bluuebunny/crossref_metadata_2025 huggingface dataset:
Pediatrics: Pyloric Stenosis
Authors: Olaya Julio
Published: October 2018

In this chapter the essential aspects of anesthesia for pyloric stenosis in the pediatric patient are discussed. Subtopics include determining electrolyte abnormalities in these patients, airway management, fluid management, and coexisting diseases. The chapter is divided into preoperative, intraoperative and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics discussed include malignant hyperthermia, pyloric stenosis and associated projectile vomiting, olive sign, hypokalemia, and assessment of fluid volume intake. Issues discussed related to intraoperative management include monitoring, rapid sequence induction, the pediatric airway, and bronchospasm. Under postoperative management, complications related to croup and to postoperative apnea and hypoglycemia are addressed.
Pediatrics: Epiglottitis
Authors: Olaya Julio
Published: October 2018

In this chapter the essential aspects of anesthesia for epiglottitis are reviewed. Subtopics include defining the classic chest X-ray signs in patients with this disease, such as the thumb print sign, airway management, and steps to take to avoid laryngospasm in these patients. The case presented is a pediatric patient with emergent respiratory distress. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Issues addressed for preoperative evaluation include diagnosis in this patient, volume status, and selection of anesthetic technique. Intraoperative topics focus on airway management. Postoperative management addresses primarily extubation.
Thoracic: VATS (One-Lung Ventilation)
Authors: Gupta Ruchir
Published: October 2018

In this chapter the essential aspects of anesthes for video-assisted thoracic surgery (VATS) are discussed. The algorithm for determining correct double-lumen tube (DLT) placement, troubleshooting hypoxia in the DLT-ventilated patient, and management of the airway are discussed. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics include assessment of respiratory function and cyanosis. Issues discussed relate to intraoperative management include monitoring, epidural catheter placement, use of a double-lumen tube, single-lung ventilation, and addressing hypoxia and massive bleeding. Postoperative concerns addressed include extubation, pain control and altered mental status.
Thoracic: Mediastinal Mass
Authors: Yuan Stanley , Marino Joseph
Published: October 2018

In this chapter the essential aspects of anesthesia for a patient undergoing biopsy of a mediastinal mass are discussed. Specifically, adequate airway management of the patient with such a mass is discussed. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics include assessment of the patient’s airway, asthma, and endocrine status. Issues discussed related to intraoperative management include induction and preserving spontaneous ventilation, use of awake intubation and of a reinforced endotracheal tube, and complications from hypotension and hypoxia. Postoperative concerns addressed include extubation and managing complications that can develop in the post-anesthesia care unit.
Cardiovascular: Carotid Endarterectomy
Authors: Gupta Ruchir
Published: October 2018

In this chapter the essential aspects of anesthesia for carotid endarterectomy are discussed. Subtopics include transient ischemic attacks, cerebral monitoring, shunt placement, and cerebral blood flow management. The chapter is divided into preoperative, intraoperative and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics include cardiac and neurological assessment and taking into account the patient’s hypertension. Issues discussed related to intraoperative management include considerations regarding use of general or regional anesthesia in this case, monitoring with electroencephalography, induction, and addressing cerebral ischemia. Postoperative concerns discussed are postoperative airway distress, potential hematoma, and treating hypertension.
Obstetric: Preeclampsia
Authors: Bao Xiaodong
Published: October 2018

In this chapter the essential aspects of anesthesia for preeclampsia are discussed. Subtopics include HELLP syndrome, a life-threatening liver disorder comprising hemolysis, elevated liver enzymes, and low platelet count. Other subtopics addressed are eclampsia, disseminated intravascular coagulation, magnesium therapy, and hydralazine. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics include potential effects of drug use on the mother and fetus, and identifying preeclampsia. Issues discussed related to intraoperative management include magnesium therapy, thrombocytopenia, and fetal heat rate deceleration. Postoperative concerns discussed are assessment and treatment of postpartum hemorrhage, seizure, and hypotension.
Additional Topics: Pediatrics
Authors: Gupta Ruchir , Cadogan Monique , Vickers Barbara
Published: October 2018

In this chapter several topics related to managing pediatric anesthesia are discussed. Subtopics include managing patients with the CHARGE syndrome, tetralogy of Fallot, Treacher-Collins syndrome, and malignant hyperthermia. Also addressed is anesthetia management in a pediatric patient with pyloric stenosis. Airway management in pediatric patients is also discussed, including induction. Differences between an omphalocele and a gastroschisis are outlined, and closure of an omphalocele in an infant is addressed. Each scenario is presented as a short, three- to four-question additional topic.
Additional Topics: Neuroanesthesia
Authors: Gupta Ruchir
Published: October 2018

In this chapter several topics related to neuroanesthesia are discussed. Subtopics include management of a partially ruptured cerebral aneurysm, resection of an intracranial tumor, and pathogenesis of autonomic hyperreflexia. Also addressed is triple H therapy for cerebral vasospasm. Ways of preventing transurethral retrograde prostatectomy (TURP) syndrome are presented. Concerns regarding resection of a growth hormone–secreting pituitary tumor are also discussed. Lithium therapy is addressed in the context of electroconvulsive therapy. Anesthetic management in a patient with hyponatremia is discussed, as is evaluation of peripheral neuropathy. Precautions to prevent exacerbation of multiple sclerosis symptoms are outlined. Each scenario is presented as a short, three- to four-question additional topic.
Basics of Objective Structured Clinical Exam (OSCE)
Authors: Vuong William , Gupta Ruchir
Published: October 2018

In this chapter the basics of the new Objective Structured Clinical Exam (OSCE) are discussed. The grading requirements and the important bullet points that need to be addressed are reviewed in detail.
Clinical Scenario #2: Treatment Options
Authors: Gupta Ruchir , Tran Minh Chau Joe
Published: October 2018

In this chapter the essential aspects of treatment options regarding a clinical scenario are discussed. The chapter begins with a mock scenario of a patient with lacerated multiple tendons in her hand. The mock scenario is followed by a task statement that describes the specific action that the student must take. In this case, the task is to discuss with the patient the anesthetic options given the patient’s specific concerns and agree upon an anesthetic plan. Included in this process is communicating to the patient the benefits and risks associated with each option, as well as concern for her safety. An action plan is then presented in a stepwise manner with mock responses and a discussion of the responses. Grading points are also discussed and how to achieve maximum score is presented.
Clinical Scenario #4: Ethical Issues
Authors: Gupta Ruchir , Tran Minh Chau Joe
Published: October 2018

In this chapter the essential aspects of ethical issues in relation to periprocedural complications are discussed. The chapter begins with a mock scenario of a patient with multiple serious comorbidities requiring an urgent exploratory laparotomy. The mock scenario is followed by a task statement that describes the specific action that the student must take. The task here is to discuss how to manage the patient’s Do-Not-Resuscitate (DNR) status in the perioperative period. An action plan is then presented in a stepwise manner with mock responses and a discussion of the responses. The plan here involves demonstrating behaviors consistent with application of the principles in the ASA Guideline for the Ethical Practice of Anesthesiology—the principles of (1) patient autonomy, (2) beneficence, and (3) nonmaleficence. Grading points are also discussed and how to achieve maximum score is presented.
Clinical Scenario #6: Practice-Based Learning and Improvement
Authors: Gupta Ruchir , Tran Minh Chau Joe
Published: October 2018

In this chapter the essential aspects of practice-based learning improvement are discussed. The chapter begins with a mock scenario involving an initiative to design and implement a quality improvement project to improve the number of cases starting on time. The mock scenario is followed by a task statement that describes the specific action that the student must take. In this case, the task is to explain to a colleague the general steps of how to design and implement a quality improvement project. An action plan is then presented in a stepwise manner with mock responses and a discussion of the responses. Grading points are also discussed and how to achieve maximum score is presented.
Perioperative arrhythmias
Authors: Dean John
Published: October 2018

This chapter describes perioperative cardiac arrhythmias. These comprise narrow complex arrhythmias, broad complex arrhythmias, and heart block. The chapter describes the perioperative management of pre-existing arrhythmias (such as atrial fibrillation), including the patient with an implanted pacemaker or defibrillator. It also describes the management of arrhythmias which may arise during the course of anaesthesia.
The epidemiology and pathophysiology of coronary artery disease
Authors: Henderson Robert , Varcoe Richard
Published: October 2018

This chapter discusses the epidemiology and pathophysiology of ischaemic heart disease (IHD). IHD is a leading cause of death and disability across industrialized countries and is a major threat to health in developing countries. Reductions in IHD mortality in industrialized countries can be largely explained by modification of cardiovascular risk factors and improved management of cardiovascular disease, but these advances are partially offset by the epidemic of obesity and diabetes. There is compelling evidence that atherothrombosis, the pathological process underlying most cases of IHD, is caused by a chronic inflammatory process in the arterial intima. Exposure to risk factors and deposition of lipoprotein in the intima cause upregulation of atherogenic and prothrombotic processes, and the development of atherosclerotic plaques. Plaque disruption exposes the thrombogenic contents of the plaque to circulating blood, which can activate the coagulation cascade, and cause arterial thrombosis and acute coronary syndrome.
The history of interventional cardiology
Authors: Rogers Toby , Kent Kenneth , Pichard Augusto D.
Published: October 2018

The history of the understanding of the heart shows how far scientific research has come. Experimentation resulted in the scientific discovery of congenital heart disease by Mason Sones, whose work led to the understanding of obstructive coronary artery disease, risk stratification for patients, and subsequently to a road map for revascularization procedures. Werner Forssmann is another significant name, having demonstrated the feasibility of placing catheters in the heart by passing a urethral catheter through his own brachial vein into his right atrium. This chapter focuses on the scientific developments following on from these discoveries.
Vascular access: femoral versus radial
Authors: Wiper Andrew , Roberts David H.
Published: October 2018

This chapter discusses arterial access sites for performing coronary angiography and percutaneous coronary intervention with their subsequent benefits and limitations. Access site complications and subsequent management are discussed in detail. New techniques are described (e.g. balloon-assisted tracking, slender techniques, and ultrasound-guided puncture) and evidence-based guidelines discussed. There is discussion on ‘tips and tricks’ by two experienced interventional consultant cardiologists and discussion about alternative arterial access site selection in patients undergoing non-coronary procedures. Finally, there is discussion about future access trends.
Care following percutaneous coronary intervention
Authors: O’Gallagher Kevin , Byrne Jonathan , MacCarthy Philip
Published: October 2018

This chapter covers how to take care of a patient in both the short term and the long term after a percutaneous coronary intervention (PCI) procedure. Post-procedural care involves monitoring the patient for any signs of complications and taking the appropriate steps to correct these in a timely manner. Certain patients, based on various criteria, are more likely to have complications than others and it is vital to know how to identify these patients. Prompt identification and treatment of complications improves outcomes. The length of hospital stay will also vary from patient to patient, and this chapter covers how to assess when a patient is stable and suitable for discharge. Longer term management in the outpatient setting after PCI is described, with guidance on the indications for repeat non-invasive testing/angiography.
Coronary physiology in clinical practice
Authors: Muller Olivier , Fournier Stephane , De Bruyne Bernard
Published: October 2018

Coronary physiology is a diagnostic tool that helps to make the decision about the optimal treatments for patients. Physiological measurements assess the function of the coronary circulation, which can be used in combination with precise functional information to tailor the course of treatment for any patient who has been diagnosed with, or is suspected to have, coronary heart disease. Over the past two decades, after different animal and human validation works and observational studies, large randomized trials based on physiological measurements have modified our therapeutic strategies in patients with stable coronary artery disease.
Cardiac computed tomography for the interventionalist
Authors: Coenen Adriaan , Swart Laurens E. , Budde Ricardo P. J. , Nieman Koen
Published: October 2018

Coronary computed tomography angiography (CTA) is a method used to eliminate the possibility of coronary heart disease in a patient without an invasive procedure. Technological developments mean that CTA also produces less radiation than ever before, making it safer for both the patient and the practitioner. This chapter covers the principles and protocols in cardiac computed tomography (CT), guidance on interpreting the resulting images, and summarizes studies on the use of CT after various interventional procedures.
Stable coronary disease: medical therapy versus percutaneous coronary intervention versus surgery
Authors: Farooq Vasim , Serruys Patrick W.
Published: October 2018

This chapter describes the use of the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial in reducing uncertainty in the decision between coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) in complex coronary heart disease. Discussing the criticisms of major randomized trials such as the Bypass Angioplasty Revascularization Investigation (BARI) and Coronary Angioplasty versus Bypass Revascularization Investigation (CABRI) trials, the chapter explores the clinical evidence supporting decision-making between medical, percutaneous, and surgical-based revascularization therapy, the increasing requirements for a more individualized assessment of patients undergoing revascularization, and reviews the clinical tools currently available to assist in this decision-making process.
Percutaneous coronary intervention in non-ST elevation acute coronary syndrome
Authors: Alaour Bashir , Mahmoudi Michael , Curzen Nick
Published: October 2018

Coronary heart disease is the single most common cause of death in the UK and in Europe, although death rates are declining in most European countries. Hospital mortality rates between non-ST elevation acute coronary syndrome and ST-elevation myocardial infarction are compared, with an examination of the pathophysiology, clinical syndromes, and trials of conservative versus early invasive strategy throughout the chapter. Finally, special subgroups are considered, including those with anaemia and diabetes mellitus.
Coronary bifurcation stenting: state of the art
Authors: Louvard Yves , Garot Philippe , Hovasse Thomas , Chevalier Bernard , Lefèvre Thierry
Published: October 2018

The difference between a coronary bifurcation lesion and an ordinary lesion lies in the presence of a side branch (SB). Such branches are particularly instrumental in the development of atheroma because of local bloodflow patterns. The clinical importance of a SB depends on its diameter, which is strongly correlated with its flow and the myocardial mass that it supplies. The diameter of the SB, main branch (MB), and of the proximal segment of the MB are indeed interdependent, as evidenced by Murray’s law. Therefore, a coronary bifurcation should be divided into three segments, each with its own reference diameter. This chapter covers state-of-the-art coronary bifurcation stenting processes, the fundamental aspects of the technique, definitions and classification, and different strategies.
Percutaneous coronary intervention for left main coronary artery stenosis
Authors: Mahmoudi Michael , Curzen Nick , Hughes Christine , Farah Bruno , Fajadet Jean
Published: October 2018

Significant left main coronary artery disease (LMCAD) occurs in 5–7% of patients undergoing coronary angiography. Patients with LMCAD have a 50% 3-year mortality despite optimal medical therapy. As such, coronary artery bypass grafting (CABG) emerged as the gold standard therapy for the treatment of patients with LMCAD either in isolation or in association with disease elsewhere in the coronary circulation. Advances in stent and adjunctive intracoronary imaging as well as pharmacotherapy has enabled percutaneous coronary intervention (PCI) to challenge CABG in such patients, with a host of randomized and observational studies comparing the safety and efficacy of PCI with CABG. This chapter covers historical data on CABG in LMCAD, compares various PCI techniques with CABG, and finally evaluates the differences in efficacy and safety.
New oral anticoagulants: the evidence base and role in patients undergoing percutaneous coronary intervention
Authors: Dzeshka Mikhail S. , Brown Richard A. , Lip Gregory Y. H.
Published: October 2018

Despite major advances in treatment and risk stratification, cardiovascular disease remains highly prevalent in modern society. Activation and progression of pathways involved in adverse myocardial and vascular remodelling occur in an age-dependent manner. Indeed, epidemiological studies have consistently shown age to be independently associated with increased lifetime cardiovascular risk, particularly with regard to coronary artery disease and its complications. Structural remodelling in the ageing heart, particularly the left atrium, creates a morphological substrate for the development of atrial fibrillation, the most common sustained arrhythmia and notably more prevalent in older patients. Concomitant atrial fibrillation and coronary artery disease commonly occur in everyday clinical practice. Both conditions are associated with thrombotic complications, e.g. coronary thrombosis in acute coronary syndrome or after stent implantation, while atrial fibrillation confers increased risk of stroke. Antithrombotic therapy is of the highest priority therefore, but with consideration of different thrombotic pathways.
In-stent restenosis in the drug-eluting stent era
Authors: Chandrasekhar Jaya , Caixeta Adriano , Généreux Philippe , Dangas George , Mehran Roxana
Published: October 2018

Since the inception of percutaneous coronary intervention, restenosis has been considered a significant problem. Although drug-eluting stents (DES) have reduced rates of in-stent restenosis (ISR) compared with bare metal stents across all lesion subsets, ISR has not been abolished. DES efficacy has been limited by suboptimal polymer biocompatibility, efficacy of pharmacological agents, in vivo pharmacokinetic properties, and local drug resistance and toxicity. While the first two DES to be manufactured (sirolimus- and paclitaxel-eluting stents) have the longest clinical follow-up, extensive data are now also available on zotarolimus- and everolimus-eluting stents. The uptake of biolimus-eluting stents has recently increased in clinical practice. Although the low frequency of DES ISR makes it difficult to investigate this condition fully, many studies have examined the mechanism, incidence, predictors, and optimal treatment of DES restenosis. This review discusses the data relevant to DES restenosis and the perspective on the current treatment of this condition.
No-reflow in native coronaries and vein grafts: the role of drugs and distal protection
Authors: De Maria Giovanni Luigi , Banning Adrian
Published: October 2018

Restoration of normal coronary bloodflow and relieving myocardial ischaemia is the main goal of percutaneous coronary intervention (PCI). However, whilst reducing an epicardial coronary stenosis by balloon dilatation may appear to be a relatively easy task, subsequent detrimental changes in bloodflow can paradoxically result in reduced/impaired myocardial perfusion. This condition of mismatch between post-PCI epicardial coronary patency and impaired myocardial reperfusion is defined as slow-flow or no-reflow. It is typically caused by and related to the presence of a damaged, dysfunctional, and/or obstructed coronary microvasculature. When no-reflow occurs, it has an adverse effect on the subsequent mid- and long-term prognosis as it is associated with a higher risk of reinfarction, arrhythmias, heart failure, and a higher in-hospital and long-term cardiac mortality. Frustratingly, nearly four decades after the first PCI, there is still uncertainty about the pathophysiology of no-reflow and a need to define successful prevention and treatment strategies.
Bioresorbable vascular scaffolds
Authors: Brown Adam J. , West Nick E. J.
Published: October 2018

In this chapter, current limitations of existing metallic drug-eluting stent technology and potential advantages of bioresorbable scaffolds (BRSs) are explored, alongside existing clinical data for BRSs and interventional techniques that may optimize implantation of these novel first-generation devices, with consequent potential for improved clinical outcomes.
Novel device therapies for resistant hypertension
Authors: Chan Kenneth , Saxena Manish , Lobo Melvin D.
Published: October 2018

Resistant hypertension (RHTN) is defined as uncontrolled office blood pressure (>140/90 mmHg) despite treatment with maximum tolerated doses of three or more antihypertensive agents from at least three different classes, including a diuretic. The prevalence of RHTN is about 8–18% in hypertensive patients and confers greatly increased risk of cardiovascular morbidity and mortality.
Stem cell delivery and therapy
Authors: Choudry Fizzah , Mathur Anthony
Published: October 2018

Despite the important advances in medical and catheter-based therapy that have driven down mortality associated with cardiovascular disease, particularly acute myocardial infarction, long-term mortality and morbidity in patients with left ventricular systolic dysfunction remains unacceptably high. The processes of myocardial damage and adaptation were thought to be irreversible as the heart was considered to be a terminally differentiated post-mitotic organ. This dogma has been challenged recently, particularly with the demonstration of continued cell division within the adult heart following injury such as myocardial infarction. Several researchers have now isolated and identified resident cardiac stem cells that are capable of differentiating into multiple cardiac cell lineages such as cardiomyocytes and vascular smooth muscle cells. However, the self-renewal capabilities of the human heart are unable to overcome the massive loss of cardiomyocytes, up to a billion cells, seen in myocardial infarction and heart failure. This is in contrast to non-mammalian vertebrates such as the zebrafish, which have been demonstrated to be able to regenerate up to 20% of the left ventricle following injury. There is therefore a growing initiative to determine whether the human heart can also be directed to elicit a regenerative response following injury either through upregulation of its own intrinsic repair mechanisms or by the addition of biological therapies such as adult stem/progenitor cells. The role of the interventional cardiologist is in the development of protocols and techniques that allow the safe and efficient targeted delivery of these cells to patients as well as identifying patient groups that may derive the most benefit.
The nature of intellectual disability nursing
Authors: Barr Owen , Gates Bob
Published: October 2018

This chapter explores the nature of intellectual disability. It identifies what intellectual disability is and the different degrees manifested, along with definitions of intellectual disability and its incidence and prevalence. The chapter also identifies how intellectual disability is diagnosed. Causes and manifestations of intellectual disability are outlined, along with the presentation of common conditions found in people with intellectual disability. The nature of intellectual disability nursing is explored, along with how it may be viewed as the purist form of nursing by adopting holistic approaches and working, as it does, with people across their lifespan. The principles and values of intellectual disability policy are outlined for each of the jurisdictions of the UK and the Republic of Ireland.
Working with families
Authors: Barr Owen , Gates Bob
Published: October 2018

The majority of people with intellectual disabilities live with family members, and those people who live elsewhere usually very much value contact with family members. Therefore, nurses who work with people with intellectual disabilities need to have a clear understanding of families and collaborative working. This chapter explores the definition of families, the impact that having a person with intellectual disabilities as a family member may have, and how this can change the life cycle of a family as families adapt to their changing circumstances. It also explores collaborative working with family members, parents with intellectual disabilities, parents of people with intellectual disabilities and siblings, as well as looking at family quality of life and social, cultural, and spiritual factors that may need to be considered.
Assessment
Authors: Barr Owen , Gates Bob
Published: October 2018

It is a professional requirement of nursing regulators such as the Nursing and Midwifery Council and the Nursing and Midwifery Board of Ireland that all nursing interventions should be based upon, and underpinned by, an accurate and structured nursing assessment of a person’s physical, mental, and social abilities and needs. Nurses need to have an understanding of how to assess changes in a person’s physical and mental health, including their level of pain, distress, and ability to make informed decisions, and how this may fluctuate in different settings and across the lifespan. They also need to be alert to the risks of diagnostic overshadowing when undertaking assessments, from which they will plan nursing care in collaboration with the people with intellectual disabilities and their carer/carers.
Changes across the lifespan
Authors: Barr Owen , Gates Bob
Published: October 2018

This chapter outlines in depth the particular challenges of people with intellectual disabilities and their families may encounter across the lifespan. The impact of screening and diagnosis is explored, along with challenges encountered with going to school, and the attendant issues of transition/s and how this is managed. Also explored is the move from adolescence to adulthood that presents people with the possibility of relationships, marriage, and families. The chapter reviews the course towards, and the inevitability of, growing older and its impact on people with intellectual disabilities, especially those with Down syndrome, and the ultimate stage of life—passing/dying—and the importance of managing this well for people with intellectual disabilities.
Therapeutic interventions
Authors: Barr Owen , Gates Bob
Published: October 2018

This chapter outlines a variety of therapeutic interventions that are more commonly used with people with intellectual disabilities to help them address challenges to their health and well-being. Typically, some of these interventions are used by specialist therapists, but increasingly nurses for people with intellectual disabilities are developing specialist and advanced areas of practice. Each section, where appropriate, not only describes the intervention in detail, but also identifies the evidence base supporting it. Nurses for people with intellectual disabilities and students of nursing will find this chapter a useful resource in their everyday practice.
Lifestyles and intellectual disability nursing
Authors: Barr Owen , Gates Bob
Published: October 2018

A significant component of the role of nurses for people with intellectual disabilities is contributing to enabling people with intellectual disabilities to live the lifestyle they choose. Advice about residential alternatives, work, supported employment, and planning on retirement are all things on which the nurse should be able to advise, and signpost people to the services they need. Importantly, helping and advising the family and carers about setting up networks and circles of support and that making and keeping friends are as important and can all contribute to leading a happy and healthy lifestyle.
Research and intellectual disability nursing
Authors: Barr Owen , Gates Bob
Published: October 2018

This chapter examines research and nursing for people with intellectual disabilities. This chapter is an introduction to some of the key concepts in nursing research that are most relevant to nursing for people with intellectual disabilities. The major methodological approaches to quantitative and qualitative research are outlined, to help in identifying and evaluating their use in practice. The key stages of the research process are outlined, so that students and practitioners will know what to look for when reading research and with what to start if they want to pursue their own research ideas. Finally, the chapter examines some of the issues that are important to research for nurses for people with intellectual disabilities. These include ethical issues that are fundamental to all research, as well as working collaboratively with people with intellectual disabilities, carers, and children in research.
Practice resources
Authors: Barr Owen , Gates Bob
Published: October 2018

Nursing for people with intellectual disabilities has moved from a narrowly defined role, within long-term care, to a much broader role within the National Health Service and beyond. It is a health profession supported and endorsed by many as unique in its breadth of employment base, located as it is among the various sectors. The role of nurses for people with intellectual disabilities spans community support specialists, liaison nursing roles between services and agencies, and roles in secure or forensic health settings, and these roles offer support across all age ranges. With such exciting possibilities, in practice come challenges such as where to access up-to-date resources that will support nurses for people with intellectual disabilities and students in their practice. Where a student finds new resources for their jurisdiction, they may find it useful to append their own notes to the sections within this chapter; the layout of the book has been designed for students to make relevant notes on.
Prescribing
Authors: Raine Tim , Collins George , Hall Catriona , Hjelde Nina , Dawson James , Sanders Stephan , Eccles Simon
Published: October 2018

This chapter explores prescribing, including general considerations in prescribing, how to prescribe, best practice, drug interactions, reporting adverse drug reactions, special considerations, controlled drugs, enzyme inducers and inhibitors, endocarditis prophylaxis, night sedation, steroid therapy, topical corticosteroids, empirical antibiotic treatment, and Clostridium difficile (C. diff).
Gastroenterology
Authors: Raine Tim , Collins George , Hall Catriona , Hjelde Nina , Dawson James , Sanders Stephan , Eccles Simon
Published: October 2018

This chapter discusses gastroenterology, and includes abdominal pain and abdominal pain emergency, GI bleeding emergency, acute upper GI bleeds, acute lower GI bleeds, nausea and vomiting, diarrhoea, constipation, liver failure and liver failure emergency, and jaundice.
Neurology
Authors: Raine Tim , Collins George , Hall Catriona , Hjelde Nina , Dawson James , Sanders Stephan , Eccles Simon
Published: October 2018

This chapter discusses neurology, including coma and reduced GCS and coma and reduced GCS emergency, adult seizures emergency, paediatric seizures emergency, seizures, neurodegenerative disorders, stroke and stroke/CVA/TIA emergency, focal neurology, back pain, headache, and dizziness.
Haematology
Authors: Raine Tim , Collins George , Hall Catriona , Hjelde Nina , Dawson James , Sanders Stephan , Eccles Simon
Published: October 2018

This chapter explores haematology, including anaemia, transfusion of blood products, clotting emergencies, bleeding, and anticoagulation.
Emergency department
Authors: Raine Tim , Collins George , Hall Catriona , Hjelde Nina , Dawson James , Sanders Stephan , Eccles Simon
Published: October 2018

This chapter explores the emergency department, including trauma, head injury, neck injury, falls and collapse, acutely painful limb emergency, acute limb pain, chronic limb pain, limb swelling, joint pain, neck lumps, ENT, groin lumps, burns and burns emergency, anaphylaxis in adults, hypotension emergency, hypotension, shock, pyrexia, overdose emergency, overdose and deliberate self-harm, vaginal bleeding, gynaecological causes of pain, contraception, early pregnancy (1st trimester), later pregnancy (2nd/3rd trimester), delivery, and after delivery (post-partum).
Cognitive behaviour therapy for psychosis
Authors: Byrne Majella , Jolley Suzanne , Peters Emmanuelle
Published: October 2018

This chapter outlines current cognitive behaviour therapy approaches for positive psychotic symptoms and their theoretical underpinnings. The difficulties of translating research into frontline practice are examined, with recommendations for effective implementation. Evidence for the effectiveness of cognitive behaviour therapy for psychosis (CBTp) is reviewed, identifying challenges in the design, conduct, and interpretation of evaluations. New developments are highlighted, including specific interventions designed to target single psychological processes hypothesized to cause or maintain distressing psychotic symptoms. The current evidence for CBTp specifically for those with persisting and distressing positive symptoms of psychosis, who either do not respond to medication or have chosen not to take medication, is outlined. Finally, predictors of good outcome in CBTp are presented.
Novel treatments and future directions
Authors: Miyamoto Seiya , Miyake Nobumi
Published: October 2018

The advent of new-generation antipsychotic drugs has broadened the options for the pharmacological treatment of schizophrenia. However, there are still medical needs not met by current antipsychotic treatment, particularly for patients with negative symptoms and cognitive impairments, and for treatment-resistant schizophrenia. A growing body of research has identified new molecular mechanisms and novel pharmacological targets for treating schizophrenia beyond just dopamine D2 antagonism. This chapter provides a review of compounds in development and emerging non-pharmacological interventions for schizophrenia, and also considers approaches towards personalized and precision medicine for the disorder.
Hostility to Hospitality
Authors: Balboni Michael J. , Balboni Tracy A.
Published: October 2018

Spiritual sickness troubles American medicine. Through a death-denying culture, medicine has gained enormous power—an influence it maintains by distancing itself from religion and spirituality, which too often remind us of our mortality. As a result of this separation of medicine from spiritual traditions, patients facing serious illness infrequently receive adequate spiritual care despite the large body of empirical data demonstrating its import to patient meaning-making, quality of life, and medical utilization. This secular–sacred divide also unleashes depersonalizing social forces through the market, technology, and legal-bureaucratic powers that reduce clinicians to tiny cogs in an unstoppable machine. Hostility to Hospitality is one of the first books of its kind to explore these hostilities threatening medicine and offer a path forward for the partnership of modern medicine and spirituality. Drawing from interdisciplinary scholarship including empirical studies, interviews, history and sociology, theology, and public policy, the authors argue for structural pluralism as the missing piece to changing hostility to hospitality.
The Frequency of Spiritual Care at the End of Life
Authors: Balboni Michael J. , Balboni Tracy A.
Published: October 2018

Data suggest that clinicians infrequently provide spiritual care within life-threatening illness, at least within the perspective of patients’ accounts. Boston patients indicate that 13% of patient–nurse relationships and 6% of patient–physician relationships at any point in their clinical relationship entailed a spiritual care encounter. Nurses and physicians perceive spiritual care to be a more frequent occurrence. The gap in perception that exists may partially be due to underlying religious demographic differences between patients, nurses, and physicians. While most patients experience illness as a spiritual event, and there are notable medical outcomes and growing national guidelines calling for clinician spiritual care, by most accounts, including nurses and physicians, spiritual care seldom occurs. Questions arise regarding why physicians neglect or avoid providing spiritual care in serious illness.
Toward a Theology of Medicine
Authors: Balboni Michael J. , Balboni Tracy A.
Published: October 2018

This chapter highlights how within Western medicine’s partnership with the Abrahamic traditions, there were three foundational values informing why and how medicine should be practiced in caring for the sick: (1) the human body cannot be treated apart from the soul, (2) hospitality is the foundational motive driving clinicians and hospitals, and (3) medicine is a divine gift. The Abrahamic traditions imbued into medicine these understandings, justifying medicine’s proper use based on theological grounds. This theology is most clearly embedded in early encounters with Hippocratic medicine, which pushed Jewish and Christian thinkers to articulate perspectives that have penetrated these traditions from that time onward. As part of the larger argument of the book, it highlights how the Abrahamic traditions approached illness and medicine in order to better contextualize subsequent chapters that compare these traditional Western religious values to secular medicine.
The Fundamentals of Brain Neurotransmission
Authors: Friedel Robert O. , Stahl Stephen M.
Published: October 2018

This chapter outlines the fundamental principles underlying neuroscience, particularly as it relates to neurotransmission and neuropharmacology. It then reviews and synthesizes of the role of different neurochemical and neurotransmitter systems that underlie brain function and synaptic transmission, including GABA, glutamate, serotonin, dopamine, norepinephrine, acetylcholine, and histamine. In addition, it describes various psychoactive medications are used in the treatment of personality disorders, such as mood stabilizers and antipsychotics. Moreover, it describes how these agents target these systems by describing their different mechanisms of action. It provides a primer to better understand the pathophysiology and pharmacological treatment of personality disorders discussed in the book.
Genetics of Personality Disorders
Authors: Reichborn-Kjennerud Ted , Kendler Kenneth S.
Published: October 2018

This chapter reviews the evidence for genetic contributions to the etiology of personality disorders (PDs) as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM; 5th ed.). This approach and some of the controversial issues associated with its development are briefly described in the first section. The second section evaluates the evidence for genetic influence on DSM PDs from family and twin studies using quantitative genetic methods. Studies that move beyond individual PDs are also reviewed, together with studies on the extent to which common genetic factors influence PDs and normal personality traits and PDs and pathological personality trait domains. Stability of genetic influences on PDs over time are also examined. Molecular genetic studies are reviewed in the third section. The fourth section deals with gene environment interplay, and the final section discusses future directions in the exploration of genetic influences on PDs.
The Neurobiology of Attachment and Mentalizing
Authors: Luyten Patrick , Fonagy Peter
Published: October 2018

This chapter addresses the neurobiology of attachment and mentalizing from a developmental psychopathology perspective. It defines attachment, considers its key role in the modulation of the stress response, and describes the general neurobiological process by which this occurs. The chapter then considers the neurobiology of attachment and proceeds to discuss the neurobiological underpinning of mentalizing in relation to attachment and stress regulation. It also focuses on the early development of both capacities in relation to stress regulation and discusses the relationship to the development of psychopathology and personality disorder in particular across the lifespan, with a focus on early childhood and adolescence.
Emotion Regulation
Authors: Bertsch Katja , Koenigsberg Harold , Niedtfeld Inga , Schmahl Christian
Published: October 2018

This chapter describes the processes and systems implicated in regulation of emotion. Emotion regulation is an important topic in many fields of psychiatric disorders. According to the established model developed by Gross and colleagues, emotion regulation can be distinguished into antecedent-focused and response-focused emotion regulation strategies. This chapter reviews several implicit and explicit forms of emotion regulation including attention, habituation, and reappraisal. It describes multiple behavioral sequelae to emotion dysregulation such as avoidance and self-harm behaviors. The chapter synthesizes the evidence of altered emotion processing and regulation across multiple personality disorders and introduces emotion regulation as a target for psychotherapy for personality disorders.
Social Cognition in Personality Disorders
Authors: Lis Stefanie , Derish Nicole E. , Perez-Rodriguez M. Mercedes
Published: October 2018

Changes in social cognition are increasingly recognized as core illness features in the personality disorders with a broad impact on social functioning. Despite the significant disability caused by social cognitive dysfunction, treatments for this symptom dimension tailored to the specific deficits of a disorder are still missing. This chapter characterizes the different domains of social cognitive processing and describes different approaches and instruments for measuring impairments. It provides a short overview of the evidence demonstrating changes in social cognition in schizotypal personality disorder, borderline personality disorder, and antisocial and avoidant personality disorder, as well as the neurobiology of social cognition. During the recent past the number of studies addressing this topic increased tremendously. Nevertheless, research in this area is still young and requires approaches that study these functions while emphasizing the social context and associate deficits observed in experimental paradigms with interpersonal dysfunction during every-day life.
Li-ion battery material under high pressure: amorphization and enhanced conductivity of Li4Ti5O12
Authors: Huang Yanwei , He Yu , Sheng Howard , Lu Xia , Dong Haini , Samanta Sudeshna , Dong Hongliang , Li Xifeng , Kim Duck Young , Mao Ho-kwang , Liu Yuzi , Li Heping , Li Hong , Wang Lin
Published: October 2018

Lithium titanium oxide (Li4Ti5O12, LTO), a ‘zero-strain’ anode material for lithium-ion batteries, exhibits excellent cycling performance. However, its poor conductivity highly limits its applications. Here, the structural stability and conductivity of LTO were studied using in situ high-pressure measurements and first-principles calculations. LTO underwent a pressure-induced amorphization (PIA) at 26.9 GPa. The impedance spectroscopy revealed that the conductivity of LTO improved significantly after amorphization and that the conductivity of decompressed amorphous LTO increased by an order of magnitude compared with its starting phase. Furthermore, our calculations demonstrated that the different compressibility of the LiO6 and TiO6 octahedra in the structure was crucial for the PIA. The amorphous phase promotes Li+ diffusion and enhances its ionic conductivity by providing defects for ion migration. Our results not only provide an insight into the pressure depended structural properties of a spinel-like material, but also facilitate exploration of the interplay between PIA and conductivity.
Automobile Prices in Market Equilibrium with Unobserved Price Discrimination
Authors: D’Haultfœuille Xavier , Durrmeyer Isis , Février Philippe
Published: October 2018

In markets where sellers are able to price discriminate, individuals pay different prices that may be unobserved by the econometrician. This article considers the structural estimation of a demand and supply model of differentiated products with such price discrimination and limited information on prices taking the form of, e.g., observing list prices from catalogues or average prices. Within this framework, identification is achieved not only with usual moment conditions on the demand side, but also through supply-side restrictions. The model can be estimated by GMM using a nested fixed point algorithm that extends the usual contraction mapping algorithm to our setting. We apply our methodology to estimate the demand and supply in the French new automobile market. Our results suggest that discounting arising from price discrimination is important. The average discount is estimated to be 9.6%, with large variation depending on buyers’ characteristics and cars’ specifications. Our results are consistent with other evidence on transaction prices in France.