bluuebunny/crossref_metadata_2025 huggingface dataset:
The treatment of bipolar disorder in the elderly
Authors: Sousa Alves Gilberto , Sudo Felipe Kenji , Pantel Johannes
Published: November 2017

Bipolar disorder (BD) is an extremely disabling condition characterized by mood switches, and cognitive and functional impairment. The current chapter discusses the updated review on pharmacological and non-pharmacological interventions targeting BD in the elderly. The risk of concurrent medical diseases (eg, metabolic syndrome) and relatively lower tolerability than young BD make the patient safety a major concern in most cases. Evidence-based guidelines, although useful for promoting rational and effective therapy, are generally lacking in elderly BD. Current recommendations for acute mania include atypical antipsychotics, careful use of lithium, and election of valproate as the gold-standard therapy. In acute BD depression, first-line agents in monotherapy may include lithium, lamotrigine, quetiapine, and quetiapine extended release (XR). Electroconvulsive therapy may be an option for severe/refractory cases. Family members or caregivers should be encouraged to support the patient, since potential ethical issues involving patrimony or profession may arise during the treatment.
The management of treatment-resistant bipolar disorder
Authors: Selek Salih , Passos Ives Cavalcante , Soares Jair C.
Published: November 2017

Treatment-resistant bipolar disorder is a challenging area in clinical psychiatry and both defining treatment resistance and managing it is difficult despite new emerging pharmacological and non-pharmacological treatments. This chapter revisits the definition in treatment resistance in bipolar and summarizes the general recommendations in treatment-resistant bipolar disorder by taking revision of the guidelines to ‘pole position’. Manic and depressive episodes are covered in different subtitles. A short description of the complementary and alternative treatments is also mentioned. Special conditions in treatment resistance including co-morbidities, mixed states, and substance abuse are discussed separately. Future directions are also addressed by both evidence-based and naturalistic findings. Final recommendations for mania and depression are discussed after each subtitle and illustrated with a figure to give readers a visual summary.
Staging and neuroprogression in bipolar disorder: treatment implications
Authors: Cavalcante Passos Ives , Kapczinski Flávio
Published: November 2017

It is known that if, not all, a substantial proportion of patients with bipolar disorder (BD) present a progressive course with functional and cognitive impairment. In addition, patients with BD and multiple mood episodes have a worse response to lithium and cognitive behaviour therapy. However, many current treatment guidelines do not take these clinical features that change with illness progression into account. In order to clarify these clinical questions, the term ‘neuroprogression’ was conceptualized as the pathological rewiring of the brain that takes place in parallel with the clinical deterioration in the course of BD. It provides a heuristic basis for conceptualizing the biochemical foundation of changes in brain circuits related to the progressive course of BD. Herein, we aim to review risk factors, biological underpinnings, and treatment implications related to neuroprogression in BD.
Cognitive enhancement in bipolar disorder: current evidence and methodological considerations
Authors: Miskowiak Kamilla W. , Kessing Lars V.
Published: November 2017

Cognitive dysfunction is an emerging treatment target in bipolar disorder (BD). Numerous trials have assessed the efficacy of novel pharmacological and psychological treatments on cognition. Overall, the results are disappointing, possibly due to methodological challenges. A key issue is the lack of consensus on whether and how to screen for cognitive impairment and on how to assess efficacy. We suggest that screening for cognitive impairment is critical and should involve objective neuropsychological tests. We also recommend that the primary outcome is a composite of neuropsychological tests with socio-occupational function as co-primary or secondary outcome. Trials should include fully or partially remitted patients, ensure that concomitant medication is kept stable and that statistical methods include mixed models or similar ways to take account of missing values. Future treatment development should implement a ‘circuit-based’ neuroimaging biomarker model to examine neural target engagement. Interventions targeting multiple treatment modalities may also be beneficial.
Neuromodulatory approaches for bipolar disorder: current evidences and future perspectives
Authors: Brunoni Andre Russowsky , de Sampaio Pereira Júnior Bernardo , Klein Izio
Published: November 2017

Bipolar disorder is a prevalent condition, with few therapeutic options and a high degree of refractoriness. This justifies the development of novel non-pharmacological treatment strategies, such as the non-invasive techniques of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), as well as the invasive techniques of deep brain stimulation (DBS) and vagus nerve stimulation (VNS). In this chapter, we provide a summary of the development of the techniques as well as the studies carried out with patients with bipolar disorder. Although many promising results regarding the efficacy of theses techniques were described, the total number of studies is still low, highlighting the need of further studies in larger samples as to provide a definite picture regarding the use of clinical neuromodulation in bipolar disorder.
The role of complementary and alternative therapies for the management of bipolar disorder
Authors: Ravindran Arun V. , da Silva Tricia L.
Published: November 2017

Complementary and alternative medicine (CAM) therapies are a group of diverse medical and health systems, practices, and products not currently considered to be part of conventional medicine. These therapies have growing popularity and it is suggested that more than a third of patients with bipolar disorder (BD) use some form of CAM therapy. Although there are several forms of CAM therapies, including physical therapies, nutraceuticals, herbal remedies, and mindfulness-based interventions, reports in BD are few in number and often of poor quality. Sleep deprivation has the strongest evidence for benefit as an augmentation therapy in bipolar depression. There is promising evidence for other CAM therapies, including exercise, bright light therapy, omega-3 fatty acids, N-acetylcysteine, and the traditional Chinese medicine formulation, Free and Easy Wanderer Plus. However, limitations such as small number of studies, small sample sizes, few randomized investigations, and contradictory findings currently preclude definitive recommendations.
A brief history of ankylosing spondylitis
Authors: Siebert Stefan , Raj Sengupta , Tsoukas Alexander
Published: November 2017

The history of ankylosing spondylitis (AS) dates back to the discovery of skeletons with characteristic spinal changes. The disease was further defined by correlating pathological and clinical features, and the development of clinical radiology. Subsequent epidemiology and familial studies highlighted the association with other related conditions as part of the spondyloarthritides. The discovery of HLA-B27 confirmed this association. Over the past two decades, genome-wide association studies, and advances in imaging and immunology have yielded dramatic insights into the disease and the development of highly effective therapies.
Peripheral musculoskeletal involvement in axial spondyloarthritis
Authors: Siebert Stefan , Raj Sengupta , Tsoukas Alexander
Published: November 2017

In addition to the axial diseases that characterizes axial spondyloarthritis (axSpA), many patients also develop peripheral musculoskeletal involvement. This can include peripheral joint synovitis, enthesitis, and dactylitis. Peripheral musculoskeletal involvement is an important component of the disease with significant impact on function and quality of life. Many of the features may also be subtle and overlooked, unless specifically evaluated and examined. In particular, hip disease is a bad prognostic feature and, if present, may require more aggressive therapy or surgical intervention. On occasion, further imaging may be required to detect enthesitis or subtle joint inflammation in order to inform treatment decisions.
Drug treatment for axial spondyloarthritis
Authors: Siebert Stefan , Raj Sengupta , Tsoukas Alexander
Published: November 2017

The pharmacological therapy for patients with axial spondyloarthritis (axSpA), especially those with severe disease, has been transformed by the introduction of the biologic therapies, and anti-TNF therapy in particular. Until approximately 2005, treatment options for ankylosing spondylitis (AS) were limited to exercise therapy and non-steroidal anti-inflammatory drugs (NSAIDs). The TNF inhibitors appear to have a good safety profile in axSpA, with no new safety signals. The high cost of innovator biologics remains an issue and it will be interesting to observe the effect of the introduction of multiple biosimilar TNF inhibitors in clinical practice. New therapeutics targeting different cytokine and signalling pathways should also become available over the next few years, so it remains to be seen what their role will be in the management of axSpA. This chapter reviews some of the key drug therapies and advances in the management of axSpA.
Cardiovascular therapy techniques
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Defibrillation 52

Temporary cardiac pacing 54

Intra-aortic balloon counterpulsation pump 56

Cardiac assist devices 58

Therapeutic cooling 60

Defibrillation is the delivery of sufficient electrical current to depolarize a critical mass of myocardium and enable restoration of coordinated electrical activity. All defibrillators have three features in common:
...
Nutrition
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Enteral nutrition 82

Parenteral nutrition 84

Immune-enhancing nutrition 86

Nutrition is an important part of intensive care medicine. This may seem self-evident, but the lack of randomized controlled clinical trials to document the usefulness of nutrition in the ICU has been pointed out. The fact that nutrition may be associated with adverse effects has led to some authors to the point where they question the use of nutrition as such in the ICU. However, the majority of intensivists are in favour of providing nutrition for their patients, basically relating to the fact that sooner or later any individual will starve to death without nutrition. The controversy will then be when and how to provide nutrition for the patients. As for many different routines in the ICU, nutrition should also be protocolized, and exceptions from protocol should be rare and well motivated. The nutritional routines should be well known by everybody working in the unit, and everybody should be well informed and hopefully unanimous behind the rationale for the particular routines used....
Cardiovascular monitoring
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

ECG monitoring 98

Arterial pressure monitoring 102

Insertion of central venous catheters 104

Common problems with central venous access 106

Pulmonary artery catheter: indications and use 108

Pulmonary artery catheter: insertion 110

Echocardiography 112

Clinical application of echocardiography in the ICU 116

Doppler 118

Pulse pressure algorithms ...
Neurological monitoring
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Intracranial pressure monitoring 130

Intracranial perfusion 132

EEG and CFAM monitoring 134

Other forms of neurological monitoring 138

In adults, the normal resting intracranial pressure (ICP) is 0–10mm Hg. ICP may rise to 50mm Hg or so during straining or sneezing, with no impairment in function. It is not, therefore, ICP alone that is important but rather the interpretation of the measurement in pathological conditions. Many of the clinicopathological changes associated with brain injury are the result of pressure differences between the intracranial compartments, with consequent shift of brain structures, rather than the absolute level of ICP....
Haematological disorders
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Bleeding disorders 388

Anaemia in critical care 392

Sickle cell anaemia 394

Haemolysis 396

Disseminated intravascular coagulation 398

Neutropenic sepsis 400

Haematological malignancies in the ICU 404

Coagulation monitoring 406

Inappropriate activation of the coagulation process. Usually presents as haemorrhage, but 5-10% may show micro-thrombi (e.g. digital ischaemia)....
Pain and post-operative intensive care
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Pain management in ICU 508

Intensive care for the high risk surgical patient 510

The acute surgical abdomen in the ITU 512

The medical patient with surgical problems 514

Relief from pain is not only indicated on humanitarian and ethical grounds alone, but has medical and possibly cost benefits....
Death and dying
Authors: Waldmann Carl , Soni Neil , Rhodes Andrew
Published: November 2017

Confirming death using neurological criteria (brainstem death) 530

Withdrawing and withholding treatment 532

The potential heart-beating organ donor 534

Non-heart-beating organ donation 538

The brainstem provides the anatomical link between the spinal cord and cerebral hemispheres relaying sensory and motor impulses between the periphery and higher cortical centres. It also contains cranial nerve nuclei, the reticular activating system and cardiorespiratory control centres, the destruction of which underlies the process of confirming death according to neurological criteria (brainstem death)....
Head & neck cancer
Authors: Ajithkumar Thankamma , Barrett Ann , Hatcher Helen , Cook Natalie
Published: November 2017

The head and neck region encompasses anatomical sites below the brain and above the clavicles, excluding skin and thyroid. The sites most commonly involved with cancer are the oral cavity, larynx, and pharynx. Overall 5-year survival rates for head and neck cancer have improved only slightly over the past two decades remaining at just over 50%. This figure in part reflects the population who present with this disease in terms of age and comorbidity (typically about 15% intercurrent death rates at 5 years), as well as the tendency to develop second primaries and metastases. The poor long-term survival rates may also reflect the fact that 60% of patients with head and neck cancer have advanced disease at the time of presentation (stage III/IV disease). The dominant treatment failure in head and neck cancer is locoregional relapse and this remains the main focus for clinicians involved in the management of these patients....
Gynaecological cancers
Authors: Ajithkumar Thankamma , Barrett Ann , Hatcher Helen , Cook Natalie
Published: November 2017

Cervical cancer is a serious health problem, with nearly 520,000 women developing the disease each year worldwide of whom 443,000 are women in developing countries (Parkin et al. 2005).

There are many risk factors from epidemiological to analytical implicated in the development of cervical cancer....
Bone tumours and soft tissue sarcomas
Authors: Ajithkumar Thankamma , Barrett Ann , Hatcher Helen , Cook Natalie
Published: November 2017

Primary malignant tumours of bone are rare and comprise a large number of histological subtypes.

• The most common are osteosarcoma, Ewing's family of tumours, and chondrosarcoma. Each of these has further subgroups which will be discussed in detail under their subheadings.

• The remaining subgroups are exceptionally rare and include the presentation of spindle cell sarcoma of bone e.g. malignant fibrous histiocytoma (MFH), within the bone as a primary lesion. MFH of bone is treated as other primary bone tumours (Bramwell et al. 1999)....
Haematological malignancies
Authors: Ajithkumar Thankamma , Barrett Ann , Hatcher Helen , Cook Natalie
Published: November 2017

Hodgkin's lymphoma (HL), now called Hodgkin disease, is one of the neoplastic diseases of the lymphatic tissue. In 1832, Thomas Hodgkin first described the disease in his historic paper entitled ‘On Some Morbid Appearances of the Absorbant Glands and Spleen’. In 1898 and 1902 Carl Sternberg and Dorothy Reed contributed the first microscopic descriptions of the pathognomonic Hodgkin and Reed–Sternberg (H-RS) cells (...
Cancers of unknown primary
Authors: Ajithkumar Thankamma , Barrett Ann , Hatcher Helen , Cook Natalie
Published: November 2017

Cancer of unknown primary (CUP) site is one of the 10 most frequent cancers, accounting for approximately 3–5% of all malignant tumours. Patients with CUP present with disseminated metastatic lesions for which a laboratory and clinical work-up fail to identify the primary site.

CUP represents a heterogeneous group of mainly epithelial tumours with more or less unique clinical and biological behaviour....
History and Phenomenology of Schizophrenia and Related Psychoses
Authors: Marcsisin Michael J. , Gannon Jessica M.
Published: November 2017

Psychosis has probably affected humans since the start of humanity itself, although the construct of schizophrenia is a relatively new phenomenon, dating back to the nineteenth century. Work by Emil Kraepelin and Eugen Bleuler helped consolidate ideas about psychotic disorders, setting the stage for both clinical care and neuroscience research in subsequent centuries. Phenomenologically, psychotic symptoms range from “positive” symptoms (delusions, hallucinations), to “negative” symptoms (avolition, affective blunting), to “disorganization” symptoms (disorganized speech and behavior), which all combine to produce functional deficits. Different psychotic disorders have different combinations of symptoms, which can combine with mood and anxiety symptoms to affect functioning problems in unique ways. These symptoms can be recognized fairly reliably in individuals. Understanding the inner experience of psychosis can help improve patient-centered care.
Neurobiology of Schizophrenia
Authors: Hoftman Gil D. , Salisbury Dean F.
Published: November 2017

Schizophrenia is a brain disease with unknown etiology; a variety of neurodevelopmental mechanisms contribute to its pathogenesis. In this chapter, we review some of the most salient neurobiological findings that seem to be linked with the pathophysiology of psychosis generally and schizophrenia specifically. Several important findings have been made from neuroimaging and neuropathology, including reduced whole-brain volume, enlarged ventricles, and decreased cortical gray matter. Abnormalities in the prefrontal cortex, such as decreased dendritic spine density, are particularly important for cognitive and negative symptoms in schizophrenia. Functional imaging suggests that patterns of activation may be closely linked to symptom clusters. We will review neurotransmitter abnormalities, especially dopamine but also glutamate and GABA, and relevant circuitry and connectivity problems related to pathology. Finally, we will discuss genetics and heritability, and the challenges of identifying relevant loci in such a complex disorder.
Principles of patient and family assessment
Authors: Chovan John D. , Cluxton Douglas , Rancour Patrice
Published: November 2017

A comprehensive palliative care nursing assessment of the patient and family occurs throughout the trajectory of the illness and is a holistic view that includes the physical, psychosocial, and spiritual domains. Patient and family assessment provides the foundation for mutual goal setting, devising a plan of care, implementing interventions, and evaluating the effectiveness of care. Reassessments are done throughout the patient’s illness, looking for changes from previous assessments to ensure that quality of life is maximized in all domains. The palliative care nurse understands above all that, irrespective of the phase or focus of the assessment, two of the most important assessment questions the nurse can ask the patient and family are “What is your greatest concern?” and “How can I be of help?”
Pain at the end of life
Authors: Paice Judith A.
Published: November 2017

Pain is highly prevalent in palliative care, yet the majority of individuals can obtain good relief with available treatment options. An awareness of barriers to adequate pain care allows palliative care nurses to assess for and to plan interventions to overcome these obstacles when caring for patients. Advocacy is a critical role of the palliative care nurse. Assessment of pain, including a thorough history and comprehensive physical exam, guides the development of the pharmacological and nonpharmacological treatment plan. Pharmacological therapies include nonopioids, opioids, coanalgesics, cancer therapies and, in some cases, interventional techniques. Intractable pain and symptoms, although not common, must be treated aggressively. In some cases, palliative sedation may be warranted.
Anorexia and cachexia
Authors: Wholihan Dorothy
Published: November 2017

Anorexia/cachexia syndrome (ACS) is recognized as a serious aspect of advanced or terminal illness and as an area requiring further research with respect to its pathophysiology and treatment options. The management of ACS is complicated by numerous obstacles, including lack of clear definitions and guidelines, inconsistency in assessment and management strategies, and knowledge deficits about this complex clinical syndrome in health professionals and caregiving families. The challenge is compounded by the interwoven emotional symbolism of food and nurturance. Palliative care nurses are optimally situated to coordinate and drive the necessary multidisciplinary approach to address anorexia and cachexia in advanced, progressive disease.
Anxiety and depression
Authors: Pasacreta Jeannie V. , Minarik Pamela A. , Nield-Anderson Leslie , Paice Judith A.
Published: November 2017

This chapter provides information regarding the assessment and treatment of anxiety and depression among individuals faced with chronic or life-threatening illness, and delineates psychosocial interventions that are effective at minimizing these troubling symptoms. Practical guidelines regarding patient management and identification of patients who may require formal psychiatric consultation are offered.
Sexuality
Authors: Matzo Marianne
Published: November 2017

Healthcare practitioners should assume a leading role in the assessment and remediation of potential or identified alterations in sexual functioning. Not all couples will be concerned about their sexual health at this point of their life together. However, people may find that being physically close to the one they love is life-affirming and comforting. Assessment of sexual health should occur for all patients to determine whether these needs and hopes include maintenance of their sexual health. The healthcare practitioner’s offer of information and support can make a significant difference in a couple’s ability to adjust to the changes in sexual health during end-of-life care.
Caring for those with chronic illness
Authors: Maxwell Terri L.
Published: November 2017

The prevalence of chronic illness is increasing as the population ages. Despite differences in illness trajectories and difficulty estimating prognosis, patients with chronic noncancer conditions experience similar symptoms and have common needs as the illness progresses. Individuals with chronic progressive illness and their families benefit from an interdisciplinary palliative approach to care, and as the disease advances, hospice care should be considered.
Cultural considerations in palliative care
Authors: Mazanec Polly , Panke Joan T.
Published: November 2017

This chapter defines culture and the complexity of its components as they relate to palliative care. It emphasizes recognizing how one’s own values, practices, and beliefs impact care. Finally, selected palliative care concepts and issues influenced by culture are discussed. This chapter is not intended to be a “cookbook” approach to describing behaviors and practices of different cultures as they relate to palliative care but, rather, a guide to raising awareness of the significance of cultural considerations in palliative care.
Elderly patients
Authors: Derby Susan , Tickoo Roma , Saldivar Reggie
Published: November 2017

This chapter is organized into two main sections. The first section provides an overview of special concerns of older patients at the end of life. The second section focuses on the assessment and management of common symptoms experienced by this population at the end of life.
Palliative care of cancer survivors
Authors: McCabe Mary S. , Corcoran Stacie
Published: November 2017

Being told you are cancer-free does not mean you are free of the consequences of the disease. Seventy-six percent of cancer survivors are over age 60 years and have coexisting medical conditions that complicate posttreatment recovery to maximum health. Childhood cancer survivors also carry a heavy burden of medical and psychological problems resulting from their experience with cancer. Cancer diagnosis and treatment affects the family as well as the patient. Improvements are needed in the coordination of care for cancer survivors to assure optimal quality of life.
Pediatric care
Authors: Jones Barbara , Levetown Marcia , Hellsten Melody Brown
Published: November 2017

Palliative care is as applicable in the emergency department (ED) and in the intensive care unit (ICU) setting as it is in the home. This chapter discusses transitioning goals of care between pediatric care settings, which is a critically important issue for children who die, since the vast majority of childhood deaths occur in an ICU setting.
Palliative care in the Neonatal Intensive Care Unit
Authors: Thaxton Cheryl , Carter Brigit , Hornik Chi Dang
Published: November 2017

This chapter presents the core values of neonatal palliative care within the context of providing culturally appropriate, compassionate, individualized, family-centered developmental care (IFCDC) and patient-focused care for infants receiving care in the NICU environment. To illustrate use of palliative care with the neonatal population, a case study was supplied by a parent.
Reflections on occupational stress in palliative care nursing
Authors: Vachon Mary L.S. , Huggard Peter K. , Huggard Jayne
Published: November 2017

This chapter discusses the stressors and rewards of work in palliative care. Recent research related to the concepts of stress, burnout, and compassion fatigue and related concepts is reviewed and there is a discussion clarifying some of the concerns and overlaps with the measurement of these concepts. The literature on stress, compassion fatigue, and burnout in hospice/palliative care from 2008 to 2013 is reviewed. The concepts of empathy and compassion are discussed, followed by a discussion of spirituality in professional caregivers in palliative care. The chapter concludes with current research on what is being done to decrease stress and improve coping mechanisms in palliative care.
Palliative care and requests for assistance in dying
Authors: Volker Deborah L.
Published: November 2017

The purpose of this chapter is to review the ethical and legal status of assisted dying, summarize empirical findings regarding both professional and lay opinions and experiences with assisted dying, and offer guidelines for responding to requests for assisted dying.
Clinical interventions, economic impact, and palliative care
Authors: Coyne Patrick J. , Smith Thomas J. , Lyckholm Laurel J.
Published: November 2017

Economic outcomes are increasingly important for all types of healthcare, including palliative care. There are substantial opportunities for improvement by using disease management strategies and care pathways. Directed, ethically motivated interventions about futile care appear to produce significant cost savings. The use of advance directives or hospice care may be good medical care, but have not been shown to produce major economic benefit. Integrated palliative care teams have been shown to reduce hospital and end-of-life care costs for seriously ill patients. For treatment to be justified, there must be some demonstrable improvement in disease-free or overall survival, toxicity, quality of life, or cost effectiveness.
Palliative care in Australia and New Zealand
Authors: O’Connor Margaret
Published: November 2017

The purpose of this chapter is both to profile palliative care in Australia and New Zealand and to provide insights into key innovations, focusing on developments in areas of education and training; research; policy and international links; and advanced practice roles education, policy, and international links.
Palliative care in Latin America
Authors: Pastrana Tania , Parra Giordano Denisse Ruth , Sánchez Cárdenas Miguel Antonio , Montoya Xiomara Carmona , de Oca Beatriz Montes
Published: November 2017

This chapter focuses on palliative care in one Portuguese-speaking country (Brazil) and eighteen Spanish-speaking countries (Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, and Venezuela). The challenge for palliative care in Latin America is to develop a model of care appropriate to the sociocultural context and integrated to public health, including suitable policies, education, and implementation of palliative care programs to all levels of society.
A good death
Authors: Walker Gay
Published: November 2017

Using the case study “Maddie‘s Story,” this concluding chapter discusses how specialized pediatric palliative care helps terminally ill children and their families navigate through their complex journey at end of life and beyond. Through pediatric palliative care, children can experience a “good death,” and family and friends can indeed experience peace and opportunity.
Rural palliative care
Authors: Bakitas Marie A. , Clifford Kathleen N. , Dionne-Odom J. Nicholas , Kvale Elizabeth
Published: November 2017

Providing palliative care to persons living in rural areas across the globe presents significant barriers including: transportation, geographical and economic challenges, and often a lack of local clinicians with expertise and resources to provide complex palliative care services. Strategies are being designed and successfully implemented to meet the challenges of rural palliative care, including telehealth, phone-based care, specially trained lay community workers, and academic-community partnerships.
Deliver Us from Certainty: Training for Narrative Ethics
Authors: Irvine Craig , Charon Rita
Published: November 2017

This chapter summarizes the application of philosophical thought in healthcare with the rise of bioethics in the United States. The dominant approach, a rule-based principlism, is described, with a summary of challenges to principlism including casuistry, virtue ethics, and narrative ethics. Narratologists examine the ethical relationships between readers and texts, while clinicians and bioethicists practice narrative ethics through a “ground-up” attention to each patient’s particular needs and desires. Revealing the commonalities between the ethics of reading and the ethics of clinical practice, the chapter proposes the fruitfulness of putting them side by side. Training in narrative medicine may be the optimal training for those who practice narrative ethics in clinical settings, for the major tools of narrative ethics are those fortified by close reading, use of the imagination, radical humility, and the capacity to represent situations so as to fully perceive them.
Creativity: What, Why, and Where?
Authors: Hermann Nellie
Published: November 2017

Creativity is at the center of narrative medicine’s work. It lets clinicians perceive and imagine what their patients undergo, lets patients articulate events of illness, and lets all acknowledge their own complex experiences in healthcare. The chapter proposes that creativity is present in our everyday lives, whether or not we are artists. Creativity is an openness to uncertainty and doubt, an expansion of the mind, a way of being in the world that quickens the spirit. The chapter explains the interior processes of writing about one’s own life and the consequences of having written. It details the forms and dividends of creative writing in narrative medicine and describes the roles and goals for creative writing in healthcare. Without distinguishing between “great writers” and the rest of us, the chapter expresses plainly and deeply the human necessity for bringing forth from within the self the unsaid experiences of life.
Cognitive Load Theory and Patient Safety
Authors: Harry Elizabeth , Sweller John
Published: November 2017

Effective patient care depends on the ability to store and retrieve patient information and medical knowledge. All knowledge is either acquired from the environment or created de novo through trial and error. In either case, cues from the environment are filtered through working memory to attempt to guide action. Psychological principles such as resource theory and cognitive load theory suggest that humans have a limited amount of working memory that can be used to assimilate new information. When working memory is overloaded (i.e., cognitive overload), one’s attention is limited to fewer salient patient data pieces and one will naturally begin to ignore potentially crucial information. Cognitive overload can occur as a result of highly complex information, poorly organized information, distracting environments, or provider physiology. Attention to factors that lead to cognitive overload are critical in designing safe patient care systems.
Situation Awareness
Authors: Schulz Christian M.
Published: November 2017

In anesthesia, situation awareness (SA) represents the degree to which an anesthetist perceives the information in her or his environment, comprehends the patient’s situation, and projects the patient’s situation into the future. There are three levels of SA: perception, comprehension, and projection. After perception, basic information has to be integrated, and several cognitive mechanisms enable correct, complete, and quick development of SA. These processes require long-term memory content such as mental models, similar (prototypical) situations that have been experienced earlier, automaticity, and medical knowledge including guidelines and algorithms. Several tools have the potential to provide qualitative and quantitative assessment of SA in anesthesia, including goal-directed task analysis (GDTA) and SA error taxonomy. In this chapter, the role of SA in anesthesia is illustrated, and factors are described that have the potential for either enhancing or hindering the development of adequate SA.
Complex Systems and Approaches to Quality Improvement
Authors: Riskin Loren , Macario Alex
Published: November 2017

This chapter, “Complex Systems and Approaches to Quality Improvement,” serves as an introduction to complex systems management and current thinking in improvement science. It explains the context behind quality improvement (QI) initiatives, beginning with a discussion of the ultimate goals of this movement. It then briefly reviews the history of QI development and early leaders in the field. The universal elements of a successful QI or patient safety project are discussed, followed by the exploration of commonly encountered barriers to systems and individual improvement. The chapter also highlights the differences between QI work and traditional research study. Selected tools to examine and prevent risk are explored, including informal approaches, Deming’s model for improvement, Six Sigma, healthcare failure mode and effects analysis (HFMEA), and root cause analysis (RCA).
Regulating Quality
Authors: Lagasse Robert S.
Published: November 2017

Governmental regulation has attempted to lower healthcare costs and improve quality. In the 1980s, diagnostically related groups (DRGs) shifted Medicare hospital payments from a cost-based system to a condition-based system. More recently, the Affordable Care Act (ACA) funded value-based purchasing initiatives through reductions in DRG payments. The ACA also established Accountable Care Organizations that must be willing to be accountable for the quality, cost, and overall care of Medicare beneficiaries in a “medical home” model. On the physician side, a Merit-Based Incentive Payment System is replacing the Sustainable Growth Rate formula. The effect of regulation may be uncertain, but further change seems inevitable.
Health Information Technology Use for Quality Assurance and Improvement
Authors: Doyle Christine A.
Published: November 2017

Health information technology (HIT) has become an important part of patient care, and can provide useful solutions for a quality assurance and improvement (QA&I) program by illustrating current quality and demonstrating gaps in quality that can be targeted for improvement. Like any other information technology project, however, HIT solutions can give misleading results if the wrong information is selected for review or if there are systematic errors in data handling. Although many health information systems are sometimes maligned as a glorified statistical tool or billing document, well-designed and implemented anesthesia information management systems (AIMS), perioperative electronic health records (EHR), and other software solutions can provide an excellent vehicle for use in quality programs. When planning the implementation of a major HIT project, it is usually best to start at the “end”—the desired workflow and goals of the project—and then work backward.
Operating Room Fires and Electrical Safety
Authors: Cohn Stephan , Klock P. Allan
Published: November 2017

Understanding electrical systems and fire safety protocols in the operating room is fundamental to patient and staff safety. Modern operating rooms are designed to reduce the risk of electrical hazards. Line isolation transformers were developed in the era of explosive anesthetics to reduce the risk of sparks and macro-shock. Isolated electrical supplies are still used in operating rooms because they allow surgery to continue while the line isolation alarm is activated and the source of the fault is investigated and deactivated. Ground fault circuit breaker interrupters may also be used in operating rooms, but if a fault is detected, they will deactivate the electrical circuit, which may be disruptive to surgical or anesthetic care. Micro-shock occurs when a small amount of current is delivered directly to the myocardium via an indwelling catheter or pacing wire. Operating room fires, though relatively rare, can cause devastating patient injury but are largely preventable.
Managing Adverse Events
Authors: Staender Sven
Published: November 2017

The focus of anesthesiologists’ training and activities concerns the management of critically ill patients and the avoidance of catastrophe, rather than management of the aftermath. Anesthesiologists spend years acquiring technical expertise, and there are checklists for dealing with complications. Anesthesiologists have accumulated an immense knowledge in physiology, pathophysiology, and pharmacology, but there is little understanding of how to deal with the overwhelming emotions that occur after a severe complication or adverse event. Death or severe harm to a patient under an anesthesiologist’s care may be rare, but can significantly impact a professional’s ability to care for patients and may also affect his or her life outside the hospital.
Muscle
Authors: Kjaer Michael , Mackey Abigail
Published: November 2017

Skeletal muscle is not only essential for human movement and performance, but is unfortunately also a common site for acute injuries related to physical activity and sports. The influence of exercise on skeletal muscle represents a wide range all the way from (i) physiological adaptation with regard to metabolism, morphology, and contractile properties, through (ii) physiological development of muscle hypertrophy, to (iii) pathological/physiological responses to heavy unaccustomed exercise with associated delayed onset of muscle soreness, and ending with (iv) muscle injury caused by either strain or contusion (and seldom laceration) trauma. In the present chapter we will focus on the muscle responses to acute stimuli that cause muscle injury of minor or larger magnitude, and the ensuing recovery....
Meniscus
Authors: Blain Emma , Duance Victor
Published: November 2017

Menisci are present in several locations, e.g. the acromioclavicular joint (Tischer et al. 2009), the temporomandibular joint (Tanaka et al. 2008), and the tibiofemoral joint. All are susceptible to sports injuries, but the most prevalent are to the knee. Therefore only the meniscus of this joint will be considered in detail in this chapter....
Articular cartilage
Authors: Roberts Simon
Published: November 2017

Synovial joints allow the efficient and controlled movement necessary for sport with a biological shock-absorbing bearing of hyaline cartilage. This is an extremely low friction surface, with a coefficient of one-sixth of that of ice on ice, lower than most man-made bearing materials. It has viscoelastic properties allowing dynamic congruity and minimization of transmitted pressure and impact....
Training, recovery and adaptation
Authors: van Someren Ken , Howatson Glyn
Published: November 2017

Organized physical training in the pursuit of sporting excellence is not a recent phenomenon. Reports of structured athletic training programmes date back to the ancient Greeks, when they were used for both military and Olympic preparation. Despite an extensive history, it was not until the mid to late twentieth century that what is now considered a scientific approach to training theory developed. The description of the General Adaptation Syndrome by Dr Hans Selye in 1956, which examined the relationship between training stress and adaptation, and the work of Metveyev, Harre, and others in the 1970s and 1980s developed the foundation of training theory and its application to athletic training programmes....
Radiology
Authors: Bearcroft Philip
Published: November 2017

A number of radiological techniques are available for the evaluation of the injured athlete. In this chapter each technique will be considered in turn. The technique will be explained first in terms of technical aspects together with variations on the basic theme. Then the strengths and weaknesses of each technique will be described together with specific clinical uses. Understanding the strengths and weaknesses of these techniques will allow a rational approach to imaging of these patients, leading to a rapid accurate diagnosis and effective treatment process....
Pharmacological pain management in sports injuries
Authors: Speed Cathy
Published: November 2017

The perception of pain is a biological mechanism which warns that damage has occurred and protects against further damage, allowing healing to occur. Acute pain often acts as an indicator of injury severity and progression or healing. The same may apply in some with chronic injuries, but in others pain may not correlate with tissue damage and/or may not be a sign that the tissue needs to be protected from mechanical stress. The management of most sports injuries involves early mobilization where possible, and pain management in the treatment of these injuries is important to allow rehabilitation to proceed and to ease distress. Modalities play an important role in this respect, and are discussed elsewhere (Chapter 2.4). Injection therapies are also discussed elsewhere (Chapter 2.6). Thorough counselling of the athlete is a priority to ensure that he/she understands what the pain represents, as this will be likely to affect compliance. For example, a degree of pain during eccentric exercise protocols in the rehabilitation of chronic tendinopathies would be anticipated, and would not contraindicate continuation of a set programme. In contrast, when an athlete is returning to sporting activities after injury, pain that is experienced during the activity would not be acceptable, and the athlete is also advised during this period that conclusions as to the tissue’s reaction to activity should not be drawn until the day after the training session. Athletes should also be taught appropriate self-help strategies to manage their pain and when this involves medication, how and when to take it. Principles for the use of medications in pain management are given in ...
Orthotics
Authors: Dixon Sharon , Roberts Sophie
Published: November 2017

An orthotic is a custom-made insole which fits inside a shoe with the purpose of changing the way in which the foot functions during both standing and dynamic gait. There are many theories regarding the influence of these devices on the foot and lower limb. It is widely accepted that the fundamental principle is that an orthotic encourages a change in the movement pattern of the foot, aiming to alleviate stress to musculoskeletal structures, and produce changes in muscle firing patterns. An example of how an orthotic works is when one is used to change the functioning position of the medial longitudinal arch of the foot by altering the orientation of the calcaneus and potentially reducing the demand on the tibialis posterior tendon....
Injuries to the elbow and forearm
Authors: Speed Cathy
Published: November 2017

Elbow injuries in sport can affect any athlete in relation to trauma, but overuse injuries are seen most frequently in overhead/throwing athletes and gymnasts across a wide age spectrum. The consequences of such injuries can be serious and result in loss of time in training and competition. The close interplay between the shoulder and elbow as part of the kinetic chain is well illustrated by the fact that, in those recreational tennis players with a history of lateral epicondylitis, there is a 63% greater incidence of shoulder injury (...
Injuries to the lower leg
Authors: Speed Cathy , Ribbans Bill
Published: November 2017

The lower leg is one of the most common sites of injury in sport, particularly involving acute and chronic injuries to muscle and bone. For example, almost 50% of stress fractures are seen in the tibia, and over 6% affect the fibula (Matheson et al...
Knee injuries
Authors: Colaco Henry , Haddad Fares , Speed Cathy
Published: November 2017

The knee is a synovial hinge joint which achieves a range of movement of 0°–150° flexion with a complex combination of sliding, gliding, and rolling movements. The three components involved are the medial and lateral compartments of the tibiofemoral joint and the patellofemoral joint. The joint is lined with hyaline articular cartilage and stability is primarily provided by the joint capsule, menisci, ligaments, and muscles....
Injuries to the foot
Authors: Ribbans Bill , Speed Cathy
Published: November 2017

Injuries to the foot and ankle are common in sport and considered to represent 10–15% of all sports injuries. The demands of running, jumping, turning, and cutting inevitably take their toll on this complex anatomical region. Even minor injuries can cause significant dysfunction. Adverse biomechanical issues may cause injury to the foot itself and frequently result in injury elsewhere in the lower limb, lumbar, or pelvic regions....
Disability sport
Authors: Webborn Nick
Published: November 2017

Disability sport is the term used for any sport undertaken by someone with a disability and in this respect is all encompassing. The word ‘Paralympic’ is the term applied to elite sport competition for people with disabilities who have physical or visual impairments. It is derived from the Greek word ‘para’ meaning ‘alongside’ and the word ‘Olympic’, i.e. it is ‘parallel to the Olympics’. The International Paralympic Committee was formed in 1989 and is the overall body that organizes the summer and winter Paralympic Games. There are 20 summer Paralympic sports and five winter Paralympic sports. Reference to injuries in these sports will be discussed in this chapter rather than injuries in disability sport in general which is too broad a topic....