bluuebunny/crossref_metadata_2025 huggingface dataset:
Combining magnetically isolated CD45 cells with serum maintains intact drug responsiveness for ELISpot analysis in clinical trials
Authors: Mavrangelos Chris , Wijenayaka Asiri , Sales Kurt J , Hughes Patrick A
Published: January 2025

Enzyme-linked immunosorbent spot analysis is frequently used to investigate immune responsiveness during clinical trials. However, ELISpot classically utilizes peripheral blood mononuclear cell isolates from whole blood, requiring relatively high blood draw volumes and removing both granulocytes and bound drug. Here, we describe a novel protocol whereby CD45 cells are magnetically isolated from human whole blood and co-incubated with serum isolated from the same subject. Infliximab is a well characterized anti-tumor necrosis factor α (TNF-α) antibody in clinical use since the late 1990s. We demonstrated that TNF-α inhibition by infliximab in spiked whole blood is lost on peripheral blood mononuclear cell isolation but remains in serum, and that combining serum from infliximab spiked whole blood with magnetically isolated CD45 immune cells inhibited PMA/ionomycin-stimulated TNF-α secretion. This novel protocol has important implications for enzyme-linked immunosorbent spot analysis in clinical trials in which blood volume is limited, and keeping drug responses intact provides critical information.
Subtypes A1 and D, and recombinant HIV-1 natural polymorphisms associated with lenacapavir drug resistance in Uganda
Authors: Omoding Daniel , Musinguzi Nicholas , Boum Yap , Muzoora Conrad , Kigozi Simone , Hunt Peter W , Martin Jeffrey N , Bangsberg David R , Haberer Jessica E , Siedner Mark J , McCluskey Suzanne M , Lee Guinevere Q
Published: January 2025

Background

Lenacapavir, a novel HIV-1 capsid inhibitor, shows promise for treating MDR HIV-1, as well as for pre-exposure prophylaxis (PrEP) in prevention of HIV infection. Its unique mechanism and lack of cross-resistance with other antiretroviral classes make lenacapavir a significant addition to HIV therapy. The clinical trials CALIBRATE and CAPELLA have demonstrated high viral suppression rates in both ART-naive individuals and individuals with MDR HIV-1. Lenacapavir-associated resistance mutations, such as M66I and Q67H, rarely seen as natural polymorphisms in lenacapavir-naive populations, are predominantly studied in subtype B HIV-1.

Objectives

Our study aimed to investigate the prevalence of lenacapavir resistance-associated mutations in HIV-1 subtypes A1 and D in a cohort of individuals living with HIV-1 from southwestern Uganda.

Methods

Utilizing plasma samples from ART-naive adults living in Uganda, HIV-1 Gag p24 (capsid) sequences were analysed for lenacapavir resistance mutations.

Results

Among 546 lenacapavir-naive participants, no major lenacapavir resistance-associated mutations were found. Minor mutations were present in 1.6% of participants, with T107A being the most common. Longitudinal data indicated the persistence of T107A for at least 3 years post-ART initiation in one participant. Phylogenetic analysis indicated individuals carrying T107A were found independently in distinct locations within the tree, suggesting that T107A might have arisen from multiple distinct base substitution events. Shannon entropy analysis showed high variability in certain capsid sites, but none overlapped with known lenacapavir resistance sites.

Conclusions

These findings suggest a low prevalence of naturally occurring lenacapavir resistance mutations in Uganda, supporting lenacapavir’s potential efficacy in this region.
A validated method for capillary phosphatidylethanol 16:0/18:1 quantification with two different 10-µl volumetric absorptive microsample devices in the same setup
Authors: Andreassen Trine N , Gule Marina , Havnen Hilde , Spigset Olav , Skråstad Ragnhild Bergene
Published: January 2025

There is a growing interest for quantification of drugs in capillary blood. Phosphatidylethanol (PEth) is a biomarker for alcohol intake measured in whole blood, thus making it a candidate for capillary sampling. Our laboratory has been running a method for PEth quantification in venous blood since 2016, and we aimed to expand this method to also include capillary dried blood spot (DBS) samples. Two 10-µl volumetric absorptive microsampling (VAMS) devices, Capitainer®B Vanadate and Mitra®, were included in the method development and validated. Calibrators and quality controls were spiked during automatic sample extraction without the VAMS devices present, making it possible to extract and analyze both types of VAMS samples in the same setup. With the Mitra device, all pre-established validation criteria were fulfilled in the measuring range of 0.03 to 4.0 µM (21–2812 ng/mL), including method comparison with our venous blood method. Capitainer fulfilled all validation criteria, except for the accuracy of samples with PEth levels ≥ 0.5 µM (≥ 352 ng/mL) (deviation −17.1% to −20.5%). The correlation analysis between Capitainer and the venous blood results showed no constant bias, but an acceptable small proportional mean difference of −7.6%. Overall, the method validation results for both Capitainer and Mitra were considered acceptable. Both devices were found to be suitable for the analyses of PEth.
Effects of engineered nanomaterials on the cardiovascular system
Authors: Ichihara Sahoko
Published: January 2025

With the explosive development of nanotechnology, engineered nanomaterials are currently being used in various industries, including food and medicine. Concern about the health effects of nanomaterials has been raised, and available research indicates that the relative surface area of nanomaterials seems to correlate with the severity of their toxicity. With regard to engineered nanomaterials, the scope of their acute and chronic toxicities and their mechanisms are not fully understood. Studies suggest that exposure to certain nanomaterials can generate reactive oxidant species and enhance permeability of the phagolysosomal membrane, which leads to inflammasome activation, causing oxidative stress and inflammation. Since the latter 2 are implicated in the development of cardiovascular diseases, such as hypertension and atherosclerosis, it can be presumed that exposure to engineered nanomaterials could significantly impact cardiovascular function. In this review, I raise issues that should be considered in the assessment of the effects of engineered nanomaterials on cardiovascular function, and evaluate their cardiovascular toxicity as described in various in vitro and/or in vivo toxicological studies and industrial investigations.
Session 8: Working with Your Thoughts (Part III)—Changing the Cycle of Thoughts and Feelings
Authors: Beck J. Gayle
Published: January 2025

This chapter introduces the A-B-C-D approach to address the changing cycle of thoughts and feelings. With the A-B-C-D technique, clients are asked to focus on negative trauma-related beliefs about themselves and the world, which may be driving a feed-forward loop of negative thinking and feelings. The downward arrow technique is introduced as a structured way to teach group members how to use Socratic questioning with themselves, to go beyond negative or distressing thoughts to access the ultimate negative belief. Therapists should emphasize that the three cognitive skills included in this program are distinct but complement one another. The chapter provides a review of the previously introduced material on coping self-statements and cognitive shifts.
Session 3: Beginning to Tackle Avoidance of Trauma Cues, Mindfulness (Part II)
Authors: Beck J. Gayle
Published: January 2025

This chapter builds on the prior one, discussing how clients can use their mindfulness skills to address avoidance of trauma cues. Multi-tasking and single-tasking are contrasted, helping clients to notice differences between thoughts, emotions, and actions. By practicing mindfulness, clients can teach themselves how to stay in the present, thus allowing them to notice subtle trauma cues more easily and to link these cues to trauma-related responses. This Group CBT session will include detailed discussion of exposure to trauma cues, which will help to take some of the distress out of trauma-related triggers and allow clientss to begin to reclaim their lives.
Session 9: Addressing Anger (Part I)—Using the A-B-C-D Approach
Authors: Beck J. Gayle
Published: January 2025

This chapter focuses on how Veterans can address their anger by using the A-B-C-D approach. Both the positive and negative aspects of anger are reviewed. Anger can be a component of posttraumatic stress disorder (PTSD) and may result in estrangement from others. Part of what contributes to this anger and irritability is the fact that people's lives are different from what they were before the trauma. Thus, becoming aware of specific situations that often produce angry responses is vital in understanding the beliefs that lead to anger. The downward arrow technique that was introduced in the prior session can be helpful for clarifying the beliefs that are activating people's anger.
Hippocampal Neuroanatomy
Authors: Amaral David G. , Lavenex Pierre , Insausti Ricardo
Published: January 2025

This chapter provides an overview of the neurons and intrinsic and extrinsic connections of the rodent, nonhuman primate, and human hippocampal formation. While the hippocampus and related cortical regions have many of the same excitatory and inhibitory neurons as other cortical regions, it also has at least a few neuron types, like the mossy cell, that do not occur in other cortical areas. What is most distinctive about the hippocampal formation is the organization of its intrinsic connections, which are generally, though not exclusively, unidirectional. While there are similarities in the features of the rodent, nonhuman primate, and human hippocampal formation, there are also many substantive differences.
Structural and Functional Properties of Hippocampal Neurons
Authors: Spruston Nelson , Piskorowski Rebecca , Chevaleyre Vivien , Eyre Mark D. , McBain Chris J. , Bartos Marlene
Published: January 2025

This chapter explores the complex menagerie of excitatory and inhibitory neurons in the hippocampal formation. Ultimately, neural computations are performed by circuits, but these computations are shaped by the types of neurons they contain and their properties. This chapter considers the properties of neurons throughout the hippocampal formation in the context of their local circuitry as well as inputs and outputs from other brain regions. As most of what is known about the cellular properties of hippocampal neurons derives from studies in rodents, this chapter focuses on the hippocampal formation of the rat and mouse. This chapter focuses on concepts that are likely to apply in both rats and mice, as well as other mammalian species, including humans and other primates.
Local Circuits
Authors: Grosmark Andres D. , Milstein Aaron D. , Losonczy Attila , Soltesz Ivan
Published: January 2025

In this chapter we summarize the excitatory and inhibitory local circuit architecture found in the main hippocampal layers, with a special emphasis on cataloguing both unique and recurring circuit motifs. The function of these circuits is examined with a particular focus on their role in performing elementary computations, their plasticity, their functions in supporting distinct network states and oscillations and their role in parallel and convergent information processing. Finally, we discuss how these local circuits are controlled by neuromodulatory inputs as well as how some local circuits exert non-canonical long-range inhibitory control.
Aging and the Hippocampus
Authors: Burke Sara N. , Barnes Carol A.
Published: January 2025

The chapter begins with an overview of the comparative aspects of typical aging in humans, monkeys, and rodents. Subsequent sections then summarize our historical and current knowledge of how advanced age impacts hippocampus-dependent behaviors, as well as the anatomy, biophysics, synapses, neuromodulation, plasticity, neuron activity dynamics, and gene expression within this structure. The dentate gyrus, CA3, and CA1 subregions are discussed separately, because aging can impact each region differently. When available, data are also included from the subiculum and entorhinal cortex. The chapter ends with a discussion regarding the remarkable consistency in the types of preservation or vulnerability of the aged hippocampus observed in humans, monkeys, and rodents.
Schizophrenic Psychosis and the Hippocampus: Schizophrenia Mechanisms in the Hippocampus
Authors: Tamminga Carol A. , Scott Daniel , Ivleva Elena I.
Published: January 2025

This review of psychosis pathophysiology in schizophrenia articulates the background, rationale, and supporting data for the involvement of the hippocampus in psychosis manifestations, driven by hippocampal hyperactivity. Gross reduction of dentate gyrus excitatory function during the adolescent life-phase can generate pathological changes in the hippocampus, causing its hyperactivity (CA3 and CA1) and alterations in hippocampal efferent circuits. This all distorts learning and memory functions in schizophrenia. A person with schizophrenia often has unremitting psychosis, with cognitive and negative symptoms, and the disease extends from adolescence to advanced age. The causal mechanisms are not yet understood. Hippocampal hyperactivity is an informative biomarker for psychosis and could be responsible for some of the manifestations of the disorder itself. Exploration in reverse translation animal models confirms the phenomena and suggests some potentially involved mechanisms and treatment targets in CA3 and CA1.
The Dark Side of Creative Talent
Authors: Fogel Barry S. , Jiang Xiaoling
Published: January 2025

Suicides and psychiatric hospitalizations of celebrity writers, artists, and performers are frequent news. Creativity is associated with bipolarity. In addition, creative writers have increased prevalence of depression and alcohol use disorder. Clinically significant and treatable mood disorders of creative professionals often are normalized or romanticized. Their problematic substance use often is treated with relative neglect of comorbid depression or bipolar illness. Treatment of depression in creative professionals often is unsuccessful because their bipolarity is missed, or the treatments offered are incompatible with their work or affect it adversely. Popular musicians are especially vulnerable, and they have a high suicide rate. Performers’ touring schedules can interfere with consistent general medical care, resulting in depressive consequences of untreated diseases. A patient’s wealth and/or celebrity can entail trust or boundary issues with clinicians. Personalized treatment of creative professionals’ accounts for their distinctive lifestyles, work, and vulnerabilities. Examples are presented from several creative genres.
Truck-Driving Blues
Authors: Fogel Barry S. , Jiang Xiaoling
Published: January 2025

Truck drivers have a high prevalence of depression. Their life expectancies are short, in part due to unhealthy lifestyles and associated chronic diseases. Depressed drivers are more likely to be involved in crashes. Their occupational risk factors for injury, general medical illness, and depression include chronobiologic stress; continual exposure to noise, vibration, and polluted air; poor-quality food at truck stops; prolonged periods of sitting; time pressures; loneliness when away from home; work–family conflicts; and work schedules that interfere with consistent healthcare. Obesity and associated sleep apnea are prevalent and challenging to treat. Drivers’ occupational culture contributes to normalization of illness and pain, denial or externalization of depression, and internal stigma. Evaluation of a depressed truck driver should identify addressable job-related risk factors and neglected general medical problems. Enhancement of function and crash prevention are non-stigmatizing foci for clinical intervention compatible with occupational culture.
Choosing Wisely
Authors: Kersh Jay S. , Sweitzer BobbieJean
Published: January 2025

The landscape of preoperative testing before noncardiac surgery is moving from conservative, broadly based screening of patients to a more focused one where a patient’s comorbidities and the nature of the procedure are more carefully considered, resulting in fewer unnecessary tests, fewer dollars spent, and a higher quality of care. However, because postoperative complication rates occur in approximately 17% of patients, a delicate balance of testing with appropriate evaluation and optimization is necessary. The goals of all preoperative clinics include identification and assignment of new or undocumented diagnoses, elucidation of the need for specialty consultations, assessment of risk, optimization of medication regimens, improvement of underlying pathologies, discussion of anesthetic techniques, education of patients and families, and arrangement for postoperative disposition. Secondarily, the care provided by a preoperative clinic should reduce case cancellations and increase the efficient use of procedure and operating room facilities.
Shoulder Replacement in Patient Who Had a Heart and Lung Transplant
Authors: Gross Caroline R. , Zafirova Zdravka
Published: January 2025

Patients with prior heart and lung transplants present increasingly for a wide range of noncardiac surgeries and pose unique challenges to the perioperative team. The cardiovascular physiology of transplant patients predisposes them to arrhythmias and hemodynamic instability. Their increased risk of perioperative pulmonary complications stems from immunosuppression, residual lung disease, and disorders of the transplanted lungs. Because multiorgan effects of immunosuppression therapy may affect perioperative outcomes, the preoperative visit should address the immunosuppression regimen, including its continuation and required modifications. Special attention must be paid to the prevention and diagnosis of infectious complications and the utilization of appropriate targeted antimicrobial prophylaxis and therapy. The impact of specific anesthetic and surgical techniques on the transplanted organs must be considered. Comprehensive perioperative management requires a multidisciplinary team approach including clinicians specializing in heart and lung transplantation.
A 56-Year-Old with a Recent CVA for Elective Surgery
Authors: Pulley Debra D.
Published: January 2025

Perioperative stroke is associated with increased morbidity and mortality. Improvements in perioperative care have decreased the incidence of myocardial ischemia and mortality but not stroke. The vast majority of perioperative strokes are ischemic. Risk factors include age, comorbidities such as cerebrovascular disease, coronary artery disease, congestive heart failure, atrial fibrillation, kidney disease, the type of surgery, and perioperative hypotension. It is important to identify perioperative stroke quickly and explore potential treatment options such as endoluminal thrombectomy. After an acute stroke, subsequent surgery increases the risk of another stroke, major adverse cardiac event, and 30-day mortality. Latest evidence suggests the risk levels off at 3 months. The decision on whether to proceed with surgery in less time involves multiple considerations including evidence-based medicine and shared decision-making.
Preoperative Anemia Management
Authors: Cummings Kenneth
Published: January 2025

Anemia, defined as a hemoglobin level of less than 13 g/dL in men or 12 g/dL in women, is present in almost 40% of patients undergoing noncardiac surgery. The presence of anemia is an independent risk factor for perioperative morbidity and mortality. However, it is also associated with transfusion, which is also associated with worse outcomes. Thus, preoperative correction of anemia may reduce a patient’s perioperative risk and improve his or her surgical outcome. This chapter will review the diagnosis and classification of anemia, its treatment, and the evidence available to guide therapy, including iron supplementation therapy and the administration of erythropoiesis-stimulating agents.
Blood Conservation
Authors: Perelman Seth , Mabry Christian
Published: January 2025

Physicians have a unique role in that they have taken an oath to treat patients to the best of their ability based on their medical knowledge and experience. At times their decisions will conflict with a patient’s wishes, which forces them to provide quality care using alternative techniques. In the case of Jehovah’s Witnesses, religious doctrine forbids the infusion of “major blood fractions” even if it is a potentially life-saving treatment. This limits the treatment available to the healthcare team in patients who are rapidly bleeding and showing signs of physiological stress. A focused, well-planned patient blood management program can be implemented to address this issue even before a patient reaches the hospital to allow high-quality care that aligns with the patient’s own wishes.
Informed Consent
Authors: Harden Stephen , Sadovnikoff Nicholas
Published: January 2025

Obtaining informed consent from a patient before a planned intervention is an essential process conducted between the physician performing the intervention and the patient. The context for anesthesiologists is unique in the sense that most patients have already consented to a surgical or interventional procedure, the performance of which requires anesthesia. The authors provide a detailed description of the three standards by which the process of consent is conducted, namely the reasonable-physician standard, the reasonable-patient standard, and the particular-patient standard. In this chapter, the authors review the fundamental components of the informed consent process with special attention to the anesthesiologist.
My Friend’s Son Requests Surgery for Gynecomastia Caused by the Drugs He Uses for Bodybuilding
Authors: Adler Adam C. , Chandrakantan Arvind
Published: January 2025

Anabolic steroid use is a common problem among professional athletes and is increasingly used in middle and high school athletics. A recent survey demonstrated an incidence of 2.7% even in middle school athletes, showing that anabolic steroid use is pervasive even at lower levels of athletics. With increasing emphasis on younger age for scholarship eligibility, there is higher prevalence of anabolic steroid use. However, the younger age of steroid use exposes the adolescent to key long-term consequences during a period of major hormonal change. This chapter focuses on a male adolescent with anabolic steroid use, although female bodybuilders also suffer from long-term anabolic steroid use. The major issue is not merely the risks from steroid use, but also from concomitant agent use as well as high-risk behaviors with substances such as alcohol, tobacco, or other performance enhancing drugs.
My Patient Is Twitching Like a Fish out of Water
Authors: Abola Ramon E.
Published: January 2025

tion, increased risk of aspiration, the subjective sensation of weakness, and postoperative pulmonary complications. Appropriate monitoring of NMB essential to prevent residual paralysis. The train-of-four count allows an anesthesia provider to select an appropriate reversal agent and dose prior to anesthesia emergence. Quantitative measures, such as accelomyography, are superior to clinical tests (head lift) or qualitative means (visual fade on train of four) of measuring residual neuromuscular blockade. Sugammadex has been shown to reverse rocuronium NMB more rapidly than neostigmine. Sugammadex also can provide reversal of profound NMB (post-tetanic count of 1–2). Understanding the principles of appropriate monitoring and reversal of NMB are key to avoiding residual paralysis.
Explanatory models of somatization disorders across cultures
Authors: Ibrahim Ferose Azeez , Pahuja Erika , Pandey Praveen
Published: January 2025

The manifestation of psychological stress or emotional distress as physical symptoms is referred to as somatization and is influenced by cultural beliefs, attitudes, and practices. The cultural context is thus crucial in understanding somatization. Culture influences how patients present their symptoms to the healthcare system, with patients being more likely to report symptoms that are culturally acceptable. This chapter focuses on the role of sociocultural context and explanatory models in somatization, providing an overview of different cultural models, including folk illness beliefs, traditional medicine, and the Western biomedical model. The chapter also delves into cultural factors that affect the expression of somatic complaints and emphasizes the need for culturally informed and responsive healthcare practices.
Cultural evolution of somatization disorders
Authors: Nagendrappa Sachin , Das Nabagata , Harshita H. A. , Shadakshari Darshan
Published: January 2025

For many years, somatization disorders were considered to be exist as no man’s land between the area of medicine and that of psychiatry. From the initial description by Hippocrates to the current definition in the International Classification of Diseases, eleventh revision (ICD-11), there has been constant evolution in classification somatization disorders. This classification system should consider a cross-cultural approach, which, together with basic knowledge from familiarizing oneself with cross-cultural viewpoints, will prevent clinicians from overlooking psychological distress. The journey from hysteria to somatization to the current medically unexplained symptoms has been along the lines with prevailing ways of understanding illnesses that have evolved further along the same lines with the evolution of biological sciences. The common occurrence of somatization disorders in various forms has evoked interest in many researchers in the field of psychiatry.
Oxford Handbook for the Foundation Programme
Authors: Raine Tim , Collins George , Brown Fraser , Howarth Sophie
Published: January 2025

The Oxford Handbook for the Foundation Programme provides a unique resource for medical students and junior doctors as a definitive guide to the Foundation Programme. It is divided into 20 chapters, each covering a core area of the curriculum, including being a doctor, life on the wards, history and examination, prescribing, drugs, resuscitation, care at the end of life, cardiovascular, respiratory, gastroenterology, endocrinology, neurology, psychiatry, fluids and renal, haematology, skin and eyes, emergency department, primary care, procedures, and interpreting results. It presents evidence-based clinical guidance in a clear way that makes it easy to revise, remember, and implement on the ward. It gives reliable advice on what to do, and when and how to do it, with clinical diagrams that bring theory to life. It helps junior doctors navigate all aspects of their working life, from career development to workplace relations, paperwork to pay and pensions.
Interpreting results
Authors: Raine Tim , Collins George , Brown Fraser , Howarth Sophie
Published: January 2025

This chapter provides a guide to interpreting results from tests and procedures. It covers blood tests (including clotting, cardiac markers, and liver function tests), ECGs, respiratory tests (such as ABGs and respiratory function tests), and gastrointestinal tests (abdominal X-ray, urine tests). Finally, the chapter discusses the interpretation of cerebrospinal fluid results, as well as musculoskeletal checks such as autoantibodies and associated diseases, and skeletal radiographs.
Assessment in mental health nursing
Authors: Rees Helen , Chillman Adam , Sohawon Zaynab Yasin
Published: January 2025

A little mutuality, as Zaynab says in this chapter, goes a long way. So it is through a collaborative process that this chapter discusses the place that a mental health nursing assessment has in a person’s care and in nursing practice. Relevant theory, policy, and law are addressed. Good practice in preparing and conducting a mental health nursing assessment is also considered, through the lenses of patient and nursing experience. This is presented as a conversation between these voices, in a manner which it is hoped mirrors the exemplar of a mental health nursing assessment. Important considerations are highlighted, and the role of the mental state examination in compassionate assessment discussed in detail. This chapter takes the perspective that a good mental health nursing assessment should hold the virtues of voice, choice, and empowerment at its core.
Recovery-focused care and safety planning assessment and management
Authors: Simpson Alan , Sears Jessica
Published: January 2025

This chapter introduces the concepts of recovery within mental health services, the key frameworks used to apply them in practice, and the critiques and possible limitations. It summarizes key policies and explores the evidence for recovery-focused practice and sets out the therapeutic steps to help and support service users on their recovery journey: engagement, assessment, formulation, care planning, safety planning, and community and partnership working.
Key skills in telemental health
Authors: Munro Mary , Ridler Billy
Published: January 2025

Telemental health care involves the use of telecommunications and virtual technology to deliver mental health care, including assessment, reviews, therapies, and psychoeducation, and can support with medicine management. The use of telecommunication and virtual technology is not new in mental health care, and there is evidence to suggest for some people it is preferable to face-to-face support. Mental health care providers have increased their use of telemental health significantly during the COVID-19 pandemic and there has been an increasing focus on research exploring the acceptability, impact, and enablers and barriers to this form of support since the expansion of its use. The evidence base remains limited in some aspects but it is a clear choice for some service users. Care providers will need to be mindful of the potential impact on the formation of therapeutic relationships, and the risk of increasing inequalities experienced through digital exclusion when utilizing telemental health care within services.
The essence of physical health care
Authors: Nash Michael , Joggyah Roupmatee , Kakai Christine
Published: January 2025

This chapter addresses the physical health of people living with severe mental illness, an area where mental health nurses have a key role to play in improving the physical health of service users. Platform 2 of the Nursing and Midwifery Council standards of proficiency for registered nurses incorporates promoting health and preventing ill health. Nurses must demonstrate competence in areas such as illness prevention, understanding health inequalities, and improving health via health screening. This chapter will explore health screening and outline areas where mental health nurses can improve service users’ health outcomes through prevention or early detection of complications or medication side effects.
Health behaviour change theories
Authors: Atanda Opeyemi , Callaghan Patrick , Vangeli Eleni , Reavey Paula
Published: January 2025

This chapter describes evidence-based health behaviour change theories and their applications in mental health nursing practice. The authors introduce various behaviour change theories' principles, components, and models. They emphasize the importance of understanding the processes involved in behaviour change and how mental health nurses can help individuals make positive changes to change behaviour that they find harmful. The chapter also provides practical examples of how these theories can be applied in mental health nursing practice. The chapter is a valuable resource for mental health nurses seeking to enhance their understanding of behaviour change theories and their role in promoting positive health behaviour in individuals.
How Do I Manage My Adolescent Who Wants to Go Back to the Pediatrician for Pain Management?
Authors: Newlin Jennifer , Sisler India , Smith Wally R.
Published: January 2025

This chapter offers advice to the pediatric and adult physicians managing pediatric sickle cell disease (SCD) patients who are newly transferred to adult care and adjusting, sometimes with great difficulty, to the pain care offered to SCD adults. Comfortable in their relationships with their pediatricians, many adolescents face a form of “buyer’s remorse” when transferred from the pediatric to the adult SCD pain management system. They want out and sometimes try to return to the feathered nest of pediatrics where they felt comfortable. And the Western healthcare system often doesn’t treat adults with SCD pain well, compounding these patients’ frustration. Should pediatric providers be blamed for ill-preparing patients for transition? Should adult providers inheriting such patients be blamed for not meeting prior standards of pain care set in pediatrics? How can pediatric and adult SCD pain managers partner to improve transitions of SCD pain care? How can adult pain managers help newly transferred patients with the systematic differences between pediatric and adult pain care for SCD? What tools are available to help improve readiness for the transition of SCD pain care, to build trust for and improve the move to adult SCD pain care, and to improve the quality of adult SCD pain care?
Why Is My Young Adult Patient Increasing Emergency Department Visits and Opioid Use?
Authors: Smith Wally R.
Published: January 2025

This chapter addresses possible causes for emergency department utilization that may evolve from occasional to frequent and problematic among young adults with sickle cell disease (SCD), and suggests treatment approaches. Problematic use, though somewhat subjectively defined, may exhibit features that demand investigation. This chapter identifies those features, and lays out an investigative framework. It suggests clinical observational diagnostic tools, formal surveys, laboratory diagnostic tests, and mechanistic and molecular causal explanations of problematic pain patterns and/or utilization. It suggests a therapeutic approach to these patterns, one which may lead to better pain control and/or less problematic utilization.
How Do I Manage My Adult Patient in the Emergency Department or Infusion Center in a Vaso-occlusive Crisis?
Authors: Smith Wally R.
Published: January 2025

This chapter addresses management of sickle cell disease (SCD) pain in the emergency department (ED). Pain in the form of vaso-occlusive crises (VOCs) is the number one reason for ED visits in patients with SCD. This is true even though visits for VOCs in SCD are infrequent compared to the number of days patients are in pain or in a VOC. This chapter highlights that there may be dangerous causes of acute SCD pain other than VOC that should be excluded. It suggests how to manage pain for a VOC when home management has failed. It offers recommendations for timing and choices of analgesia. As well it offers recommendations and a rationale for fluid management during a VOC, which can be controversial. Last, it discusses innovations in care that may reduce pain and the need for hospitalization.
How Do I Reduce My Patient’s Constant Reliance on the Emergency Department?
Authors: Carroll C. Patrick
Published: January 2025

This chapter presents an alternate management strategy for the small subgroup of sickle cell disease (SCD) patients with exceptionally high emergency department and hospital use. While acute care visits for a vaso-occlusive crisis (VOC) are the most common presentation for SCD care, typically patients present to the hospital on only a fraction of the days they are in a VOC. This paradox may be misunderstood, especially by those repeatedly managing high-utilizing patients. Their care is surrounded by frustration and suspicion for faking or addiction, which likely colors not only their care but the care of all patients with SCD. The evidence shows that the highest-utilizing SCD patients are more medically and psychiatrically complex, not less so, than other SCD patients. The alternate management strategy in this chapter requires no judgment of the patient’s motive for repeated urgent care utilization but rather calls for redesigning the healthcare system according to behavioral principles. Clinicians are guided into shifting their thinking from a paradigm of treating frequent acute events to one of intensive, long-term, systems-based care.
What Do I Do When My Patient with Anxiety Self-medicates with Marijuana?
Authors: Walls Rachel , Smith Wally R.
Published: January 2025

This chapter emphasizes how mental health dysregulation and self-medication often go hand in hand. It profiles types and the prevalence of self-medication for pain in pediatric and adult patients with sickle cell disease (SCD), including complementary and alternative therapy. It explains that the use of cannabis by pain patients may be considered either harmful or therapeutic. It outlines and promotes a framework for understanding patients’ alternative coping techniques, especially self-medication. It lists behavioral problems as complications or causes of pain. It teaches clinicians how to manage SCD patients using cannabis for behavioral problems in particular. It promotes harm reduction related to illicit substance use and recommends strategies for patient self-help.
Current Treatments for Schizophrenia
Authors: Goff Donald C.
Published: January 2025

During the past 70 years, treatment has evolved so that effective and well-tolerated pharmacologic agents combined with psychosocial interventions now allow most people with schizophrenia to live in the community. Starting with the introduction of chlorpromazine, major advances have included clozapine, the dopamine/serotonin antagonist second-generation antipsychotics, partial dopamine agonists, and long-acting injectable formulations. Although all these drugs share dopamine antagonism in common, they vary markedly in their affinities at other receptors, in their side effects, and in their pharmacokinetic characteristics. Only clozapine differs substantially in efficacy, providing therapeutic benefit in up to 50% of people who do not respond to other agents. Important areas of focus include early intervention to improve the long-term course of illness, psychosocial interventions to improve adherence and to facilitate social and vocational recovery, and continued research efforts to improve models of schizophrenia and identify biomarkers to make possible a precision medicine approach to schizophrenia.
Animal and Cellular Models Relevant to Bipolar Disorder
Authors: McCarthy Michael J. , Young Jared W.
Published: January 2025

Bipolar disorder (BD) is a neuropsychiatric illness that affects 1% or 2% of the population. Directly targeting neurobiological mechanisms that underlie BD may lead to new treatments that are more effective and better tolerated. The neurobiological studies required are often impractical to conduct in clinical populations and frequently require alternative experimental approaches. Thus, both animal and cellular models for the study of BD have been developed. Animal models offer the capacity to test disease-relevant manipulations, network mechanisms, and interventions in whole-body systems that age and are impacted by the environment but may fail to model key aspects of clinical features. Cellular models are highly simplified systems that may not capture whole-body biology, but they offer the advantage that they can be grown directly from human patients and can model genetic or molecular features. This chapter discusses several animal and cellular models to highlight their strengths and weaknesses across key dimensions of validity.
Current Pharmacological Treatments for Bipolar Disorder
Authors: Simons Nicole W. , Charney Alexander W.
Published: January 2025

Pharmacological treatments, with and without psychotherapy, are among the primary treatments of bipolar disorder. Treatments differ for the manic and depressed phases of bipolar disorder, as well as for the acute and maintenance phases. Although lithium has historically been the gold standard for treating bipolar disorder since the mid-1900s, a variety of antipsychotics have been widely prescribed since the turn of the 21st century. The 18 currently U.S. Food and Drug Administration–approved pharmacological treatments of bipolar disorder span three pharmacological classifications: mood stabilizers, anticonvulsants, and antipsychotics. Although strong evidence exists from randomized controlled trials for their clinical efficacy, the pharmacodynamic mechanisms of approved agents for bipolar disorder remain mostly unknown.
Diagnosis and Epidemiology of Dementia
Authors: Kreisl William C. , Reitz Christiane
Published: January 2025

Dementia is a neurodegenerative clinical syndrome encompassing a wide range of diseases characterized by progressive deterioration in cognitive ability, function, and behavior. Alzheimer’s disease is the most common cause of dementia in the elderly and is defined by a set of clinical symptoms and hallmark pathological changes at autopsy. Recent advances in brain imaging and cerebrospinal fluid analysis now allow detection of the neurodegenerative and proteopathic changes found in Alzheimer’s disease. Examples of neurodegenerative dementias that can be distinguished from Alzheimer’s disease include dementia with Lewy bodies and frontotemporal dementia. Among the strongest risk factors for dementia are several vascular risk factors associated with coronary artery disease and stroke (i.e., diabetes, hypertension, obesity) and cerebrovascular disease itself. The prevalence of dementia is expected to escalate as societies age, and therapies that delay onset could considerably reduce age-specific prevalence and public health burden.
The Foundational Importance of Arts and Humanities in Medical Professionalism
Authors: Kowalsky Rachel H. , Baruch Jay
Published: January 2025

The arts and humanities provide a foundational lens through which medical professionalism can be understood, interrogated, and developed over the course of one’s career. This chapter reviews the history of the field, explores the role of the arts and humanities in professional identity formation in a constantly evolving healthcare landscape, and demonstrates the ways in which narrative-based skills of hearing, seeing, and empathy can be engaged in developing medical professionalism. The critical role of ambiguity and uncertainty in catalyzing the evolution of professional behavior is discussed, as are ways in which the humanities support this work. Finally, the application of humanities content and pedagogy to social justice is discussed, including discussions of historic narratives and the power of counternarratives, and the contributions that the humanities can make in mitigating implicit bias. Suggestions are given for modes of integrating the arts and humanities into professionalism curricula.
Assessing Professional Identity Formation
Authors: Goh Suzanne , Sarraf-Yazdi Shiva , Radha Krishna Lalit Kumar
Published: January 2025

A fundamental goal of medical education, professional identity formation (PIF) is essential for promoting self-efficacy, belonging, and meaning across the continuum of medical education. Although implied as a goal of medical education, attending to PIF has not always been explicit. While ultimately a highly individualized construct, PIF is heavily influenced by contextual and psychosocial factors at interpersonal, institutional, and societal levels. This complexity poses a challenge to the study of PIF, its systemic support, and by extension, its assessment. Challenges notwithstanding, this chapter provides an overview of the current state of PIF assessment strategies, particularly at the medical school level, with a focus on reflective portfolios.
Compassion and Professional Formation
Authors: Rosenzweig Steven
Published: January 2025

Compassion means attunement to suffering in a way the brings greater comfort and ease to both patient and physician. Empathy registers the pain and distress of another person; by contrast, compassion is characterized by the heartwarming pleasure of caring, kindness, and human connection. Compassion can be recognized as a capacity to sustain empathy and be with suffering in ways that are open-hearted and comforting. This chapter explores the psychological, neurobiological, and moral dimensions of compassion, and distinguishes the vicarious pain of empathy from the positive affective experience of compassion. It assesses compassion as central to fulfilling the mission of medicine, and antidotal to empathic distress and burnout. Finally, this chapter provides a conceptual and practical framework for developing and sustaining compassion throughout medical training and practice.
Cultivating Professionalism Through Difficult Conversations
Authors: Carlin Nathan
Published: January 2025

This chapter outlines how Samuel Shem’s The House of God can be used to host difficult conversations about professionalism in graduate medical education. The House of God is the most widely read book in medical humanities, yet, because of its use of satire, the novel was and remains controversial. Some feel that the book is so unprofessional that it should not be read. Also, despite its influence among doctors, the novel has not received much scholarly attention. The purpose of this chapter is twofold: (1) to provide some context for The House of God so that it can be appropriately understood; and (2) to demonstrate how the novel can be used to encourage the professional identity formation of medical interns and residents.
Professionalism and Employment Issues
Authors: Harter Thomas D.
Published: January 2025

Explorations of medical professionalism in terms of physicians as employees are underdeveloped. There is an abundance of literature on what it means for physicians to develop and express professionalism in patient care, but very little regarding what it means—or may mean—for physicians to develop and express professionalism in their roles as employees. The chapter takes an organizational view to assess what it is for physicians to be an employee, why physicians constitute a unique type of profession, and what sorts of commitments and obligations exist between physicians and healthcare employers. This chapter further identifies core concepts and values that ground the obligations between physicians and their employers, as well as examines two ongoing threats to physician professionalism: a growth in physicians becoming locums and the increased growth and utilization of advanced practice clinicians.
Supporting the Safe Practice of Physicians as They Age
Authors: Gallagher Thomas H. , White Andrew A.
Published: January 2025

Self-regulation is a pillar of professionalism. Supporting the safe practice of physicians as they age presents a test case of self-regulation that the profession is currently failing. Other safety-conscious industries scrutinize the performance of their practitioners more closely as they age. Yet historically the profession has relied solely on traditional peer review and credentialing processes regardless of physician age. A growing literature links increasing physician age to worse patient outcomes. In response, organizations are increasingly adopting formal late career practitioner (LCP) programs that screen all physicians over a certain age for physical and cognitive well-being. When Yale New Haven Hospital conducted screening cognitive assessments on physicians over 70, 12.7% of the 141 clinicians screened had deficits likely to impair the practice of medicine. Taking a more proactive approach to promoting the safe practice of physicians over the course of their career represents an important new frontier of medical professionalism.