bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Randomized, Controlled Trial of Total Knee Replacement
Authors: Rudran Branavan , Jones Luke D. 
Published: June 2024

Abstract
Total knee replacement (TKR) is a routine treatment for end-stage knee osteoarthritis (OA). No previous high-quality studies comparing operative to nonoperative management exist. In this randomized controlled trial (RCT), fifty patients with moderate to severe knee OA were randomly assigned to receiving TKR followed by twelve weeks of nonsurgical treatment, and fifty patients to twelve weeks of nonsurgical treatment. Outcomes included patient-reported outcome measures (PROMs) and clinical assessment. At one year, the operative group had greater improvement in all outcomes than the nonoperative group. TKR and nonoperative management strategies are superior to nonoperative management strategies alone for established knee OA.
Role of Surgery in Spinal Cord Compression Caused by Metastatic Cancer
Authors: Aframian Arash , Sugand Kapil , Hassany Hamid , Mobasheri Reza 
Published: June 2024

Abstract
The standard treatment for spinal cord compression caused by metastatic cancer at the time of publication was corticosteroids and radiotherapy. The role of surgery was not established; therefore, authors assessed the efficacy of direct decompressive surgery in a multicenter nonblinded randomized controlled trial recruiting 101 patients. They found that direct decompressive surgery alongside postoperative radiotherapy was superior to treatment with radiotherapy alone for patients with spinal cord compression caused by metastatic cancer, so much so that the trial was stopped early. Patients in the surgical treatment arm experienced superior outcomes for all primary and secondary endpoints (i.e., ability to walk, continence and functional scores, and survival) vs. patients in the group receiving steroids and radiation therapy alone. This publication has significantly impacted subsequent practice, having been cited over 1700 times in the surgical literature. Major guidelines now recommend surgical decompression for spinal cord compression due to metastatic cancer.
Pruritis
Authors: O'Duffy Rose , Presswood Maggie 
Published: June 2024

Abstract
This case on itch, or pruritus, addresses the multiple causes of itch, the pharmacological and non-pharmacological treatments available, and how to tailor these to treat the most likely underlying cause. It traces the neurobiology of itch, from the initial stimulus of unmyelinated C-fibres by pruritogens like histamine, transmission to the spinal cord, and interpretation by the brain. It compares the similarities between itch and pain, particularly the sensitization aspect of itch and how this contributes to hyperkinesis and allokinesis. It also discusses the differences, i.e. the impulse to scratch. Finally, it suggests options for the management of itch in specific clinical scenarios common to palliative care, including uraemic and cholestatic itch, opioid-induced itch, and itch related to malignancy.
Constipation
Authors: Bradley Anna , Boland Jason 
Published: June 2024

Abstract
Constipation is very common in patients receiving palliative care and is often underdiagnosed. This case covers its definition, pathogenesis, causes, diagnosis, and assessment. It reviews the management of constipation, including non-pharmacological interventions. It explores the rationale for prescribing different laxatives in palliative care, including side effects and the evidence base. Opioid-induced constipation (OIC), the commonest iatrogenic cause of constipation in patients with cancer, with widespread effects on the whole gastrointestinal tract, is reviewed. It is defined and specific management including the role of peripherally acting mu-opioid receptor antagonists (PAMORAs) is covered. This case exemplifies the important points of diagnosing and managing a patient with constipation.
Individualized End of Life Care Plans
Authors: Hicks Stephanie , Bowers Ben 
Published: June 2024

Abstract
‘Individualized End-of-Life Care Plans’ covers how we might diagnose dying to how we can provide personalized care in the last hours to days of life. It outlines the origins of the approach to end-of-life care in adults in the UK, which focuses on the five priorities of care for the dying person, and how these priorities might translate into clinical practice. The case discussed highlights the importance of individualizing symptom control needs, such as anticipatory management of catastrophic haemorrhage, as well as social and spiritual needs. It also discusses clinically assisted hydration (CAH) at the end of life, including its current evidence base and the need for future research into this important and emotive area.
Learning Disabilities
Authors: Richardson Jamie , Potter Valerie 
Published: June 2024

Abstract
People with learning disabilities (LD) often experience poorer health, face barriers to receiving effective care and have higher excess death rates as a result. While clinical care should be the same as for the rest of the population, the patient journey often deviates significantly when people with LD come into contact with health services, and this can include patients reaching the end of their life. In this case, we shall use the example of a challenging case to explore some of the barriers people with LD can face, including communication difficulties and diagnostic overshadowing, before considering approaches to improve end-of-life care which includes communication aids, reasonable adjustments, and advanced care planning.
Delivering Palliative Care to the Patient with Severe Mental Illness
Authors: Hughes Daniel , Bisset Maggie 
Published: June 2024

Abstract
This case describes the journey of Yusuf, a patient with an established diagnosis of paranoid schizophrenia, who collapses whilst an in-patient under section on a psychiatric ward. He is later found to have bowel cancer not suitable for active treatment. After outlining the evidence for the prevalence of palliative care diagnoses in those with a severe mental illness and the associated ‘parity of esteem’, we explore the complexities of delivering effective palliative care to someone with a psychotic illness, including the use of the Mental Health Act and the Mental Capacity Act. We also summarize the psychodynamic principles that may be at play and explore the system-wide complexities often encountered with such cases.
Seizures
Authors: Wells Geoffrey , Neerkin Jane 
Published: June 2024

Abstract
Seizures explores the complex management of seizure activity in the context of terminal illness. It focuses on the case of a patient with a primary brain tumour and describes the immediate and long-term management of seizures in the context of brain tumours with reference to antiepileptic drugs (AEDs) and steroids. This case describes the options for management in hospital, hospice, and community settings. The reader is guided through prescribing challenges that are faced when managing seizures in a deteriorating patient, with particular emphasis on choice of drug and available route of administration. Clinical tips highlight important pharmacological considerations around steroid use, and management of concurrent clinical symptoms such as nausea and terminal agitation. Learning points and expert commentary describe the general causes of seizures, the presenting features of seizures secondary to tumours and their anatomical location and provide prescribing guidance regarding the choice of AEDs and benzodiazepines.
Advance Care Planning
Authors: Osborne Georgina , Wee Bee 
Published: June 2024

Abstract
Advance care planning (ACP) offers people the opportunity to plan their future care and support while they have capacity to do so. This case history explores what ACP can encompass, its challenges and how, when done well, it is a key process for person-centred care. Advance care planning can help the person feel more confident in maintaining some control over future decisions. Those close to them can be more reassured that they are contributing to decisions that are aligned with the person’s preference. Advance statements are not legally binding but healthcare professionals should do their best to honour these in making best interests decisions on behalf of the person who lacks capacity. The legal framework for decision-making in situations where the person lacks capacity is different across countries, and for children as opposed to adults. It is imperative that healthcare professionals understand their local legal framework and take into account the cultural context and other needs of their individual patient and those important to them.
Specific Challenges: Homelessness
Authors: Mortimer Toni , Shulman Caroline 
Published: June 2024

Abstract
In ‘Specific Challenges: Homelessness’, a case is presented of a patient who receives terminal care in a hostel. It describes the multidisciplinary working required to make this possible and how advance care planning may need to be adapted for this population. It also shares examples of joint-working between community services and a hostel and considers the aftercare that should be undertaken. People who are homeless and living in hostels have reduced life expectancy, high rates of multiple long-term conditions, addictions, and increased frailty. Despite their high need they often have poor access to adequate health and social care, including palliative care. Hostel staff are often left to support people with extremely complex needs, including people who may be approaching end of life. However, they are usually not set up or equipped to do this.
Transition from Children’s to Adult Palliative Care
Authors: Gupta Gurpreet , Elverson Jo 
Published: June 2024

Abstract
Transition from Children’s to Adult Palliative Care highlights key challenges for adult clinicians supporting young people with life-limiting conditions. It explores issues relating not only to transition itself, but also around providing developmentally appropriate care in the context of palliative and end-of-life care. The case covers the role of an adolescent psychosocial assessment, evolving understanding of appropriate parental involvement, and the legal and practical aspects of communication, decision-making, and advance care planning for young adults with complex conditions. The importance of cross-specialty and interagency collaboration is emphasized. Symptom management and assessment of distress are considered in the context of providing holistic end-of-life care for young people who may have a learning disability or communication difficulty. Finally, the case considers the impact of the young person’s illness and death on their family, peers, and carers, including the healthcare professionals involved in supporting them. 145 words
Autonomy in Children
Authors: Rooney Marie Claire , Laddie Joanna 
Published: June 2024

Abstract
This case illustrates how autonomy in children in the context of palliative care is a complex issue, which encompasses many ethical, moral, and legal considerations. What defines ‘childhood’ is open to debate. Consideration of the child’s welfare is at the heart of treatment decisions. This should be considered in the context of the child or young person’s competence to consent (often known as Gillick competency) and the viewpoints of those with parental responsibility. Where there is a discrepancy in what constitutes the optimal welfare of the child or young person, challenges arise and can involve complex decision-making, as illustrated by this case.
Immunosuppression after Kidney Transplantation
Authors: Cherukuri Aravind , Baker Richard J. 
Published: June 2024

Abstract
Immunosuppression remains the cornerstone of medical management in kidney transplantation. Progress in the field of therapeutic immunosuppression has been the key to successful kidney transplantation and long-term allograft survival. Induction immunosuppression refers to the intense immunosuppression used in the initial days post-transplantation to circumvent early acute rejection, while maintenance immunosuppression is the lower intensity immunosuppression used for the life of the transplant to maintain allograft function and prevent rejection as the graft becomes less immunogenic. These agents are also used to reverse established rejection. The chapter highlights the immunological pathways that cause allograft rejection and how immunosuppressive agents block these pathways with the intent of reducing the incidence of rejection. It summarizes the mechanisms of action and adverse effects of commonly used agents and the immunosuppression strategies applicable to routine clinical management for certain high-risk patients.
Cancers after Kidney Transplantation
Authors: Saleem Nida , Wong Germaine , Chapman Jeremy 
Published: June 2024

Abstract
Cancer, infections, and cardiovascular diseases (CVDs) are known to be the mortality-defining outcomes after kidney transplants. However, there has been marked improvement in medical management and preventive strategies, resulting in a decline in infectious and CVD complications. CVD and post-transplant infections are discussed in chapters 8 and 9. There has been a progressive rise in cancer incidence after transplant, owing to improved post-transplant survival and the longer-term adverse effects of immunosuppression. In Australia and worldwide, cancer is one of the common causes of death in kidney transplant recipients. Kidney transplant patients consider cancer the most feared outcome because cancer impacts survival and the quality of life. This chapter discusses cancer epidemiology, risk factors, pathogenesis, surveillance, and management strategies in kidney transplant recipients.
Long-term Care of Kidney Transplant Patients—Conclusion
Authors: Rabb Hamid 
Published: June 2024

Abstract
The Conclusion summarizes all chapters of the book, highlighting the progression in the field of organ transplantation over seventy years and the importance of various immunological and nonimmunological events impacting kidney transplantation. Key highlights include: wellness after kidney transplantation, which covers important elements such as immunization, parenthood, travel and return to work for transplant recipients; acute and chronic active T-cell-mediated and antibody-mediated rejection, cardiovascular diseases, infections, cancers, and recurrent diseases, and pathways toward transplant tolerance; potential advances such as wearable kidney, implantable bioartificial kidney, and generating nephrons, which could potentially impact the management of patients with end-stage kidney disease; and pathways such as donor bone marrow transplantation, cell based and nanoparticle-based therapies potentially leading to transplant tolerance. The breadth and depth of information provided through this book will make it a desk reference for all those who are caring for kidney transplant patients across the globe.
9
Authors: Cohen Lewis 
Published: June 2024

Abstract
This chapter begins with an exploration of factors that can lead to an increased risk of dementia. These include hearing impairment, disturbed sleep, and behaviors that contribute to poor vascular health. Hearing impairment is cited as being the single most important modifiable risk factor: moderate hearing loss triples the risk, and people with a severe hearing impairment are five times more likely to develop a dementia. Genetic factors (particularly the APOE gene) are likewise explored, as is the question of why Dan believed that he would eventually receive a dementia diagnosis, just as his father did. New drugs that are available for the treatment of dementia (including those that have been rejected) are also addressed.
Fusarium species,Scedosporium species, and Lomentospora prolificans: A systematic review to inform the World Health Organization priority list of fungal pathogens
Authors: Marinelli Tina , Kim Hannah Yejin , Halliday Catriona L , Garnham Katherine , Bupha-Intr Olivia , Dao Aiken , Morris Arthur J , Alastruey-Izquierdo Ana , Colombo Arnaldo , Rickerts Volker , Perfect John , Denning David W , Nucci Marcio , Hamers Raph L , Cassini Alessandro , Oladele Rita , Sorrell Tania C , Ramon-Pardo Pilar , Fusire Terence , Chiller Tom M , Wahyuningsih Retno , Forastiero Agustina , Al-Nuseirat Adi , Beyer Peter , Gigante Valeria , Beardsley Justin , Sati Hatim , Alffenaar Jan-Willem , Morrissey C Orla 
Published: June 2024

Abstract
Recognizing the growing global burden of fungal infections, the World Health Organization established a process to develop a priority list of fungal pathogens (FPPL). In this systematic review, we aimed to evaluate the epidemiology and impact of infections caused by Fusarium spp., Scedosporium spp., and Lomentospora prolificans to inform the first FPPL. PubMed and Web of Sciences databases were searched to identify studies published between January 1, 2011 and February 23, 2021, reporting on mortality, complications and sequelae, antifungal susceptibility, preventability, annual incidence, and trends. Overall, 20, 11, and 9 articles were included for Fusarium spp., Scedosporium spp., and L. prolificans, respectively. Mortality rates were high in those with invasive fusariosis, scedosporiosis, and lomentosporiosis (42.9%–66.7%, 42.4%–46.9%, and 50.0%–71.4%, respectively). Antifungal susceptibility data, based on small isolate numbers, showed high minimum inhibitory concentrations (MIC)/minimum effective concentrations for most currently available antifungal agents. The median/mode MIC for itraconazole and isavuconazole were ≥16 mg/l for all three pathogens. Based on limited data, these fungi are emerging. Invasive fusariosis increased from 0.08 cases/100 000 admissions to 0.22 cases/100 000 admissions over the time periods of 2000–2009 and 2010–2015, respectively, and in lung transplant recipients, Scedosporium spp. and L. prolificans were only detected from 2014 onwards. Global surveillance to better delineate antifungal susceptibility, risk factors, sequelae, and outcomes is required.
Aspergillus fumigatus—a systematic review to inform the World Health Organization priority list of fungal pathogens
Authors: Morrissey C Orla , Kim Hannah Y , Duong Tra-My N , Moran Eric , Alastruey-Izquierdo Ana , Denning David W , Perfect John R , Nucci Marcio , Chakrabarti Arunaloke , Rickerts Volker , Chiller Tom M , Wahyuningsih Retno , Hamers Raph L , Cassini Alessandro , Gigante Valeria , Sati Hatim , Alffenaar Jan-Willem , Beardsley Justin 
Published: June 2024

Abstract
Recognizing the growing global burden of fungal infections, the World Health Organization established a process to develop a priority list of fungal pathogens (FPPL). In this systematic review, we aimed to evaluate the epidemiology and impact of invasive infections caused by Aspergillus fumigatus to inform the first FPPL. The pre-specified criteria of mortality, inpatient care, complications and sequelae, antifungal susceptibility, risk factors, preventability, annual incidence, global distribution, and emergence were used to search for relevant articles between 1 January 2016 and 10 June 2021. Overall, 49 studies were eligible for inclusion. Azole antifungal susceptibility varied according to geographical regions. Voriconazole susceptibility rates of 22.2% were reported from the Netherlands, whereas in Brazil, Korea, India, China, and the UK, voriconazole susceptibility rates were 76%, 94.7%, 96.9%, 98.6%, and 99.7%, respectively. Cross-resistance was common with 85%, 92.8%, and 100% of voriconazole-resistant A. fumigatus isolates also resistant to itraconazole, posaconazole, and isavuconazole, respectively. The incidence of invasive aspergillosis (IA) in patients with acute leukemia was estimated at 5.84/100 patients. Six-week mortality rates in IA cases ranged from 31% to 36%. Azole resistance and hematological malignancy were poor prognostic factors. Twelve-week mortality rates were significantly higher in voriconazole-resistant than in voriconazole-susceptible IA cases (12/22 [54.5%] vs. 27/88 [30.7%]; P = .035), and hematology patients with IA had significantly higher mortality rates compared with solid-malignancy cases who had IA (65/217 [30%] vs. 14/78 [18%]; P = .04). Carefully designed surveillance studies linking laboratory and clinical data are required to better inform future FPPL.
Mucorales: A systematic review to inform the World Health Organization priority list of fungal pathogens
Authors: Morrissey C Orla , Kim Hannah Yejin , Garnham Katherine , Dao Aiken , Chakrabarti Arunaloke , Perfect John R , Alastruey-Izquierdo Ana , Harrison Thomas S , Bongomin Felix , Galas Marcelo , Siswanto Siswanto , Dagne Daniel Argaw , Roitberg Felipe , Gigante Valeria , Sati Hatim , Alffenaar Jan-Willem , Beardsley Justin 
Published: June 2024

Abstract
The World Health Organization, in response to the growing burden of fungal disease, established a process to develop a fungal priority pathogens list (FPPL). This systematic review aimed to evaluate the epidemiology and impact of invasive fungal disease due to Mucorales. PubMed and Web of Science were searched to identify studies published between January 1, 2011 and February 23, 2021. Studies reporting on mortality, inpatient care, complications and sequelae, antifungal susceptibility, risk factors, preventability, annual incidence, global distribution, and emergence during the study time frames were selected. Overall, 24 studies were included. Mortality rates of up to 80% were reported. Antifungal susceptibility varied across agents and species, with the minimum inhibitory concentrations lowest for amphotericin B and posaconazole. Diabetes mellitus was a common risk factor, detected in 65%–85% of patients with mucormycosis, particularly in those with rhino-orbital disease (86.9%). Break-through infection was detected in 13.6%–100% on azole or echinocandin antifungal prophylaxis. The reported prevalence rates were variable, with some studies reporting stable rates in the USA of 0.094–0.117/10 000 discharges between 2011 and 2014, whereas others reported an increase in Iran from 16.8% to 24% between 2011 and 2015. Carefully designed global surveillance studies, linking laboratory and clinical data, are required to develop clinical breakpoints to guide antifungal therapy and determine accurate estimates of complications and sequelae, annual incidence, trends, and global distribution. These data will provide robust estimates of disease burden to refine interventions and better inform future FPPL.