bluuebunny/crossref_metadata_2025 huggingface dataset:
Down Syndrome
Authors: Lin Erica P. , Spaeth James P. , Handley Melanie
Published: October 2018

The majority of children with Down syndrome are friendly and separate from parents easily. The presence of comorbidities should be the area of focus for the anesthesiologist. Cardiac anomalies are commonly present, and the most common of these is common atrioventricular canal. Not all patients present with cardiac disease though, and some may present with gastrointestinal anomalies. These children also exhibit sensitivity to inhalational anesthetics resulting in bradycardia during inhalation induction. They tend to have very narrow auditory canals, making myringotomy challenging and resulting in relatively longer anesthetics for ear tube placement. Careful attention should be paid to positioning of the neck during instrumentation of the airway as well due to possible instability of the cervical spine.
Do-Not-Resuscitate Orders in the Operating Room
Authors: Sutton Caitlin D. , Mann David G.
Published: October 2018

There are many situations that the pediatric anesthesiologist encounters on a daily basis. However, caring for the patient with do-not-resuscitate (DNR) orders requires attention to a variety of requests that may not be applicable in all scenarios. End-of-life care for pediatric patients is complex and presents many challenges for all physicians. The care of a patient with a DNR order who presents for surgery requires thoughtful, open communication between all stakeholders including the primary team, the surgeon, the anesthesiologist, the patient (when mental status and development allows), and the patient’s family. To best align care with goals, DNR orders can be rescinded, continued, or—most often—modified, for the perioperative period.
Necrotizing Enterocolitis
Authors: Hylton Jared , Deverman Sarah
Published: October 2018

Necrotizing enterocolitis (NEC) is a potentially life-threatening condition that affects mainly preterm infants. It is one of the most common surgical emergencies in the neonatal intensive care unit. While medical management is the first line of treatment, if that fails, NEC becomes a surgical emergency, and the pediatric anesthesiologist must be prepared. This chapter covers the pathogenesis, risk factors, clinical presentation and diagnosis, prevention, medical and surgical management, pre- and intraoperative anesthetic assessment, and postoperative management of NEC. Topics covered include intestinal perforation, necrotizing enterocolitis, neonatal anesthesia, pneumatosis intestinalis, prematurity, and ventilatory management. The chapter ends with review questions on the chapter’s content.
Neonatal Stridor
Authors: Low Aaron , Pittaway Andrew
Published: October 2018

Stridor is a common pediatric and neonatal sign that can sometimes be associated with life-altering or even life-threatening consequences. In the neonatal population, it is often due to use of an endotracheal tube that is too small, laryngomalacia, and subglottic stenosis. Patients often present with co-existing neonatal comorbidities such as patent ductus arteriosus and bronchopulmonary dysplasia. Management of these patients is often complex, requiring exquisite teamwork by otolaryngology surgeons and pediatric anesthesiologists. This chapter reviews the pathophysiology of neonatal stridor as well as its presentation. It describes the surgical approach and challenges to anesthetic management. Crisis situations including code situationse, neonatal resuscitation, and tracheostomy are reviewed.
Ex Utero Intrapartum Treatment Procedure for Giant Fetal Cervical Teratoma
Authors: Chatterjee Debnath
Published: October 2018

The ex utero intrapartum treatment (EXIT) procedure has enabled securing the airway and performing lifesaving fetal interventions in a controlled clinical environment, allowing successful transition to the postnatal period. This book chapter focuses on the multidisciplinary life-saving approach to the management of a fetus with a giant neck mass using an EXIT-to-airway strategy. The guiding principles of an EXIT procedure and newer evolving indications are discussed. A case-based approach is used to describe the preoperative diagnostic workup, intraoperative anesthetic considerations, options for fetal monitoring, and postoperative management of an EXIT procedure. Common pitfalls and potential complications during an EXIT procedure are also discussed.
Williams-Beuren Syndrome
Authors: Chang Yonmee , Matisoff Andrew J.
Published: October 2018

Williams-Beuren syndrome, also known as Williams syndrome (WS) is a genetic disorder involving the elastin gene on chromosome 7q11.23. Elastin is important for elasticity of vascular walls, and its deficiency can lead to widespread arteriopathy, most notably supravalvar aortic stenosis of the ascending aorta and coronary artery stenosis. Because of these cardiac defects, patients with WS are at high risk for cardiac arrest under anesthesia with a documented incidence around 5%. Appropriate perioperative management of all anesthetics includes a multidisciplinary approach to risk stratification, precise anesthetic management, and disaster planning. This chapter reviews the etiology, pathogenesis, diagnosis, and manifestations of WS. The authors also discuss the preoperative workup and anesthetic implications of WS, as well as issues related to cardiac arrest and extracorporeal cardiopulmonary resuscitation.
Tracheoesophageal Fistula
Authors: Hernandez Michael R.
Published: October 2018

Tracheoesophageal fistula (TEF) in the neonate is a complex congenital disorder that may occur in isolation or as part of a larger association of findings (i.e., VACTERL association). Care of these patients must include testing to clarify the anatomic and physiologic characteristics of each finding. This is particularly important for planning of surgical and anesthetic care. Surgical options for TEF repair vary in location of incision and also whether the approach is open or minimally invasive. Patients with severe congenital heart disease, such as hypoplastic left heart syndrome, pose unique challenges to the perioperative caregiver. The anesthesia team must balance the patient’s pulmonary and systemic blood flow while still heeding the need to avoid excessive ventilation via the TEF. Regional analgesia may provide the option of early extubation after TEF repair, but risks must be weighed against the patient’s anatomic and physiologic status.
Cleft Palate, Cleft Lip, and Pierre Robin Sequence
Authors: Harvey Michelle Keese , Ayad Ihab
Published: October 2018

Pierre Robin sequence (PRS) is characterized by micrognathia, glossoptosis, and airway obstruction. Often associated with cleft palate, PRS is usually an isolated finding but is associated with a syndrome one-third of the time. The micrognathia and glossoptosis lead to airway obstruction, respiratory compromise, and feeding difficulties. Severe cases and prolonged and repeated airway obstruction and respiratory distress can lead to failure to thrive, hypoxemia, pulmonary hypertension, cardiac arrest, and death. Treatment options for the management of airway obstruction in PRS depends on the degree of obstruction and any associated comorbidities and range from noninvasive respiratory support to surgical correction of the physical defect. Patients with PRS should be considered as challenging to ventilate and intubate, and the practitioner should be well prepared for the possibility of difficulty with airway management. Anesthetic management is tailored to minimize postoperative upper airway obstruction and avoid disruption of the integrity of the surgical repair.
Seizure Surgery
Authors: Vazquez-Colon Caroll N. , Reddy Srijaya K.
Published: October 2018

Epilepsy is a disorder of the nervous system that affects over 2 million people worldwide, with the highest incidence in children. Surgical management of a child with refractory epilepsy may result in improved seizure control and better quality of life. The perioperative management of the pediatric patient for seizure surgery presents a considerable challenge to the anesthesiologist. Primary concerns include the interactions of antiepileptic medications with anesthetic drugs, the effects of anesthetic agents and medications on intraoperative neuromonitoring, and management of seizures while under anesthesia. This chapter will focus on anesthetic concerns and management for pediatric patients presenting for seizure surgery.
Achondroplasia
Authors: Costandi Andrew J. , Andras Lydia
Published: October 2018

Children with achondroplasia, the most common cause of short stature, pose several challenges for the anesthesiologists who care for them. Although a rare condition, individuals affected with achondroplasia have a normal life span and frequently present to the operating room for much needed otolaryngologic, neurosurgical, and orthopedic procedures. The common clinical features associated with achondroplasia lend a unique set of considerations including difficult airway management, both central and/or obstructive sleep apnea, unstable cervical spines, positioning problems, vascular access challenges, and perioperative respiratory complications. This chapter focuses on understanding the pathophysiology of achondroplasia and its anesthetic considerations. With good knowledge of the disease and careful preoperative planning, achondroplastic patients can safely undergo general and regional anesthesia.
Hirschsprung Disease
Authors: Sivak Erica , Malek Marcus , Hall-Burton Denise
Published: October 2018

Hirschsprung disease is characterized by the absence of ganglion cells in the enteric nervous system. Inability to pass meconium in the neonatal period, enterocolitis, bowel obstruction, or chronic constipation in older infants and children may be the presenting symptoms. Once diagnosed, surgical intervention is always required. Successful resection of all portions of aganglionic intestine may be accomplished through multiple surgical techniques. Depending upon the surgical approach required, regional anesthesia may be indicated to assist with pain control postoperatively. This chapter describes Hirschsprung disease and considers a variety of questions related to its diagnosis and treatment, as well as risks related to surgery, including anaphylaxis, laparoscopic complications, vascular injury, epidural complications, and issues related to neuraxial analgesia.
Neuraxial Anesthesia and Analgesia for Pediatric Surgery
Authors: Ballard Heather , Shah Ravi , Suresh Santhanam
Published: October 2018

Neuraxial anesthesia has a long history of use in pediatric surgery. It can be used as a sole anesthetic or as an adjunct to sedation or general anesthesia. Neonatal spinals and single-shot caudal anesthesia are effective for lower abdominal, urological, and lower extremity orthopedic surgeries. When a thoracic, lumbar, or caudal epidural catheter is utilized, postoperative analgesia can also be provided to surgeries involving the chest and upper abdomen. There is renewed interest in neuraxial anesthesia due to concerns of the effect of volatile anesthetics on the developing brain. Though research studies on the long-term effects of volatile anesthetics are still inconclusive, neuraxial anesthesia has been shown to provide effective surgical anesthesia and postoperative analgesia. When used in combination with general anesthesia, it has the benefit of reducing the amount of sedatives required. The use of ultrasound may increase success and margin of safety.
Primary Tumors of the Spine
Authors: Pham Martin H. , Hsieh Patrick C.
Published: October 2018

Primary tumors of the spinal column are rare. Computed tomography–guided biopsy is typically performed to make the diagnosis and plan the next steps in treatment. For some primary spinal column tumors, such as osteosarcoma, en bloc resection based on the Enneking classification and extensive spinal reconstruction may be indicated. Significant surgical complications are possible with en bloc resection, and extensive preoperative counseling is required. Patients with pre-existing metastatic disease will likely not benefit from en bloc resection and instead may undergo debulking surgery based on neurologic symptoms. Tumor biology and an assessment of margins dictate possible adjuvant therapy. A multidisciplinary approach is essential in managing these patients.
Anesthesia for Posterior Fossa Mass
Authors: Howell Valerie L. , Collins Margaret M. , Rochlen Lauryn R.
Published: October 2018

Lesions of the posterior fossa provide challenges for both anesthesiologists and surgeons due to this intracranial cavity’s rigid boundaries, minimal compliance, and vital neuronal contents. Common surgeries in the posterior fossa include excision of tumors, correction of congenital and acquired craniovertebral junction anomalies, and relief of pressure on the brainstem. Symptoms can present acutely and are most commonly due to compression of brain components, obstruction of cerebrospinal fluid, or increased intracranial pressure. Careful planning of the anesthetic is important to prevent exacerbation of preexisting symptoms or pathology, optimize the surgical resection, and aid in the quick diagnosis of postoperative complications. A variety of complications may occur in the perioperative period, many of which are unique to the posterior fossa or surgical approach. Anesthetic management focuses on prevention of common complications, maintenance of hemodynamic stability, facilitation of intraoperative neurophysiologic monitoring. and early postoperative neurologic evaluation through timely emergence.
Unstable Cervical Spine and Airway Management
Authors: Moore Michael R. , Farag Ehab
Published: October 2018

In patients with cervical myelopathy, the spinal cord is already compromised to a point at which there is little reserve for surgical maneuvers and the slightest adverse action can result in dramatic consequences. Awake fiberoptic intubation and neurological assessment before induction of anesthesia could be the safest way to avoid waking up the patient before proceeding with surgery in the case of absent motor evoke potentials (MEPs) in spite of increasing the stimulating voltage together with increasing the rate of stimulating pulses. Hypotension is an additional factor, which may lead to irreversible neurologic deficit in a partially compressed but functionally intact spinal cord. Intraoperative neurophysiologic monitoring for cervical myelopathy should include somatosensory evoked potentials, transcranial electric MEPs, and electromyography to provide complementary information and monitor different spinal cord tracts and individual nerve roots.
Craniosynostosis and Anesthetic Management for Cranial Vault Remodeling
Authors: Hsieh Hannah , Thornton Lauren , Mann Glenn
Published: October 2018

Craniosynostosis is a congenital malformation involving premature fusion of one or more skull sutures restricting normal growth of the cranium. The sequelae of premature cranial suture fusion are not only cosmetic and may cause elevated intracranial pressure in children. Treatment for craniosynostosis is surgical, and the perioperative management often entails a multidisciplinary team consisting of neurosurgery, plastic surgery, anesthesiology, and critical care. Although the optimal age of repair remains controversial, it is suggested that intervention is best performed prior to 12 months of age. The anesthetic challenges for these complex surgeries include difficult airway management, significant blood loss, long surgical duration, and pain control in children of young age.
Neurosurgery in Pregnancy
Authors: Berman David , Touré Ben
Published: October 2018

Pregnancy is a time of significant physiologic change that affects the vast majority of organ systems. Pregnant patients occasionally present for nonobstetric surgery, with complication rates of the procedure increased as well as the potential for fetal loss or damage as a result of the underlying disease process. Typical steps in diagnosis (such as imaging modalities) often need to be adjusted in pregnancy, and the medical or surgical treatment of neurologic disease will often change as well. A thorough understanding of pregnancy physiology, pharmacology, and teratogenicity will be important in caring for the pregnant neurosurgical patient.
Neuromuscular Disorders and Anesthesia
Authors: Manlapaz Mariel , Kothari Perin
Published: October 2018

The various neuromuscular diseases present with different airway, cardiovascular, pulmonary, and anesthetic considerations. It is useful to categorize these different diseases into nerve, neuromuscular junction, and primary muscle diseases. Understanding their pathophysiology is paramount in choosing the right anesthetic drugs (for example, depolarizing versus nondepolarizing and regional versus general anesthesia). Knowing their manifestations such as autonomic dysfunction, skeletal/cardiac/smooth/bulbar muscle involvement, or tendency for tonic contraction, allows for expectant perioperative management. Finally appreciating their association with certain disease states such as malignant hyperthermia or endocrine dysfunction can prevent complications. A brief review of myotonic dystrophy is presented here, followed by a brief summary of anesthetic considerations for various neuromuscular diseases.
Anesthesiology Applied Exam Board Review
Authors: Gupta Ruchir , Tran Minh Chau Joe
Published: October 2018

The American Board of Anesthesiology (ABA) has recently changed their Part II examination for certification to include the traditional oral exam as well as a new “simulation” portion that is geared towards having the student demonstrate the appropriate communication and technical skills necessary for the practice of anesthesiology. This book is divided into 2 sections: full length practice exams on the most high yield topic for the field of anesthesiology and full length simulation scenarios geared towards the understanding the fundamentals of the simulation portion based on the released ABA guidelines.
Renal disease
Authors: Milner Quentin
Published: October 2018

This chapter describes the anaesthetic management of the patient with renal disease. The topics include estimation of renal function, chronic kidney disease, renal replacement therapy (including haemodialysis), acute renal failure, and the patient with a transplanted kidney. For each topic, preoperative investigation and optimization, treatment, and anaesthetic management are described. The effects of impaired renal function on the elimination of anaesthetic drugs are discussed.
Endocrine and metabolic disease
Authors: Blanshard Hannah
Published: October 2018

This chapter describes the anaesthetic management of the patient with endocrine and metabolic disease. Topics covered include diabetes mellitus, thyroid and parathyroid disease, acromegaly, adrenocortical disease, steroid therapy, Cushing’s and Conn’s syndromes, apudoma (including phaeochromocytoma), and abnormalities of sodium and potassium. For each topic, preoperative investigation and optimization, treatment, and anaesthetic management are described. The perioperative management of the diabetic patient is discussed in detail, including insulin and oral hypoglycaemic therapy. Perioperative steroid management is described.
Haematology: drugs, tests, and disorders
Authors: Kerr Paul , Ford Pete
Published: October 2018

This chapter describes the anaesthetic management of the patient with a haematological disorder. Topics covered include anaemia, sickle-cell disease, porphyria, coagulation disorders, haemophilia and related disorders, platelet disorders, and hypercoagulability syndromes. For each topic, preoperative investigation and optimization, treatment, and anaesthetic management are described. There is detailed discussion about the perioperative management of the patient taking a drug which affects the coagulation system, including anticoagulants, antiplatelet drugs, and fibrinolytic and antifibrinolytic drugs. Coagulation tests are discussed in detail, and the haematological management of the bleeding patient is described.
Cardiac surgery
Authors: Evans Rhys
Published: October 2018

This chapter discusses the anaesthetic management of cardiac surgery. It begins with a description of myocardial oxygen supply and demand, risk scoring for cardiac surgery, and cardiopulmonary bypass. Surgical procedures covered include coronary artery bypass grafting (CABG) (including emergency and redo CABG), aortic valve replacement (including transcatheter aortic valve implantation), mitral valve replacement, thoracic aortic surgery, pulmonary thromboembolectomy, cardioversion, and implantation of a cardioverter-defibrillator.
Neurosurgery
Authors: Manara Alex , Shinde Samantha
Published: October 2018

This chapter discusses the anaesthetic management of neurosurgery. It begins with general principles of neurosurgery, including management of intracranial pressure. Surgical procedures covered include craniotomy (including awake craniotomy), insertion of ventriculo-peritoneal shunt, evacuation of traumatic intracranial haematoma, pituitary surgery, posterior fossa surgery, and interventional radiology treatment of intracranial vascular lesions (with particular attention to subarachnoid haemorrhage). The management of venous air embolism is described, along with a discussion of the neurological determination of death and organ retrieval from a beating-heart donor.
Vascular surgery
Authors: Stoneham Mark
Published: October 2018

This chapter discusses the anaesthetic management of vascular surgery. It begins with general principles of the anaesthetic management of vascular surgical patients. Surgical procedures covered include abdominal aortic aneurysm repair (including emergency and endovascular abdominal aortic aneurysm repair and thoraco-abdominal aortic aneurysm repair), carotid endarterectomy, peripheral revascularization operations, axillobifemoral bypass, amputations, thoracoscopic sympathectomy, first rib resection, and varicose vein surgery.
General surgery
Authors: Rucklidge Matt , McLeod Andrew , Wigmore Tim
Published: October 2018

This chapter discusses the anaesthetic management of general surgery. It begins with a description of management principles for several of the important considerations: analgesia, temperature control, fluid management, and oncological considerations. Surgical procedures covered include colorectal surgery, emergency laparotomy, laparoscopic surgery (including laparoscopic cholecystectomy and laparoscopic colonic surgery), appendicectomy, inguinal hernia repair, haemorrhoidectomy, testicular surgery, and breast surgery.
Anaesthesia for obesity
Authors: Kennedy Nick , Abou-Samra Mark
Published: October 2018

This chapter discusses the anaesthetic management of obesity surgery (bariatric surgery). It begins with an introduction to obesity surgery, risk scoring, indications for when obesity surgery should be offered, a discussion of common co-morbidities, airway considerations, handling and positioning, pharmacology, and thromboprophylaxis. Surgical procedures covered include intragastric balloon insertion and removal, gastric banding, gastric bypass, and sleeve gastrectomy.
Airway assessment and management
Authors: Cranshaw Jules , Cook Tim
Published: October 2018

This chapter discusses the assessment and management of the airway. It begins with methods of assessing the airway and describes the approach to the unanticipated difficult airway. Topics covered include failed intubation, techniques for managing the anticipated difficult intubation, the cannot-intubate-cannot-ventilate scenario, the management of the obstructed airway, rapid sequence induction, inhalational induction, and awake fibreoptic intubation. It concludes with a discussion of extubating the patient after a difficult intubation.
Mental state assessment: Specific conditions
Authors: Bhugra Dinesh , Ventriglio Antonio , Bhui Kamaldeep S.
Published: October 2018

Mental state assessment or mental state examination is important not only in reaching a diagnosis but also in engaging patients and their families and planning therapeutic interventions. In addition to the basic principles of assessment, specific psychiatric conditions require additional details. Working with children and adolescents, with older individuals, and those with intellectual disabilities brings with it special challenges. It is crucial that clinicians are aware of the cultural context of the individual being assessed and that they take care and spend time to carry out the assessment, which may need to continue over a number of sessions. To achieve optimal results and outcomes, good therapeutic alliance is essential. It is critical that clinicians are aware of the impact of culture on the genesis, perpetuation, and prognosis of symptoms. Clinicians must be even more careful when working with special groups and psychiatric disorders, which are described further in this chapter.
Psychotherapy: Specific psychotherapies
Authors: Bhugra Dinesh , Ventriglio Antonio , Bhui Kamaldeep S.
Published: October 2018

Specific psychotherapies bring specific challenges with them. Engagement with cognitive behaviour therapy and its success depends upon how the individual’s cognitions are affected by cultures and how amenable these are for therapy. Similarly, family therapy carries with it different roles of different members across cultures, and not everyone’s role will be the same. Minority therapists may face potential difficulties while looking after patients from majority cultures. General principles of psychotherapy across cultures will apply but they may carry different meanings for each individual. It is essential that therapists are flexible enough to ensure the best patient engagement, and additional modifications may be required. Each of these therapies can be reductive, reconstructive, or supportive, and a mixture of more than one approach can be utilized. Assessment must explore very carefully needs and indications for therapy. In many cultures these words have very different meanings with personal and social expectations.
Neurobiological processes in addiction
Authors: Nutt David J. , Nestor Liam J.
Published: October 2018

The brain is involved in controlling necessary motivational and cognitive processes optimized for survival. These processes can be disrupted by substances of addiction. The key neural substrates underlying these processes are made up of a network of four independent and overlapping brain circuits. These circuits govern reward processing, motivation and/or drive, learning and memory, and cognitive control. Anomalies within these circuits may also pre-date the addiction state, and facilitate the progress from experimentation to substance addiction. The subsequent excessive and chronic use of substances further exacerbates these abnormalities. Therefore, these brain circuits and key psychological processes related to their functioning must be understood if we are to develop and test new pharmacological and psychological treatment approaches in substance addiction.
Oxford Handbook for the Foundation Programme
Authors: Raine Tim , Collins George , Hall Catriona , Hjelde Nina
Published: October 2018

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 18 chapters, each covering a core area of the curriculum, including being a doctor, life on the wards, history and examination, prescribing, drugs, resuscitation, cardiovascular, respiratory, gastroenterology, endocrinology, neurology, psychiatry, fluids and renal, haematology, skin and eyes, emergency department, 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.
History and examination
Authors: Raine Tim , Collins George , Hall Catriona , Hjelde Nina , Dawson James , Sanders Stephan , Eccles Simon
Published: October 2018

This chapter discusses history and examination, including basic history and examination, recording your clerking, cardiovascular medicine, respiratory medicine, gastrointestinal medicine, neurological medicine, endocrine medicine, skin, oncological/haematological medicine, breast surgery, eye surgery, head and neck surgery, musculoskeletal surgery, urological surgery, the female reproductive system, obstetric medicine, psychiatric medicine, neonatal examination, and paediatrics.
Pharmacopoeia
Authors: Raine Tim , Collins George , Hall Catriona , Hjelde Nina , Dawson James , Sanders Stephan , Eccles Simon
Published: October 2018

This chapter is a pharmacopoeia. It lists all the drugs that a Foundation doctor commonly encounters, from ACEi to Zyban, listing dose, indication, contraindications, cautions, and side effects for each one.
Resuscitation
Authors: Raine Tim , Collins George , Hall Catriona , Hjelde Nina , Dawson James , Sanders Stephan , Eccles Simon
Published: October 2018

This chapter explores resuscitation, including early warning scores, intensive care, peri-arrest, in-hospital resuscitation, Advanced Life Support (ALS), arrest equipment and tests, Advanced Trauma Life Support (ATLS), Paediatric Basic Life Support, Newborn Life Support (NLS), and obstetric arrest.
Skin and eyes
Authors: Raine Tim , Collins George , Hall Catriona , Hjelde Nina , Dawson James , Sanders Stephan , Eccles Simon
Published: October 2018

This chapter discusses disorders of the skin and eyes, including rash and rash emergency, bacterial infections causing a rash, viral infections causing a rash, fungal infections causing a rash, infestations causing a rash, chronic inflammatory rashes, other causes of rash, skin lumps, skin cancers, breast lumps, leg ulcers, acute red eye emergency, sudden visual loss, gradual visual loss, and other visual disturbances.
Procedures
Authors: Raine Tim , Collins George , Hall Catriona , Hjelde Nina , Dawson James , Sanders Stephan , Eccles Simon
Published: October 2018

This chapter explores procedures, including practical procedures, laboratories, achievement of core foundation skills, blood and injections, taking blood (venepuncture), femoral stab, blood tubes, IV cannulation, taking blood in children, arterial blood gas (ABG), SC/IM injections, IV injections, cardiology, ECGs and cardiac monitors, exercise tolerance test, chemical cardioversion (adenosine), cardioversion and defibrillation, central lines, thrombolysis, respiratory, pleural tap, chest drain (Seldinger method), endotracheal intubation (adult), laryngeal mask airway (LMA), urology, urethral catheterization, replacing a suprapubic catheter, gastroenterology, replacing a PEG feeding tube, nasogastric (NG) tubes, ascitic tap (abdominal paracentesis), neurology, lumbar puncture (LP), normal vaginal delivery, joint aspiration and injection, local anaesthetic (LA), suturing, and reduction of fractures and dislocations.
Pharmacological management of treatment-resistant schizophrenia: advanced use of clozapine
Authors: Gee Siobhan , Taylor David
Published: October 2018

Clozapine is licensed in the UK for use in treatment-resistant schizophrenia, treatment-intolerant schizophrenia, or psychosis associated with Parkinson’s disease. As with many drugs, it is also used outside of these licensing parameters for other conditions or clinical situations—often referred to as ‘off-label’ prescribing. These off-label indications have varying degrees of theoretical support, peer-reviewed evidence, and practical experience associated with them. This chapter discusses the use of clozapine for children and adolescents, older adults, and in the treatment of aggression and mood disorders. The use of supramaximal doses of clozapine to achieve therapeutic plasma concentrations is also off-label, although adding interacting medication to reach the same result is not; these contrasting approaches are also debated. Finally, rechallenging with clozapine in patients who have previously had serious adverse events to the drug is also considered.
Psychosis and the family: the role of family interventions
Authors: Onwumere Juliana , Kuipers Elizabeth
Published: October 2018

The development of psychotic illness exerts a significant impact on the affected individual but will also affect, in a variety of ways, their family and social networks. Although psychotic conditions are severe mental health problems, they are treatable, and family care and support play an important role in helping to achieve better recovery outcomes. In its first half, this chapter provides an overview of the impact of psychosis on family carers and the close relationship that exists between family wellbeing and patient outcomes, including the relevance of expressed emotion. The second half of the chapter offers an outline of family interventions—the psychological talking therapies designed to help individuals living with psychosis and their families to improve their understanding of the illness, develop skills in positive communication, problem-solving and coping, and identify appropriate support pathways. The evidence base underpinning the interventions and future developments in working with families is also discussed.
Ultra-treatment resistance
Authors: Remington Gary , Agid Ofer , Takeuchi Hiroyoshi , Lee Jimmy , Chintoh Araba
Published: October 2018

Ultra-treatment resistance or ultra-resistant schizophrenia is defined as describing individuals who meet criteria for treatment-resistant schizophrenia and receive an adequate trial of clozapine in the absence of other confounding factors that might compromise response (e.g. substance abuse, antipsychotic non-adherence), but demonstrate a suboptimal response. Because the definition currently hinges on a trial of clozapine, ‘clozapine-resistant schizophrenia’ has also been proposed as a more precise descriptor. This chapter reviews issues specific to classifying this subpopulation, including existing criteria and challenges in their clinical application. It also underscores the importance of this conceptual framework in terms of better understanding schizophrenia’s heterogeneity and the opportunity to establish different pathophysiological subtypes, in this case based on treatment response. It reviews existing evidence specific to this sample, which at this point is limited as only recently have efforts begun to isolate these individuals for the purpose of investigation. Finally, it highlights the dynamic nature of this strategy, since gains in understanding will demand that the framework, terminology, and criteria be continuously revisited and revised.
Theology Within the Patient–Clinician Relationship
Authors: Balboni Michael J. , Balboni Tracy A.
Published: October 2018

This chapter describes how there are distinct theological beliefs about the essence of personhood and that these views inform how clinicians inevitably see and engage patients. Dichotomizing the person into immaterial and material is at its root a claim concerning the essence of personhood, and this ultimately implies an underlying religious-like position concerning the presence or absence of a soul. While the intention of the sacred–secular divide was intended to create a neutral and nonreligious sphere, counterevidence suggests that this bifurcated structure is itself based on an unverifiable, religious-like position about human essence. Understanding these aspects of personhood in radical separation and independence has led to an imagining of the patient–clinician relationship in nonrelational terms focused predominantly on the material body. The chapter unearths implicit beliefs within this practice that are essentially theological, concerning the nature of personhood.
Attachment in Personality Disorders
Authors: Perez-Rodriguez M. Mercedes , Derish Nicole E. , Palomares Nerea , Kaur Sukhbir , Cuesta-Diaz Armando , Lis Stefanie
Published: October 2018

Attachment theory suggests that early relationships with significant others play a critical role in later interpersonal relationships. Attachment styles have a significant impact on social functioning. Since personality disorders are characterized by abnormal social-interpersonal functioning, it is surprising that attachment abnormalities in personality disorders remain mostly unexplored. This chapter describes definitions and measures of attachment and briefly reviews the neurobiology of attachment. Then it describes the evidence demonstrating abnormalities in attachment in personality disorders. Finally, the psychotherapeutic implications of different attachment styles are reviewed and attachment-focused treatments for personality disorders are described. A conclusion and future directions end the chapter.
The abdomen
Authors: Thomas James , Monaghan Tanya , Thiagarajan Prarthana
Published: October 2018

Introduction

History

Swallowing symptoms

Nausea and vomiting

Abdominal pain

Bowel habit

Generalized abdominal swelling

Jaundice and pruritus

Appetite and weight

Lower urinary tract symptoms

The rest of the history

Examination

Outline examination

Inspection: hands

Inspection: upper limbs

Inspection: face

Inspection: neck and chest

Inspection: abdomen

Stomas

Abdominal scars 1: open surgery

Abdominal scars 2: laparoscopic

Palpation: general

Palpation: aorta

Palpation: liver and gallbladder

Palpation: spleen

Palpation: kidneys and bladder

Palpation: herniae

Percussion

Auscultation

‘Per rectum’ examination

Important presentations

The elderly patient
Breast cancer
Authors: Cassidy Jim , Bissett Donald , Spence OBE Roy A. J. , Payne Miranda , Morris-Stiff Gareth , Bhattacharyya Madhumita
Published: October 2018

Thoracic cancer examines the epidemiology, aetiology, and role of screening and prevention in the reduction of deaths from lung cancer, the majority caused by cigarette smoking. The pathology and genetics of lung cancer, with particular note of the driver mutations, are followed by the symptoms and signs of the disease. Appropriate investigations are described to stage the tumour. The optimum treatment for localised non-small cell lung cancer (NSCLC) is surgical resection, followed in some cases by adjuvant chemotherapy. However, most cases present with disease too advanced for surgery, and for these chemotherapy and radiotherapy are appropriate. Metastatic NSCLC can be treated with platinum based doublet chemotherapy with modest palliative benefits. Metastatic NSCLC with specific driver mutations are amenable to control by targeted therapy. Locally advanced NSCLC is often treated with similar chemotherapy and radiotherapy, ideally administered concurrently, to achieve symptom relief but also improved survival rates. Short course simple radiotherapy offers symptom relief in patients not fit for chemotherapy. Patients with localised NSCLC who are not fit for surgery, may benefit from radical radiotherapy, particularly stereotactic radiotherapy. Small cell lung cancer (SCLC) is characterised by almost universal systemic spread, so that surgery is rarely appropriate. Staging is similar to NSCLC, and chemotherapy is the mainstay of treatment, usually cisplatin or carboplatin combined with etoposide. When possible, this is combined with concurrent thoracic irradiation covering all radiological sites of disease. Prophylactic cranial irradiation reduces the risk of CNS disease. Malignant pleural mesothelioma is caused by occupational asbestos exposure. Symptoms and signs, investigation and staging, and management are discussed. Thymic tumours, their pathology, presenting symptoms including paraneoplastic syndromes, investigation, staging and treatment are reviewed.
Use of JUUL E-cigarettes Among Youth in the United States
Authors: Hammond David , Wackowski Olivia A , Reid Jessica L , O’Connor Richard J
Published: October 2018

Introduction

JUUL has emerged as the leading brand in a rapidly evolving electronic cigarette (e-cigarette) market. JUUL is distinctive for its novel nicotine delivery method that results in high nicotine concentrations, as well as its sleek, discreet design. This study examined national estimates of JUUL among youth in the United States, including whether JUUL users report different patterns of use compared to users of other e-cigarettes.

Methods

Data were analyzed from the US arm of the International Tobacco Control Policy Evaluation Project (ITC) Youth Tobacco and E-cigarette Survey, an online survey conducted in July–August 2017 with youth aged 16–19 years recruited from consumer panels (n = 4086).

Results

Overall, 14.2% of respondents had used an e-cigarette in the past 30 days. JUUL was the second-most popular brand reported by past-30-day e-cigarette users (9.7%). Compared to e-cigarette users of other brands, JUUL users were significantly older (adjusted odds ratio [aOR] = 2.50, 95% confidence interval [CI] = 1.56 to 4.01) and reported a greater number of computers in the household (a socioeconomic status proxy; aOR = 1.55, 95% CI = 1.22 to 1.96), with no differences by sex, race/ethnicity, or student status. Controlling for sociodemographic variables, JUUL users were more likely than other e-cigarette users to have ever tried to quit e-cigarettes (aOR = 2.65, 95% CI = 1.12 to 6.30), with no differences observed by smoking status, frequency of e-cigarette use, urges to use e-cigarettes, or perceived addiction to e-cigarettes.

Conclusions

JUUL was among the most popular e-cigarette brands among youth, and there were few differences in sociodemographic profile or patterns of use between users of JUUL and other e-cigarette brands.

Implications

This study examined national estimates of JUUL e-cigarette use among youth in the United States, during the early phase of JUUL’s popularity. JUUL was among the most popular e-cigarette brands among youth, and there were few differences in sociodemographic profile or patterns of use between JUUL and other e-cigarette brands. The findings help to characterize the rapid rise of this new product category within the rapidly evolving e-cigarette market at a time when the US Food and Drug Administration and public health community are seeking to understand JUUL and its appeal among young people.
Schizophrenia is Associated With an Aberrant Immune Response to Epstein–Barr Virus
Authors: Dickerson Faith , Jones-Brando Lorraine , Ford Glen , Genovese Giulio , Stallings Cassie , Origoni Andrea , O’Dushlaine Colm , Katsafanas Emily , Sweeney Kevin , Khushalani Sunil , Yolken Robert
Published: October 2018

Background

Epstein–Barr virus (EBV) is a highly prevalent human herpesvirus capable of infecting the central nervous system and establishing persistent infection.

Methods

We employed solid phase immunoassay techniques to measure immunoglobulin G (IgG) class antibodies to EBV virions and defined proteins in 432 individuals with schizophrenia and 311 individuals without a history of a psychiatric disorder. Western blot testing was performed to document reactivity to specific EBV proteins. Polygenic risk for schizophrenia was calculated from genome sequencing arrays. Levels of antibodies between the groups were compared by multivariate analyses incorporating clinical, genetic, and demographic measures.

Results

Individuals with schizophrenia had marked elevations in the levels of antibodies to EBV virions as compared to the control population. Further analyses indicated increased levels of reactivity to EBV-viral capsid antibody (VCA) but not to EBV nuclear antigen-1 (EBNA-1) or to other human herpesviruses. Western blot analysis confirmed increased reactivity to VCA proteins in the group of individuals with schizophrenia and documented a lack of increased levels of antibodies to EBNA-1. Genetic analyses indicated an additive effect of increased levels of antibodies to EBV virions and genetic susceptibility to schizophrenia, with individuals with elevated levels of both type of markers having a greater than 8.5-fold odds of a schizophrenia diagnosis.

Conclusions

Individuals with schizophrenia have increased levels of antibodies to some but not all EBV proteins indicating an aberrant response to EBV infection. This aberrant response may contribute to the immunopathology of schizophrenia and related disorders.
Patients with Dementia and Firearms: Nurses Have a Role to Play
Authors: Kritz Fran
Published: October 2018

Asking about household guns is a place to start.
Cesium Chloride, Used as Alternative Cancer Therapy, Poses Risks
Authors: Aschenbrenner Diane S.
Published: October 2018

Cesium chloride, which is used as alternative therapy by some cancer patients, has been determined to have significant adverse effects, especially cardiovascular effects.

The FDA has issued an alert stating that cesium chloride should not be used in compounded medications.
First Drug Approved for Patients with Refractory AML and Mutation in the IDH1 Gene
Authors: Aschenbrenner Diane S.
Published: October 2018

Ivosidenib (Tibsovo) has been approved to treat adults with relapsed or refractory acute myeloid leukemia who have a mutation in the IDH1 gene.
Drug Approved to Treat Smallpox After a Bioterrorist Attack
Authors: Aschenbrenner Diane S.
Published: October 2018

A new antiviral drug, tecovirimat (TPOXX), has been approved to treat smallpox. Public health scientists have raised concerns that variola virus, which causes smallpox, could be released in a bioterrorist attack, creating a public health emergency.
Food Additives Pose Health Risks
Authors: Mechcatie Elizabeth , Rosenberg Karen
Published: October 2018

According to this report:

Increasing evidence suggests that colorings, flavorings, and chemicals added to food directly or indirectly during processing or packaging have adverse effects on health, particularly in children.
Giving Thanks for Meaning in a Nonclinical Setting
Authors: Paradisi Julianna
Published: October 2018

Updated several times a week with posts by a wide variety of authors, AJN's blog Off the Charts allows us to provide more timely—and often more personal—perspectives on professional, policy, and clinical issues. Best of the Blog will be a regular column to draw the attention of AJN readers to posts we think deserve a wider audience. To read more, please visit: www.ajnoffthecharts.com.
Limiting FODMAP consumption for patients with IBS
Authors: Heavey Elizabeth , Daniel Eileen
Published: October 2018

Irritable bowel syndrome (IBS) is a chronic disorder affected by stress and dietary habits. This article explores the role of diets low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols in reducing IBS symptoms.
Staying safe
Authors: Strickler Jeffery
Published: October 2018

This article takes a look at the incidence of verbal or physical violence nurses face on a daily basis and examines the importance of preparedness in handling potentially violent situations in the workplace.