bluuebunny/crossref_metadata_2025 huggingface dataset:
What is Duncan Jopp’s crime?
Authors: Rowson Martin
Published: November 2023

The Oedipal struggle between Archie Hermiston and his awesome, hanging-judge father reaches a crisis in Chapter 3 –– ‘In the Matter of the Hanging of Duncan Jopp.’ The chapter opens:

It chanced in the year 1813 that Archie strayed one day into the Judiciary Court. The macer made room for the son of the presiding judge. In the dock, the centre of men’s eyes, there stood a whey-coloured, misbegotten caitiff, Duncan Jopp, on trial for his life. His story, as it was raked out before him in that public scene, was one of disgrace and vice and cowardice, the very nakedness of crime; and the creature heard and it seemed at times as though he understood –– as if at times he forgot the horror of the place he stood in, and remembered the shame of what had brought him there. He kept his head bowed and his hands clutched upon the rail; his hair dropped in his eyes and at times he flung it back; and now he glanced about the audience in a sudden fellness of terror, and now looked in the face of his judge and gulped. There was pinned about his throat a piece of dingy flannel; and that it was perhaps that turned the scale in Archie’s mind between disgust and pity.
How old is Kim?
Authors: Rowson Martin
Published: November 2023

Alan Sandison notes in his introduction to the World’s Classics edition of Kim that ‘As a physical being, Kim remains a rather shadowy figure’ (p. xvii). One of the shadowier aspects of Kipling’s young hero is his precise age during the first half of the narrative –– the period of his Indian liberty before he is (reluctantly) made a ‘Sahib’. The opening encounter finds Kim –– indistinguishable from Hindu lads of his age –– playing ‘King of the Castle’ astride the great gun Zam-Zammah (a symbol of the mastery of the Punjab, as Sandison points out). ‘King of the Castle’ is, of course, child’s play. The brief description which Kipling gives of the game suggests the players are very childish indeed: At this point, Kim has his first astonishing sight of the Lama, whose chela, or guide, he is to become.
Where does Fanny Hill keep her contraceptives?
Authors: Rowson Martin
Published: November 2023

I first read Fanny Hill (or, more properly, Memoirs of a Woman of Pleasure) in the 1950s, when it was still a banned book. A friend loaned me a much-thumbed copy, vilely printed in Tangiers, and evidently smuggled in by a merchant sailor. Any bookseller handling Cleland’s ‘erotic masterpiece’ in 1955 would have faced prosecution. British schoolboys caught with the book might expect instant expulsion. Adults found in possession would probably receive a formal police warning and summary confiscation of the offending object (which, one guesses, would be eagerly pored over at the station). Fanny Hill was a much less exciting text after it –– along with Lady Chatterley’s Lover –– was ‘acquitted’ and became a legal high street commodity. It was elevated to classic status by Penguin in 1985 and by OUP as a World’s Classic in the same year. Doubtless some of the more adventurous Alevel boards will soon be prescribing Fanny Hill as a set text and the BBC will chip in with a ‘Book at Bedtime’ version.
Why ‘Captain’ Newton?
Authors: Rowson Martin
Published: November 2023

The names in Ralph the Heir are very confusing –– no less than four ‘Ralph Newtons’ figure in the plot, for instance. But the romantic story at the novel’s centre is straightforward enough. Ralph Newton (‘the heir’) is parentless and has been looked after by the lawyer Sir Thomas Underwood in the office of guardian. Underwood–– a superannuated widower –– has two daughters. Patience, the elder, is her father’s housekeeper and is ‘certainly not pretty’. The younger, Clarissa, is ‘a beauty’ and the family pet. Underwood also has another ward living in his Fulham villa, Mary Bonner, a surpassingly beautiful young orphan from the West Indies. Ralph opens proceedings by lightly proposing marriage to Clarissa (‘Dear, dear Clary, –– you know I love you’) during a summer’s day lounging by the Thames, dressed fetchingly in his straw hat and Jersey shirt. She tacitly accepts his offer. Clarissa, meanwhile, is loved faithfully by Ralph’s younger brother, Gregory, a dutiful clergyman.
How many siblings has Dobbin?
Authors: Rowson Martin
Published: November 2023

In a late ‘Roundabout Paper’ Thackeray makes a charming mea culpa on the subject of his propensity to small narrative error:

It is uncivil of the reader to dwell upon these little slips. George Saintsbury, noting Thackeray’s tendency to misquote from memory, is even in two minds as to whether the conscientious editor should correct such errors. Saintsbury, in his authoritative ‘Oxford’ edition of the collected works, decided not to for the good reason that, as he says, Thackeray’s misquotations are usually improvements –– improvements, that is, on such sources as Horace, Shakespeare, or the Bible (Saintsbury had a high opinion of his author).

Thackeray’s slips of name or detail cannot be said to be improvements of this kind, but they often witness to the suppleness of his narrative and his serialist’s quick wits.
Heathcliff’s toothbrush
Authors: Rowson Martin
Published: November 2023

Judged purely by his actions Heathcliff is a villain: a wifebeater; a child-abuser, a white-collar thief, and –– as I would maintain –– a murderer. The murder, moreover, is a peculiarly sordid and cold-blooded crime. None the less readers, even those who accept that he probably killed his foster-brother Hindley, persist in seeing Heathcliff as a heroic and tragic figure. There is no obvious clash when glamorous matinée idols like Laurence Olivier and Timothy Dalton, or paragons of showbiz Christianity like Cliff Richard, play him on film, television, or stage.

An explanation for this ‘sympathy for the devil’ paradox is to be found in a muttered ejaculation of Heathcliff’s, overheard by Nelly in the intensity of his grief and sexual frustration after Cathy’s death: ‘I have no pity! I have no pity! The [more the] worms writhe, the more I yearn to crush out their entrails! It is a moral teething, and I grind with greater energy, in proportion to the increase of pain’ (p. 152; my italics). The key to our sympathy for Heathcliff, I have suggested, is to be found in that arresting phrase, ‘moral teething’, and what it implies –– particularly to parents:
Is Betsey Trotwood a spinster?
Authors: Rowson Martin
Published: November 2023

In Can Jane Eyre Be Happy? I referred in passing to Miss Trotwood, in David Copperfield, as a ‘spinster’. Donald Hawes writes to correct the error: ‘Of course she uses her maiden name and lives as a single woman (as we’re told in Chapter 1). But she was a married woman, in fact, who separated from her husband.’ Professor Hawes adds:

The second wife is indeed puzzling, as is the mis-titling of Miss (‘Mrs’) Trotwood by someone as close to Dickens in the planning of his fiction as Forster. Once pointed out, it is tempting to follow up the ‘Mrs Trotwood’ puzzle for what it reveals about Dickens’s use of peripheral detail, and his habit of keeping latent plots ‘in reserve’ (as I will argue).
How long is Alice in Wonderland for?
Authors: Rowson Martin
Published: November 2023

The above is a minor puzzle among those in the most puzzle-packed of Victorian narratives, Alice’s Adventures in Wonderland. The story opens:

It is, we apprehend, gloriously high summer. The ‘hot day’, the daisies, and the dress in which Tenniel portrays the little girl confirm this seasonal dating. It would be logical to assume the setting in Carroll’s mind was 4 July 1862; the day, that is, when Charles Lutwidge Dodgson took Alice Liddell, and her sisters Lorina and Edith, on the boating trip on the Cherwell. On that day, as literary history records, Alice’s Adventures in Wonderland was conceived as an entertainment by the maths don for his young guests.
Elms, limes, or does it matter?
Authors: Rowson Martin
Published: November 2023

George Eliot’s huge canvas in Middlemarch allows the author the opportunity for luxuriant scene painting. One location, central to the narrative, is described in loving detail–– Mr and Mrs Casaubon’s married home. Although –– as a beneficed clergyman –– he has the Lowick living, Edward Casaubon lets the rectory and lives in the nearby manor-house (inherited on the death of his elder brother). We are given an estate agent’s eye-view of Lowick Manor when Dorothea, a bride to be, calls to inspect her future home, on a ‘grey but dry November morning’, in Chapter 9:

It is not entirely clear to the mind’s eye, but it seems that a ha-ha has been banked up to hide the public thoroughfare from which one turns down the private avenue of limes to approach the manor house. As one looks out from the windows of the house, the road is invisible. For the person looking out of its windows the prospect gives the impression of a huge estate, rather than a modest country house surrounded by working farms.
Ten
Authors: Robinson Jane
Published: November 2023

Outside the station a square, a little garden in the middle, and in the middle of the garden a statue. Beyond, a broad avenue, a string of droshkies, a queue waiting beside a shelter. The sky blazes with stars. It is bitterly cold. The stars are like chips of ice. We make inquiries. The town is some distance from the station, some miles. There is a ‘bus. We stand in the queue for a little while that seems a long while. Our feet freeze. We stamp and shuffle, but it is no good. Our feet are like blocks of ice. Samarkand is an oasis; we are surrounded by desert. Why do none of the people who write romantically about desert nights mention the bitter cold that descends on the desert after sundown? We ask the patient, motionless, shawled figure in front how often the ‘buses run, if she has any idea when there will be a ‘bus. She regards us stolidly.
Japan And South-East Asia
Authors: Robinson Jane
Published: November 2023

On the Anggrek III it was hellish dark and smelt of cheese. The air was thick, the sky pitch black with the stars obscured; all sight of land was obliterated and the tropical heat was fast giving way to a damp, clammy chill. Under a torn, flapping tarpaulin over the front of the Chinese steamer, the only light came from a thumb-sized bulb swinging on the end of a ragged flex and the occasional sparks as its naked wires hit a metal plate. The smell was overpowering; oil, rust, stale spiced food, rotting fish, damp canvas, the cloying odour of salt, stale vomit and old sandals. The crew were a motley collection of youths in tattered jeans, and old, almost hairless men with sagging bellies and tired eyes.
More time-dependent processes
Authors: Cruickshank Steven
Published: November 2023

We constructed a model for the steady state Pac2o that results from any CO2 production Vco2 and alveolar ventilation VA (1.3). This model described the level at which the Paco2 ‘settles down’ after any change, but did not attempt to predict how the system behaves in moving from one steady state to another. This is our next task, and we should discover that we have done most of the hard work already with the N2 washout/O2 wash-in example.
The one-compartment model
Authors: Cruickshank Steven
Published: November 2023

Pharmacokinetics is the study of the time course of drug disposition. Pharmacokinetics is dependent upon model-building and these models tradition ally cause much anguish to students. Pharmacokinetic models are identical in principle to those we have been studying and the lessons we have learnt, for instance in modelling Paco2 or FAN2 changes with time, should make coping with these models quite straightforward.
Fourier analysis
Authors: Cruickshank Steven
Published: November 2023

We have seen how a simple sinusoidal waveform arises from the modelling of a mass-spring system. Although this is cyclical, it does not otherwise much resemble the typical blood pressure waveform that we wish now to model. It is possible by the use of the technique of Fourier analysis to reproduce any repetitive waveform by a process of adding simple sinusoidal functions, and we shall use this technique to produce a replica of a typical arterial pressure wave. This process is simple in principle and in practice is carried out by computer. The underlying theory is, however, outside our scope and we shall adopt the usual graphical approach to demonstrate the process. This method is equally applicable to other cyclical phenomena—respiratory or ICP waveforms, for example.
Inverse functions
Authors: Cruickshank Steven
Published: November 2023

A simple but important concept is that of an inverse function, which ‘undoes’ the work of another function. If we think of a function as a sausage machine-we put in the raw material (input range value), and out of the machine (rule) comes the sausage (function value) —an inverse function takes the sausage and gives us back the raw material. This is perhaps most easily seen with the quadratic and square root functions. It is not easily seen with a sausage machine.
Exponential & logarithmic functions
Authors: Cruickshank Steven
Published: November 2023

The exponential function is of enormous importance in mathematical modelling. We have examined the properties of the polynomial functions y = a+ bx+ cx:2 + dx-1 + ... (2.7); where the variable x appears in various powers-that is, multiplied by itself a number of times. We fix the coefficients and powers for our function rule and see how the function value varies with varying x.
Maxima and minima
Authors: Cruickshank Steven
Published: November 2023

We often wish to know if a function has a maximum or a minimum value, and if so, where. Differentiation is the key to finding maxima and minima. To have a maximum value, the function must increase ( +ve gradient) and then decrease (-ve gradient) as x increases. To have a minimum value, the function must decrease (-ve gradient) and then increase ( +ve gradient) as x increases. In passing from +ve to -ve or vice versa, the gradient must be zero at the minimum or maximum point if the function is continuous. If we can determine where the gradient is zero, we have found a maximum or minimum
Simulating random events: anaphylactoid reactions to anaesthesia
Authors: Cruickshank Steven
Published: November 2023

Severe anaphylactoid reactions to general anaesthesia are rare. Let us suppose that reactions of a defined severity occur in about 1 in 5000 general anaesthetics. A city anaesthesia service administers 25 000 anaesthetics annually. How many such reactions might be expected annually? It does not require penetrating statistical insight to conclude that we expect there to be five. But what do we mean by the expectation of five reactions per annum? We know that such events tend to occur ‘at random’-which means that SIJ-Ch occurrences are largely unpredictable and unconnected with each other. This randomness means that we would actually be very surprised if our expectation of five events annually was fulfilled each year. We expect considerable variability around our expected value, but ‘on average’ there would be about five.
Overcoming the barriers to implementing change in medical education
Authors: Towle Angela
Published: November 2023

Calls for reform of medical education are occurring in many countries throughout the world, and with increasing frequency (see Chapter 1). Within the USA alone, there have been at least twenty four major reports this century advocating reform, seven since the seminal General Professional Education of the Physician (GPEP) report of 1984. The rate of publication has increased to almost one per year. Typically, these reports identify similar problems with medical education, claim that previous reports have gone unheeded, argue that reform is essential and urgent, and prescribe corrections that are strikingly similar (Christakis 1995).
Wound instillation and infiltration
Authors: Mather S J
Published: November 2023

Wound infiltration and ‘field block’ are very commonly used in paediatric anaesthesia, particularly if a regional technique has not been employed. Local anaesthetic agents can be injected pre- or postoperatively by the anaesthetist or the surgeon. Additionally, solution can be instilled into open wounds before closure, when the local anaesthetic will ‘fix’ on to the tissues.
Upper limb blocks
Authors: Mather S J
Published: November 2023

These blocks, like most regional techniques in children, are usually used to supplement light general anaesthesia and more especially to provide good postoperative pain relief. Younger children are unlikely to tolerate the performance of anything other than wound infiltration without heavy sedation or general anaesthesia. Daleus, however, recommends brachial plexus blocks for emergency surgery on fractures of the arm in children with a possible full stomach. Axillary blocks alone are only really suitable for operations on the ulnar side of the forearm and hand as the musculocutaneous nerve is rarely blocked by this approach.
Investigating ischaemic heart disease
Authors: Ormerod Oliver
Published: November 2023

Cardiovascular disease is one of the major causes of death in western societies. In recent years there has been immense progress in diagnosis and pharmacological and surgical treatment of ischaemic heart disease. Vascular events are unpredictable and an acute coronary occlusion carries a high risk of mortality and possible subsequent morbidity for the individual, their family, and society should the patient survive. The proven benefit of therapeutic interventions in controlling symptoms and also improving prognosis in certain patient groups has encouraged physicians to seek out the symptoms of ischaemic heart disease and consider intervention earlier in the natural history of this disease.
Conduits for coronary artery surgery
Authors: Allen S M , Bonser R S
Published: November 2023

Relief of symptoms and long-term survival following coronary artery bypass grafting correlate to patency of the bypass conduit. Although early patency is determined by operative technique and the severity of pathological changes in the operated artery, the long-term patency depends upon the conduit used. The ideal conduit will respond to physiological and anatomical requirements, will be available in sufficient quantities for complete revascularization, and will remain patent for the lifetime of the patient. No currently available conduit matches these ideals. An operation for myocardial revascularization therefore needs to be tailored to maximize the advantages and disadvantages of the available conduits within the constraints dictated by the patients age and risk factors, the urgency of treatment. and the experience and expertise of the surgeon.
Surgery for complication of ischaemic heart disease
Authors: Tsang G M K , Bonser R S
Published: November 2023

Ischaemic heart disease is the most common cause of death in developed countries. Acute myocardial infarction (AMI) causes approximately 150 000 deaths per year in the UK and 500 000 deaths per year in the US. More than 60% of deaths associated with AMI occur within 1 hour of the event and are attributed to arrhythmias, mostly ventricular fibrillation. The in-hospital mortality for AMI is 10-15%. Most deaths are attributable to myocardial failure, a subset of which are secondary to mechanical complications.
Alternative approaches for coronary artery bypass grafting
Authors: Tsui Steven S L , Dunning John J
Published: November 2023

The past decade has seen a wave of enthusiasm for the use of limited access and minimally invasive techniques in the performance of surgical procedures. The rationale for using these approaches is to reduce the morbidity associated with surgical procedures, thereby minimizing the amount of time taken for patients to recover from their operations. This should in turn reduce the postoperative hospital stay and consequently enable an earlier return to normal for the patients. Cardiac surgery is no exception to this vogue. Over the recent years, many surgeons have developed ingenious methods, some of which are less invasive than the conventional approaches. Minimally invasive approaches have been described for most routine cardiac surgical procedures including coronary artery bypass grafting (CABG) valvular repairs and replacements.
Long-term survival following coronary artery bypass grafts
Authors: Treasure Tom , Batrick Nicola
Published: November 2023

Coronary artery bypass grafting (CABG) is 30 years old and enormous numbers of operations have been performed over the last 20 years. It has probably been studied more extensively than any other surgical procedure and yet, when we come to review the long-term results, there are substantial gaps in our knowledge. Several problems confound any attempt to interpret the effects of the operation on the long term outcome for the patient.
Epidemiology of coronary artery bypass surgery
Authors: Newton John N
Published: November 2023

In this chapter, the pattern of use of CABG surgery is described, principally in the US and the UK, and the question of what constitute an appropriate level of intervention is considered. Statistics on coronary artery surgery are remarkable because of dramatic changes in surgical rates, and in the patient population, over the last two decades and because of obvious variation in surgical rates between countries, and between different areas of the same country.
Why treat pain?
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva
Published: November 2023

The most important reason for treating pain is a basic humanitarian concern; the first requirement of medicine being to alleviate suffering. Good analgesia will reduce patient discomfort and minimize the associated psychological distress. The beneficial effects on several organ systems of better pain control may lead to improved outcome and a reduction in hospital stay. The adverse effects of pain and the stress response to surgery are illustrated in Fig. 3.1. Postoperatively, most patients show a major reduction in pulmonary function with lung volumes and flows depressed by 20-60 per cent of preoperative values. This is most obvious in patients who have undergone thoracic and upper abdominal surgery. Coughing and clearing of secretions is markedly impaired when surgery is close to the diaphragm. In addition, since movement results in pain, the diaghragm is held taught and ‘splinted’. Gas exchange is abnormal and the development of atelectasis and pneumonia result in significant morbidity.
Psychological aspects of acute pain
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva
Published: November 2023

Emotional state and personality modify our response to pain at the brain level; they do not affect peripheral pain thresholds. The most commonly studied personality traits are extrovertism and neuroticism. Extroverts are believed to complain more about their pain and may receive more analgesics in clinical situations. Patients with high neurotic-scale scores may rate their pain much higher in studies. Pain is not only associated with the idea of bodily harm but also more complex feelings of guilt, loss, and punishment that may accompany the injury. A patient’s strategy for responding to these conflicts may serve to worsen or alleviate the distress. The processes of denial, dissociation, and distraction may help to lessen the pain, whereas patients who catastrophize (characterized by negative attitudes and overly negative thoughts and ideas) will cope less well with their pain. Patients will have acquired these individual strategies from previous experience of pain and their socio-cultural development.
Pharmacology of local anaesthetic agents
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva
Published: November 2023

Local anaesthetic agents produce a transient inhibition of nerve impulse conduction. Normally when a nerve transmits an impulse its permeability to sodium is increased, resulting in a change in the electrical state of the cell (depolarization). When local anaesthetics are used the permeability of the cell membrane to sodium is reduced. This results in a slow rate of rise of the depolarization potential and failure to achieve the critical threshold for the propagation of the electrical change (action potential). Local anaesthetics can be used to block the transmission of painful stimuli at any point from the peripheral nerve to the spinal cord. The basic chemical structures of the local anaesthetic agents in current use are shown in Fig. 12.1.
Epidural analgesia
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva
Published: November 2023

Epidural analgesia is an invasive procedure which has a number of benefits. It provides optimal analgesia for operations on the lower limbs, abdomen, and thorax and allows effective chest physiotherapy in the presence of abdominal and chest incisions. It also minimizes the sympathetic stimulation of the heart which in tum decreases the oxygen demand of the heart and may decrease myocardial isehaemia. By avoiding the need for intravenous and intramuscular opioids, the epidural minimizes the sedative and respiratory depressant effects of these drugs and allows earlier return of gut function. In obstetrics, it provides optimal analgesia for labour which can be easily supplemented for a caesarian section, thus avoiding the risks of emergency general anaesthesia.
Talking to Cancer Patients and Their Relatives
Authors: Faulkner Ann , Maguire Peter
Published: November 2023

Effective communication with patients suffering from cancer and their relatives is essential for providing the best possible standards of care. This practical guide will help you to improve your ability to recognize and respond to the physical, psychological, and spiritual problems which cancer patients experience. For the first time in one volume, practical guidelines which have proven efficiency over years in clinical practice are presented. Real dialogues illustrate a clear model of eliciting, assessing, and responding to patients' needs and concerns with an emphasis primarily on the skills and strategies needed for effective communication between health professionals and patients trying to adapt to a fear-provoking diagnosis and an uncertain future. The book also provides invaluable guidance on how to deal with your own emotional responses to the challenges faced in working with seriously ill people. Everyone who cares for cancer patients will benefit from the sympathetic yet practical advice offered in this book.
Aggression and sadism in the perversions
Authors: Glasser Mervin
Published: November 2023

Anyone considering sexual deviance should keep in mind the distinction between a true perversion and the deviant elements which may feature in the sexual life of normal people or people suffering from various forms of disturbance. The vast majority of people may, from time to time, indulge in sexual fantasies which deviate from the culturally accepted norms, and many people may even put such fantasies into occasional practice, particularly as foreplay.
Benign gynecological conditions: changing indications for surgery
Authors: Chapin David
Published: November 2023

The field of gynecologic surgery includes procedures of two types: those that deal with the treatment of life-threatening diseases such as cancer or obstetrical catastrophe, and those that deal with improving the quality of life by treating conditions such as menstrual disturbances, infections, infer tility, incontinence, and less serious complications of pregnancy. Here we will discuss those quality-of-life procedures, which include dilatation and curettage, laparoscopy, and hysterectomy. These widely performed procedures are sur rounded by an atmosphere of tradition, emotion, and controversy, with very little documentation of their effectiveness, safety, or cost-to-benefit ratio. I will consider the epidemiology, history, and current understanding of these procedures, review what little literature exists, discuss the interplay between societal forces and medical practice, predict future directions, and suggest areas of future research.
Maternal mortality and morbidity
Authors: Rosenfield Allan
Published: November 2023

There have been extraordinary advances in health care in the industrial countries of Europe, North America, and Japan since the turn of the century, with par ticularly dramatic declines in both infant mortality rates and maternal mortality ratios*. But these advances have been slow to spread to the poorer developing countries of Asia, Latin America, and Africa. This has especially been the case with women’s health care generally and with maternity care more specifically. As a result, there is a very significant differential in maternal mortality ratios, even greater than the differential in infant mortality rates, between the developed and developing world. The maternal mortality ratio in rural areas of a poor developing country may be as high as 1000 per 100 000 live births, as compared with ratios in Europe and North America of between eight and 15 per 100 000 live births. What makes this situation so tragic is the fact that the vast majority of pregnancy-related deaths are preventable with relatively inexpensive existing technologies (Rosenfield 1989; Rosenfield and Maine 1985; UNICEF 1989).
Prevention of preterm birth in France
Authors: Papiernik Emile
Published: November 2023

A fetus is considered mature when the pregnancy has lasted 37 weeks since the first day of the last menstrual period (LMP). Preterm birth is defined as a birth before the fetus has reached maturity.
Screening for the abnormal baby
Authors: Reilly Philip R
Published: November 2023

During the last two decades, striking advances in our ability to search for warning signs about a developing fetus have helped many pregnant women. ln this chapter I shall describe several major screening programs that have or may become standard practice. I shall also consider some legal and public policy issues that have arisen concerning prenatal screening. But at the outset it is important to understand the crucial distinction between diagnosis and screening. Diagnosis pertains to the effort to understand an illness in a particular patient; screening pertains to the search of a healthy population whose members may be at some special risk of having an undiagnosed condition that could lead to illness in themselves or, in prenatal screening, their offspring.
Cerebral palsy
Authors: Nelson Karin B
Published: November 2023

Since its earliest description as an entity, in a report by John Little (1861) to the Obstetrical Society of London, cerebral palsy has been attributed to difficult or premature birth and often to deprivation of oxygen during birth. Although there were early arguments against such a point of view—most notably from Sigmund Freud (1897)—the impression has developed that birth asphyxia is the dominant cause of cerebral palsy and that good obstetric care should usually be able to prevent asphyxia and thus prevent the condition.
Neonatal intensive care
Authors: Lee Shoo K
Published: November 2023

In many ways, neonatal intensive care represents the epitome of modern medicine. It practices at the leading edge of technology and medical knowledge and challenges the limits of viability of life itself. Through the regionalization of perinatal care, it revolutionized the health service delivery system and incorporated concepts of preventive medicine. And by establishing neonatal care as a discipline, it trained a new generation of health care providers and inspired medical research to reach new heights.
Talking to the elderly
Authors: Currie C T
Published: November 2023

The past is another country, from which there are visitors among us. They are the elderly. For them, many things are different: money,* transport, communications, newspapers, public and private behaviour, even the landscape of the streets. Most older people have adapted quite well to the gradual transition from the familiarities of the period in which their attitudes were formed, but young people dealing with elderly patients should at least be aware of just how much change is involved.

People in their twenties today who are looking after people almost as old as the century should know that in their generation childhood death from infectious illness was commonplace, that the men could have been among the younger participants in the First World War, and that the women were among the first to have the vote.
Talking about sexual function
Authors: Myerscough Philip R , Ford Michael J , Currie C T , Doyle D , Hewitt A N M , Laing I A , Speirs A L , Wrate R M
Published: November 2023

The need for doctors to desexualize the intimacy of clinical work has been identified in earlier chapters as a factor that inhibits them from discussing patients’ sexual function, or even other ‘personal’ matters. Nevertheless, with insight and training this reluctance can and should be overcome, since health problems related to sexual function are not rarities. Surveys in general practice have shown that 10-15 per cent of patients have a sexual problem of some sort. Sexual problems apart, enquiry about contraceptive practice is often an appropriate part of history-taking. The widespread prevalence of sexually transmitted diseases means that doctors in all specialties have to keep these infections in mind in dealing with disorders of many body systems, and to be informed about the pattern of the patient’s sexual behaviour.
Developing the skills
Authors: Myerscough Philip R , Ford Michael J , Currie C T , Doyle D , Hewitt A N M , Laing I A , Speirs A L , Wrate R M
Published: November 2023

A central theme of this book is the message that skill in interviewing is essentially a product of professional learning, rather than an innate ability that some possess from birth, but others lack. It is sometimes claimed that students should be selected for admission to medical schools partly on the basis of their ability to communicate, that only ‘outgoing’ personalities should be accepted, in the hope that all doctors would, almost automatically, turn out to be good communicators. Perhaps some form of personality and aptitude testing might be a fruitful part of the selection process, rather than reliance solely on the student’s ability to score well in a narrow range of science subjects in school qualifying exams. However, given the range of careers a medical graduate may pursue—in clinical, administrative, laboratory, investigative, or military medicine, for example—it would be difficult to specify the particular qualities to be required in every entrant. In all these fields communication skills are of great value, even though the doctors concerned may not be in day-to-day contact with patients.
Adult and professional learning
Authors: Havelock Peter , Hasler John , Flew Richard , Mcintyre Donald , Schofield Theo , Toby John
Published: November 2023

The term ‘adult learning’ implies that adults learn differently from children. In fact, this is not entirely true; however, the circumstances in which the two groups find themselves do differ. The many similarities between children and adults learning include some important points: People learn best when: In other words, teachers need to be enthusiastic, clear about what they are trying to do, and use a range of teaching methods. They need to help learners build on their previous experience.
An environment for learning
Authors: Havelock Peter , Hasler John , Flew Richard , Mcintyre Donald , Schofield Theo , Toby John
Published: November 2023

In Chapters 4 and 5 the creation of a learning plan and assessment of progress was discussed, with emphasis concentrated mainly on the trainer and trainee. In this chapter we look at important features of the training practice and further characteristics of trainers.
Teaching methods
Authors: Havelock Peter , Hasler John , Flew Richard , Mcintyre Donald , Schofield Theo , Toby John
Published: November 2023

So far, we have discussed what trainees learn, how their progress should be reviewed, and emphasized the need for training practices that provide high-quality care with a variety of teachers and experiences.
Learning in hospital
Authors: Havelock Peter , Hasler John , Flew Richard , Mcintyre Donald , Schofield Theo , Toby John
Published: November 2023

Most of this book is concerned with training in general practice but this is only one part of the 3 years of preparation for general practice. A wide range of experiences has been reported by doctors in hospital training grades. A number of posts have broad-based educational programmes, learning objectives, protected time set aside, and the involvement of SHOs in their own learning. Unfortunately this is not the experience of many SHOs; whether or not their career goal is general practice. All junior hospital posts are training posts requiring time and expertise for planned learning. In this chapter we examine three issues—the balance between education and service, the function of SHO posts, and the purpose of hospital training for GPs—and then go on to consider various aspects of the posts.
Assessing clinical skills
Authors: Holsgrove Gareth
Published: November 2023

It is not really how much a doctor knows that is so important, it is the effectiveness with which knowledge can be retrieved, organized, combined with technical and interpersonal skills, and used in practice. Consequently, examiners are becoming increasingly interested in methods of assessing these clinical skills. For test-developers, this is a particularly interesting and rewarding area because it presents the challenge of producing assessment methods that must have a high validity, yet need to be acceptably reliable and not excessively demanding of resources. Unlike the recall or application of knowledge, the higher-order skills covered in this and the next two sections (communication skills and competence) cannot be assessed by written tests. They must be observed.
Evaluating the curriculum
Authors: Holsgrove Gareth
Published: November 2023

Evaluating teaching is an important part of the curriculum evaluation process, but not the only part. The content, timing, duration, assessment, feedback to students (and tutors), and a number of other aspects of the curriculum must also be evaluated. It is important to look beyond an evaluation of teaching when the curriculum features self-direc1ed learning. In this situation, formal teaching may be almost totally absent, but it is intended that a considerable amount of learning will occur. The course leader will also be interested in evaluation of new elements of the course particularly now that there is a much greater emphasis on quality assurance. There are two perspectives on teaching that those responsible for organizing or working on a course will need to know about. The first is what the students feel about it; the second, how the staff see their own teaching.
Epidemiology - incidence, causes, and seventy
Authors: Appleton Richard
Published: November 2023

This chapter will briefly discuss how common brain injury, and in particular, head injury is in children, the causes of brain injuries, and how both the severity and outcome of brain injuries can be assessed and measured. Head injury is the most common cause of death in childhood and is a major source of handicap and disability. In 1992, reported deaths from head injuries (including skull fractures) to the Office of Population Censuses and Surveys (OPCS) totalled over 3500; 278 of these occurred in children under the age of 15 and 553 under the age of 20 years.
Brain (head) injury team
Authors: Baldwin Tony , Nash, Julie , Appleton Richard
Published: November 2023

Recovery from a brain injury is not like a recovery from any other injury, since the effects are far more complex and pervasive and affect a whole range of attributes. These changes can range from the subtle and barely noticed to being extremely significant and severe, fundamentally altering the child’s emotional, intellectual, and social behaviour. They can be observed both in the acute stage, and frequently the deficits remain long past the point in which a total physical recovery has taken place. Insome cases, skills have to be retaught and alternative strategies given, and the child’s behaviour may need modifying. At the same time both the child and family need emotional support and reassurance.
Speech and language difficulties
Authors: McMahon Siobhan
Published: November 2023

Speech and language therapists have an important role to play as members of the multidisciplinary team caring for the brain-injured child. While many children can and do make excellent recoveries from traumatic brain injury, most will require some help with communication, even if this is just for a short time. In addition there is increasing evidence that many children with brain injuries go on to have long-term difficulties with some aspect of communication.
Emotional, behavioural, and social difficulties
Authors: Demellweek Colin , O’Leary, Audrey , Baldwin Tony
Published: November 2023

Although the term ‘emotional, behavioural, and social difficulties’ is used in this chapter, these problems may also be referred to as being psychosocial, psychiatric, neuropsychiatric, or as reflecting personality or characterological changes. These differences exist since it is possible to view problems from different perspectives. For example, irritability appears to be common following brain injury (BI). This may be considered to be emotional (i.e. feelings of irritation are more intense and frequent), the behavioural con sequences of which may interfere with social relationships and, if persistent, be seen as an aspect of the individual’s personality or character.
Musculo-skeletal problems: introduction—the scope of musculo-skeletal medicine
Authors: Wardrope Jim. , English Bryan
Published: November 2023

Musculo-skeletal problems are common!An average department will see 2000+ ankle sprains per year, but it might miss the diagnosis in the 1 case of osteomyelitis.This book sets out to give a clear method of assessing patients with musculo-skeletal problems.Take the best possible history.Examine the patient systematically.Investigate appropriately.Record the assessment in the notes.Arrange appropriate follow-up with advice on where and when to seek help if symptoms continue or get worse.
Soft-tissue injury and repair: relevance to treatment
Authors: Wardrope Jim. , English Bryan
Published: November 2023

Tendon injury may be overlooked (e.g. Achilles tendon). Total ruptures are often treated surgically.Ligament injury presents a spectrum of damage from minor self-limiting partial tears to complete ruptures of ligament complexes.Closed nerve injury is often treated conservatively (apart from pressure on the spinal cord or nerve roots which may be a surgical emergency).
Principles of treatment for soft-tissue trauma
Authors: Wardrope Jim. , English Bryan
Published: November 2023

Give good advice preferably with written instructions.Use splints and crutches only for definite indications, if possible retain mobility.Analgesia:paracetamol safe and effective;non-steroidal anti-inflammatory agents may have some benefits where there are no contraindications;little evidence that topical non-steroidal anti-inflammatory agents are effective in soft-tissue injury.
The leg
Authors: Wardrope Jim. , English Bryan
Published: November 2023

TraumaThe tibia and fibula are commonly fractured, even by a seemingly innocuous blow (e.g. a kick when playing football).Compartment syndrome is commonest in the leg. Suspect this in a patient with severe pain following injury.Haematomas may be tense enough to compromise skin vascularity.A patient with a sudden sharp pain behind the heel has a rupture of the Achilles tendon until proven otherwise. All such patients must have Simmond’s test (or similar) performed.In children, fractures of the tibia are very hard to diagnose. Suspect in a toddler who is not weight bearing after a minor twisting injury.
The back
Authors: Wardrope Jim. , English Bryan
Published: November 2023

Sudden acute back pain is a valid reason for attending an A&E department.A full history and examination including neurological examination of the legs is essential.Examination of saddle area sensation and anal tone is essential.X-rays are not indicated in a young person after a lifting type of injury unless there are neurological signs or unusual features in the history.Neurological signs (severe bilateral limitation of SLR, bilateral motor/sensory loss, saddle anaesthesia/loss of bladder or anal tone) may indicate a surgical emergency—refer.
Radiology
Authors: Harvey CJ , Roberts HRS , Shaw PJ
Published: November 2023

Diagnostic radiology plays a vital role in patient management and all clinicians need to be able to recognise the radiological appearances of many medical conditions. Not only are traditional imaging techniques important, but newer techniques such as interventional radiology, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine and ultrasound are increasingly important in clinical practice and also, the interpretation of radiological images is an integral part of professional examinations for MRCP (part II): there are five compulsory questions based on printed photographic material, with additional radiographs or other diagnostic images being shown occasionally throughout. This book will cover all modalities in radiology, providing a guide to the principles of plain radiographic film interpretation and an understanding of the roles and limitations of more complex imaging across general medicine. The material is presented through the discussion of a hundred fully-illustrated cases in question and answer format.
The principles and practice of oncology
Authors: Johnston Patrick G , McDermott Ultan
Published: November 2023

In the UK cancer is a major problem today. Approximately a quarter of a million people are diagnosed with cancer and 120 000 die each year. While improvements in cardiovascular disease have resulted in a decline in mortality from heart disease, cancer mortality continues to rise and is expected to be the major cause of death across the next decade. Currently one person in three living in the UK will develop cancer during their lifetime and one in five will die from the disease. Over 60% of all cancers will occur in the over-65 age group and as our populations get older clinicians will be faced with increasing numbers of patients at risk or presenting with malignant disease.
The pathology of cancer
Authors: McManus Damian T
Published: November 2023

Neoplasia (literally ‘new growth’) has been defined by Willis in functional terms as a disorder of cell growth in which there is a permanent and inherited change in cells resulting in a pathological proliferation of tissue which is excessive, purpose- less, and autonomous, continuing indefinitely regardless of stimuli or effects of the expanding neoplasm on the surrounding tissues.
Cancer Prevention and Screening
Authors: Kennedy Richard D
Published: November 2023

Cancer prevention can be divided into two areas: primary prevention: this is an attempt to modify factors that promote or pro- tect against carcinogenesis. Examples include dietary modification, smoking cessation, reducing sun exposure, reduction of carcinogens in the workplace, prophylactic surgery, and the use of chemopreventative drugs. secondary prevention: this is the early identification and treatment of pre- malignant or early malignant disease. Examples include population screening, surveillance of high-risk groups, and genetic susceptibility testing.
The Radiology of Cancer
Authors: Torreggiani William , Lee Michael J
Published: November 2023

Modern radiological imaging plays a major role in the diagnosis, staging, and follow-up of cancer. The choice of which imaging modality to use depends on several factors, namely, the information being sought, the most appropriate imaging modality to detect the cancer being sought, and the local availability of various imaging modalities.
The principles of chemotherapy
Authors: Johnston Patrick. G
Published: November 2023

Medical oncology is the cancer speciality that focuses on the systematic management of the cancer patient with chemotherapy and other systemic treatments. The smallest clinically detectable tumour lump is approximately 1 cm in diameter and already contains one billion tumour cells (Fig. 10.1).