhythm therapy, and family intervention. Functional remediation represents a new option for patients with functional impairment. Most findings indicate the benefits of adjunctive psychological treatments to improve the outcomes of BD. Controversial results have also been found, highlighting the need for a better identification of treatment moderators and mediators to design interventions tailored to the target population. Recently, cognitive remediation, mindfulness-based cognitive therapy, dialectical behaviour therapy, and eye movement desensitization and reprocessing have begun to be tested, as well as Internet-based psychological interventions, but it is too early to draw conclusions about their efficacy.
Functional remediation therapy for bipolar disorder
Authors: Torrent Carla , del Mar Bonnin Caterina , Martinez-Arán Anabel
Published: November 2017

Impairment in functional outcome is commonly observed even when patients are euthymic and includes multiple areas of functioning. Many factors such as sociodemographic, clinical, pharmacological, and neurocognitive variables have been associated with functional impairment. The term ‘functional remediation’ has been coined to define an innovative strategy aimed at targeting the critical factors for full psychosocial adjustment and functional recovery in the context of psychoses and more specifically bipolar disorders. Functional remediation involves not only neurocognitive techniques and training but also psychoeducation on cognition-related issues and problem-solving within an ecological framework. The inclusion of context processing, performance monitoring, encoding, and manipulation of the information as well as fostering compensatory strategies must be included in the functional remediation intervention. In this regard, real-world problems affecting daily functioning are used for bipolar disorder to be transferred to daily practice.
Predominant polarity, polarity index, and treatment selection in bipolar disorder
Authors: da Costa Sabrina C. , de Quevedo Joao L. , Carvalho André F.
Published: November 2017

Bipolar disorder (BD) is a chronic and disabling illness, with lifetime prevalence of 2.4% worldwide. Predominant polarity (PP), ie, depressive versus manic, may influence illness characteristics, treatment selection, and outcomes in BD. PP has been proposed as a course specifier for BD, although not included in the Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5). The polarity index (PI), a metric algorithm that reflects antimanic versus antidepressant maintenance efficacy of available treatments for BD, is calculated as the ratio of number needed to treat (NNT) for prevention of depression and NNT for prevention of mania. Evidence indicates that the net PI of ongoing maintenance-treatment regimens for BD is related to the patient’s PP. Additionatlly, PP and PI may aid in treatment selection and outcome prediction in BD. Therefore, this chapter provides an overview of putative roles of PP and PI in the course and treatment selection for BD.
The role of electroconvulsive therapy in the treatment of bipolar disorder
Authors: Milev Roumen
Published: November 2017

This chapter examines the use of electroconvulsive therapy (ECT) for treatment of patients with bipolar disorders. It briefly reviews the basics of ECT, stimulus parameters, placement of electrodes, and seizure threshold. The data for efficacy and tolerability of ECT for bipolar disorder, including mania, depression, mixed states, and across the lifespan is reviewed. Although there is a paucity of good-quality randomized studies, all available data, including case reports and naturalistic observations, support the use of ECT in this population, and reinforce the widespread use of ECT in everyday clinical practice. Good-quality randomized control trials are urgently needed to address numerous unanswered questions, in order to improve efficacy and reduce side-effect burden of one of the best treatments for bipolar disorder.
The treatment of bipolar disorder in the era of personalized medicine: myth or promise?
Authors: Fabbri Chiara , Serretti Alessandro
Published: November 2017

Bipolar disorder (BD) is a chronic disease associated with high personal and socio-economic burden. Genetics accounts for 20–95% of variability in central nervous system drug disposition and pharmacodynamics, thus genetic markers are considered a promising way to develop tailored treatments and improve the prognosis of the disease. Among mood stabilizers, lithium response was the most investigated phenotype and the most replicated genes are involved in synaptic plasticity (BDNF), serotonergic (SLC6A4) and dopaminergic (DRD1) neurotransmission, and second messenger cascades (GSK3B). Relevant pharmacogenetic findings regarding other mood stabilizers are hyperammonaemia (CPS1 gene) and hepatic dysfunction (POLG gene) induced by valproate and immune-mediated cutaneous hypersensitivity reactions (HLA-B*1502) induced by lamotrigine or carbamazepine. Polymorphisms in cytochrome (CYP) P450 genes are expected to provide useful information particularly in case of polypharmacy. Despite few pharmacogenetic tests are currently recommended, the development of pharmacogenetics in other fields of medicine provides an encouraging perspective.
The epidemiology of ankylosing spondylitis, axial spondyloarthritis, and back pain
Authors: Siebert Stefan , Raj Sengupta , Tsoukas Alexander
Published: November 2017

Low back pain is a leading cause of disability worldwide. The prevalence of inflammatory back pain (IBP) has been calculated to be in the range 8–15% in a UK primary care population and 5–7% in a US population-based cohort. IBP rates are significantly higher in patients with psoriasis, uveitis, or inflammatory bowel disease than the general population. There is a paucity of good epidemiological studies to define the true incidence and prevalence of ankylosing spondylitis (AS), axial spondyloarthritis (axSpA), and spondyloarthritis (SpA), with wide variation as a result of geographic, demographic and methodological factors. The global prevalence estimates range from 0.01–0.2% for AS, to 0.32–0.7% for axSpA and around 1% for SpA overall. The global incidence estimates range from 0.44–7.3 cases per 100,000 person-years for AS to 0.48–62.5 cases per 100,000 person-years in SpA. The demographics and natural history of disease progression are also discussed.
Extra-articular manifestations of axial spondyloarthritis
Authors: Siebert Stefan , Raj Sengupta , Tsoukas Alexander
Published: November 2017

Axial spondyloarthritis (axSpA) is associated with a number of extra-articular manifestations (EAMs) reflecting shared clinical, genetic, and pathophysiological

features. The EAMs are considered part of the spondyloarthritis spectrum and should be differentiated from complications arising as a consequence of the disease (covered in a separate chapter). The key EAMs of axSpA are inflammatory bowel disease (IBD), uveitis, and psoriasis. EAMs carry their own morbidity and often warrant treatment in their own right. Furthermore, the presence of EAMs may influence the choice of therapy used to treat the underlying axSpA. Clinicians should ensure that the well-recognized EAMs of axSpA are actively and regularly enquired about when reviewing patients with axSpA.
Classification criteria and diagnosis in spondyloarthritis
Authors: Siebert Stefan , Raj Sengupta , Tsoukas Alexander
Published: November 2017

The spondyloarthropathies (SpA) are heterogeneous multisystem disorders with no single ‘gold standard’ clinical, laboratory, pathological or radiological feature to confirm the diagnosis. A number of criteria have therefore been developed to support clinical practice and research. In this chapter, we highlight the important differences between classification and diagnostic criteria, which are often confused although they have very different applications. We then review some of the major SpA classification criteria including the modified New York criteria for ankylosing spondylitis (AS), the Amor and ESSG criteria for SpA, and the ASAS criteria for axial spondyloarthritis (axSpA). The evolution of these classification criteria has facilitated many significant advances in the field of axSpA and SpA in general. Specifically, the development of classification criteria for axSpA that do not rely on established radiographic damage has allowed biologic therapies to be investigated, and used, in earlier disease and for a wider population of patients.
Renal therapy techniques
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Haemodialysis 64

Haemo(dia)filtration 68

Peritoneal dialysis (PD) 70

The first human haemodialysis was performed in 1943 by Willem Kolff in The Netherlands for the treatment of acute renal failure. Following this, haemodialysis was adopted for the treatment of acute renal failure in the immediate post-war years and then for chronic renal failure from the 1960s. Currently haemodialysis is the most common form of replacement treatment for end-stage renal disease (ESRD). Haemodialysis is one method used for treatment of acute renal failure, and ESRD patients will develop critical illness. An understanding of the principles of haemodialysis and how it is carried out is therefore essential....
Fluids
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Crystalloids 142

Colloids 144

Sodium bicarbonate 146

Blood 150

A substance with properties of a crystal; aqueous fluids containing dissolved sugars or salts (Table 9.1.1).

• Isotonic crystalloids

• ‘Normal saline’

• Hartmann's (Ringer's lactate)

• Hypotonic crystalloids

• ‘Half-normal saline’...
Haematological drugs
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Anticoagulants and heparin-induced thrombocytopenia 220

Thrombolysis 224

Antifibrinolytics 226

For >50 years, the options for therapeutic anticoagulation were limited to unfractionated heparin (UFH) and oral vitamin K antagonists. While highly effective, both drugs have major safety problems. Both have narrow therapeutic ranges, substantial interindividual dose variability, major side effects and require regular therapeutic drug monitoring, with a narrow therapeutic window and high incidence of bleeding complications....
Metabolic disorders
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Electrolyte disorders 410

Hyponatraemia 414

Hypernatraemia 416

Categorizing metabolic acidoses 418

Metabolic acidosis aetiology 420

Metabolic alkalosis 422

Glycaemic control in the critically ill 426

Diabetic ketoacidosis 428

Hyperosmolar diabetic emergencies 430

Thyroid emergencies: thyroid crisis/thyrotoxic storm 432

Thyroid emergencies: myxoedema coma 434

Hypoadrenal crisis ...
Poisoning
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Management of acute poisoning 440

Acute poisoning remains one of the most common medical emergencies, 5–10% of hospital medical admissions. In the majority of cases, the drug ingestion is intentional, but the in-hospital mortality remains low (<0.5%). There are specific antidotes available for a small number of poisons and drugs; in most intoxications, basic supportive care is the main requirement and recovery follows. Internet-based information services such as Toxbase are useful: ...
Physical disorders
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Hypothermia 498

Drowning and near-drowning 500

Rhabdomyolysis 502

Pressure sores 504

Defined as core temperature <35°C

Mild 32–35°C; moderate 26–32°C; severe <26°C

Increasing age, abnormal mental state, immobility (orthopaedic, Parkinsonism), drugs (alcohol, barbiturate, major tranquillizers, antidepressants), endocrine (hypothyroidism, hyperglycaemia, adrenal insufficiency, hypopituitarism), autonomic neuropathy (diabetes mellitus, Parkinsonism), malnutrition, renal failure, sepsis (excessive heat loss from vasodilatation), exposure (inadequate clothing/eating, near drowning)....
Thoracic tumours
Authors: Ajithkumar Thankamma , Barrett Ann , Hatcher Helen , Cook Natalie
Published: November 2017

Primary tracheal tumours represent <1% of all respiratory malignancies and can arise from the respiratory epithelium, salivary glands, and mesenchymal structures of the trachea. Most tumours in adults are benign while this is the case in only 30% of tumours in children. Primary tumours in adults are predominantly of adenoid cystic or squamous cell histology (Gaissert et al. 2006)....
Gastro-intestinal cancers
Authors: Ajithkumar Thankamma , Barrett Ann , Hatcher Helen , Cook Natalie
Published: November 2017

Oesophageal cancer is a common cancer in the UK with an annual incidence of 16.5 for men and 8.5 for women per 100,000 and >7000 new cases per year (ONS 2004). The incidence has risen steadily over the last 20 years mainly due to an increase in adenocarcinomas, whereas SCCs have decreased slightly. Despite advances in the treatment OS rates remain poor at <15% (ONS 2004)....
Genito-urinary cancer
Authors: Ajithkumar Thankamma , Barrett Ann , Hatcher Helen , Cook Natalie
Published: November 2017

Renal cell carcinoma (RCC) accounts for approximately 2% of cancer diagnosis worldwide. It has the highest mortality of any urological cancer. Clear-cell renal cell carcinoma (CC-RCC) is the commonest RCC. CC-RCC has the highest prevalence in Eastern Europe and is the fifth commonest solid tumour in the UK. Incidence of primary CC-RCC rises after the age of 40 years old and there is a 2:1 male to female ratio....
Psychosocial Treatment for Psychotic Disorders: Systems of Care and Empirically Supported Psychosocial Interventions
Authors: Gannon Jessica M. , Eack Shaun M.
Published: November 2017

In this chapter, we discuss psychosocial interventions, including psychotherapies and other services useful for helping individuals with psychotic disorders. We explain the basics components of the systems of care through which these services are frequently offered, focusing on outpatient treatments. Psychosocial rehabilitation is highlighted, as it helps patients move towards recovery, which is an important model for psychosocial care. A number of evidence-based psychotherapies are explored, notably cognitive-behavioral therapy (CBT), family therapy, and cognitive remediation. Many of these treatments can be given individually or in groups, and although underutilized, can improve outcome when combined with somatic therapies. Other services have been shown to be useful in recovery, such as case management, assertive community treatment, and housing, and these are explored in this chapter as well. Finally, we review the role of hospitalization and involuntary treatment in the care of patients with psychotic disorders.
Introduction to palliative nursing care
Authors: Coyle Nessa
Published: November 2017

Providing palliative care depends on the nurse having strong interpersonal skills and clinical knowledge and is informed by respect for the person and the ethical principles of autonomy, beneficence, nonmaleficence, and justice. The genuine, warm, and compassionate relationship of a nurse with his or her patient is frequently a healing relationship even in the face of death. It is a combination of state-of-the art clinical competence with fidelity to the patient, the ability to listen and remain present in the face of much suffering and distress, and effective communication. It is the nurse who provides much of the care and support to patients and families throughout a disease trajectory and the one who is more likely to be present at the time of death than any other health professional.
Communication in palliative care
Authors: Dahlin Constance M. , Wittenberg Elaine
Published: November 2017

Communication, a learned skill that establishes the nurse-patient relationship, is composed of 20% verbal and 80% nonverbal characteristics. The art of nursing communication includes listening, silence, presence, and therapeutic use of self to facilitate a patient- and family-centered process. Nursing communication includes gathering and imparting information and providing support and reassurance as dictated by the individual needs of patients and families. Nurses have a direct role in difficult conversations such as advance care planning, delivery of bad news, poor prognosis, or transition to hospice and palliative care.
Fatigue
Authors: O’Neil-Page Edith , Anderson Paula R. , Dean Grace E.
Published: November 2017

This chapter provides an overview of fatigue as it spans the illness trajectory and end-of-life experience for patients with chronic progressive disease. While fatigue is a complex phenomenon that has been widely studied, there is still no universally accepted definition. Individuals with cancer and many other chronic, progressive diseases continue to experience fatigue and its costs, not only in the economic sense but also in its physical, emotional, and psychological impact on life. Cancer-related fatigue is a serious problem that interferes with physical, psychological, emotional, social, and economic functions. The need for healthcare providers to recognize and identify symptoms and explore management strategies is crucial to the lessening of human suffering.
Nausea and vomiting
Authors: Chow Kimberly , Cogan Daniel , Mun Sonni
Published: November 2017

Nausea and vomiting are symptoms commonly experienced in advanced disease, especially the cancer population. Clear understanding of the different concepts surrounding nausea and vomiting is essential and will aid in screening, preventing, assessing, and treating symptoms as well as improve understanding of the incidence and severity of patient distress. The cause of nausea and vomiting is often multifactorial and requires a thorough assessment and understanding of the emetic pathway and neurotransmitters involved in order to aid treatment decisions. Pharmacologic and nonpharmacologic interventions should be used to manage the distressful symptoms of nausea and vomiting. Nurses play a vital role in helping patients and family members manage and cope with nausea and vomiting.
Bowel management
Authors: Caraccia Economou Denice
Published: November 2017

As multiple factors contribute to constipation, proactive management is essential for successful outcomes. Treating diarrhea requires a thorough assessment and therapy directed at the specific cause. Palliative care should allow for a thoughtful and realistic approach to management of bowel-related symptoms within the goals of care. Attention to elimination is an essential part of palliative care especially related to opioid use.
Artificial nutrition and hydration
Authors: Gabriel Michelle S. , Tschanz Jennifer A.
Published: November 2017

Decreased appetite or inability to tolerate or enjoy food and fluids is often a hallmark of the terminal phase of an illness. Discussions and decisions regarding initiating or withholding artificial nutrition and hydration at the end of life are guided by goals of care, evaluation of benefits and burden, ethical and cultural considerations, and the beliefs and wishes of the patient and family. Patients have the right to refuse hydration and nutrition, whether parenteral or oral. Nurses are responsible for promoting patient autonomy, providing education regarding benefits and burdens of interventions in order, promoting informed decision making, and delivering quality care with the rest of the are team.
Lymphedema management
Authors: Fu Mei R. , Lasinski Bonnie B.
Published: November 2017

Lymphedema is a syndrome of abnormal accumulation of lymph fluid and multiple symptoms that is caused by irreversible damage to and congenital malformation of the lymphatic system. There is no cure for lymphedema, and management of lymphedema requires daily self-care and changes in lifestyle. Promotion of lymph fluid flow and prevention of infection is fundamental to achieve long-term effective lymphedema management. This chapter prepares nurses to understand, assess, and manage lymphedema in various clinical settings, including acute, outpatient, community, and palliative care.
Skin disorders
Authors: Seaman Susie , Bates-Jensen Barbara M.
Published: November 2017

Skin disorders are both emotionally and physically challenging for patients and caregivers. Cutaneous symptoms may be the result of disease progression, complications associated with end-stage disease or the end of life, or simple changes in function of urinary or fecal diversions. All cutaneous symptoms require attention to basic care issues, creativity in management strategies, and thoughtful attention to the psychosocial implications of cutaneous manifestations. Although the goals of care do not include curing the condition, they always include alleviating the distressing symptomatology and improving quality of life. The most distressing symptoms associated with skin disorders are odor, exudate, and pain.
Delirium, confusion, agitation, and restlessness
Authors: Heidrich Debra E. , English Nancy K.
Published: November 2017

Delirium, confusion, and agitation are common symptoms in the palliative care setting and are extremely distressing to both patient and family. Identifying patients at risk of developing these symptoms can lead to early recognition and prompt treatment. The etiology of these symptoms is frequently multifactorial; some causes are reversible and others not. The bedside nurse and advanced practice palliative care nurse are central to the assessment and management of patients experiencing delirium. Patient and family education regarding the reasons for these mental changes and how they will be managed is essential.
Insomnia
Authors: Bourdeanu Laura , Hein Marjorie J. , Liu Ellen A.
Published: November 2017

Insomnia is a symptom characterized as inconsistent or ineffective sleep patterns that can significantly impact a person’s quality of life. There remains a lack of knowledge specifically related to assessing and managing insomnia in cancer patients. Many pharmacological and nonpharmacological therapies are available that can be helpful. All nurses in all settings can play an important role in advancing the knowledge and skills related to addressing insomnia. Though it is a common symptom noted by cancer patients, especially those undergoing aggressive forms of treatment, research regarding insomnia in cancer patients is scarce. This chapter will apply as a model for assessment and treatment of insomnia to cancer patients; however, these principles can also be considered for patients without cancer.
Complementary and alternative therapies in palliative care
Authors: Kravits Kate
Published: November 2017

The focus in this chapter is on evidence-based complementary therapies. Alternative therapies are discussed in a limited manner in order to provide a context for understanding the range of complementary and alternative (CAM) therapies that are used by patients. Cancer is used as a model of a chronic progressive disease that illuminates opportunities for the use of CAM therapies. Patients’ independent use of evidence-based complementary therapies often promotes feelings of self-efficacy with hopeful and positive attitudes arising from these feelings. Patients can participate in their care by knowing that they have options to promote comfort and quality of life.
The meaning of hope in the dying
Authors: Cotter Valerie T. , Foxwell Anessa M.
Published: November 2017

To assist palliative care nurses, this chapter explores the many dimensions of hope and identifies its possible influence on health and quality of life. Nursing assessment and strategies to foster hope are described. In addition, specific issues such as “unrealistic hopefulness” and cultural considerations in the expression and maintenance of hope are discussed. The goals of the chapter are to provide the reader with an understanding about this complex but vital phenomenon, to offer guidance in the clinical application of this concept to palliative nursing care, and to explore some of the controversies about hope that challenge clinicians.
Bereavement
Authors: Corless Inge B.
Published: November 2017

Bereavement is the state of having lost a significant other. Loss is a generic term indicating the absence of a current or future possession or relationship. Grief is the emotional response to loss. Mourning encompasses the death rituals engaged in by the bereaved.
Spiritual assessment
Authors: Johnston Taylor Elizabeth
Published: November 2017

This chapter reviews models for spiritual assessment, presents general guidelines on how to conduct a spiritual assessment, and discusses what the nurse ought to do with data from a spiritual assessment. These topics are prefaced by arguments supporting the need for spiritual assessments, descriptions of what spirituality “looks like” among the terminally ill, and risk factors for those who are likely to experience spiritual distress.
End-of-life care for patients with mental illness and personality disorders
Authors: Morgan Betty D.
Published: November 2017

This chapter examines what is known about palliative care and the mentally ill, including those with serious mental illness (SMI) and personality disorders (PDs). Special issues related to communication and treatment are presented as well as strategies for care for this population. Ethical issues including capacity and competency for decision-making as it relates to those with SMI and end-of-life care are also discussed. Collaboration and consultation between providers is essential in providing end-of-life care for those with SMI.
Grief and bereavement in pediatric palliative care
Authors: Limbo Rana , Davies Betty
Published: November 2017

The purpose of this chapter is to define common words associated with grief; to describe factors that affect the grief of family members, the effects of grief on them, and the nurse‘s role in helping grieving individuals and their families; and to discuss the needs of nurses who work in pediatric palliative care.
Pediatric pain
Authors: Layman-Goldstein Mary , Kramer Dana
Published: November 2017

To prevent suffering for children and their families, nurses and other healthcare professionals must apply the most up-to-date techniques of pain assessment and management to all children they care for, especially from the time a child receives a diagnosis of a potentially life-threatening illness through his or her survival or death. By application of an integrated treatment plan that is based on the developmental level of the individual child, involves his or her family, and uses both pharmacological and nonpharmacological interventions, optimal pain control is possible.
The advanced practice registered nurse
Authors: Wiencek Clareen
Published: November 2017

Advanced practice nursing builds on the strong foundation of nursing practice by incorporating advanced knowledge and expertise in assessment, diagnosis, and management of persons with serious or life-limiting illness. In addition, the palliative care advanced practice registered nurse (APRN) demonstrates skilled communication and the ability to drive treatment plans based on the goals and preferences of the patient and family. Advanced practice nursing in palliative care is recognized as a specialty with its own scope and standards of practice, education and training programs, and certification. Palliative care APRNs contribute to the financial viability of palliative care programs by providing cost-effective care and effective billing and reimbursement processes.
Ethical considerations in palliative care
Authors: Prince-Paul Maryjo , Daly Barbara J.
Published: November 2017

This chapter addresses what Bishop and Scudder refer to as the “primary sense of nursing practice,” the moral sense. The objective is to prepare the nurse for identifying, addressing, and resolving the complex questions that arise in caring for individuals and families facing life-limiting illnesses. A brief review of the major theories that are the basis for the commonly accepted principles of autonomy, beneficence, nonmaleficence, and justice is included. Following this review, specific issues that the palliative care nurse is likely to face are explored, with particular attention to analysis of the problems.
Nursing education
Authors: Malloy Pamela
Published: November 2017

Student nurses are exposed primarily to curative-oriented, sometimes futile care and are less likely to encounter comfort-oriented care. Although many healthcare providers work with people at the end of their lives, nurses spend the most time with the dying and their families. Most nurses will provide palliative care to patients and their families no matter where they practice. This chapter suggests that education in palliative care should begin in the nursing schools and extend through clinical inservices, continuing education courses, and professional conferences.
International palliative care initiatives
Authors: Connor Stephen R.
Published: November 2017

This chapter serves as an introduction to the chapters that follow on International Palliative Care Initiatives. A public health model is used to help foster the growth and development of palliative care and hospice services. This model comprises four components: policy, education, medication availability, and implementation. There are several international initiatives nurses interested in supporting the advancement of palliative care globally.
Palliative care in the UK
Authors: Preston Nancy , Froggatt Katherine
Published: November 2017

As the delivery of healthcare has been devolved down to the four countries—England, Scotland, Wales, and Northern Ireland—there are therefore differences in budgets, priorities, and regulatory processes that shape how palliative care is delivered. Each of the nations in the United Kingdom has developed its own palliative care strategy that reflects these differences, and they commonly promote the use of the three tools and approaches: an integrated care pathway, the Gold Standards framework, and advance care planning.
Palliative care in South Korea
Authors: Kim Hyun Sook , Kim Boon Han
Published: November 2017

Most Koreans would prefer to withdraw from medically futile life-sustaining treatment, but many Koreans still receive futile treatment even after their conditions are diagnosed as terminal. Korean law does not allow doctors to remove life-sustaining treatment, regardless of the patient‘s condition or desires or those of family members. The limited hospice palliative care that is offered often demands a high degree of family responsibility; the caregivers of terminal patients are usually immediate family members or private caregivers hired by the family. For these reasons, Korean family members of terminally ill patients experience heavy physical, emotional, and social stresses, much more so than families in the West.
Palliative care in situations of conflict
Authors: Cherny Nathan I.
Published: November 2017

Incurable, life-threatening illness is endemic, and it often occurs in places of conflict. In these circumstances, care delivery is often compromised or complicated. Situations of conflict occur in many places in the world, and at any time a substantial proportion of the world population is involved in conflict of one sort or other. Conflicts, such as war or terror, traumatize the involved populations. In this situation, bereavement, fear, anxiety, and depression become commonplace. The observations in this chapter are derived from experiences working with Palestinian and Israeli patients in a Jewish hospital in Jerusalem over the past 15 years.
Palliative care as a human right
Authors: Brennan Frank , Gwyther Liz , Lohman Diederik , Kiyange Fatia , Ezer Tamar , Mwangi-Powell Faith N.
Published: November 2017

With the enormous disparities in the provision of palliative care globally and the significant benefits that flow from its provision, the palliative care community began articulating a profound but challenging idea—that palliative care should be seen as a human right. There have been many such statements, from both the perspective of pain management and palliative care. This chapter explores how this proposition can be justified, what this proposition means in reality, and how using these concepts can be tools of advocacy and change.
Palliative chemotherapy and clinical trials in advanced cancer
Authors: Sun Virginia
Published: November 2017

This chapter describes the use of chemotherapy and cancer investigational agents as a palliative treatment for patients with advanced cancer. Emphasis is placed particularly on the role of palliative chemotherapy and the dichotomy between clinical trials of cancer investigational therapeutic agents and palliative care. Finally, an in-depth analysis of the role of nurses in supporting patients and families receiving palliative chemotherapy or investigational agents through clinical trials is discussed.
Palliative care in mass casualty events with scarce resources
Authors: Wilkinson Anne , Matzo Marianne
Published: November 2017

The purpose of this chapter is to offer an introduction to the topic of disaster response/emergency nursing and the role palliative care can play during a mass casualty event (MCE) for vulnerable populations not normally addressed in usual disaster planning and response. This chapter examines issues associated with providing medical care under MCE circumstances of scarce resources; the current level of preparation of nurses to respond in these emergencies; the role for palliative care in the support of individuals not expected to survive; and recommendations of specific actions for a coordinated disaster response plan.
A Narrative Transformation of Health and Healthcare
Authors: Charon Rita , Marcus Eric R.
Published: November 2017

The co-authors of this chapter—an internist and a psychoanalyst—examine the situation of a patient whose care was enhanced by narrative methods of collaborative writing by physician and patient. In turns, the co-authors discuss psychoanalytic and narratological aspects of this clinical case. The analyst proposes that, in the care of medically ill patients, transference may occur not to the analyst but to the illness itself and that a stabilizing transitional space, as described by D.W. Winnicott, may open up within routine medical practice. The internist reviews concepts of creativity, reflexivity, and reciprocity as aspects of a narratively fortified practice. Together, they can unite patient and clinician in care for a specific episode of illness and can also create both participants’ reciprocal awareness of the inevitability of death to come, binding them in a powerful and lasting alliance as fellow humans facing mortality.
The Human-Technology Interface
Authors: Drews Frank A. , Zadra Jonathan R.
Published: November 2017

The goal of this chapter is to outline considerations that are critical for the development of effective human-technology interfaces (HTI) in anesthesiology. It first provides an introduction to the social aspects of human technology interaction (the socio-technical systems perspective). It describes some of the specific properties of monitoring natural systems (i.e., patients) and how they differ from the task of monitoring technical systems (i.e., airplanes). The chapter examines important human factors concepts that should be considered when developing an HTI (e.g., the controls for a new medical device) and describes the currently available types of interfaces in anesthesia by focusing on tasks and devices. It presents considerations of how automation impacts the practice of anesthesiology, with a detailed description of currently available automated systems, and discusses principles of user-centered design. . The chapter concludes with an outlook of how future technologies in anesthesia will pose new challenges for HTI development.
Oral and maxillofacial sports injuries
Authors: Gibbons Andrew , MacKenzie Neil
Published: November 2017

In sport, the face is frequently the most exposed part of the body. The incidence of sports facial injuries varies hugely around the world, according to the sports played in a particular country. In the USA, approximately 12% of maxillofacial injuries seen in large trauma centres are sports related (...
Injuries to the pelvis, hip, and thigh
Authors: Speed, Cathy , Rhee Jae , Haddad Fares
Published: November 2017

Injuries to the musculoskeletal pelvis and thigh in sport are extremely common. Injury can occur at one or multiple sites of the bony pelvic ring, and in the soft tissues of the groin, abdominal wall, and thigh. Athletes in certain sports are particularly prone to hip injury, especially those involved in running, soccer, hockey, rugby, and dancing. Although recognized as a common region of injury, the true epidemiology is not known, as the spectrum of injury is wide, diagnosis can be complex, and injury classification is still debated in some conditions. Nevertheless, soft tissue injury and dysfunction are the most common forms of injury seen and, indeed, hamstring injury is the most frequent injury in a number of sports, including athletics, soccer, rugby union, and Australian Football League. Hamstring injuries are also the most common recurrent injury in sport....
Orthopaedic injuries to the hand and wrist
Authors: Downing Nicholas
Published: November 2017

Almost any type of hand injury can occur during sport and few, if any, hand-specific injuries occur uniquely during sporting activity. Therefore this chapter will be restricted to injuries that are part of the common spectrum of hand and wrist injuries but are also commonly sustained during sporting activity....
Running injuries
Authors: Hamilton Bruce
Published: November 2017

Nothing in life was worth very much that did not entail some risk. So do not be afraid of strains and sprains, aches and pains.

Percy Wells Cerutty

Schoolboy Athletics, p.115, c.1966

Distance running is an extremely popular activity with many thousands of runners competing in major city marathons as well as weekly club running events. Most of these runners are not competitive in any given race, but will have their own goals and reasons for participating. As with other forms of exercise, running has significant health and social benefits, and the prevention of injury and thus maintenance of participation should be a key goal for any practitioner. While there has been some variance in the literature in defining what exactly a distance runner is, there is agreement that individuals who run on a regular basis are susceptible to overuse injuries. Up to 70% of competitive distance runners may be injured during any single year, although even this may be an underestimate because of the use of different injury definitions and study limitations (...
Cricket injuries
Authors: Orchard John , James Trefor , Kountouris Alex , Farhart Patrick
Published: November 2017

Injuries are a common part of cricket, particularly affecting fast bowlers (Leary and White 2000; Gregory et al. 2002; Orchard et al. 2002; Stretch 2003). In 2005, cricket was the first sport to publish consensus international injury definitions (Orchard et al. 2005b...
Duchenne de Boulogne (1806–1875)
Authors: Emery Alan E. H. , Emery Marcia L. H.
Published: November 2017

Chapter 5 discusses Guillaume Benjamin Amand Duchenne, or Duchenne de Boulogne, who played a singularly important role in the history of muscular dystrophy.
Resolution of heterogeneity
Authors: Emery Alan E. H. , Emery Marcia L. H.
Published: November 2017

Chapter 7 discusses the problem of heterogeneity and the attempts that were made to resolve it.
Form and content in Jaspers’ psychopathology
Authors: Walker Chris
Published: November 2017

Jaspers drew the distinction of form and content from the Transcendental Analytic of Immanuel Kant’s Critique of Pure Reason (1781, 1787). The form of an experience allows us to distinguish normal image from true hallucination from pseudohallucination, all of which experiences may have the same content. The form-content distinction applies to all psychopathological knowledge – not just to phenomenology. The distinction is explicit in Jaspers’ phenomenology and psychology of understandable connections, but only implicit in the psychology of objective performance and causal connections. Should we step beyond particular knowledge to psychic life as a whole – to nosology, eidology and biography – the form-content distinction no longer applies and we are in the realm of Kantian regulative ideas. Kant’s theory of knowledge and critique of metaphysics is absolutely central to Jaspers’ psychopathology.
Trauma and stabilization
Authors: Prout Jeremy , Jones Tanya , Martin Daniel
Published: November 2017

This chapter, written by trauma anaesthetists from King’s College Hospital, London, covers the general aspects of trauma management as well as targeted management for specific situations. The pathophysiology of trauma injury with primary and secondary insult is described along with classification and management of shock. Patient triage and trauma scoring is explained with initial resuscitation and management of emergency anaesthesia. The chapter includes a detailed description of management of haemorrhage and coagulopathy in trauma with use of adjuncts to haemostasis, evidence from the CRASH study and point-of-care testing. Special considerations in burns, electrocution, drowning, hypothermia, and paediatric trauma are detailed.
Ophthalmic anaesthesia
Authors: Prout Jeremy , Jones Tanya , Martin Daniel
Published: November 2017

This chapter covers the considerations for pre-assessment in ophthalmic patients with special reference to the elderly and paediatric populations and factors that influence the choice of anaesthetic technique. Local anaesthesia options are described with conduct of subTenons and peribulbar blocks, benefits and complications. General anaesthesia is discussed with special reference to paediatric patients and circumstances such as penetrating eye injury. Perioperative management may require drugs that influence intra-ocular pressure and the physiological control of intra-ocular pressure is explained.