bluuebunny/crossref_metadata_2025 huggingface dataset:
Meta-Analysis: Association of Parent and Child Mental Health with Pediatric Health Care Utilization
Authors: Lavigne John V , Meyers Kathryn Mendelsohn
Published: May 2019

Objective

To examine the association of psychological factors and pediatric health care utilization.

Method

Ovid Medline and PsychInfo were searched and archival and forward searchers were conducted of relevant articles. Studies of the association between psychological risk factors and pediatric health care utilization of outpatient services, emergency department, inpatient length of stay, and costs were identified. Effect sizes were expressed in the form of the standardized mean difference. From 4,546 studies identified in the search, 69 studies met inclusion criteria.

Results

There were significant low-moderate associations between higher outpatient visits and general child mental health (MH) problems (mean ES [mES] = 0.35), overall psychopathology (mES = 0.44), and internalizing symptoms (mES = 0.16). Results were significant for any parent MH problem (mES = 0.18). For emergency department (ED) visits, there were significant association between more ED visits and any child MH problems (mES = 0.25), internalizing symptoms (mES = 0.24), externalizing symptoms (mES = 0.16), and Attention Deficit/Hyperactivity Disorder (mES= 0.14), as well as parent MH (mES = 0.24) and maternal depression (mES = 0.21). Increased hospitalizations were associated with any child MH problem (mES = 0.3), overall child psychopathology (mES = 0.49), child depression (ES = 0.41), and any parent MH problem (mES = 0.54). For costs, results were significant for any child MH problem (mES = 0.38).

Conclusions

Child and parent MH problems are significantly associated with increased HCU.
‘Mountains Moved into the Sea’: The Western Reception of Psalm 46:1 and 3 [45:1 and 3 LXX] From the Septuagint to Luther
Authors: Abernethy Andrew T
Published: May 2019

When Martin Luther wrote his famous hymn Ein feste Burg ist unser Gott in the 1520s, it was uncommon to understand Ps. 46:1–3 [45:1–3 LXX] as a celebration of the peace available to those taking refuge in God amidst raging hostility—as the earth shook and mountains moved into the heart of the sea. Instead, for over a millennium, Augustine’s allegorical interpretation of verse 3 held sway. These verses contained ‘hidden’ truths made known when Christ came, so the shaking earth was the Jews, the mountains were Christ and his apostles, and the sea was the Gentiles in 46:3. According to Augustine, then, 46:1–3 celebrates God’s being a refuge amidst the working out of his plan to redeem the Gentiles through the mission of Christ and his apostles. This essay recounts the reception of 46:1–3 from the Septuagint to the time of Luther in a way that demonstrates the influence of the Septuagint’s translation of the superscription (verse 1), the dominance of Augustine’s allegorical interpretation of 46:1–3 for over a millennium, and how Luther’s growing appreciation of the historical sense shifts his interpretation of 46:1–3 away from Augustine to align with most interpreters in the early church and Nicholas of Lyra.
When Seventy Equals Seventy-Two: A Reception-Historical Contribution to the Text-Critical Problem of Luke 10:1, 17
Authors: Johnson Nathan C
Published: May 2019

The question of how many disciples Jesus sends in Luke 10:1—70 or 72—has long brought interpreters to an impasse, with Bruce Metzger concluding that the number is ‘elusive’ and ‘cannot be determined with confidence’. However, one simple solution has yet to be considered. Appealing to ancient number theories, reception history, and Luke’s manuscript tradition, this essay maintains that 70 and 72 were often, strangely, the same number in antiquity. A facile solution in isolation, equating 70 and 72 is demonstrated to be a common phenomenon in antique Jewish and Christian literature. The implication of such a finding for the interpretation of Luke is that the numerous intertexts proposed for Luke’s 70/72 disciples—the Table of Nations, Moses’ elders, the number of languages—are all at least admissible on text-critical grounds.
Positive Regard and Affirmation
Authors: Farber Barry A. , Suzuki Jessica Y. , Lynch David A.
Published: May 2019

This chapter meta-analytically reviews the research on the association between therapist positive regard and treatment outcome. The history of the construct of unconditional positive regard in client-centered theory, as well as the efforts to operationalize and measure this construct, are reviewed. Several clinical examples are presented. The meta-analysis, which features 64 studies, yielded a small positive association between positive regard and treatment outcome, g = 0.28. To control for the repeated use of data sets and study samples within the database, a multilevel meta-analysis was adopted that indicated a stronger relation between positive regard and clinical outcome, g = 0.36. These analyses support positive regard’s standing as a significant component of the therapy relationship that leads to improved clinical outcomes. The chapter concludes with limitations of the research, patient contributions, diversity considerations, and practice recommendations.
Self-Disclosure and Immediacy
Authors: Hill Clara E. , Knox Sarah , Pinto-Coelho Kristen G.
Published: May 2019

We conducted a qualitative meta-analysis of 21 studies that examined the clinical consequences of therapist self-disclosure (TSD) and immediacy (Im) in psychotherapy. The most frequent consequences were enhanced therapy relationship, improved client functioning, gain in insight, and overall helpfulness, suggesting that the consequences are mostly positive and therapeutic. TSD was associated more often with improved mental health functioning, more overall helpfulness, and more enhanced therapy relationships, whereas Im was associated more often with clients opening up and being more immediate. The chapter concludes with limitations of the research, diversity considerations, and research-informed recommendations for judiciously using TSD and Im in practice.
Cultivating Positive Outcome Expectation
Authors: Constantino Michael J. , Vîslă Andreea , Coyne Alice E. , Boswell James F.
Published: May 2019

Patients’ outcome expectation (OE) represents their belief about the mental health consequences of participating in psychotherapy. In this chapter, the authors first discuss the definitions of OE and similar constructs, common OE measures, clinical examples of OE, several landmark studies, and results of a previous meta-analysis of the OE-outcome association. The chapter then presents an updated meta-analysis of 81 independent samples with 12,722 patients. The overall weighted effect size was r = .18, or d = .36. Next, the authors present moderators and mediators of the OE–outcome link (the former in the context of the meta-analysis), evidence supporting causality in the association, patient factors related to OE, and limitations of the research base. Finally, the chapter reviews diversity considerations, training implications, and therapeutic practices with regard to OE and its robust association with therapy outcome.
Repairing Alliance Ruptures
Authors: Eubanks Catherine F. , Muran J. Christopher , Safran Jeremy D.
Published: May 2019

A rupture is a deterioration in the therapeutic alliance, manifested by a disagreement between the patient and therapist on treatment goals, a lack of collaboration on therapeutic tasks, or a strain in their emotional bond. This chapter presents the most frequently used measures of alliance ruptures and clinical examples to illustrate their repair. To examine the relation of rupture repairs to outcome, the authors conducted a meta-analysis on 11 studies (1,314 patients) that compared the treatment outcomes of patients with rupture-repair episodes to those of patients with unrepaired ruptures. Results yielded an effect size of r = .29, d =.62, 95% confidence interval [.10, .47], p =.003, indicating a moderate relation between rupture resolution and positive patient outcome. To examine the impact of rupture resolution training or supervision on patient outcome, the authors examined 6 studies (276 trainees/supervisees) that compared the outcomes of trainees who received rupture resolution training with a comparison group. Results did not find a significant relation, r = .11, d = .22, 95% confidence interval [-.09, .30], p = .28. Moderator analyses indicated that the relation between training and outcome was stronger when the sample included fewer patients with personality disorders, when the training was more closely aligned with cognitive behavioral therapy than psychodynamic therapy, and when the treatment was brief. The chapter concludes with limitations of the research, diversity considerations, and research-informed therapeutic practices for repairing ruptures in ways that contribute to good outcome in therapy.
Coping Style
Authors: Beutler Larry E. , Edwards Christopher J. , Kimpara Satoko , Miller Kimberley
Published: May 2019

Over the course of 60 years of research, several personality traits have emerged as potential predictors of differential change in psychotherapy. Among them is the patient’s coping style, commonly distinguished between those who deal with change by looking inwardly (internalization) and those who deal with it outwardly (externalization). This chapter provides definitions of coping styles, clinical examples, and frequent measures. It updates a 2011 meta-analytic review that revealed a consistent interaction between coping styles and treatment focus—symptom focus versus insight focus. The current meta-analysis of 18 studies revealed a medium to large effect (d = .60) and suggested that a symptom focus proves more effective for internalizing patient whereas an insight focus is generally more effective for internalizers. The chapter concludes with limitations of the research, diversity considerations, and therapeutic practices based on the meta-analytic results.
Concussion Care Manual
Authors: Brody David L.
Published: May 2019

This practical manual is for clinicians who care for patients with concussions. The effects of concussions are a recognized problem in the medical community and among the general public. Most people recover well from concussions, but a substantial minority does not. Most clinicians, however, do not have specific training in how to evaluate and treat concussion patients who do not make a rapid and complete recovery. This manual is based on the experience of the former director of the concussion clinic at Washington University in St. Louis, currently the director of the NIH/Uniformed Service University Traumatic Brain Injury Research Group. The manual provides step-by-step guidance for managing problems related to complex concussions: diagnosis, treatment strategies, headaches, sleep disruption, attention deficit, mood instability, anxiety and depression, post-traumatic stress, personality change, balance problems, dizziness, fatigue, and so forth. Specific sections address returning to work, driving, school, and contact sports. The manual also specifically addresses concussion in adolescents, children, elderly individuals, contact-sport athletes, military personnel, and patients involved in medico-legal matters. Finally, the manual discusses how to set up and run a concussion clinic. Clinicians with a broad range of backgrounds, including primary care physicians, nurse practitioners, physician’s assistants, athletic trainers, emergency medicine doctors, neurologists, neurosurgeons, psychiatrists, and rehabilitation medicine physicians should be able to use the manual effectively. Resident physicians and other trainees can use the manual without extensive background reading. Lists of Internet-based resources and other available publications direct the reader to information beyond what a pocket-sized manual can provide.
Introduction
Authors: Brody David L.
Published: May 2019

This manual is for everyone who treats people with concussion. There are more than 3 million brain injuries each year in the United States and millions more around the world. Most of these injuries are concussions. After concussion, 30% or maybe even more can have prolonged symptoms and deficits. Much of this manual is written for the people who take care of the 30%. There is not one specific “post-concussion syndrome.” Instead, there are many post-concussive paths, and this manual is written to help those who are tasked with figuring this out, one patient at a time. This manual is about pragmatic approaches to taking care of patients in the absence of true scientific evidence. This manual is written to be used “on the fly,” right now, without a lot of prior studying or memorization. This manual is meant to supplement, not replace, the knowledge and judgment of medical providers caring for concussion patients.
General Treatment Strategies
Authors: Brody David L.
Published: May 2019

Top 10 General Priorities: (1) Do one thing at a time. (2) Stop or taper impairing medications before adding new ones. (3) Minimize side effects of medications. (4) Offer rehabilitative therapy and lifestyle modification interventions as well as medications. (5) Educate and comfort. (6) Give an honest prognosis with a positive spin. (7) Use a healthy dose of Vitamin P (“placebo”) in an appropriate way. (8) Under the right circumstances, it’s OK to use a big dose of Vitamin S (the “therapeutic scare”) also. (9) Offer follow-up and appropriate referrals. (10) Support the family.
Smell and Taste Problems
Authors: Brody David L.
Published: May 2019

Specialized rehabilitative strategies involving olfactory training can modestly improve smell perception. There are no specific medications or surgical procedures available for smell and taste (which is also mostly smell) dysfunction. The most important thing is education for safety, specifically with regard to smoke, natural gas leaks, car malfunctions, and spoiled food. Overeating is also a common consequence, which can be remedied by making food spicier. Phantosmia (smelling things that aren’t really there) is rare but can respond to treatment including trials of medications usually used for neuropathic pain.
When Is It Safe to Fly or Travel to High Altitude?
Authors: Brody David L.
Published: May 2019

Most commercial airplanes are pressurized to the equivalent of about 7000 to 8000 feet. U.S. Air Force researchers have shown that uninjured people experience very little change in cognitive function or symptoms at this altitude, but that this is not the case after concussion. Symptoms and deficits that had resolved can come back at altitude, most notably headaches, slowing of cognitive performance, and impaired balance. Inform the patient and family about this risk and then let them make their own decisions about whether it is worth it. No evidence of permanent harm from flying or traveling to moderate altitude in concussion patients exists, but it has not been carefully studied.
Concussion in the Elderly
Authors: Brody David L.
Published: May 2019

Elderly individuals over age 65 represent the fastest growing group of traumatic brain injury patients. Many elderly individuals are taking anticoagulant medications, and an initial computed tomography (CT) scan is warranted to rule out intracranial hemorrhage, though a second CT scan is generally unnecessary if the first scan is negative and the patient’s neurological condition is stable. Elderly can be more susceptible to side effects of medications; thus, smaller doses may be preferred. Balance training is advised to reduce risk of falls. Concussion may be both a cause and a consequence of neurodegenerative diseases. Driving may be especially problematic in elderly after concussion.
Typical Flow for a Concussion Clinic
Authors: Brody David L.
Published: May 2019

Many variations are possible. One successful clinic runs as follows: Patient is referred to the clinic. Clinic administrator requests medical records. Provider reviews the records and approves initial office visit. Clinic administrator schedules the initial office visit as routine or semiurgent. Clinic administrator makes sure that the patient brings a reliable collateral source. Patient completes Rivermead Post-Concussive Symptoms Questionnaire, Neurobehavioral Symptom Inventory, or other self-report form. Provider obtains history and exam with documentation recorded on a preprinted sheet outlining the most important issues following concussion. Physical therapist and psychometrician see the patient. Provider reviews the data from the physical therapist and psychometrician, performs additional testing, obtains additional history, formulates assessment, and discusses plans with patient and collateral source. Provider gives the patient and collateral source a brief handwritten or printed summary of the assessment and plan, then sends medical records to other medical providers.
Subthalamo-Pallidal Circuit
Authors: Wilson Charles J.
Published: May 2019

The subthalamo-pallidal system constitutes the second layer of circuitry in the basal ganglia, downstream of the striatum. It consists of four nuclei. Two of them, the external segment of the globus pallidus (GPe) and subthalamic nucleus (STN), make their connections primarily within the basal ganglia. The others, the internal segment of the globus pallidus (GPi) and the substantia nigra pars reticulata (SNr), are the output nuclei of the basal ganglia. Collectively, their axons distribute collaterals to all the targets of the basal ganglia. Rare interneurons have been reported in each of them from studies of Golgi-stained preparations, but they have not so far been confirmed using more modern methods. The circuit as described here is based primarily on studies of the axonal arborizations of neurons stained individually by intracellular or juxtacellular labeling.
The Insect Visual System: Correspondence with Vertebrates and with Olfactory Processing
Authors: Strausfeld Nicholas J.
Published: May 2019

A 1915 monograph by the Nobel Prize–winning neuroanatomist Santiago Ramón y Cajal and Domingo Sánchez y Sánchez, describing neurons and their organization in the optic lobes of insects, is now standard fare for those studying the microcircuitry of the insect visual system. The work contains prescient assumptions about possible functional arrangements, such as lateral interactions, centrifugal pathways, and the convergence of neurons onto wider dendritic trees, to provide central integration of information processed at peripheral levels of the system. This chapter will consider further indications of correspondence between the insect-crustacean and the vertebrate visual systems, with particular reference to the deep organization of the optic lobe’s third optic neuropil, the lobula, and part of the lateral forebrain (protocerebrum) that receives inputs from it. Together, the lobula and lateral protocerebrum suggest valid comparison with the visual cortex and olfactory centers.
Olfactory Cortex
Authors: Wilson Donald A. , Barkai Edi
Published: May 2019

Although the piriform cortex anatomical structure is simple and well defined compared to neocortical structures, it subserves higher brain function like other associative cortices. While the piriform cortex is engaged in relatively basic functions like identifying familiar odors and discriminating between similar odors, it also has a central role in complex tasks, such as integration of information about the identity and the reward value of odors. Such a variegated capability is enabled by its intrinsic hardwire, which resembles that seen in high neocortical areas, and by efficient sets of connections with ascending and descending brain areas with which the cortex generates synchronized activity.
Cochlear Microcircuits
Authors: Fuchs Paul Albert , Wu Jing-jing Sherry , Vyas Pankhuri , Zachary Stephen Paul
Published: May 2019

The mammalian cochlea functions as a sensitive frequency analyzer of the acoustic world. To a large extent, this operation is intrinsic to the peripheral organ itself, resulting from the exquisitely differentiated mechanics of the sensory epithelium that encodes sound onto cochlear afferents. The precise arrangement of afferent innervation further refines and differentiates that coding. In addition, cochlear operation is modulated by feedback from efferent neurons making contact with hair cells and afferent neurons. In this way, microcircuits of the auditory periphery involve an intricate interplay of micromechanics and cellular integration. This chapter will describe that interplay, with an emphasis on the synaptic connections of sensory hair cells with afferent and efferent neurons. To do so requires an understanding of the peripheral transduction pathway, which begins with an overview of cochlear function.
Olivocerebellar System
Authors: Llinás Rodolfo R.
Published: May 2019

The olivo-cerebellar system is one of the most conserved in the vertebrate brain, being present in all forms studied so far. It comprises a set of bilaterally symmetrical inferior olivary (IO) nuclei, ventrally located in the bulbar brainstem, and the overlying cerebellum. These two structures are mutually linked through axonal pathways within the cerebellar peduncles. The anatomical and functional relation between the inferior olive and the cerebellum, at the cellular level, has been the subject of much study. Indeed, while the neuronal elements that comprise the system are well defined, as is their mutual connectivity, the ultimate function as a motor timing organizer is now well established.
The Heartbeat Neural Control System of the Leech
Authors: Calabrese Ronald L.
Published: May 2019

In medicinal leeches, heartbeat is a continuous, automatic function. Rhythmic constrictions of two muscular lateral vessels (the hearts) move blood through the closed circulatory system. The hearts are coordinated so that one beats in a rear-to-front progression (peristaltically), whereas the other one beats nearly synchronously along its length. The same coordination modes as in the hearts—peristaltic and synchronous—occur in the heart motor neurons: on one side, they are active in a rear-to-front progression, while on the other, they are active nearly synchronously. The rhythmic activity pattern of the heart motor neurons derives from the cyclic inhibition that they receive from the heartbeat central pattern generator (CPG). The core CPG comprises seven bilateral pairs of identified heart (HN) interneurons that occur in the first seven ganglia, HN(1)–HN(7).
Economics of Acute Pain Medicine
Authors: Harrington Brian E. , Mariano Edward R.
Published: May 2019

Appropriate resource allocation is vital for the successful delivery of acute pain medicine services. This chapter describes core concepts in acute pain medicine (such as use of multimodal analgesia and pain protocols) and reviews the economic considerations regarding acute pain medicine program development and implementation, including consideration of value-based models that are intended to promote efficient, high-quality care at a lower cost. Notably, while many of the principles may be universally applicable, the underlying context regards deployment of acute pain medicine programs within healthcare settings in the United States. The chapter concludes with a section on future directions in acute pain medicine.
Arthroscopic Shoulder Surgery
Authors: Melton M. Stephen , Kim James Kyunghoon , Nielsen Karen C.
Published: May 2019

Shoulder arthroscopy is an extremely common elective ambulatory surgery procedure that is performed for a multitude of indications. Significant postoperative pain associated with these procedures necessitates an adequate multimodal analgesic plan. Peripheral nerve blockade (PNB) is commonly performed for intraoperative anesthesia and/or postoperative analgesia. This chapter reviews patient- and surgery-specific considerations for outpatient shoulder arthroscopy anesthesia and analgesia. Interscalene block (ISB) is commonly performed PNB for shoulder surgery, although side effects associated with its use have spurred interest in alternative techniques. The safety and efficacy of adjuvants to extend local anesthetic duration achieved with single-injection PNBs for arthroscopic shoulder surgery are still under investigation. As such, extended postoperative analgesia relies on continuous catheter techniques. Appropriate dosing regimens must be employed for both single-injection ISB and continuous interscalene brachial plexus block, and a protocol must be in place for safe, effective discharge and follow-up of patients going home with perineural infusions.
Arthroscopic Knee Surgery
Authors: Flaherty James , Elliot Clint , Wardhan Richa
Published: May 2019

Arthroscopic knee is one of the most common outpatient orthopedic procedures. Specifically, anterior cruciate ligament (ACL) repair is a common procedure with numerous multimodal analgesia considerations. Via the example case, this chapter examines acetaminophen pharmacology and the efficacy of acetaminophen as a multimodal analgesic, including comparing its benefit with that obtained with nonsteroidal anti-inflammatory drugs. It also discusses regional anesthetic concerns related to ACT repair, the utility of regional anesthesia in the perioperative pain management of an ACL repair, and options for managing postoperative pain resulting from arthroscopic surgery. Finally, it addresses questions pertaining to pharmacogenomics and the epigenetics of acute pain management.
Breast Surgery
Authors: Wardhan Richa , Greengrass Roy
Published: May 2019

Breast surgery is commonly performed under general anesthesia. Opioids are often utilized for pain management. Regional anesthesia is superior to opioids in many ways, and opioids are best avoided in patients with cancer due to their immunosuppressant effect. Regional anesthesia can be effectively utilized not only as postoperative pain management but also as intraoperative anesthesia. This chapter discusses anatomic considerations to analgesia in breast surgery, detailing the innervation of the breast and the chest wall. It also discusses techniques for providing surgical anesthesia and postoperative analgesia, focusing on the various regional nerve blocks that are available to achieve anesthesia and analgesia of the breast and the chest wall.
Complex Spine
Authors: Edwards David A. , Sobey Christopher
Published: May 2019

Patients undergoing extensive spine surgery suffer from significant pain throughout the perioperative period. Of note, many patients utilize opioid medications preoperatively, which increases the risk of postoperative pain and numerous other risks. This chapter describes how central sensitization plays an essential role throughout the perioperative period and should be considered when planning tailored analgesic regimens. The chapter also details how NMDA antagonists such as ketamine can be used in the postoperative setting to reduce pain intensity and decrease opioid use. It concludes with a discussion of how the risk of opioid-induced ventilatory impairment can be managed postoperatively, including with nursing evaluation for somnolence and sedation at regular intervals in the first 4 hours after discharge from the postanesthesia care unit.
Craniotomy
Authors: Grasu Roxana , Raty Sally
Published: May 2019

This chapter discusses postcraniotomy headache (PCH), a common yet frequently underdiagnosed and undertreated occurrence, with up to 30% of patients experiencing persistent headache after surgery. The chapter identifies risk factors for the development of acute and persistent PCH and describes mechanisms for its development, such as injury to the sensory nerves supplying the scalp and underlying tissues or to the perivascular nerves that supply sensation to the dura mater. Pain management following craniotomy is a balancing act of achieving adequate analgesia while avoiding oversedation, respiratory depression, hypercapnia, nausea, vomiting, and hypertension. Current evidence suggests that a balanced, multimodal approach to the treatment of acute PCH is often required to optimize pain control, minimize undesired side effects, and prevent the development of persistent PCH.
Sickle Cell Pain Crisis
Authors: Bansal Vikram , Sharma Deva , Shastri Uma
Published: May 2019

Acute sickle cell pain crises pose a significant challenge to acute pain medicine physicians. Knowledge of underlying mechanisms, whether vaso-occlusive or not, can be useful in planning successful analgesic regimens. This chapter describes the pathophysiology and epidemiology of sickle cell disease. It also addresses how anesthesiologists should evaluate patients with sickle cell disease and acute pain. The chapter then presents numerous opioid delivery options that should be judiciously utilized to optimize patient function. Nonopioid adjuncts, such as acetaminophen or ketamine, should be aggressively pursued, and in some scenarios, perineural interventions may be appropriate. In any scenario, a comprehensive team-based approach is encouraged.
Pediatrics
Authors: Sofer Michale , Kraemer Francis Wickham
Published: May 2019

Following surgery, pediatric patients suffering from pain warrant consistent and frequent pain assessments. This chapter describes a variety of scales that can be used and that must be tailored to the developmental stage of the child. Examples of commonly used pediatric scales include the Neonatal Pain, Agitation and Sedation Scale (N-PASS); Face, Legs, Activity, Cry, Consolability (FLACC); Numerical Rating Scale (NRS); and the Wong Baker FACES Pain Scale. In the setting of open abdominal surgery, certain interventional techniques (continuous epidural, peripheral truncal blockade) can be used to significantly decrease pain and must be tailored to the individual patient and specific surgical subtype. Separate from interventional techniques, older children may also use patient-controlled analgesia (PCA) devices to deliver systemic opioids. For patients who are too young or are unable to press a PCA device, a variety of nurse-controlled analgesic protocols exist to deliver such systemic analgesic therapies.
Pediatrics: Scoliosis Repair
Authors: Sobey Jenna , Menser Carrie
Published: May 2019

This chapter discusses scoliosis repair, one of the most common major orthopedic surgeries performed in pediatric patients. Adolescent idiopathic scoliosis is the most common form and affects 1% to 3% of children and adolescents between the ages of 10 and 16. The anesthetic management of these patients can be challenging due to potential physiologic derangements that may be present. Adequate perioperative pain management is crucial, given the potential for significant postoperative and chronic pain conditions following repair. The rate of chronic postsurgical pain following scoliosis repair in pediatric patients averages about 20%. A balanced approach to analgesic management is best utilized to optimize pain relief while limiting side effects. Proper preparation for the perioperative experience, including setting expectations and planning for pain management, is a key factor in a successful recovery.
Limbs and Trunk
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: May 2019

This chapter emphasizes various clues apparent from the patient’s history and physical examination. Observation of how a patient walks, talks, and undresses is vital. Miscellaneous aspects of the history, particularly sensory symptoms, are elaborated, and clues to psychogenic disorder are described. Also emphasized is the value of inspecting the limbs, skin, and joints. Short cuts are listed about the formal physical motor and sensory examination and how to analyze coma.
Demyelination
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: May 2019

This chapter describes various clues to the diagnosis of multiple sclerosis (MS) based on the history, physical examination and investigation. Red flags that should alert the clinician to an alternative diagnosis are listed. Disorders that may present like MS and lead to erroneous diagnosis are discussed.
Movement Disorders
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: May 2019

This chapter deals with classic Parkinson’s disease and the main variants such as progressive supranuclear palsy, multiple system atrophy, and the corticobasal syndrome. There are details on chorea, particularly Huntington’s disease, chorea-acanthocytosis, McLeod’s syndrome, Sydenham’s chorea, Wilson’s disease. The main varieties of tremor are described as are neurodegeneration with brain iron accumulation. Subsequent parts deal with tics, restless legs syndrome, periodic movements of sleep, and painful legs and moving toes. Several Handles are specified for dystonia and its subdivisions, Lesch-Nyhan syndrome, gait disorders, paroxysmal dyskinesias, stereotypies, psychogenic movement disorders, and myoclonus.
The Fast Neurological Examination
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: May 2019

The final chapter is a coalescence of material already detailed in earlier chapters but in a form that will save time in the clinic. The suggested approach is for the patient you wish to screen, having predicted from the history that there will be few physical signs. This would apply to most patients with nonspecific headache and dizziness for example. The cranial nerves are listed first followed by brief examination of limbs.
Capitalizing on the Health Impacts of Improving Housing Conditions
Authors: McKnight Michael , Norton Ruth Ann
Published: May 2019

Chapter 5 looks at the impact of the Green & Healthy Homes Initiative (GHHI) and its various partners in government, the private sector, and philanthropy in work it carried out which was intended to revolutionize health and housing. The aim has been to break the current link between unhealthy housing and unhealthy families. As GHHI has expanded its work some common themes have emerged, which the chapter outlines. When measuring the impact of comprehensive services, access to data is critical, the chapter argues. Armed with the information from robust analysis, providers such as GHHI and its partners are able to maximize program design and referral sources.
Working with the Faith Community to Improve Health
Authors: Joyner Richard , Treyz Alexandra
Published: May 2019

This chapter shares a powerful story from Edgecombe, North Carolina, about parlaying the trust and relationship inherent in many faith communities into successful collaborations with the local school system and their Federally Qualified Health Center (FQHC). The keys lesson from this story is the importance of maintaining a holistic view towards spiritual and physical health and a recognition that the contribution of the congregation can produce remarkable results.
Overview—Policy: Achieving Sustained Impact
Authors: Hunter Edward L. , Bradley Don W.
Published: May 2019

This chapter introduces the next section of this book which is about policy and how to achieve sustained impact. There has recently been a growing recognition of the role that policy plays in the pursuit of community health goals. Public health leaders have articulated the importance of policy as a public health approach. Similarly, wide experimentation is taking place regarding the use of policies on health care reimbursement to reshape the contribution that delivery systems can make to community health objectives. Also, policy provides a prime example of the importance of cross-sector collaboration. Policy can affect all sectors, and it is rarely developed, implemented, and sustained without the active engagement of a broad coalition of interests. Public policy, the primary focus of this section of the book, is responsible for many of the most important advances in health in the last century.
Case Study: Nontraditional Partners in the Case of Kansas City
Authors: Hall Scott , Archer Rex
Published: May 2019

This chapter demonstrates the power of non-traditional partnerships to achieve policy change at the local level. The chapter's review of the work of the Kansas City Chamber of Commerce and the KCMO Health Department to motivate adoption of Tobacco 21 initiatives in multiple jurisdictions highlights the importance of business and public health working together.
Heart failure
Authors: Zannad Faiez , Ferreira João Pedro , McDonagh Theresa
Published: May 2019

Heart failure (HF) is a common condition, with an increasing incidence with age. Chronic heart failure with reduced left ventricular ejection fraction (HFrEF) results from impaired systolic dysfunction and represents about half of HF cases. The commonest aetiology is myocardial ischaemia. Chronic heart failure with preserved left ventricular ejection fraction (HFpEF) is symptoms and/or signs of heart failure, with left ventricular ejection fraction in the normal range. Acute HF is characterized by a rapid onset of signs and symptoms of HF, requiring urgent treatment. Acute HF may present as a first occurrence (de novo) or, more frequently, as a consequence of acute decompensation of chronic HF and may be caused by primary cardiac dysfunction or precipitated by extrinsic factors, often in patients with chronic HF. The diagnostic, workup, and treatment options for these conditions will be summarized in the chapter.
Cardiomyopathy
Authors: Boffa Giovanni
Published: May 2019

Hypertrophic cardiomyopathy (HCM) is characterized by the presence of increased left ventricular (LV) wall thickness that is not explained by loading conditions. The LV diastolic function is impaired in the majority of patients, and resting or provocable LV outflow tract obstruction is often present. The management of HCM is directed towards minimizing symptoms, improving LV diastolic function, and reducing LV outflow tract obstrucion. Beta-blockers reduce myocardial oxygen demand and improve LV filling via their negative chronotropic and inotropic effects. Moreover, they decrease LV outflow tract obstruction. The calcium channel blockers verapamil and diltiazem can be used when beta-blockers are contraindicated or ineffective. Diuretics improve dyspnoea in patients with increased pulmonary capillary pressure, and their use is mandatory if signs of fluid retention are present. The role of non-pharmacological treatment (surgery, electrical and mechanical device implantation) is important in specific groups of patients. Dilated cardiomyopathy is defined by the presence of LV dilatation and systolic dysfunction in the absence of abnormal loading conditions or coronary artery disease. Treatment of symptomatic patients should follow the therapeutic algorithm proposed by European Society of Cardiology guidelines on heart failure. First-line treatment includes diuretics, angiotensin-converting enzyme (ACE) inhibition (or angiotensin receptor blockade), beta-blockade, and aldosterone antagonism. The complex neprilysin inhibitor sacubitril/valsartan is recommended to replace ACE inhibitors in patients who remain symptomatic despite optimal treatment. The If channel inhibitor ivabradine should be considered for patients in sinus rhythm and with a resting heart rate of >70 bpm. ICD implantation with cardiac resynchronization function, LV assist devices, and heart transplantation are indicated in selected patients.
Pregnancy and lactation
Authors: Banerjee Anita , Banerjee Debasish , Jha Vivekanand
Published: May 2019

Cardiovascular disease in pregnancy remains a significant cause of morbidity and mortality worldwide. In the developed world, congenital heart disease remains the most frequently encountered presentation, and in the developing world, it is rheumatic heart disease. However, with ageing of the maternal population and cardiovascular risk factors, women are presenting with familiar cardiac conditions such as heart failure. Pre-pregnancy counselling and appropriate and timely management lead to an optimal outcome for the mother and baby. This chapter describes the physiology and provides up-to-date guidance on drug therapy of cardiovascular disease in pregnancy.
Oxygen and cancer
Authors: Harris Adrian L. , Ashcroft Margaret
Published: May 2019

Oxygen is required for most multicellular, aerobic organisms to survive and function. The vasculature provides the conduit for delivering oxygen via haemoglobin in the blood to organs, tissues, and cells. In diseases such as cancer, low tissue oxygenation or hypoxia occurs in solid tumours because of an inadequate supply of oxygen due to aberrant tumour vasculature. Hypoxia is a key feature of most solid tumours and underlies many of the processes associated with how cancer progresses; including tumour cell survival and proliferation, genetic instability, immune responses, angiogenesis, invasion and metastasis, and metabolic adaptive responses. Solid tumours contain several different cell types that respond to hypoxia within the tumour microenvironment. Hypoxia-inducible factors (HIFs) are a highly evolutionarily conserved family of dimeric transcription factors that are central to mediating the cellular response to hypoxia by regulating the expression of a diverse array of targets. Hypoxia and HIF activation is associated with treatment failure, resistance, and poor clinical outcomes. This chapter will provide an overview of the role of hypoxia in cancer, outline the methods used to measure hypoxia clinically, and discuss the impact of hypoxia on current front-line therapies being used to treat cancer.
Molecular profiling in cancer research and personalized medicine
Authors: van Dam Pieter-Jan , Van Laere Steven
Published: May 2019

Recent efforts by worldwide consortia such as The Cancer Genome Atlas and the International Cancer Genome Consortium have greatly accelerated our knowledge of human cancer biology. Nowadays, complete sets of human tumours that have been characterized at the genomic, epigenomic, transcriptomic, or proteomic level are available to the research community. The generation of these data was made possible thanks to the application of high-throughput molecular profiling techniques such as microarrays and next-generation sequencing. The primary conclusion from current profiling experiments is that human cancer is a complex disease characterized by extreme molecular heterogeneity, both between and within the classical, tissue-defined cancer types. This molecular variety necessitates a paradigm shift in patient management, away from generalized therapy schemes and towards more personalized treatments. This chapter provides an overview of how molecular cancer profiling can assist in facilitating this transition. First, the state-of-the-art of molecular breast cancer profiling is reviewed to provide a general background. Then, the most pertinent high-throughput molecular profiling techniques along with various data mining techniques (i.e. unsupervised clustering, statistical learning) are discussed. Finally, the challenges and perspectives with respect to molecular cancer profiling, also from the perspective of personalized medicine, are summarized.
Principles of chemotherapy
Authors: Kerr David J. , Haller Daniel , Verweij Jaap
Published: May 2019

Systemic cancer treatment stems initially from empirically discovered DNA synthesis inhibitors, which either deplete the cell of nucleotides, induce cross-link, or cause DNA single and double strand breaks or impair the cellular machinery of DNA repair, using mechanistically diverse drugs. A period of enlightenment followed, with anticancer drug development driven by an increased understanding of enzymes and pathways involved in cell signalling, control of angiogenesis, and epigenetics. This provided a parallel path towards precision cancer medicine where specific drugs can be targeted to patients with particular mutations. These include point mutations in RAS, which are used to exclude colorectal cancer patients from being treated with epidermal growth factor inhibitors; chromosomal translocations encoding fusion proteins which are cancer specific and serve as novel drug targets (e.g. BCR/ABL and imatinib, or EML4-ALK fusion oncogene and crizotinib). More recently, there has been a reanimation of immune approaches to cancer therapy with the clinical introduction of immune checkpoint inhibitors, designer T cells, and patient-specific antitumour vaccines. What next? It may be that next-generation sequencing provides an endless stream of so-called actionable mutations that permits tailored application of mutation-specific drugs, but so far there is little evidence of clinical benefit from such therapies.
Explanation of basic concepts of medical terminology
Authors: Huda Ahmed Samei
Published: May 2019

People often compare general medicine to psychiatry using false assumptions or incomplete comparative information. Doctors’ role in healthcare relies in part on their sapiental authority, i.e. their knowledge. This sapiental authority relies on developing a medical model to learn and use information. The medical model relies on standardized terminology to aid communication and learning. The medical model allows them to identify problems and recall information on outcomes and treatments. The medical model may also allow explanation of how problems occur and the biopsychosocial model is preferred. Other models of explanation and intervention may also be used and may be superior for certain functions or explanations. The concepts of disease, illness, and health are not clear-cut and often require professional judgements—influenced by culture—based on distress or risk of adverse outcomes to identify examples of, e.g. disease. Condition may be used instead for states that may require medical attention.
Biological factors and health
Authors: Huda Ahmed Samei
Published: May 2019

There is often a lack of identified causal biological mechanisms or biological differences of structure or process for many psychiatric diagnostic constructs. There is a lack of useful biomarkers common to all people who meet criteria for a psychiatric diagnostic construct that differentiates them from the healthy population. This can also be the case for general medical conditions for both aetiology and differences in structure or process and sometimes lack of useful biomarkers but this occurs to a lesser extent. There are also occasions when medical conditions cause mental health problems directly. For this reason doctors will always be involved in mental health to some degree and will use diagnostic constructs to describe these conditions as they are familiar with diagnosis in their medical practice. There are examples of clear biological abnormalities that are often detected accidentally that do not require treatment. Medically unexplained or functional symptoms/syndromes are commonly seen in general medicine, although the term ‘medically unexplained’ is contentious. Many diagnostic constructs—medical or psychiatric—involve complex polygenetic interactions with the environment.
Early interventions to prevent stigmatization and its consequences
Authors: Sartorius Norman
Published: May 2019

People with mental illness are usually characterized by the unpredictability of their behaviour: this feature is central to the concept of ‘mentally ill’ and has found its expression in words such as ‘alien’ (describing a person whose behaviour is different and unpredictable) or ‘alienist’ (as a description of a psychiatrist who deals with mentally ill people). Unpredictability is the very basis of stigma: individuals with mental illness are separated from other people by their key characteristic of being different, alien, unpredictable—and therefore funny, dangerous, not belonging. The consequence of this fact for the fight against stigmatization is that a key element of work must be the education of parents, teachers, and others who influence the development of children in order that these children become adults who accept the notion that people with mental illness are similar to themselves (and to other people who do not have the illness) and that it is the illness that makes them different. Interventions against stigmatization must therefore begin not with the onset of illness or with the first encounter with a mentally ill person but with the concept formation—hence, early in life. Parents and teachers are, of course, not the only ones who influence children and the formation of concepts; media and other sources of information must participate in these efforts. The chapter also describes some of the measures that have been shown, in the course of several major studies in recent years, to be effective in reducing stigma.