bluuebunny/crossref_metadata_2025 huggingface dataset:
Triathlon injuries
Authors: Jaques Rod
Published: November 2017

Triathlon is an event that involves sequential swimming, cycling, and running. It first appeared on the Olympic programme in Sydney 2000. Competition distances vary (Table 4.7.1) but are based on approximate ratios of the three disciplines first established in 1979 by the Hawaii Ironman Championship which consists of a 3.8 km swim, 180.2 km cycle, and a 42.2 km run....
Golf injuries
Authors: Speed Cathy
Published: November 2017

Golf is a game with rapidly increasing popularity, played worldwide. Golfers are a wide spectrum of the population in terms of their size, shape, age, fitness, and health status As a result, injuries in golf can involve aggravation of a pre-existing condition such as osteoarthritis or present as acute or chronic overuse injuries ...
Soccer injuries
Authors: Fuller Colin
Published: November 2017

Football, or soccer, is the most popular team sport in the world with over 200 countries affiliated to the international governing body Fédération Internationale de Football Association (FIFA) (www.fifa.com); the Football World Cup is the most popular televised sports event. The sport appeals equally to males and females, adults and children. Whilst the 11-a-side game is the most common form of football, five-a-side football using smaller indoor or outdoor pitches is a popular variation of the game. The following discussion relates to injuries sustained in the 11-a-side format....
Boxing injuries
Authors: Loosemore Mike
Published: November 2017

Boxing or fighting with clenched fists is one of the most ancient of all recorded sports. The greatest knowledge of boxing in ancient times comes from the writings, statues, and poetry of the Ancient Greeks (Fig. 4.18.1). Boxing was considered an integral part of education:
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Badminton injuries
Authors: Speed Cathy
Published: November 2017

The sport of badminton originated in Gloucestershire, England, in the 1860s and has evolved to become a game played by millions across the world. Badminton is the world’s fastest racket sport with shuttles reaching 200 mph in top international competitions. When played at high level, this fast and powerful game demands high levels of strength, agility, endurance, and tactical awareness. Most of the injuries seen are related to microtraumatic overuse, and are associated with high impact, lunging, rotating, and spinal extension. The mechanics of the sport present a good example of the influence of any impairment or dysfunction within the kinetic chain on other links along the same kinetic pathway. For example, restriction in the thoracic spine can lead to increased demands on the shoulder and arm when attempts are made to achieve adequate range of motion to play an overhead shot....
Cancer control and the burden of cancer
Authors: Elwood Mark , Sutcliffe Simon
Published: November 2017

Chapter 1 discusses that treatment is essentially a facility-based intervention according to defined or accepted protocols; care describes the coordination and integration of activities to enhance well-being, including treatment episodes, across the various locations and circumstances in which care is provided; and control refers to the system response to meet the needs of the population served, encompassing issues of awareness, communication, education, access, support, costs, etc. associated with interventions to control cancer.
Active cancer prevention
Authors: Colditz Graham , Beers Courtney
Published: November 2017

Chapter 2 describes the key potentially modifiable risk factors that are responsible for more than half of the seven million deaths from cancer worldwide. Using evidence-based strategies to impact individual and population behaviour changes, public health efforts driven by sound knowledge, legislative support/backing, and social commitment have the potential to rapidly reduce the cancer incidence and mortality in the twenty-first century. Our aging population and the burden of cancer that comes due to aging demands we act now to achieve this global benefit.
The impact of immunization on cancer control: the example of HPV vaccination
Authors: Burchell Ann , Franco1 Eduardo
Published: November 2017

Chapter 6 reviews briefly the role of infections as causal agents in cancer, describes anti-hepatitis B virus (HBV) immunization as the first cancer vaccine paradigm, and finally focuses on the latest paradigm of prophylactic vaccination against human papillomavirus (HPV) infection as the new front in cancer prevention.
Population-based cancer control and the role of guidelines – towards a ‘systems’ approach
Authors: Browman George P. , Brouwers Melissa , Fervers Béatrice , Sawka Carol
Published: November 2017

Chapter 8 explores the role of guidelines beyond the clinician-patient context and profile several ongoing guideline initiatives to illustrate how cancer guidelines are being integrated into broader cancer control activities.
Shifting the paradigm: from complementary and alternative medicine (CAM) to integrative oncology
Authors: Leis Anne , Sagar Stephen , Verhoef Marja , Balneaves Lynda , Seely Dugald , Oneschuk Doreen
Published: November 2017

Chapter 13 aims to explore the rationale for increased CAM utilization by cancer patients and survivors from a historical and ontological perspective, and to document the paradigm shift towards integrative oncology as a pivotal part of a cancer control framework.
Integrating cancer control with control of other non-communicable diseases
Authors: Burton Robert , Leowski Jerzy , Courten Maximilian de
Published: November 2017

Chapter 21 discusses the integration of cancer control with control of other non-communicable diseases, including shared modifiable social, environmental, and behavioural determinants, systems that improve health, health sector responses to non-communicable diseases, and how a comprehensive view of chronic disease prevention and control also has implications for workforce and infrastructure planning.
Refining the clinical picture
Authors: Emery Alan E. H. , Emery Marcia L. H.
Published: November 2017

Chapter 6 discusses the dramatic rise in interest in the late 1860s and early 1870s about Duchenne muscular dystrophy.
Nosology of the dystrophies
Authors: Emery Alan E. H. , Emery Marcia L. H.
Published: November 2017

Chapter 8 discusses the evidence available by the end of the last century that there was more than one type of dystrophy and the subsequent problem of classifying them.
Biochemical diagnosis and carrier detection
Authors: Emery Alan E. H. , Emery Marcia L. H.
Published: November 2017

Chapter 10 discusses biochemical diagnosis and carrier detection in Duchenne muscular dystrophy.
Jaspers in his time
Authors: Leoni Federico
Published: November 2017

The chapter describes Jaspers’ debt towards XIX century philosophies - in particular Nietzsche’s Lebensphilosophie, Weber’s sociological thinking, Dilthey’s philosophy of Geisteswissenschaften, Husserl’s phenomenology. Husserl offered Jaspers an access to the ground structures of human experience, beyond abstractions and intelletual reconstructions of traditional philosophy and psychology. Dilthey provided him a neat epistemological differentiation between the methods of explication (natural sciences) and comprehension (human sciences). Weber’s sociology elaborated a precious notion of “Idealtypus”, central to Jaspers phenomenological psychopatology. Nietzsche’s meditation on the Uebermensch offered Jaspers, paradoxically enough, an insight about the nature of illness on weakness, which Jaspers philosophical anthropology assumed since the Allgemeine Psychopatologie as a constitutive dimension of human life as such.
Jaspers on explaining and understanding in psychiatry
Authors: Hoerl Christoph
Published: November 2017

This chapter offers an interpretation of Jaspers’ distinction between explaining and understanding, which relates this distinction to that between general and singular causal claims. Put briefly, I suggest that when Jaspers talks about (mere) explanation, what he has in mind are general causal claims linking types of events. Understanding, by contrast, is concerned with singular causation in the psychological domain. Furthermore, I also suggest that Jaspers thinks that only understanding makes manifest what causation between one element of a person’s mental life and another ultimately consists in – that is, the particular way in which one psychic event can emerge from or arise out of another. I contrast the resulting view both with a view on causation in psychiatry recently put forward by John Campbell, and also with another view that is the target of Campbell’s attack, which is due to Donald Davidson and Daniel Dennett.
Jaspers and neuroscience
Authors: Broome Matthew R.
Published: November 2017

In this chapter, Jaspers' views on neuroscience and its relationship to psychopathology are described. Firstly, there will is a brief historical discussion of neuroscience and its place in the first biological psychiatry of the late nineteenth century, showing how Jaspers' concerns fit into wider worries of his near contemporaries around 'brain mythology'. Secondly, the chapter offers a detailed exegesis of Jaspers' views on the psyche and neuroscience in the translated 1959 edition of General Psychopathology, including his views on the unity of the psyche and soma and the importance of both psychopathology and neurology as modes of investigation in psychiatry. Thirdly, a brief survey of Jaspers later general views on science and pluralism is presented. The chapter argues that Jaspers is not by any means opposed to a neuroscientific approach in psychiatry, but rather criticises the view that neuroscience is the only means to study mental disorder.
Karl Jaspers’ existential concept of psychotherapy
Authors: Schlimme Jann E.
Published: November 2017

Karl Jaspers developed and portrayed his existential understanding of psychotherapy in a number of papers and in the different editions of his General Psychopathology. In this chapter I will first describe Jaspers’ own understanding of psychotherapy and will argue that for Jaspers’ we, as human beings, need to philosophize with respect to existential questions, as they cannot be tackled in a scientific manner. This entails that there is a gap between the two kinds of liberty which can be achieved through a psychotherapeutical modulation of our behaviour, on the one hand, and which can be grasped as existence in a Jaspersian sense, on the other hand. Accordingly I will argue that due to methodological reasons, Jaspers did not intend to develop an existential form of psychotherapy, but an existential understanding of psychotherapy. I will demonstrate that his writings offer a rich framework for such an understanding.
Delusional atmosphere and the sense of unreality
Authors: Ratcliffe Matthew
Published: November 2017

In this chapter, I begin by outlining Jaspers’ account of ‘delusional atmosphere’ or ‘delusional mood’, focusing upon the ‘sense of unreality’ that is central to it. Then I critically discuss his well-known claim that certain ‘primary delusions’ or ‘delusions proper’ cannot be understood phenomenologically. I reject that view and instead sketch how we might build upon Jaspers’ insights by developing a clearer, more detailed phenomenological analysis of delusional atmosphere, thus further illuminating how certain delusional beliefs arise. However, I concede that this task poses a particular challenge for empathy, and suggest that a distinctive kind of empathy is required in order to overcome it. I call this ‘radical empathy’. I conclude by considering how we might relate a phenomenological approach along these lines to non-phenomenological research on delusions, and tentatively suggest that recent neurobiological work on ‘predictive coding’ might offer a complementary way of explaining them. I do not claim (or seek) to naturalise the phenomenology through neurobiology, but I at least maintain that there is potential for fruitful commerce between the two.
Understanding mood disorders: Karl Jaspers’ biological existentialism
Authors: Ghaemi S. Nassir
Published: November 2017

abstracts and keywords to be supplied.
Reaction and development of manic and melancholic-depressive patients
Authors: Kraus Alfred
Published: November 2017

The significance of Jaspers’ differentiation of the notions of reaction and development in his General Psychopathology is shown by clinical examples of manic and melancholic as well as bipolar disturbances. Supplemented by his concepts of “situation” and “comprehensibility” the relevance of all these concepts for diagnostic classification, development and symptomatology of these states is demonstrated and discussed. These issues are compared with extended modern empirical and psychopathological research, in particular that on the personality structure of these patients. The results are brought in connection with Jaspers’ important concepts of the antinomic structure of human being, borderline situation and sc. “Gehäuse” in order to deepen our understanding of the clinical states of melancholia and mania on the background of the identity structure of these patients.
Respiratory system
Authors: Prout Jeremy , Jones Tanya , Martin Daniel
Published: November 2017

This chapter includes a summary of respiratory physiology, respiratory mechanics (pressure-volume relationships and compliance, airway resistance and the work of breathing) and the pulmonary circulation (pulmonary vascular resistance, shunt and lung zones). Measurement of respiratory flow, lung volumes and diffusion capacity is summarized, as well as measurement and interpretation of arterial blood gases. The physics behind capnography and pulse oximetry are explained with abnormalities related to clinical contexts. The common clinical scenarios of respiratory failure and asthma are discussed with initial management and resuscitation.
General therapeutics
Authors: Prout Jeremy , Jones Tanya , Martin Daniel
Published: November 2017

Drugs used during the perioperative period may have implications for both the patient and the environment. Drugs may cause toxicity such as propofol infusion syndrome or dependency problems in the long-term. Perioperative anaphylaxis, the triggers, recognition and management is detailed. Management of patients with acute poisoning is included with general assessment and supportive management as well as specific antidotes. The clinical consequences of paracetamol poisoning are discussed in detail.
Thoracic anaesthesia
Authors: Prout Jeremy , Jones Tanya , Martin Daniel
Published: November 2017

Pre-assessment of patients for thoracic surgery with prediction of postoperative dyspnoea is important and may determine ‘operability’ of malignancy. Anaesthetic conduct for common thoracic surgical procedures such as thoracotomy, video-assisted thorascopic surgery, mediastinal surgery, and bronchoscopic techniques are described. Techniques for providing one-lung ventilation using double-lumen tubes or endobronchial blockers are discussed along with the physiology of one-lung ventilation, hypoxic vasoconstriction, and techniques to improve oxygenation. Thoracic postoperative care such as pain and chest drain management is included
Core topics in intensive care medicine
Authors: Prout Jeremy , Jones Tanya , Martin Daniel
Published: November 2017

This chapter on aspects of intensive care for FRCA commences with the recognition of the critically ill patient, use of early warning scores, outreach teams and the systematic assessment of the acutely ill patient. Sepsis has been a recent focus area for healthcare systems; the definition of sepsis, pathophysiological processes leading to organ dysfunction and management including early goal-directed therapy, supportive techniques and the role of specific therapies such as steroids and activated protein C are included. Acute lung injury and respiratory distress syndrome with management and specific ventilatory strategies are described. Important aspects of providing sedation and analgesia on intensive care are explained as well as the complex ethical aspects of this speciality with regards to consent and end-of-life decisions
Anaesthesia for plastic and reconstructive surgery
Authors: Prout Jeremy , Jones Tanya , Martin Daniel
Published: November 2017

This chapter describes the anaesthetic considerations for major plastic surgery and in particular free flap surgery including the physiology of the microcirculation. Laminar flow characteristics of the microcirculation allow the anaesthetist to manipulate the perfusion pressure, extent of vasodilation and viscosity to improve flow dynamics for improved flap outcome. The pathophysiology of a burn injury is described; the burn wound and systemic response including shock and inhalational injuries. The initial assessment of the burn follows an ABCDE approach with details of assessing burn area and depth. Initial management guides fluid resuscitation demonstrating the Parkland formula and assessing response to resuscitation. Special considerations for Intensive Care are described.
Sources of exposure, incidents, and emergencies
Authors: Robertson John , MartinM Colin J
Published: November 2017

There are many uses of radiation outside healthcare, and this chapter gives an overview of sources both natural and man-made. Radon which is the single largest source of public exposure is considered in some detail. In the event of an incident involving radiation sources whether in a hospital or in the community, medical physicists with their expertise in radiation use may be called upon to provide advice. In the event of a major accident, such as one involving a nuclear facility, it is likely that radiation monitoring and decontamination of individuals will be required, and in some institutions medical physicists may have an important role to play here as well. The chapter sets out practical information that may be of use in dealing with such situations.
Risk control in diagnostic medical exposures
Authors: Martin Colin J , Sutton David G
Published: November 2017

All medical exposures to ionizing radiation carry an increased risk of malignant disease. This chapter describes methods for evaluating the risks from exposures of varying magnitude from either the effective dose or doses to individual organs. Risk factors which can be utilized in assessments are included. Procedures should only be carried out if they will influence patient management and factors to be considered in the justification process are considered. In addition, techniques should be optimized so that doses to individual patients are as low as compatible with the medical requirements of each examination. The explanation of risks to patients is discussed for situations when a patient is to undergo a high dose procedure or has received an exposure greater than intended.
Lasers
Authors: Moseley Harry
Published: November 2017

The rapid increase in the use of lasers in healthcare has introduced new challenges. The hazards depend on the characteristics of the laser and the different modes of interaction with tissue. If the laser beam were to strike the unprotected eye, serious damage could occur, the site of damage depending on the wavelength of the laser radiation. The risk is reduced in the case of extended sources but, potentially, may be increased when a repetitively pulsed laser is used. These concepts are all discussed in addition to summarizing current legislation and standards. The laser protection adviser (LPA) is someone who is knowledgeable in the evaluation of risk associated with the use of lasers and has responsibility for provision of expert advice to the user. This chapter contains much useful information for the LPA and others interested in understanding the principles of laser safety.
Recovery room procedures
Authors: Hatfield Anthea
Published: November 2017

Airway protection, laryngeal masks, and intubation are described as well as gas delivery circuits. Emergency equipment required for reintubation, and the technique for this procedure, are outlined. Instructions for intravenous and intramuscular injections are clearly explained.
Design of the recovery room
Authors: Hatfield Anthea
Published: November 2017

A traditional recovery room is described with clear instructions for setting out floor space, trolley bays, and nurses’ station. Diagrams and illustrations show the type of recovery room most commonly used with more imaginative designs also included.
Special problems
Authors: Hatfield Anthea
Published: November 2017

Allergy, prolonged drug reactions, and delayed emergence and problems, large and small, that do not have a special chapter are covered in Chapter 10. The effect of residual relaxant drugs, and the management of these patients, is covered in these pages. Patients with brain damage, headache, or emergent delirium and violent or crying patients are described. Awareness, and its ongoing implication, is discussed. Treatment for extravasation and arterial injections are prescribed. Hiccups, shaking and shivering, pressure areas, care of the eyes, shoulder tip pain, sweating, mouth care, and urinary retention are all covered in this chapter.
Paediatrics
Authors: Hatfield Anthea
Published: November 2017

Babies and small children of all ages have surgery and come to the recovery room with special needs. Airway management, apnoea and pneumothorax, laryngospasm, and fluid management are some of the important features covered in this chapter. The diagnosis and treatment of shock and cardiac arrest are also covered in depth.
Shock
Authors: Hatfield Anthea
Published: November 2017

Shock is a clinical diagnosis that occurs when the circulation fails. Read this chapter carefully and learn to recognize the early signs and symptoms of shock. Ideally you should be treating shock even as you make the diagnosis. This chapter will teach you about the different types of shock, their distinguishing features, and specific treatments. You will also learn to distinguish the different stages of shock and the physiology paragraphs will help you understand the changes the body’s metabolism.
The bleeding patient
Authors: Hatfield Anthea
Published: November 2017

Part one of this chapter tells you about the physiology of blood and oxygen supply, about anaemia and tissue hypoxia, and the physiology of coagulation. Drugs that interfere with clotting are discussed. Bleeding, coagulation, and platelet disorders are covered as well as disseminated intravascular coagulation. Part two is concerned with bleeding in the recovery room: how to cope with rapid blood loss, managing ongoing blood loss, and how to use clotting profiles to guide treatment. There is also a section covering blood transfusion, blood groups and typing. Massive blood transfusion is clearly described, there are guidelines about when to use fresh frozen plasma, when to use platelets, and when to use cryoprecipitate. The final section of the chapter is about problems with blood transfusions.
Surgical issues
Authors: Hatfield Anthea
Published: November 2017

Every type of surgery (excluding cardiac and neurosurgery) is referenced in this chapter with special attention to the recovery room needs of each specialty. The immediate postoperative care of the patients is simply and thoughtfully discussed so that their postoperative care will give them the best possible chance for a positive result after their surgery. Drains, catheters, and special procedures like bronchoscopy are also described.
Working with people
Authors: Hatfield Anthea
Published: November 2017

Staffing your recovery unit, having meetings, emphasizing communication, and trust are all important parts of running a successful recovery room. Above all, the patients must feel safe and this calm atmosphere will be enhanced when all the staff are happy at work. Cultural and religious sensitivities are important; these are addressed here as well as the way to involve carers and relatives in the early stages of the patient’s awakening.
Morphological aspects of pathology
Authors: Wyatt Laura A. , Doherty Michael
Published: November 2017

Osteoarthritis (OA) is the commonest condition to affect synovial joints, but although any synovial joint can be affected, most studies of pathology relate to large joints (knees and hips). OA involves the whole joint and pathological alterations typically occur in all joint tissues. Established OA is characterized by a mixture of tissue loss and new tissue production resulting in focal loss of articular hyaline cartilage together with bone remodelling and osteophyte formation. Articular cartilage may show increased thickness in the earliest stages of OA with increased numbers of hypertrophic chondrocytes, followed by progressive decline in matrix components, thickness, and chondrocyte number. Surface fibrillation and vertical clefts become evident in mid- to end-stage OA and eventual complete loss of cartilage can occur, predominantly in maximum load-bearing regions, with subsequent eburnation and furrowing of bone. Bone remodelling may lead to alteration of bone shape and variable trabecular thickness in subchondral bone, whilst subchondral microfractures may result in localized osteonecrosis, fibrosis, and ‘cysts’. Endochondral ossification of new fibrocartilage produced predominantly at the joint margin produces characteristic bony osteophytes. The synovium shows areas of hyperplasia with varying amounts of lymphocyte aggregates and inclusion of osteochondral ‘loose’ bodies, and the outer fibrous capsule thickens to help stabilize the compromised joint. Synovial fluid increases in volume but decreases in viscosity. Periarticular changes include type II muscle atrophy and enthesophytes.
Pathophysiology of periarticular bone changes in osteoarthritis
Authors: Goldring Steven R.
Published: November 2017

Under physiological conditions, the subchondral bone of diarthrodial joints such as the hip, knee, and phalanges forms an integrated biocomposite with the overlying calcified and hyaline articular cartilage that is optimally organized to transfer mechanical load. During the evolution of the osteoarthritic process both the periarticular bone and cartilage undergo marked changes in their structural and functional properties in response to adverse biomechanical and biological signals. These changes are mediated by bone cells that modify the architecture and properties of the bone through active cellular processes of modelling and remodelling. These same biomechanical and biological factors also affect chondrocytes in the cartilage matrix altering the composition and structure of the cartilage and further disrupting the homeostatic relationship between the cartilage and bone. This chapter reviews the structural alterations and cellular mechanisms involved in the pathogenesis of osteoarthritis bone pathology and discusses potential approaches for targeting bone remodelling to attenuate the progression of the osteoarthritic process.
The innervation of the joint and its role in osteoarthritis pain
Authors: McDougall Jason J. , Vilensky Joel A.
Published: November 2017

Diarthrodial joints possess an extensive network of sensory and sympathetic nerve fibres whose physiological functions are varied and complex. Nerves are primarily located in the synovium but also innervate the subchondral bone, the outer third of menisci, and the superficial surface of tendons and ligaments. Large-diameter, myelinated neurons are involved in joint position sense while small-diameter neurons with thin or no myelin typically sense pain. The small-diameter nerves in conjunction with sympathetic fibres control synovial blood flow and maintain joint homeostasis. In patients with osteoarthritis (OA), the sensory nerves become sensitized and increase their firing rate in response to normal movement. This peripheral sensitization is mediated by numerous algogenic agents released into the OA knee including neuropeptides, eicosanoids, and proteinases. A portion of joint afferents fire in the absence of mechanical stimuli and encode pain at rest. Interestingly, the firing rate of joint afferents does not correlate with OA severity, indicating that pain is a poor predictor of joint pathology. Evidence is accumulating to suggest that a subpopulation of OA patients who are unresponsive to classical non-steroidal anti-inflammatory drugs may be suffering from neuropathic pain in which there is damage to the joint nerves themselves. Better understanding of the biology of joint nerves could help in the development of patient-targeted therapies to alleviate OA pain and inflammation.
Morphology
Authors: Aspden Richard , Gregory Jenny
Published: November 2017

The study of joint morphology can help us to understand the risk factors for osteoarthritis (OA), how it progresses, and aids in developing imaging biomarkers for study of the disease. OA results in gross structural changes in affected joints. Growth of osteophytes, deformation of joint components, and loss of joint space where cartilage has broken down are all characteristics of the disorder. Certain bone shapes as well as malalignment predispose people to future OA, or may be a marker for early OA. Geometrical measures, such as the alpha angle or Wiberg’s CE angle, used to be the primary tool for investigating morphology. In recent years, however, statistical shape modelling (SSM) has become increasingly popular. SSM can be used with any imaging modality and has been successfully applied to a number of musculoskeletal conditions. It uses sets of landmark points denoting the anatomy of one or more bones to generate new variables (modes) that describe and quantify the shape variation in a set of images via principal components analysis. With the aid of automated search algorithms for point placement, the use of SSMs is expanding and provides a valuable and versatile tool for exploration of bone and joint morphometry. Whilst the majority of research has focused on hip and knee OA, this chapter provides an overview of joint morphology through the whole skeleton and how it has helped our ability to understand and quantify the risk and progression of osteoarthritis.
Lifestyle
Authors: Runhaar Jos , Bierma-Zeinstra Sita M. A.
Published: November 2017

Modern lifestyles put a great burden on the human musculoskeletal system. Since 1980, the worldwide prevalence of obesity has tripled in many European countries. Obesity is known to affect both weight-bearing and non-weight-bearing joints due to a combination of mechanical overload and systemic inflammation. On the other hand, both to combat the obesity pandemic and to increase or maintain the quality of life, physical activity and sports are encouraged next to a healthy diet. Although both have a positive influence on cardiovascular risk factors, physical activity and especially sporting activities do lead to increased loading of the active joints and increased risk for joint injuries, which might lead to osteoarthritis development. This chapter provides an overview of the current knowledge on lifestyle risk factors for the development and progression of osteoarthritis as published in recent systematic reviews, complemented with several narrative reviews.
Clinical assessment: signs, symptoms, and patient perceptions in osteoarthritis
Authors: Kloppenburg Margreet
Published: November 2017

Osteoarthritis (OA) is a disorder that can affect any joint. It results in a high clinical burden in many patients. Patients with OA experience a wide range of symptoms and clinical signs such as pain, disability, stiffness, tenderness, crepitus, and decreased mobility and strength in their osteoarthritic joints, where the impact depends on the involved joint. Also general symptoms such as fatigue and psychosocial consequences are experienced by OA patients. The impact of symptoms and signs does not only depend on osteoarthritic abnormalities, but also on patient factors, such as coping strategies and illness perceptions, and co-morbidities. In this chapter, general and joint-specific symptoms and signs as well as the impact of patient factors are discussed.
Ultrasound in osteoarthritis and crystal-related arthropathies
Authors: Grassi Walter , Okano Tadashi , Filippucci Emilio
Published: November 2017

Ultrasonography (US) is a safe and cheap imaging technique which in experienced hands allows for a multiplanar and multisite high-resolution assessment of both morphological and structural features of bone, cartilage, and intra- or periarticular soft tissues. This chapter describes the main applications of US in patients with osteoarthritis (OA) and crystal-related arthropathies. Imaging plays a key role for diagnosis, prognosis, and follow-up in patients with OA. Although conventional radiography is still the gold standard imaging technique in daily clinical practice, US has been revealed to be capable of detecting a wide spectrum of otherwise undetectable details, including cartilage damage, joint effusion, synovial hypertrophy, osteophyte formation, and meniscal protrusion. Crystal visualization by US has the potential to change the diagnostic approach in patients with suspicion of crystal-related arthropathies. The double-contour sign, due to urate crystal deposits on the chondrosynovial interface of the hyaline cartilage, is a highly specific finding for gout as well as the hyperechoic spots within the hyaline cartilage for calcium pyrophosphate dihydrate crystal deposition disease. The potential applications of US in the management of patients with OA and crystal-related arthropathies are not only limited to diagnosis and monitoring. Finally, US guidance allows the real-time visualization of the needle moving through different tissues and reaching the target to aspirate and/or inject. The correct placement of the tip of the needle plays a key role in improving efficacy and reducing side effects of the injection.
Psychological strategies in osteoarthritis of the knee or hip
Authors: Dekker Joost , Bossen Daniel , Holla Jasmijn , de Rooij Mariëtte , Veenhof Cindy , van der Leeden Marike
Published: November 2017

Characteristic clinical presentations of osteoarthritis (OA) include pain and activity limitations. These presentations are dependent on psychological processes. The literature reviewed in this chapter leads to the following conclusions: (1) symptoms of depression, anxiety, and fatigue are more prevalent among patients with OA than among the general population. Recently, a depressive mood phenotype has been identified in knee OA. (2) Symptoms of depression, anxiety, and fatigue, as well as other psychological variables are established risk factors for future worsening of pain and activity limitations. (3) Psychological interventions such as depression care and pain coping skills training have been demonstrated to improve pain and activity limitations, as well as psychological outcomes. Self-management may have beneficial effects, although there is clearly room for improvement. Interventions combining psychological interventions with exercise therapy have been shown to be effective; improved outcome over exercise therapy alone stills needs to be demonstrated. (4) Psychological interventions are effective in improving exercise adherence and promoting physical activity. Overall, it can be concluded that the psychological approach towards OA is fruitful: the psychological approach has resulted in substantial contributions to the understanding and management of clinical presentations of OA, including pain and activity limitations.
Systemic analgesics (including paracetamol and opioids)
Authors: Bannwarth Bernard , Berenbaum Francis
Published: November 2017

Apart from non-steroidal anti-inflammatory drugs (NSAIDs), there are only two categories of systemic analgesics, namely paracetamol (acetaminophen) and opioids, that are currently available worldwide for clinical use. Paracetamol is poorly effective in relieving pain and improving function in patients with symptomatic osteoarthritis (OA). Furthermore, its safety profile is less favourable than classically thought. In fact, there is evidence paracetamol acts as a weak inhibitor of the cyclooxygenase enzymes. Given that paracetamol poses a lower risk of severe adverse events than NSAIDs while being better tolerated than opioids, it is usually considered as the first-line systemic analgesic for OA. Commonly prescribed opioids are primarily agonists of the mu receptors, thereby producing similar desirable (analgesia) and untoward effects. Meta-analyses of short-term clinical trials showed that, on average, the modest clinical benefits of opioids did not outweigh the side effects in patients with knee or hip OA. Accordingly, most current guidelines support the use of opioids for selected OA patients only (e.g. patients who have not had an adequate response to other treatment modalities and are not candidates for total joint arthroplasty). In view of the limited efficacy and/or potential harms of available analgesics, particular attention was paid to novel painkillers, especially nerve growth factor (NGF) antagonists. Although these agents provided clinically meaningful improvements in pain and physical function in patients with hip or knee OA, they lead to severe side effects, including rapidly destructive arthropathies and neuropathies. Thus, if approved for marketing, NGF antagonists would be reserved for selected and well-defined patients with OA.
Epidemiology of gout
Authors: Hider Samantha , Roddy Edward
Published: November 2017

Gout is the most prevalent inflammatory arthritis in men. Data from epidemiological studies conducted in several countries suggest that the prevalence and incidence of gout have risen over the last few decades, although incidence may have stabilized recently. Dietary factors (animal purines, alcohol, and fructose), co-morbid medical conditions (obesity, metabolic syndrome, hypertension, and chronic kidney disease), and medications (diuretics, aspirin, beta blockers, angiotensin converting-enzyme inhibitors, and non-losartan angiotensin II receptor blockers) have been confirmed to be risk factors for both hyperuricaemia and gout. In contrast, low-fat dairy products, coffee, vitamin C, calcium channel antagonists, and losartan appear to reduce the risk of developing gout. People with gout are themselves at increased risk of developing cardiovascular disease and chronic kidney disease, independent of traditional risk factors for these conditions.
The genetic basis of gout
Authors: Merriman Tony R.
Published: November 2017

An individual’s risk of gout is determined by a complex relationship between inherited genetic variants and environmental exposures. Genetic variants that control hyperuricaemia and subsequent progression to clinical gout specify pathogenic pathways that could be therapeutically targeted. Genome-wide association studies (GWAS) have provided novel insights into the pathways leading to hyperuricaemia. GWAS have identified the renal uric acid transporter SLC2A9/GLUT9 and the gut excretory molecule ABCG2, which each have very strong genetic effects in the control of urate levels and risk of gout. Histone deacetylase inhibitors are able to correct the genetically-determined ABCG2 dysfunction. Other renal uric acid transporters, such as SLC22A11/OAT4 and SLC22A12/URAT1 have been confirmed to be genetically associated with urate and the risk of gout. Genes that generate urate during glycolysis (e.g. GCKR) are also implicated. In contrast very little is known about genetic variants that control the progression from hyperuricaemia to gout with the toll-like receptor 4 gene being the only gene with replicated evidence of association.
Imaging of gout
Authors: Keenan Robert T. , Pai Sneha , Schlesinger Naomi
Published: November 2017

Gout is a systemic metabolic disease. The enzyme urate oxidase (uricase) that catalyses the oxidation of uric acid to the more soluble compound allantoin is inactive in humans. This may lead to hyperuricaemia. Hyperuricaemia is often present for many years prior to clinical signs of gout. Acute attacks occur as a result of an inflammatory response to monosodium urate (MSU) crystal deposition leading to intense pain and inflammation in the affected joints. Uncontrolled hyperuricaemia and resultant gout can evolve into a destructive arthritis. Imaging may be helpful in the diagnosis of gout as well as in monitoring the response to gout treatment. Plain X-rays are widely used for joint imaging in patients with gout. However, plain X-rays of joints affected by gout are frequently normal, especially early in the disease. In these cases, advanced imaging modalities may be useful. Advanced imaging can help evaluate inflammation, structural joint changes, and magnitude of tophaceous deposits. Advanced imaging modalities include computed tomography (CT), dual-energy CT (DECT), magnetic resonance imaging (MRI), and ultrasound (US). CT may be most suitable to evaluate bone changes in gouty joints and DECT to evaluate tophaceous deposits. MRI may best evaluate soft tissues and Inflammation. US is useful during patients’ visits to the rheumatologist and allows evaluation of cartilage, soft tissues, synovium, and tophaceous deposits. This chapter reviews imaging modalities used in gout patients and discusses their application in the diagnosis and management of gout.
Treatment of acute gout
Authors: Khanna Puja
Published: November 2017

Acute gout is a common inflammatory arthritis in the adult population. Epidemiological evidence suggests that the prevalence of gout is steadily on the rise due to longevity, coexisting comorbidities, and iatrogenic causes contributing to hyperuricaemia. Acute gout usually presents as a self-limiting flare of synovitis that occurs due to deposition of monosodium urate crystals. The frequency of flares generally increases over time in patients who continue to have hyperuricaemia and their risk factors for acute gout attacks have not been adequately addressed. Effective treatment of acute gouty arthritis is primary focused on pain which is the primary symptom but must target both the pain and underlying inflammation. Acute gout is frequently treated with non-steroidal anti-inflammatory agents, colchicine, and corticosteroids. This chapter reviews the available therapies for management of acute gout and ones that have shown promising results.
Long-term management of gout
Authors: Perez-Ruiz Fernando , Urionagüena Irati , Chinchilla Sandra P.
Published: November 2017

Long-term management of gout comprises several aspects. Although in the short term, prophylaxis and treatment of acute episodes of inflammation are of great importance, the milestone for the long-term management of gout is targeted, sustained, and long-term control of hyperuricaemia. Treating to target subsaturating serum urate (SUA) levels, which may be initially dependent on the severity of the disease in the individual patient, is associated with a progressive reduction to no episodes of acute inflammation, regression and disappearance of subcutaneous and articular monosodium urate deposits and associated chronic inflammation, and improvement in patient-reported, health-related quality of life. Early and effective urate-lowering treatment to target levels will also prevent the development of structural damage. Urate-lowering treatment includes any measure intending to reduce SUA levels to target: lifestyle changes, modifications of concomitant medications favouring hyperuricaemia, and urate-lowering medications (ULMs). Availability of ULMs is variable worldwide, and prescription should be judicious, according to approved labels, and always considering associated health conditions and concomitant medications. Effectiveness and safety should be periodically monitored. Long-term treatment of gout still remains suboptimal in the twenty-first century. As practising clinicians, we cannot afford to neglect a ‘curable disease’.
Asymptomatic hyperuricaemia: to treat or not to treat?
Authors: Bardin Thomas
Published: November 2017

Asymptomatic hyperuricaemia is a frequent finding and evidence is growing that it could be an independent cardiovascular risk marker. Recent studies challenge the dogma not to treat asymptomatic hyperuricaemia. However, no urate-lowering drug has been approved for the management of asymptomatic hyperuricaemia in Western countries, because the lack of large randomized control trials precludes assessment of benefits. Asymptomatic hyperuricaemia should lead to lifestyle changes and promote the search for cardiovascular risk factors amenable to therapy, in order to lower the hazards of cardiovascular disease and mortality.
Basic calcium phosphate crystal deposition
Authors: Dalbeth Nicola
Published: November 2017

Basic calcium phosphate (BCP) crystals deposit within periarticular and articular sites, leading to a variety of clinical presentations. The most well-recognized clinical syndromes associated with BCP crystal deposition are calcific tendinitis and BCP crystal-associated destructive arthritis such as Milwaukee shoulder syndrome. There is emerging evidence that BCP crystals also play a role in osteoarthritis pathogenesis. Within the joint, tissue responses to BCP crystals include induction of pro-catabolic and inflammatory pathways. Clinical management of BCP crystal-associated arthropathies is limited by the lack of reliable and feasible methods to detect crystals, and the current unavailability of systemic therapies that promote BCP crystal dissolution.
Cataract
Authors: Cleary Georgia , Barsam Allon
Published: November 2017

This chapter focuses on cataract, which is the pathological opacification of the crystalline lens. Cataract is an important cause of visual impairment and blindness worldwide, in both developed and developing countries. Fortunately, acquired cataract is a reversible cause of visual impairment and, in developed countries, cataract surgery is the most commonly performed elective surgical procedure. This chapter outlines lens anatomy and embryology, along with clinical knowledge areas that include acquired cataract (clinical evaluation and treatment), intraoperative and post-operative (infectious and non-infectious) complications of cataract surgery, and lens dislocation. Practical skills, including biometry, local anaesthesia, implantation of intraocular lenses, and Nd:YAG laser capsulotomy, are also discussed.
Refractive surgery
Authors: Cleary Georgia , Barsam Allon , Donnenfeld Eric
Published: November 2017

In a perfect optical system, a point source of light is focused onto a single point on the image plane; in the eye, light is focused on the retina. Optical aberrations are caused by imaging system imperfections which cause deviations in the transmission of light, preventing the convergence of light to a single point of focus. In recent years an increased understanding of higher-order wavefront aberrations has allowed improvements in both the measurement and treatment of refractive error. This chapter discusses refractive surgery. It details refractive error, aberrations, and presbyopia, along with preoperative evaluation for refractive surgery, laser refractive surgery, other corneal refractive procedures, refractive lens surgery, intraocular lenses, phakic intraocular lenses, and presbyopia correction.
Medical retina
Authors: Sundaram Venki , Michaelides Michel
Published: November 2017

This chapter starts off with a discussion of fundus fluorescein angiography and the causes of abnormal fluorescein angiography. It then discusses indocyanine green angiography, including the main indications for this technique. It goes on to cover fundus autofluorescence imaging and electrophysiology. It also includes clinical knowledge areas of diabetic retinopathy, hypertensive retinopathy, retinal vein occlusion, retinal artery occlusions, age-related macular degeneration, central serous chorioretinopathy, retinal vascular anomalies, inherited retinal disorders, macular dystrophies, and choroidal dystrophies. It also discusses a number of important clinical trial studies and contains a section on the use of intravitreal injections of agents against vascular endothelial growth factor (known as VEGF).