bluuebunny/crossref_metadata_2025_split huggingface dataset:
Attention-Deficit/Hyperactivity Disorder (ADHD)
Authors: Albano Anne Marie , Silverman Wendy K. 
Published: March 2024

Abstract
This chapter details the Attention-Deficit/Hyperactivity Disorder (ADHD) module in the Anxiety and Related Disorders Interview Schedule for DSM-5, Child and Parent Version: Child Interview Schedule (CIS). To meet criteria for a diagnosis of ADHD, the child must respond “yes” to at least six of Questions 1–9 in the Attention Deficit section or “yes” to at least six of Questions 1–9 in the Hyperactivity and Impulsivity section. Also, the child must have indicated that the problem has been going on for at least 6 months, began before age 12, and occurs in more than one setting. For ages 17 and older, at least five symptoms are required for the diagnosis. It is also important to measure interference through the Feelings Thermometer.
Endocrinology
Authors: Phylactou Maria 
Published: March 2024

Abstract
Whilst the main aim of this chapter on endocrinology is to arrive at a working practical knowledge of diabetes, it will also raise awareness of the other glands, so that their dysfunction can be recognized and investigated where appropriate. This chapter contains 44 questions that encompass all of the important areas of this subject, with detailed explanations. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Medicine to track revision progress and revise effectively.
Rheumatology
Authors: Sinharay Rudy 
Published: March 2024

Abstract
It is a core skill for the budding physician to be able to assess and diagnose inflammatory arthritis, autoimmune disorders, vasculitis, soft tissue disorders, spinal problems, and metabolic bone disease. Rheumatological disease covers extremely common conditions like gout and osteoarthritis to rare conditions like sceleroderma and a systematic approach to history, physical examination and investigation is vital. This chapter contains 26 questions that encompass all of the important areas of rheumatology, with detailed explanations. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Medicine to track revision progress and revise effectively.
Geriatric medicine
Authors: Furmedge Dan 
Published: March 2024

Abstract
Geriatric medicine is the largest ‘medical’ specialty in the United Kingdom, with the number of geriatricians expanding due to and ageing population. Managing frailty and complex medical comorbidity is the core skill of a geriatrician. In this chapter, questions give a taste of some of the common clinical areas in geriatric medicine and will demonstrate how geriatric medicine crosses almost every specialty. This chapter contains 18 questions that encompass many of the important areas of this subject, with detailed explanations. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Medicine to track revision progress and revise effectively.
History of Mechanical Ventilation
Authors: Griffiths Mark , White Mary , Chakkalakal Nirmala Mary 
Published: March 2024

Abstract
Summary
The evolution of artificial mechanical ventilation has been very influential in the development of respiratory and critical care medicine. Mechanical ventilation is a crucial aspect of resuscitation, intensive care medicine, and anaesthesia. It has evolved from simple mechanically delivered support to advanced, patient-triggered, micro-processor-controlled systems. Progress along this path has furthered the aims of achieving effective life support with reduced risk and increased comfort. Advances in our understanding of respiratory disease and physiology have occurred alongside, and frequently been synergistic with, the evolution of mechanical ventilation. Understanding how mechanical ventilation developed from its earliest stages to its current and future incarnations provides a key underpinning to the understanding of respiratory critical care.
Gas Exchange
Authors: Cumpstey Andrew , Grocott Mike 
Published: March 2024

Abstract
Summary
Inadequate gas exchange (respiratory failure) is the most common reason for admission to critical care and associated with high mortality rates. Effective gas exchange requires adequate ventilation, diffusion, and perfusion. Hypoxaemia (low blood oxygen saturation) will result if any of these are inadequate, whereas hypercapnia typically results from inadequate ventilation. Two different types of respiratory failure can be considered clinically—normocapnic (sometimes called ‘Type 1’), where oxygenation is impaired but ventilation and therefore clearance of carbon dioxide (CO2) is not, and hypercapnic (‘Type 2’), where inadequate ventilation impairs CO2 clearance as well as oxygenation. In physiological terms—and regardless of the underlying disease process—hypoxaemia always results from one of five possible causes: less inspired oxygen (e.g. high altitude), hypoventilation, impaired diffusion across the alveolar membrane, inequality of ventilation and perfusion (‘V/Q mismatch’), and shunting (blood flow that does not participate in gas exchange). Increasing the inspired oxygen may seem the obvious treatment for respiratory failure; however, unnecessary hyperoxia likely also carries inherent risk of harm and may not fully resolve the situation either. This chapter reviews these topics in detail and considers how investigations (e.g. arterial blood gases) can be used to target respiratory failure treatment.
Non-invasive Ventilation in Critical Care
Authors: Gregoretti Cesare , Cortegiani Andrea , Russotto Vincenzo , Pisani Lara 
Published: March 2024

Abstract
Summary
Acute respiratory failure (ARF) is characterized by impaired gas exchange and increased work of breathing, secondary to an acute lung and/or respiratory pump failure. Ventilatory assistance to respiratory function can be applied either invasively through an endotracheal tube or by means of external interfaces, such as masks, mouthpieces, prongs, and helmets, referred to as non-invasive ventilation (NIV). Acute NIV needs to be provided in an appropriately skilled and equipped environment, with ready access to advanced respiratory therapies, including invasive mechanical ventilation. Effective use of NIV requires understanding of the ventilator system and interfaces. Key ventilator features include the nature of gas delivery (high-pressure or turbine-driven), the variables used for setting gas delivery, and the timing of breaths and the circuits. Ventilators can deliver either non-invasive continuous positive airway pressure (CPAP) or vary the positive pressure, at different levels (nPPV) to facilitate ventilation. A wide variety of interfaces are available, although those commonly used for acute NIV include orofacial masks, total face masks, and helmets. The type of ventilator, the settings on that ventilator, and the interface all need to be individualized to the patient dependent on their underlying pathology, physiological features, and capacity to tolerate NIV, and a careful approach to patient optimization is critical to successful use of NIV.
Clinical Applications of Non-invasive Ventilation in Critical Care
Authors: Longhini Federico , Vaschetto Rosanna , Navalesi Paolo 
Published: March 2024

Abstract
Summary
Non-invasive ventilation (NIV) is the first-line treatment in patients with an exacerbation of severe chronic obstructive pulmonary disease causing hypercapnic acute respiratory failure (ARF). NIV (in particular, non-invasive continuous positive airway pressure, CPAP) is strongly recommended for patients with ARF due to cardiogenic pulmonary oedema. NIV may be indicated to treat hypoxaemic ARF secondary to surgical procedures, chest trauma, neuromuscular disorders or occurring in immunocompromised patients, to prevent further deterioration and need for endotracheal intubation, or with a palliative intent in patients with end-stage disease. NIV may help to speed up the weaning process in hypercapnic patients, while its use in hypoxaemic ARF requires further investigations. NIV should be considered after extubation to prevent the development of post-extubation respiratory failure in ‘at-risk’ patients, while it is presently not advised in established post-extubation respiratory failure. NIV is controversial in de novo hypoxaemic ARF. Given the uncertainty of evidence there is presently no clear strong recommendation on the use of NIV for de novo hypoxaemic ARF and acute asthma.
Monitoring Cardiovascular Function in Critically Ill Patients
Authors: Gabriel Rodney A , Pinsky Michael R 
Published: March 2024

Abstract
Summary
Haemodynamic monitoring is an essential aspect of the care of patients with respiratory failure because cardiovascular compromise may occur as a result of respiratory failure and mechanical ventilation. Monitoring needs to be personalized based on the severity of respiratory failure, its aetiologies, and concerns of either too much or too little fluid resuscitation on gas exchange. Monitoring includes non-invasive and invasive measures that can be both intermittent and continuous in their recordings. In general, one starts with the least invasive monitoring and escalates to more invasive one as the level of cardio-respiratory insufficiency and management intensify. Non-invasive vital signs are often adequate in an otherwise stable subject. However, the assessment of the adequacy of the circulation requires estimates of the effective blood flow and end-organ function. Invasive measures include central venous pressure, which is only useful as a stopping rule to fluid infusion, if it increases. Arterial pressure defines the input pressure of organ perfusion and on a beat-to-beat basis forms the dynamic measures of volume responsiveness. Pulmonary artery pressures are useful to monitor when pulmonary hypertension is present or anticipated. Finally, cardiac output can easily be estimated by a variety of techniques and devices, making its use commonplace.
Bronchoscopy in Critical Care
Authors: Singh Suveer 
Published: March 2024

Abstract
Summary
Bronchoscopy in the intensive care unit was developed in the early 1970s. Its flexibility and versatility provide diagnostic and therapeutic value. Common indications are to facilitate placement of a definitive airway, airway sampling for infection, and clearance of secretions. More complex situations such as airway haemorrhage, percutaneous tracheostomy insertion, foreign body removal, burn inhalation injury, tracheal tears, and persistent air leaks in mechanically ventilated patients are amenable to diagnostic and therapeutic bronchoscopy. However, published evidence is limited, and when available does not necessarily demonstrate overall benefit of bronchoscopy in intensive care. Single-use disposable bronchoscopes are increasingly important in the acute. care setting, where a quick set up, rapid visualization, and avoidance of contamination are intrinsic advantages. Further, the quality of optics is approaching that of the standard of reusable bronchoscopes. Bronchoscopy of the acutely sick awake patient is a valuable skill, requiring expertise and experience. A working understanding of endobronchial anatomy, physiological effects, and risks and complications of bronchoscopy in this setting is necessary. Bronchoscopy in the intensive care unit is safe, although well-known complications such as hypoxaemia, hypotension, cardiac arrhythmias, and pneumothorax must be anticipated. Simulated training is shown to improve patient-related outcomes, while offering an understanding of ventilatory physiological changes peri-procedurally. Protocols for preparation, documentation, and World Health Organization–style surgical ‘timeouts’ should be encouraged. Training programmes still require significant development to ensure maintenance of satisfactory contextual and experiential skills and competencies.
Gastric Protection
Authors: Krag Mette , Møller Morten Hylander , Singh Suveer , Wise Matthew P 
Published: March 2024

Abstract
Summary
Critically ill patients are at risk of gastrointestinal bleeding with stress ulcer prophylaxis being widely and somewhat uncritically used. In recent years, the evidence base has grown, and data on stress ulcer prophylaxis versus placebo as well as data comparing different agents are now available. High-quality trials and systematic reviews indicate that acid suppressants reduce the risk of gastrointestinal bleeding without obvious side effects. The overall mortality seems unaffected by the use of stress ulcer prophylaxis. The most severely ill patients are also the patients at highest risk of stress ulceration. Hence, the use of stress ulcer prophylaxis and the choice of agent should be decided following an individual assessment. Data on the effect of enteral feeding is needed, as well as data comparing use of histamine-2-receptor antagonists versus placebo and data on the effect of proton pump inhibitors on mortality amongst the most severely ill patients.
Mucus and Bronchopulmonary Clearance
Authors: Leaver Susannah , Ball Jonathan 
Published: March 2024

Abstract
Summary
This chapter covers the roles of airway surface liquid (ASL), the mucociliary escalator, and cough reflex in protecting the respiratory tract in health. The injurious result of certain disease processes and the negative impact of endotracheal intubation and mechanical ventilation on bronchopulmonary clearance are also discussed. Numerous mucolytic agents are currently used in clinical practice to combat these deleterious effects. These work by modifying ASL production, secretion, and composition, and may have an effect on the mucociliary escalator. Since there is a paucity of evidence in this area, their effects are extrapolated from their use in other respiratory conditions.
Human Factors
Authors: Hingston Christopher D 
Published: March 2024

Abstract
Summary
Despite advances in medical therapies, around 10% of patients admitted to hospital will suffer a serious adverse incident. Half are thought preventable with ordinary standards of care.1 In the United States of America, medical error is the third leading cause of death.2 Patients admitted to the intensive care unit experience on average 1.7 medical errors a day.3 Fortunately, the majority of these do not lead to significant patient harm, being trapped before they can do so. Human factors or ergonomics is the scientific study of humans and the systems in which they work in order to optimize performance. A number of cognitive skills and behaviours, known as non-technical skills can influence team performance. These include situational awareness, decision-making, communication, teamworking, leadership, as well as fatigue and stress management. Many high-risk industries have recognized the importance of developing these skills to mitigate error. Such teachable and trainable skills are also relevant to healthcare professionals. In doing so team performance can be enhanced, with resultant reduction in medical error and associated patient harm.
Ventilator-associated Pneumonia
Authors: Grover Vimal , Singh Suveer 
Published: March 2024

Abstract
Summary
Ventilator-associated pneumonia (VAP) is a lower-respiratory-tract infection that develops in those patients mechanically ventilated by way of a cuffed endotracheal tube within the trachea. It is associated with significant morbidity and mortality. VAP develops through a combination of factors—host, environmental, and those related to the infectious agent. It is unclear why some patients do not get VAP despite similar circumstances to others. This highlights currently unknown aspects of its aetiology including genetic and epigenetic factors. Potentially pathogenic microorganisms gain access to the lower airway, by micro-aspiration of pooled oropharyngeal secretions beyond the cuff. The diagnosis of VAP does not have a universally accepted clinical gold standard. However, a practically accepted definition incorporates elements of new fever, purulent secretions, radiographic lung deterioration, worsening blood, and/or bronchoalveolar biomarkers of inflammation and physiological deterioration, together with grades of quantitative microbiology. Prevention of VAP is dependent on measures to reduce the duration of mechanical ventilation, reduce the microbial burden in the airway, as well as improvements in reducing micro-aspiration of secretions. Standardization of specific ventilator care bundles, through a series of good practice measures, can reduce the incidence of VAP.
Bacterial Pneumonia
Authors: Woods David R , José Ricardo J 
Published: March 2024

Abstract
Summary
Bacterial pneumonia is lung parenchymal inflammation due to infection by a bacterial pathogen and it manifests with infective symptoms including cough productive of purulent sputum, dyspnoea, hypoxia, and pyrexia. This correlates clinically with bronchial breath sounds, radiological evidence of new pulmonary infiltrates, and often raised blood markers of inflammation. Both, community-acquired pneumonia (CAP, infection contracted outside of a hospital setting) and hospital-acquired pneumonia (HAP, an infection developing at least 48 h following hospitalization and not incubating at the time of admission) are accountable for increased morbidity, mortality, and use of healthcare resources worldwide. Here, we discuss the microbiology, current practice, evidence base, as well as the controversies and future directions of the management of CAP and HAP, excluding ventilator-associated pneumonia.
Pleural Infection
Authors: Lang-Lazdunski Loïc 
Published: March 2024

Abstract
Summary
Pleural infection is a common and increasing clinical problem in respiratory and critical care medicine. It carries significant morbidity and mortality and, despite optimal medical management, up to 30% of patients will die or require surgery. Chest X-ray remains the cornerstone of identification of pleural effusions in the setting of infection, but real-time pleural ultrasound now plays a critical role in the assessment of and guidance of drainage in pleural effusion or empyema. Emerging biomarkers together with currently available markers of inflammation may help identify infection in the setting of pleural effusion. Pleural fluid pH, LDH, and glucose remain key elements in the decision-making process regarding drainage of the pleural space. Traditionally, pleural infections have been managed by thoracocentesis, appropriate antibiotic therapy, placement of a chest tube, adequate nutrition, and chest physiotherapy. Surgery (thoracoscopic debridement or thoracotomy and decortication) was reserved for patients failing initial medical management. Recently published clinical trials as well as new guidelines have modified significantly approaches to radiological assessment, use of biomarkers, management algorithms, intrapleural therapies, and pleural drainage techniques whilst clarifying the role and ideal timing of surgery in pleural infections.
Travellers’ Pneumonia
Authors: Chaudhry Dhruva , Singh Pawan Kumar , Govindagoudar Manjunath B 
Published: March 2024

Abstract
Summary
With an increase in international travel, infectious agents are migrating frequently and changing the epidemiology of airborne infectious diseases in particular. Respiratory infection including pneumonia in returned travellers is an important cause for sought healthcare. Risk of contracting the infections depends on destination, trip duration, type of trip, etc., and the host factors such as age, gender, and co-morbid conditions. The aetiology of pneumonia in returned travellers is diverse and requires an index of clinical suspicion with the appropriate, sometimes special testing. Critical care management is supportive and predominantly for respiratory failure. Respiratory infections due to H1N1, SARS, MERS, and SARS-CoV-2 have posed a global threat and need constant reconnaissance of travellers. Infection control measures and personal protective equipment (PPE) should be deployed while treating these highly infectious diseases. Specific treatments are available for influenza viruses and relevant bacterial pneumonias.
Pharmacology of Anti-infective Drugs in Critical Illness
Authors: Gant Vanya 
Published: March 2024

Abstract
Summary
The disturbed physiology of critical illness considerably impacts blood and tissue concentrations of antimicrobials. In addition, the antimicrobials themselves vary enormously in chemical structure (and therefore charge, solubility, hydrophilicity, etc.), adding yet more complexity to effective and correct calculation of appropriate dose and interval timing. Examples here include on the one hand increased concentrations of hydrophilic beta-lactam antibiotics secondary to poor renal function and/or acute kidney injury, and on the other decreased antibiotic concentrations from increased volumes of distribution, decreased protein binding, and (sometimes artificially augmented by filtration or haemodialysis) renal clearance. Lipophilic antibiotics such as macrolides are less affected by physiological changes—although issues such as obesity influence dosing for optimal outcomes. Some antibiotics also have a narrow efficacy range and therapeutic index. Accordingly, aminoglycosides work best when used in high, once-daily dosing strategies with mandatory therapeutic drug monitoring. On the other hand, beta-lactam antimicrobials often have very short half-lives and are either bactericidal or entirely ineffective when only just below therapeutic concentrations. With such drugs, the most important pharmacodynamic parameter is therefore a ‘time above minimal inhibitory concentration’ optimized with shorter administration regimens, extended or even continuous infusions. None of these considerations should absolve treating physicians from deciding whether individual cases of infection are not better treated by removing the source of infection, as antibiotics alone cannot be expected to deal with large, undrained infected collections for instance.
Pulmonary Haemorrhage
Authors: Kouranos Vasilis 
Published: March 2024

Abstract
Summary
Diffuse alveolar haemorrhage is an acute condition associated with high morbidity and mortality. Among many conditions it can accompany, antineutrophil cytoplasmic antibody associated vasculitis, Goodpasture syndrome, connective tissue diseases, infections, and drug exposure seem to be the most common ones. Haemosiderin-laden macrophages are usually identified in the bronchoalveolar lavage, and histopathologic findings usually include evidence of pulmonary capillaritis. Despite the severity and high mortality, the current treatment options remain empirical targeting the control of inflammatory/infectious component, haemostasis, and supportive care. The various causes, acute and often life-threatening original presentation, and lack of evidence-based treatment options pose an important challenge to the clinicians.
Pulmonary Hypertension and Cor Pulmonale
Authors: Price Laura C , John Wort S , Finney Simon J 
Published: March 2024

Abstract
Summary
Intensive care management of pulmonary hypertension (PH) and acute cor pulmonale or right ventricular (RV) failure can be challenging, with the high risk of pulmonary hypertensive crises, cardiovascular collapse, and associated high mortality. Indeed, the presence of PH and RV dysfunction predicts mortality in patients with pre-existing PH, as well as acute respiratory distress syndrome, acute pulmonary embolism, and following surgical procedures (including certain cardiothoracic procedures and surgery in patients with pre-existing PH). The key to managing PH in the intensive care unit setting is early recognition and prevention of RV failure. Patients with chronic PH should have elective interventions carefully planned, with provision for management of PH crises in experienced centres. Management of acute PH and RV dysfunction often lies outside a clear evidence base and is based on physiological principles, with novel interventions including the impact of extracorporeal circuits such as extracorporeal membrane oxygenation considered in this chapter.