bluuebunny/crossref_metadata_2025 huggingface dataset:
Cell-Free DNA Screening for Fetal Aneuploidy
Authors: Battarbee Ashley N. , Vora Neeta L.
Published: February 2021

In a prospective, multicenter blinded study at 35 international centers, the Noninvasive Examination of Trisomy (NEXT) study evaluated the performance of cell-free DNA screening for fetal trisomy compared to standard first trimester screening with nuchal translucency and serum analytes in a routine prenatal population. Among the 15,841 women who had standard screening and cell-free DNA analysis with neonatal outcome data, there were 68 chromosomal abnormalities (1 in 236). Of these, 38 were Trisomy 21 (1 in 417). Cell-free DNA analysis had a higher area under the curve (AUC) for trisomy 21, compared to standard screening (0.999 vs. 0.958, p = 0.001). Cell-free DNA analysis also had greater sensitivity, specificity, and positive predictive value compared to standard screening for trisomy 21, 18, and 13. While cell-free DNA analysis cannot detect all chromosome abnormalities, it performed better than standard screening for detection of trisomies 21, 18, and 13 in a routine population including low- and high-risk women.
Elective Bilateral Oophorectomy Versus Ovarian Conservation at the Time of Benign Hysterectomy
Authors: Yi Johnny , Wasson Megan
Published: February 2021

The Nurses’ Health Study prospectively evaluated long-term mortality associated with oophorectomy versus ovarian conservation at the time of benign hysterectomy in women with no history of gynecologic cancer, other cancers, coronary heart disease, stroke, or pulmonary embolus. The study showed that performing a bilateral oophorectomy at the time of a benign hysterectomy is associated with an increased risk of all-cause mortality as well as mortality from coronary heart disease, lung cancer, and colorectal cancer. Concurrent oophorectomy is associated with a decreased risk of ovarian cancer. It was also found to reduce the risk of breast cancer when performed in women younger than 47.5 years of age. This study has been supported by further research showing that bilateral oophorectomy is not associated with improved all-cause mortality and is associated with greater mortality particularly in younger, premenopausal women.
Laparoscopic Excision Versus Ablation for Endometriosis-Associated Pain
Authors: Newcomb Laura , Donnellan Nicole
Published: February 2021

This systematic review and meta-analysis examines and compares endometriosis-associated pain in women who have undergone laparoscopic excision versus ablation as a treatment for their endometriosis. Both laparoscopic excision and ablation have been utilized as methods of surgical management for women who fail conservative medical therapies; however, it is unclear if one technique is superior to the other in decreasing endometriosis-associated pain. This meta-analysis includes 2 randomized controlled trials that examine dysmenorrhea, dyspareunia, dyschezia, and chronic pelvic pain scores in patients before and after undergoing each type of surgery and concludes that laparoscopic excision of endometriosis is superior to ablation in all of these aspects.
The Therapeutic Centaur
Authors: Khanna Rahul , Edgcomb Juliet Beni , Hopwood Malcom
Published: February 2021

This is an age of convergence, where insights from disparate disciplines are coming together to meet modern challenges. In this chapter, the authors describe the ways convergence science will impact the workflow of future psychiatrists. They anticipate human clinicians to work in close partnership with technology; streamlining, eliminating, and transforming a range of clinical activities. Here, they provide a framework for modernizing perennial skills and present a roadmap for the development of new knowledge. They anticipate that two important areas of knowledge for future psychiatrists will include clinical informatics and data science. The potential of convergence psychiatry will be realized most effectively as they update clinical training to reflect the shift toward transdisciplinary science. The authors advocate for psychiatrists to embrace interaction with emerging technology including highlighting the risk if they fail to do so.
Promoting Early Child Development
Authors: Bhavnani Supriya , Estrin Georgia Lockwood , Mukherjee Debarati , Patel Vikram
Published: February 2021

Current estimates suggest that over 200 million children are at risk of suboptimal cognitive development globally, with the majority living in low-income communities. This has profound implications for mental and physical health, learning attainment, and productivity throughout the life course. Supporting young children to reach their full developmental potential requires a multi-faceted approach across diverse sectors and disciplines. This chapter emphasizes convergence science as the foundation of implementing effective and scalable solutions that assess, promote, and protect developmental trajectories from an early age. The authors highlight how the use of such an approach, which spans disciplines and sectors, can overcome barriers to scaling up effective solutions, particularly in low resource settings, while also emphasizing key ethical considerations of developing and implementing technological innovations. They conclude by presenting a case study on developing acceptable, feasible, and valid scalable technological solutions to aid in the longitudinal assessment of cognitive development to achieve the vision of optimizing their developmental potential.
Digital Health Entrepreneurship
Authors: Charles Wendy , Wulfovich Sharon , Meyers Arlen
Published: February 2021

Digital health technologies can promote advancements in mental healthcare using methods of electronic data collection and high-powered computing. There is a growing recognition that implementation of these technologies can address the quadruple aim in healthcare by improving health of populations, increasing quality of care, reducing costs, and increasing workforce engagement. The convergence drivers of innovation in digital health are described in a discipline referred to as digital health entrepreneurship. This chapter introduces digital health entrepreneurship, and its relationship to convergence science, and describes the strategies to advance digital health entrepreneurship in mental health.
Innovating Dementia Care Through Convergence Science in Brain Health
Authors: Fajersztajn Laís , Oliveira Maira Okada de , Miller Bruce L.
Published: February 2021

Similar to psychiatric issues, brain health issues (e.g., dementia and cognitive aging) are characterized by their complexity, multisystemic nature and broad societal impact, hence making them poorly suited to siloed approaches of thinking and innovation. Brain health, like mental health, also involves the integration of insights from the mind, the brain, and behavior. Therefore, the authors that propose a more integrated approach is required for brain health innovation and suggest convergence science as an instructive model to consider. Sixty-eight percent of the dementia cases will occur in low-and-middle income countries. The diagnosis of dementia is accompanied by high caregiver burden, high financial costs for the family and few therapeutic alternatives. By telling the history of the University of California, San Francisco (UCSF) Memory Aging Center (MAC) and the Global Brain Health Institute (GBHI) we present a promising case of convergence science in brain health. Both integrates diverse disciplines and professionals. The USCF MAC integrates dementia care, research, education, and GBHI. GBHI integrates several professionals from developing countries to reduce the impact of dementia around the world.
Regulation of coronary flow
Authors: Bruining Nico , Boersma Eric , Duncker Dirk J.
Published: February 2021

This chapter describes the regulation of coronary blood flow. The left ventricle generates the systemic arterial blood pressure that is required to maintain coronary blood flow. The coronary circulation is unique among regional vascular beds in that its perfusion is impeded during the systolic phase of the cardiac cycle by the surrounding contracting cardiac muscle. Systolic contraction increases left ventricular wall tension and compresses the intramyocardial microvessels, thereby impeding coronary arterial inflow. This compression is not uniformly distributed across the left ventricular wall, resulting in a redistribution of blood flow from the subendocardium to subepicardium.
Biology of bypass vessels and their relation to patency and disease
Authors: Lüscher Thomas F.
Published: February 2021

Current standard surgical technique in patients undergoing coronary bypass grafting involves the use of an internal mammary artery (also known as an internal thoracic artery) bypass graft, in general to the left anterior descending coronary artery, and in many centres also the use of the right internal mammary artery to the right coronary artery. Several clinical studies have shown the superiority of mammary artery bypass grafts for survival of patients compared to the use of venous bypass grafts alone. Indeed, the internal mammary artery has several biological features, discussed in this chapter, that are remarkable and of great interest for biologists, cardiologists, and surgeons alike.
Nuclear cardiology
Authors: Pazhenkottil Aju P. , Buechel Ronny R.
Published: February 2021

Nuclear imaging was first introduced with the development of scintillator cameras by Hal Anger in the early 1960s. Hence, nuclear imaging is one of the oldest non-invasive imaging techniques in cardiology, beside echocardiography. Over the last few decades, nuclear imaging has seen tremendous advances and has generated great interest as a non-invasive method to assess a variety of medical conditions. Aside from 18F-fluorodeoxyglucose positron emission tomography (PET) for patients with oncological disease, the growth of nuclear medicine in recent years has been mainly driven by the increasing use of single-photon emission computed tomography (SPECT) and PET myocardial perfusion imaging studies in patients with known or suspected coronary artery disease. While SPECT as a non-invasive method is widely available, PET has superior spatial and temporal resolution, allowing quantification of radiotracer uptake and thereby contributing important insights into the pathophysiological regulation of myocardial blood flow and cardiac metabolism.
Magnetic resonance imaging
Authors: Gotschy Alexander , Manka Robert
Published: February 2021

Cardiovascular magnetic resonance (CMR) has become an established non-invasive imaging modality for the diagnosis of coronary artery disease and contributes important information for therapeutic decisions regarding revascularization. Besides having the unparalleled versatility to provide insight on a range of diagnostic parameters such as cardiac morphology, function, myocardial texture, and vascular flow, CMR allows the detection of ischaemia and myocardial viability to guide therapeutic decisions. For the identification of ischaemia, CMR provides two basic methods, which are routinely used in clinical practice. Ischaemia can either be visualized as regional hypoperfusion when using CMR perfusion imaging during vasodilator-induced hyperaemia, or as impaired regional wall motion under dobutamine stress CMR. For the assessment of viability, the late gadolinium enhancement technique represents a sensitive CMR method to discriminate viable myocardium from irreversibly damaged myocardial scar tissue. CMR has proven its robustness, diagnostic performance, and prognostic value in patients with coronary artery disease in several multicentre trials.
Perioperative risk scoring systems for coronary artery bypass grafting
Authors: Bruce Ferguson T. , Nashef Samer A. M.
Published: February 2021

Coronary artery bypass grafting is the most studied and evaluated therapy in medical history. Part of this evaluation has included the careful modelling of the specific risks and benefits of coronary artery bypass graft intervention in stable ischaemic heart disease and acute coronary syndromes. Risk models allow the prediction of mortality and morbidity after surgery and the most widely used models in coronary artery bypass grafting worldwide are EuroSCORE II and the STS models. In this chapter, the current status of risk modelling in coronary artery bypass grafting is discussed, along with a view of future challenges and anticipated successes.
Preoperative assessment in coronary bypass surgery
Authors: Sellers Daniel , Djaiani George
Published: February 2021

Coronary revascularization surgery has become extremely safe over the past 50 years, in terms of absolute mortality. However, in an era where quality of care and recovery are increasingly scrutinized, complications such as stroke, cognitive impairment, prolonged ventilation, renal impairment, wound infection, and even blood transfusion are increasingly important, with rapid recovery to normal function routinely expected by patients, care givers, and healthcare systems alike. These complications are ideally prevented or mitigated preoperatively, with a thorough system of preassessment, targeted evidence-based therapies to reduce morbidity, and careful risk assessment as part of a coherent perioperative approach. This chapter reviews the potential for each of these interventions to improve postoperative outcomes, in addition to an enhanced recovery process, and summarizes them in a schema ready to be introduced into practice.
Revascularization using the saphenous vein as a composite graft
Authors: Kim Ki-Bong
Published: February 2021

The saphenous vein conduit has been used as an aortocoronary bypass graft in almost all previous studies, and its use as a composite graft was reserved for patients with diffusely atherosclerotic or calcified ascending aorta to minimize ascending aorta manipulation and to reduce the risk of neurological injury.
The radial artery
Authors: Tranbaugh Robert F. , Gaudino Mario , Buxton Brian F. , Tatoulis James
Published: February 2021

The radial artery is an easily harvested, versatile, and high-quality conduit with proven safety and efficacy during coronary artery bypass grafting. When properly harvested and deployed, the long-term patency is excellent and similar to the left internal thoracic artery. Either open or endoscopic harvesting may be used and target vessel stenosis should be at least 70%. Radial artery grafting is superior to saphenous vein grafting and appears to be equivalent to using the right internal thoracic artery. Adoption of radial artery grafting may be the most direct path to routine multiple arterial bypass grafting in the majority of patients undergoing coronary artery bypass grafting.
Total arterial revascularization
Authors: Yanagawa Bobby , Taggart David P. , Puskas John D.
Published: February 2021

The superiority of coronary artery bypass grafting with a single internal thoracic artery and saphenous vein grafts over percutaneous coronary intervention has been demonstrated in large, multicentre randomized controlled trials, particularly for patients with diabetes and complex coronary disease. Long-term graft patency is critical to the benefit that coronary artery bypass grafting provides, since graft failure begets recurrent angina, need for repeat intervention, myocardial infarction and diminished survival. Saphenous vein grafts have significant rates of early and late graft failure.
Incisions for coronary revascularization
Authors: Subramanian Valavunar A. , Patel Nirav C.
Published: February 2021

The most commonly performed incision for coronary revascularization is median sternotomy as it allows complete access to all target vessels and safe establishment of cardiopulmonary bypass. For targeted revascularization, various minimally invasive incisions can be used to access the left anterior descending artery, marginal arteries, and right coronary arteries in isolation. Grafting is then performed on the beating heart under direct vision.
Off-pump coronary artery bypass grafting
Authors: Torregrossa Gianluca , Taggart David P. , Puskas John D.
Published: February 2021

Off-pump coronary artery bypass grafting is a highly specialized technique with the potential for reduction of in-hospital morbidity and mortality, particularly in high-risk patient populations. When possible, it should be performed as a clampless or no-aortic-touch technique with multiple or all-arterial conduits. By optimizing longevity of graft patency with arterial conduits and minimizing the risk of perioperative stroke by minimizing aortic manipulation, clampless and no-aortic-touch off-pump coronary artery bypass grafting techniques may be considered the ideal form of surgical coronary revascularization.
Surgical techniques to bypass diffuse coronary disease
Authors: Fukui Toshihiro , Takanashi Shuichiro
Published: February 2021

With the recent and rapid advances in percutaneous coronary intervention, the rate of high-risk patients with diffusely diseased coronary arteries including severe calcifications or soft plaques in the vessel wall has been increasing. Long segmental reconstruction with or without endarterectomy is a surgical method for the treatment of diffusely diseased coronary arteries. However, it has been historically associated with high morbidity and mortality rates, and has not gained widespread acceptance. Recent developments in surgical techniques have resulted in improved outcomes after long segmental reconstruction grafting with or without endarterectomy. In patients with a diffusely diseased left anterior descending artery, this method has the advantage of enhancing the blood supply to the diagonal and septal arteries, thus relieving ischaemia in the anterior and septal territories of the heart. This benefit cannot be obtained with conventional bypass grafting to the distal left anterior descending artery alone, as diffusely diseased segments are left untreated. This chapter reviews the technical aspects and outcomes of long segmental reconstruction with or without endarterectomy of the left anterior descending artery using the left internal thoracic artery.
Coronary artery bypass grafting with postinfarction ventricular septal defect and with ventricular pseudoaneurysm
Authors: Badiwala Mitesh V.
Published: February 2021

Postinfarction ventricular septal defect and ventricular pseudoaneurysm are rare complications of acute transmural myocardial infarction. Because they are rare, surgical experience with these conditions is limited but advancements in surgical technique have resulted in improved survival. The infarction exclusion technique for repair of postinfarction ventricular septal defect in particular has resulted in significant survival benefit. Concomitant coronary artery bypass grafting has been demonstrated to improve long-term survival in those patients undergoing ventricular septal defect repair.
The Epidemiology of Cancer in Children and Adolescents
Authors: Stiller Charles A. , Gatta Gemma
Published: February 2021

Under 2% of all cancers in industrialized countries occur in childhood and adolescence, but they account for a much larger proportion of total population life years potentially lost to cancer. Total incidence is about 160 per million in children and 200 per million in adolescents. In children, leukaemias account for one third of all malignancies and CNS tumours for one quarter. In adolescents, lymphomas account for one quarter of cases and leukaemias, CNS tumours, and carcinomas each for about 15%. Five-year survival exceeds 80% for many childhood and some adolescent cancers. Although survival of adolescents is high overall, survival for several types of cancer is markedly lower than in children. Infants under a year of age also tend to have lower survival. Excess mortality continues beyond 25 years from diagnosis of childhood cancer. The risk of developing a second primary cancer is about six times that in the general population. The causes of most childhood cancers remain unknown. The principal established exogenous causes are ionizing radiation, ultraviolet radiation from sunlight, and certain viruses. Up to 10% of children and adolescents with cancer may have germline mutations in cancer predisposition genes. If one child in a family has cancer, then that child’s siblings have approximately double the risk of the general population for developing childhood cancer, but this could well be entirely accounted for by familial syndromes. Significantly raised or reduced risks of childhood cancers have been linked to polymorphic variants of certain genes, though many of these associations remain to be replicated.
Chemotherapy and Other Anti-Cancer Drugs
Authors: Zwaan Michel , Veal Gareth J. , Moreno Lucas
Published: February 2021

Chemotherapy plays a prominent role in the treatment of paediatric malignancies. Several pharmacokinetic and pharmacodynamic mechanisms must be taken into account when administering chemotherapy. These mechanisms may contribute to the clearance, toxicity, and/or efficacy of cytotoxic drugs. Examples are age, sex, body composition, genetic polymorphisms, and co-administered drugs. A new era of childhood cancer treatment is emerging, characterized by the development of new agents resulting from advances in molecular biology. Directing drugs against the abnormalities identified only in tumour cells is known as targeted therapy. Such compounds ought to have better anti-tumour activity and improved safety profiles. Monoclonal antibodies are becoming more important, especially in the treatment of haematological malignancies, but also in neuroblastoma. Moreover, other advances in immunotherapy, with bispecific T-cell engaging (BITE) antibodies and chimeric-antigen receptor T-cells for example, are rapidly changing the landscape of available therapies to treat childhood cancer. After a long period during which there were very few registrations of new drugs for use in children, the regulatory incentives introduced in both North America and Europe now stimulate research directed towards the identification and evaluation of new drugs in paediatric oncology.
Allogeneic Stem-Cell Transplantation in Children and Adolescents with Malignancies
Authors: Balduzzi Adriana , Lucchini Giovanna , Dalle Jean-Hugues , Handgretinger Rupert
Published: February 2021

Allogeneic haematopoietic stem-cell transplantation (HSCT) is of benefit for children and adolescents affected with malignancies which are refractory to conventional chemotherapy. Since the first HSCT took place in 1957 and human leukocyte antigen (HLA) genetics were unravelled, thousands of patients have been virtually cured from their disease after undergoing HSCT. Eligibility criteria, donor selection, stem-cell source, conditioning regimen, graft-versus-host disease (GvHD) prophylaxis, and supportive therapy evolved over time and contributed to the reduction in transplant-related mortality. In this chapter, alternative donors are mentioned and the excursus which led to ongoing haploidentical HSCT approaches are detailed. Issues related to HSCT in acute lymphoblastic leukaemia (ALL) (the most frequent indication for HSCT in paediatrics), acute myeloid leukaemia, and solid tumours are discussed. The impact of minimal residual disease on HSCT outcome in ALL, strategies to exploit the graft-versus-tumour effect in solid tumours, and post-HSCT immunotherapy are highlighted.
Symptoms and Emergencies in Children with Brain and Spinal Tumours
Authors: Zerah Michel , Walker David , Whitton Shaarna
Published: February 2021

Central nervous system (CNS) tumours affect about one in two thousand children up to 15 years of age. They present with neurological signs and symptoms that are diverse, fluctuate in severity, and are related to raised intracranial pressure or focal neurological brain or spinal injury. The onset of these symptoms frequently varies, determined by the speed of growth of the tumour tissue and the eloquence of the brain region within which it is growing. Emergency presentations predominate: relief of raised intracranial pressure can save lives, and relief of spinal-cord compression can prevent or reduce risks of paralysis or incontinence. For these reasons, this chapter presents evidence of a new population-based symptom-awareness programme called ‘HeadSmart Early Diagnosis of Brain Tumour’ directed at informing the public and profession, which has been demonstrated to accelerate brain-tumour diagnosis nationally. The chapter concludes that optimized management of presentation of CNS tumours has the capacity to avoid unnecessary loss of life at the time of diagnosis and to reduce consequential lifelong disability.
Neuroblastoma
Authors: Eggert Angelika , Brodeur Garrett M. , Schleiermacher Gudrun
Published: February 2021

Neuroblastoma, a malignant neoplasm of the sympathetic nervous system, is the most common extracranial solid tumour in childhood. Since its first description in the nineteenth century, its highly heterogeneous clinical presentation has challenged clinicians and fascinated basic researchers. Neuroblastoma serves as a paradigm for the prognostic utility of biological and clinical data and the potential to tailor therapy for patient cohorts at low, intermediate, and high risk for recurrence. This chapter presents an overview of the key genetic, molecular, histological, and clinical features of neuroblastoma, as well as current risk-stratification strategies and therapeutic approaches. It also highlights how our understanding of tumour pathogenesis, coupled with molecular analyses, has illuminated critical signal transduction pathways and key molecules involved in neuroblastoma tumourigenesis, pointing to novel therapeutic targets for clinical development. Future treatment avenues for relapsed neuroblastoma are discussed, including new drugs targeting ALK, MYC/MYCN, histone deacetylases, or MDM2/TP53.
Childhood Liver Tumours
Authors: Perilongo Giorgio , Zsiros József
Published: February 2021

Childhood liver tumours are a heterogeneous group of neoplasms encompassing individually rare histological varieties. This chapter discusses the two most frequent subtypes—hepatoblastoma and hepatocellular carcinoma. In relation to hepatoblastoma, it covers the biology, epidemiology, clinical presentation, diagnosis, and discusses the different treatment strategies including risk-adapted treatment and orthotopic liver transplantation. The chapter reviews the renewed histological classification of paediatric primary liver tumours, the revised PRETEXT (pre-treatment extent) system to describe tumour extension, and the novel risk-stratification system for hepatoblastoma. It also reviews the treatment results and the prognosis of patients with hepatoblastoma. Finally, the chapter discusses the even rarer tumour, hepatocellular carcinoma.
Anatomy and physiology of the gastrointestinal tract
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The anatomy and physiology of the gastrointestinal (GI) tract chapter provides information on the parts, structure, and function of the gut. The hollow tube of the gastrointestinal tract begins at the mouth and ends at the anus. The GI tract in part lies within the abdominal cavity and the pelvic cavity. There are also the accessory organs of the liver, pancreas, and gall bladder. The nerves, hormones, secretions, and blood supply to the gut are also explored. The role of the GI tract is to ingest food and fluids. These are digested through mechanical and chemical means such as chewing. The nutrients are then absorbed, predominantly in the ileum. Waste products are finally eliminated via the anus.
Liver
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The liver chapter explores this large organ, explaining diseases and conditions of the liver. The common diseases of the liver are explained with the identification of the more frequently presenting symptoms. The occurrence rates of these liver conditions are defined and any potential causes reported. The investigations that are used to diagnose the condition are described. Treatment options or preventative measures are also explained with a description of any potential complications. Conditions such as haemochromatosis, non-alcohol fatty liver disease, ascites, and Wilson’s disease are explored within this chapter. Diseases such as hepatitis and cirrhosis are examined in greater detail and require long-term nursing care. Concise descriptions of caring for people with diseases and conditions of the liver can increase knowledge, enabling better nursing care.
Nursing assessment
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The nursing assessment chapter explores the essential processes required to enable nurses to effectively assess patients and subsequently plan care. Undertaking a general patient history is important to determine a general health assessment. Additionally, there are a number of additional assessments that can be undertaken to gain greater understanding of specific gastrointestinal systems, such as a gastrointestinal assessment, a liver assessment, or a nutritional assessment. After performing an assessment through the use of questions, to gain more details about the patient and any condition they might be presenting with, a physical examination is necessary of the abdomen and rectum; a digital rectal examination may be undertaken. Succinct explorations on the various assessment methods that nurses use to evaluate the needs of patients can be reviewed when necessary within clinical practice by the nurse.
Nutrition
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The nutrition chapter explains how nutrition is an essential aspect of gastrointestinal nursing care, exploring what foods are needed for health. It is important that the nurse understands the constituents of food, such as carbohydrates, vitamins, and minerals. It is also necessary for the nurse to have an overview of common food intolerances and allergies. There is a brief discussion on some of the dietary conditions that can occur such as undernutrition, obesity, anorexia, or bulimia. The influence of the diet on health is also explored as this is an area in which the nurse can provide advice and support to patients. There is also discussion on functional foods, such as probiotics and prebiotics. Succinct exploration related to nutrition can be reviewed by the nurse as necessary within clinical practice.
Clinical nutrition
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The clinical nutrition chapter is related to nutritional support provided in a number of ways, including enteral and parenteral. It is important for the nurse to understand the care of feeding tubes, such as nasogastric feeding tubes and gastrostomy tubes. There is discussion about short-term and long-term enteral feeding as well as administration of drugs and feed. There is an in-depth exploration of parenteral nutrition that includes catheter access, catheter insertion, and catheter care. There can be issues with clinical nutrition, such as problems associated with feeding termed refeeding syndrome. Succinct discussion related to clinical nutrition can be useful within clinical environments by the nurse.
Other issues in gastrointestinal care
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The final chapter is about other issues in gastrointestinal (GI) care and incorporates other important issues related to GI care that do not easily fall into other categories. This will ensure that as many GI-related topics as possible are covered to provide the nurse with a fuller understanding of GI nursing. This chapter incorporates issues related to scars, such as changes in body image and how this can cause psychological issues. Finally, issues related to sexuality, such as sexual dysfunction and erectile dysfunction, will be explored. Concise explanations of the issues within this chapter can aid the nurse, although it is often difficult for nurses to discuss these topics in a busy clinical environment.
Gender perspectives in migration
Authors: Thara Rangaswamy , Raman Aarthi
Published: February 2021

There is critical and compelling evidence to suggest that whatever form migration takes place, it is accompanied by differing levels of stress, which may fall disproportionately on women. This considerable stress may well lead to mental health problems, even though migrants may be more resilient. This chapter reviews work on gender perspectives in mental health aspects of migration. Although of great clinical and social significance, this aspect has not been well researched, especially in low- and middle-income countries. While both genders are susceptible to psychological problems, women seem to have higher rates of depression and anxiety. Young women refugees are often sexually exploited and abused. This is particularly marked in the antenatal and postnatal periods, more so if access to health care is problematic. The country of origin of the migrants, their literacy and socio-economic levels, family cohesiveness, and quality of social support need to be considered when planning interventions for this group.
Mental health needs of lesbian, gay, bisexual, and transgender migrants
Authors: Hopkinson Rebecca , Keatley Eva S. , Ahola Joanne
Published: February 2021

Lesbian, gay, bisexual, and transgender (LGBT) migrants have a unique set of experiences that affect mental health. Many are forced to flee their home countries owing to persecution, and both pre- and post-migration factors can affect their well-being. Mental health providers would benefit from learning about the specific needs of this population. In this chapter, we will discuss LGBT migrant experiences with regard to pre- and post-migration factors affecting mental health. We will address relevant terminology, factors that affect mental health, and helpful information about providing culturally sensitive care. We will use case examples to illustrate the information provided.
Mental health issues of child refugees and migrants
Authors: Guzder Jaswant
Published: February 2021

Increasing global numbers of voluntary and forced migrating children under 18 years of age represent the majority subpopulation among refugees and migrants. With arrival in high-income countries, most children achieve positive secure growth. Pre- and post-migratory experiences, developmental issues, familial, and sociocultural contexts contribute to mental health risk evaluation along with additional child challenges related to mastery of attachment disruptions, acculturation, educational adjustments, resilience capacities, mental health distress, or emerging disorders. Theories of positive post-traumatic growth generated by adversity, as well as current models of child cultural formulation evaluation and preventive intervention strategies, emphasize resilience promotion, cultural safety, and trauma transformation, implicating sociocultural, familial, legal, educational, and collective agendas. Mental health interventions are best approached within contextual, systemic, and advocacy-oriented frameworks. Migrant child case vignettes relevant to clinical work are included to acknowledge individual agency, as well as collective or familial belonging in shaping their hybrid identities.
High-skilled migration and mental health
Authors: Ventriglio Antonio , Gupta Susham , Watson Cameron
Published: February 2021

High-skilled migrants are more likely to migrate for professional or educational reasons. There is a difference between the high-skilled migrants and labour in that the former may well be responding to pull factors, whereas the latter may be responding to push factors related to migration. These migrants are also more likely to belong to permanent migration category. High-skilled migrants are those with a university degree or extensive/equivalent experience in a chosen field. They are largely likely to migrate from low- to middle-income countries to high-income countries. The immigration rates show that these migrants are likely to be self-selected; have skills that are in demand and globally transferable. In the post-migration phase they may experience mental ill health, especially if they do not feel valued; feel overqualified for the jobs they are doing; and if they experience a discrepancy between aspirations and achievement. Their clinical needs may well differ from those of migrant labour.
Ethics and migrant psychiatry
Authors: Deakin Nicholas A. , Ventriglio Antonio , Bhugra Dinesh
Published: February 2021

Ethical practice of medicine in general and psychiatry in particular form an integral part of medical professionalism in order to ensure that patients not only get the best treatments for their needs but also that these are delivered in an ethical framework. For centuries, doctors and psychiatrists have continued to rely on the four principles of autonomy, beneficence, non-maleficence and justice as critical components of decision-making in treating their patients. As the concepts of health have changed the basic principles remain the same. This “four principles” approach has much to offer medical professionals when they are faced with ethical dilemmas in clinical and non-clinical practice. In this chapter, we outline the basis of these principles and consider the key strengths while using this theory. For psychiatrists there is a major imperative as their actions can deprive patients of their liberty. The “four principles” should be considered when making ethical decisions, and in conjunction with professional judgement and wider ethical frameworks.
Psychotherapy and refugees
Authors: Brady Francesca , Katona Cornelius , Walsh Eileen , Robjant Katy
Published: February 2021

This chapter explores effective psychotherapeutic interventions for treating post-traumatic stress disorder in adult vulnerable migrants, including cognitive behavioural therapy (CBT), eye movement desensitization and reprocessing, and narrative exposure therapy. An overview of the evidence for these treatments is discussed, as well as how these can be implemented effectively for vulnerable migrants who face ongoing instability and uncertainty, as well as multiple barriers to accessing appropriate treatment. The additional needs of vulnerable migrants are therefore also highlighted. The chapter proposes that to assist individuals effectively in recovering from their traumatic experiences, support must be offered to address these needs, alongside any psychological treatment. A service case example is presented to highlight how an integrated model of care can most effectively meet the needs of vulnerable migrants.
Intercultural counselling and psychotherapy with new immigrants and refugees
Authors: Tribe Rachel
Published: February 2021

This chapter will review what is meant by intercultural therapy and discuss the relevant terminology in relation to refugees and migrants. It will then briefly consider some of the major differences between an immigrant and a refugee and the implications that this may have for intercultural therapy. Shifts across narratives about migrants and refugees in the new country will be discussed and their possible implications for psychological well-being considered. The issue of power operating at multiple levels will be reviewed. Therapeutic services that concentrate only on an individuals’ refugee or migratory status may inadvertently minimize the experience of a service user and reduce an individual to a part of their life (as a migrant or refugee) rather than considering the whole lived experience of that person. This reductionist approach may also risk underestimating the strengths that an individual possesses. The use of therapeutic skills in innovative ways and in diverse contexts will be discussed and their potential in working with refuges and migrants in culturally and non-stigmatising ways discussed.
Why do a cardiopulmonary exercise test?
Authors: Kinnear William J.M. , Hull James H.
Published: February 2021

This chapter describes how a maximal cardiopulmonary exercise test (CPET) assesses the exercise capacity of an individual. It identifies whether exercise is limited by the heart or lungs, or by another factor. The test can be used to elucidate the cause of symptoms such as breathlessness. By quantifying exercise capacity, a CPET can be used as a tool to plan physical training. Information from a CPET helps quantify the risk of a surgical intervention and is used in planning post-operative care. Performance in a CPET is a predictor of subsequent mortality. A CPET should be preceded by a full clinical history and a thorough clinical examination. The test is best interpreted alongside the results of simple preliminary investigations.
Oxygen uptake
Authors: Kinnear William J.M. , Hull James H.
Published: February 2021

This chapter describes how the most important parameter measured during a cardiopulmonary exercise test (CPET) is the volume of oxygen taken up by the body at peak exercise. This is called the maximum oxygen uptake, or VO2max. Sometimes the terms ‘peak’ and ‘maximal’ are also used to describe oxygen uptake. It is measured by looking at the volume of air inspired and the oxygen content of the expired air. Predicted values depend on age and sex. A VO2max of more than 80% of predicted makes significant heart or lung disease unlikely. The lower the VO2max, the worse the prognosis.
Maya religion and traditions
Authors: Baquedano Gaspar
Published: February 2021

Although suicide appears to be an individual act, this auto-destructive behaviour occurs in a wider context. According to statistics, suicide is strongly ingrained in the Maya culture of Mexico. Why do the Maya in the Yucatecan area have the highest suicide indexes in the country? This text proposes a psycho-anthropological perspective which focuses on the Maya religion and traditions with the central theme of suicide. If the process is understood, we can then develop better strategies for its prevention. This work proposes that suicide is much more than a medical issue. A psycho-anthropological approach towards suicide seems to be worthwhile when added to other psychiatric models in mental health. This perspective could be fruitful for understanding other social groups around the world that share a culture, inherited traditions, and religious beliefs about suicide.
Legislation and ethics of physician-assisted suicide and euthanasia in psychiatric patients
Authors: Courtet Philippe , Olié Emilie
Published: February 2021

Euthanasia is the act by which a third party (a physician or qualified healthcare practitioner) intentionally terminated a patient’s life by the patient’s request—the doctor administers the prescription. Physician-assisted suicide is where a physician or healthcare practitioner provide the means to a patient under the patient’s request, which will intentionally terminate the patient’s life—the individual then self-administers the prescription. Assisted suicide is where a physician or a healthcare practitioner is not directly involved and usually another third member or organization would assist in providing the patient with the means for self-administered suicide. This text presents the available data from the Benelux region on euthanasia and physician-assisted suicide requests that are grounded in psychiatric disorders. From a psychiatrist’s point of view, clinical and ethical questions are raised by such practices, since suicide prevention is a primary purpose of psychiatric care and a key focus of training.
Suicidal behaviour and bipolar disorder
Authors: Vinberg Maj , Nordentoft Merete
Published: February 2021

Bipolar disorder is a severe mental illness characterized by mood swings with episodes of depression, hypomania, mania, and mixed episodes. Bipolar disorder, especially in depressed and mixed episodes, is a major risk factor for suicide. Further, untreated bipolar disorder, comorbid anxiety, substance abuse, personality disorder, and treatment-resistant course are all factors accentuating the overall risk for suicide among patients with bipolar disorder. Evidence of long-term effective treatment is scarce with one notable exception, long-term lithium treatment. Early treatment, addressing both bipolar disorder and it´s comorbidities, especially targeting identification of acute episodes and substance use is recommended to enhance the prevention of suicide in this inherited at-risk group of suicide patients. Future clinical research should target the efforts towards the development of pragmatic tools easy to translate and use in clinical everyday settings.
An economic perspective on suicide across the five continents
Authors: McDaid David , Kennelly Brendan , Ahern Susan , McElroy Brendan
Published: February 2021

In considering suicide prevention measures, it is important to consider potential economic risk factors, and the costs and consequences of suicide. We provide an overview of some areas where economics has played a role in the analysis of suicide and prevention strategies. Evidence on the wide-ranging socioeconomic costs and consequences of suicide is provided, including a reflection on the development of economic theories on individual motivations for suicide. Evidence from econometric models at cross-country and single country levels on the links between suicide and socioeconomic risk factors is reviewed. Cost-effectiveness is used as part of decision-making processes in health and other sectors. In respect to suicide prevention there is growing evidence of cost-effective measures. Incorporating economic analyses into future effectiveness studies is likely to help strengthen the case for investment in suicide prevention. There is also scope to look at the economic implications of interventions already shown to be effective.
Family psychoeducation after a suicide attempt
Authors: Krysinska Karolina , Andriessen Karl
Published: February 2021

Family can play an important role in supporting a person at-risk of suicide, as well as through treatment and recovery after a suicide attempt. This text provides an overview of the impact a suicide attempt can have on the family and the needs of family carers. Examples of psychosocial interventions for people, mostly adolescents, who have made a suicide attempt and their families are presented along with psychoeducational materials developed for family carers, whose emotional proximity may hinder and/or facilitate engagement with the suicidal person. Although several interventions are promising, further research into the effectiveness of psychoeducational interventions and family involvement after a suicide attempt is warranted.
Individual therapy techniques with suicidal adolescents
Authors: Spirito Anthony , Esposito-Smythers Christianne , Cheek Shayna
Published: February 2021

This chapter provides a brief summary of the literature on individual therapy with suicidal adolescents. The primary focus is on the treatment of adolescents who have attempted suicide. However, effective treatment of an underlying condition, such as depression, does not necessarily result in a reduction in suicidality. Therapy techniques specific to cognitive, emotional/affective, interpersonal, and intrapsychic factors are reviewed. These techniques were chosen based on the current treatment outcome literature, treatment protocols tested in clinical trials, and the clinical literature. Techniques from cognitive behavioural therapy (CBT), dialectical behaviour therapy (DBT), psychodynamic psychotherapy, and interpersonal psychotherapy (IPT) are described. An approach to psychoeducation regarding suicidality is also presented.