bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opioid infusions
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva 
Published: November 2023

Abstract
The standard prescription of intermittent analgesic drug regimens commonly leads to inadequate pain control. Improvement may be achieved using some form of continuous analgesic drug administration technique. This may have several advantages including: avoidance of troughs in plasma drug concentrations (resulting in pain) which occur with intermittent dosage schedules; avoidance of high-peak plasma concentrations (causing adverse effects) after bolus administration. Continuous intravenous infusions should result in a constant level of analgesia for the duration of the infusion, avoiding periods of inadequate pain relief and periods of excessive sedation from intermittent high concentrations of drug by the administration of repeated bolus doses.
Patient-controlled analgesia (PCA) systems
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva 
Published: November 2023

Abstract
The development and introduction of PCA systems into clinical practice has endeavoured to provide a method of analgesia which will bypass any difficulties relating to inappropriate dosing schedules, unpredictable drug absorption, or patient variability. It is a system that also avoids dependence upon the nurses or doctors to provide analgesic medication. These people may be unavailable at times or occupied with other tasks; reliance upon them for analgesia may therefore be a factor in the failure of current regimes to provide satisfactory analgesia. With the PCA systems the patient is in control of their analgesia all the time. Not only does the PCA system provide improved analgesia, it also allows patients to feel in control of their pain.
Spinal anaesthesia
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva 
Published: November 2023

Abstract
The earliest reported use of spinal anaesthesia in man was by August Bier, in 1898, who injected cocaine intrathecally. The technique was further developed and used widely with newer local anaesthetic agents. Fears of neurological complications following spinal anaesthesia led to a decline in its popularity in the UK in the 1950s. These fears have since been felt to be unjustified. Spinal anaesthesia is now recognized as a safe and effective technique. It is principally used to provide anaesthesia for surgical procedures below the umbilicus, particularly for orthopaedic and urological operations. With most of the currently available local anaesthetic agents for spinal use, the blockade produced is of relatively short duration and provides little postoperative analgesia. Techniques using the insertion of catheters into the subarachnoid space can offer analgesia by continuous administration of local anaesthetic providing a prolonged block. Since the catheters must be inserted intrathecally and may give a portal of entry for bacteria this technique is not, so far, widely used.
Pain control in special situations
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva 
Published: November 2023

Abstract
Analgesia for the obstetric patient is unusual in that the doctor must consider two patients the fetus and the mother and the effects the chosen method of analgesia will have on both. It is also a situation in which the patient may herself express a preference for particular methods of analgesia. Analgesia may be required for labour, following operative procedures performed during pregnancy such as cervical cerclage (Shirodkar suture) and after Caesarean section. Any techniques used during labour should produce efficient relief from pain whilst maintaining consciousness between contractions and good patient co-operation. It should not influence the process of labour. Respiratory depression, particularly of the neonate, should be minimal. Pain relief in labour is a major topic and, other than a brief review, is beyond the scope of this book. Interested readers are referred to the additional reading list for this chapter.
The acute pain service
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva 
Published: November 2023

Abstract
For many years acute pain has been managed primarily by junior medical and nursing staff, many of whom have received minimal training to equip them for the task. It is not surprising that numerous studies of hospital patients have shown that acute pain is often poorly controlled, despite many advances in the drugs and techniques available to us. Management of chronic and terminal pain has developed enormously over the last 25 years, with many patients now receiving psychological, pharmacological, and physical treatments in multidisciplinary pain clinics and hospices. There is now widespread acceptance that these conditions are best managed by staff with specialist training.
Case studies in-pain management
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva 
Published: November 2023

Abstract
The patient studies in this chapter have been chosen to illustrate commonly encountered problems in the accident and emergency department as well as those in the medical and surgical wards. Techniques such as regional blockade and the administration of epidural opioids may not be widely available and staff should seek help if unsure about the practice in their particular unit. In all instances it is important to maintain attention to the patient’s general condition and specifically to ensure an adequate airway, oxygenation, and the correction of hypovolaemia or other cause of shock in the individual patient, as necessary.
Patient assessment: structure and content
Authors: Faulkner Ann , Maguire Peter 
Published: November 2023

Abstract
The aim of an initial assessment is to establish which problems concern the patient, whether they be physical, social, psychological, or spiritual. The health professional should interview in a way which engenders trust and promotes compliance with advice and treatment. Beginning the interview; assessing the current problems and their impact; and ending the interview form three distinct parts of the assessment.
Recognizing and handling difficult situations
Authors: Faulkner Ann , Maguire Peter 
Published: November 2023

Abstract
Many cancer patients have concerns which may pose problems for health professionals, especially when the cause of the concern is not made clear. If difficult situations arise as a result of the patient’s, or relatives’, fears and worries, it can leave health professionals with the feeling that they are somehow responsible for the patient’s emotional state. In this chapter, some difficult situations which commonly occur will be described, and useful strategies for coping with them will be contrasted with less effective, but more common techniques.
Injuries to children
Authors: Morton N S 
Published: November 2023

Abstract
The priorities are assessment of the airway while neck control is carried out, assessment of breathing and the circulation while controlling bleeding, assess ment of the level of consciousness and an overall assessment for other injuries. This scheme can be carried out very quickly and is easily remembered as an alphabetical list: The details of this scheme are similar to the rapid assessment of anycritically ill child but you must assume the cervical spine is injured until proven otherwise and you must actively look for injuries other than the most obvious.
Paediatric Ventilatory Care
Authors: Kerr M 
Published: November 2023

Abstract
The first breath marks the most radical change which will ever take place in the respiratory system. The adjustment from a fluid-filled to an air-filled lung is dramatic, but it is only the first of many adaptations which will take place as the lungs mature. The aetiology and clinical course of respiratory failure in infants and children is often quite unlike that seen in adults. The response to ventilatory support may also differ according to age. An understanding of the immature respiratory system can help explain these clinical differences and allow ventilatory management to be tailored to the needs of the patient.
Nursing Aspects of Paediatric Intensive Care
Authors: Macnab R 
Published: November 2023

Abstract
In this chapter, general principles of paediatric intensive care nursing are outlined, and a detailed discussion of the particularly important nursing issues is presented. Nursing assessment of critically ill infants and children, the nursing care of children in pain, the organization of nursing care, intensive support for parents and other family members and the provision for the dying child in the paediatric intensive care unit (PICU) are covered.
Legal and ethical aspects of paediatric intensive care
Authors: Morton N S 
Published: November 2023

Abstract
The legal and ethical framework for decision-making in paediatric intensive care is more complex than in adult practice. Although the primary duty of care is to the child, the decisions usually involve parents or guardians acting as advocates for the child. It is important that good lines of communication are established as soon as possible between the paediatric intensive care unit staff and the parents or guardians because changes in the child’s condition can happen very rapidly. The paediatric intensive care unit environment is complex and fraught with risks. Interventions must often be immediate before informed consent can be obtained. Allocations of intensive care resources, consent to treatment, withholding or withdrawing intensive care, diagnosis of brain death, organ donation and medical accidents all give problems. Each case must be considered individually with the overriding principle of acting at all times in the best interests of the child within the prevailing locally determined medical, social and legal rules.
Communication
Authors: Modell Michael , Mughal Zulf , Boyd Robert 
Published: November 2023

Abstract
Until recently, hospital consultants formed a more powerful and prestigious part of the medical establishment in the UK than GPs, but this is changing. General practitioners are closer to the ‘consumers’ than hospital doctors, and their patterns of referral for secondary care can have a more direct influence on which services are provided by which hospital or other provider. Their opinion is being sought and they are being wooed by other sections of the health service in an unprecedented manner. In turn, decision-making and power are also being shared with nurses, pharmacists, and other health professionals, who are being given prescription rights, formalized advisory roles and direct access to patients. Registers of practitioners of complementary medicine are being established; managerial power and numbers are increasing. The advent of fund-holding practices means that, for the first time in almost 50 years, there is a significant financial component to the doctor-patient interaction. Even without fund-holding there may be a perception by patients that treatment is being withheld because of cost.
Catastrophes and potential catastrophes in infants
Authors: Modell Michael , Mughal Zulf , Boyd Robert 
Published: November 2023

Abstract
Avoidable death and avoidable brain damage haunt any doctor treating babies and children. Disabilities are discussed in Chapter 8 and we are concerned in this chapter mainly with sudden infant death and with symptoms in babies that may mean life-threatening illness. However, many potentially fatal conditions can also lead to disabilities if the child survives. One of the challenges of general practice is to be able to pick out the child who has a major life-threatening disease from the majority, who have relatively minor self-limiting conditions.
Practising prevention
Authors: Modell Michael , Mughal Zulf , Boyd Robert 
Published: November 2023

Abstract
The aims of health promotion are to abolish avoidable child death and disease, to manage disability and resultant handicap, to mitigate the effects of deprivation and poor parenting, and to encourage healthy habits for children to take into adult life. Its aims do not include an over-dependence on medication or an exaggerated concept of what medicine can solve. They do include a positive attitude to life and the ability to make the most of one’s resources and opportunities.
Psychosocial problems of childhood
Authors: Modell Michael , Mughal Zulf , Boyd Robert 
Published: November 2023

Abstract
The General Practitioner is a doctor who provides personal, primary and continuing medical care to individuals and families ... His diagnosis will be composed in physical, psychological and social terms. (Royal College of General Practitioners 1969) Doctors always need to ask not only ‘what is the matter with the patient?’ but also ‘why is this child being brought to me at this moment?’ A rise in the frequency with which a parent brings the small child with upper respiratory tract infections is one indication of increased stress within the family. Not only do mothers in such circumstances have a lower threshold for consulting, but children living in stressed families are also more likely to develop minor infections. An out of hours call to see a minimally sick child who could well have been brought to the surgery during the day may be another indication of a stressed or disorganized family. Equally, the manner in which a child’s physical problems are presented is an important indicator of family tensions. Perhaps one minor symptom after another is revealed to the GP, who is left with a feeling that, even if the consultation had gone on for another hour, the mother still would not have had the chance to express all her anxieties about the child.
Children with disabilities, and school health services
Authors: Modell Michael , Mughal Zulf , Boyd Robert 
Published: November 2023

Abstract
The World Health Organization has defined impairment as a pathological process affecting normal physiology or anatomy, disability as reduced ability to perform normal functions resulting from an impairment, and handicap as the consequence or disadvantage for an individual resulting from a disability or an impairment. Until the last decade mental handicap was defined by comparing a child’s intellectual ability to that of his peers. Intelligence tests were a standardized means of measuring a child’s mental age from which IQ could be calculated, by dividing the mental age by the real age and multiplying by 100. Thus the general development of a 10-year-old child with an IQ of 20 was equivalent to that of a child of 2 years. IQ scores formed the basis for planning for an individual’s educational needs.
Infectious diseases
Authors: Modell Michael , Mughal Zulf , Boyd Robert 
Published: November 2023

Abstract
If the ill child wants to stay in bed, fine. Otherwise there is no reason why he should not sit in a chair, or lie on the sofa watching TV. Some parents of young children find it helpful to put aside a box of toys that are only brought out if their child is unwell. Teenagers may enjoy quietly listening to their personal stereo. Sick children feel ill at ease and behave in a more dependent, immature way they may feel more comfortable sleeping in the parents’ room for a night or two, or vice versa. Previously clean and dry toddlers may revert to wearing nappies.
Other respiratory disorders
Authors: Modell Michael , Mughal Zulf , Boyd Robert 
Published: November 2023

Abstract
Respiratory disease and otitis media account for 40 per cent of consultations by children under five years (Morbidity statistics from general practice 1986). This is not surprising considering that, on average, children have 12 acute respiratory infections in their first two years of life. Parental smoking is important. In a large British study involving 13 000 children under five years, maternal smoking during pregnancy was associated with a significantly increased risk of the child being admitted to hospital with a lower respiratory tract infection. ‘Bronchitis’ was most likely in children of mothers who smoked, surprisingly even if this was only in the antenatal period. Paternal smoking did not have a significant influence on the amount of serious respiratory disease.
Anaemia and bruising
Authors: Modell Michael , Mughal Zulf , Boyd Robert 
Published: November 2023

Abstract
A constant supply of oxygen is needed by the tissues and it is the function of haemoglobin to combine reversibly with oxygen, allowing the red blood cells to pick up the gas from the lungs and release it in the capillary bed. Interestingly, a litre of blood after leaving the lungs contains the same volume of oxygen as a litre of air-200 mL. Because of the different haemoglobin values at different ages (Table 17.1), it is important for the GP to know the normal range, making it less likely that he will treat a child for a non-existent anaemia. Haemoglobin concentration at birth is high by adult standards (16-18 g/dL). It initially falls rapidly and then more gradually to a low at two months of age, when the normal range is about 10.5-14.5 g/dL. After that there is a gradual rise throughout child hood but the haemoglobin concentration remains below adult values until adolescence.
Fits and faints
Authors: Modell Michael , Mughal Zulf , Boyd Robert 
Published: November 2023

Abstract
One of the most frightening experiences for any parent, is to witness their child having a convulsion, particularly its first. They have visions of a dead or braindamaged child, and it is common for him to be rushed directly to the Accident and Emergency department of the nearest hospital, bypassing the GP. A fit is usually unpredictable, and the child may have appeared reasonably well a few minutes before: Jimmy was the 14-month-old baby of French parents. He was brought to the surgery with a fever and an upper respiratory tract infection. The GP told the mother that the child was not seriously unwell, had a self-limiting illness, and only needed paracetamol. A few hours later a very angry mother rang from the hospital. Jimmy had a convulsion five minutes after she had left the surgery. The parents had taken him directly to the hospital, where he was now better. However, she never wanted to see the doctor again, who was obviously quite unable to realize how sick her child had been.
Recurrent pains
Authors: Modell Michael , Mughal Zulf , Boyd Robert 
Published: November 2023

Abstract
Complaints of aches and pains at one site or another, recurring over several months or years, are common in childhood. Often they seem to peter out or, at least, the family becomes able to cope with the symptom at a domestic level, once the doctor has guessed or established the family’s specific fear, and has been able to reassure them that the pains are not, for example, appendicitis, leukaemia or a brain tumour. Other family members may have dysmenorrhoea, indigestion, or migraine. The abdomen and head and limbs seem to be the most common sites for recurrent pains in children; chest pains or chronic backache are rarer. Although, in most patients, there is no physical cause to account for the pain, careful assessment is necessary. Chronic backache, unlike the others, is more usually a symptom of some underlying organic pathology in a child. It, and limb pains are discussed in Chapter 21.
Congenital disorders and genetic disease
Authors: Modell Michael , Mughal Zulf , Boyd Robert 
Published: November 2023

Abstract
Genetics is becoming more and more relevant to primary care. The aim of this chapter is to put this major development which affects existing and future babies and children, into context. Practice staff have an important role in educating and counselling carriers of common recessively inherited conditions (haemoglobin disorders, cystic fibrosis), in providing information to those offered testing elsewhere, and in referring carrier couples for genetic counselling. Many women attending for family planning advice intend to have a baby in the near future. This may be an ideal opportunity for preconception counselling. Antenatal care often includes several screening tests often inadequately explained. Being alert to the genetic components of handicap or chronic disease is important, so that the need to refer parents of children affected by these conditions for genetic advice is not overlooked. All members of a primary health care team who come into contact with parents or potential parents must be able to give basic genetic information. However, it may be advisable for larger practice teams to arrange for one member, perhaps a health visitor or practice nurse, to receive additional training in this area.
Perversion as a regulator of self-esteem
Authors: Rosen Ismond 
Published: November 2023

Abstract
Regulation of self-esteem is a major function of the perversions. Patients seeking help for the relief of their perversions, simultaneously complain of feelings of inadequacy, with under or over self-assertion, as evidence of a disordered narcissistic economy. Perverse fantasies or actions function as a source of intense pleasure that elevates self-esteem. Conversely, following perverse acts patients may complain of feelings of shame and guilt that diminishes their self-esteem.
The gender disorders
Authors: Stoller Robert J 
Published: November 2023

Abstract
Most psychoanalysts, following Freud (1905), believe all psychopathology, not just the sexual deviations, results-by such mechanisms as castration anxiety and penis-envy in the oedipal conflict-from disturbances in the development of gender-identity, that is, of masculinity and femininity. This discussion, however, will be restricted to the gross aberrations of masculinity and femininity: primary and secondary transsexualism, transvestism, certain types of homosexuality, inter-sexuality, and certain aspects of psychosis.
Child sexual abuse
Authors: Kolvin Israel , Trowell Judith 
Published: November 2023

Abstract
Over the two last decades sexual abuse of children has now come to be seen as one of the new ‘epidemics’ of childhood and yet previously it must have been present in communities; the question arises, why was it not viewed as pathological behaviour and a serious problem affecting children’s physical and psychological health. It would seem that multiple factors must have contributed to what appears to be a suppression of the facts, or perhaps it was a reluctance to acknowledge the presence of sexual abuse.
Behavioural therapy treatment for sex-off enders
Authors: Abel Gene G , Osborn Candice A 
Published: November 2023

Abstract
Behavioural therapy evolved out of learning theory and is used to evaluate and treat psychiatric and psychological symptoms by directly decreasing the frequency of pathological behaviours and increasing the frequency of appropriate behaviours. Behavioural therapy for sex-offenders initially focused on single treatment interventions, such as aversion therapy, to change the paraphiliac’s deviant behaviour.
The use of guidelines and criteria in peer review
Authors: Grol Richard , Lawrence Martin 
Published: November 2023

Abstract
We have described peer review as a systematic assessment of one’s own and one another’s pattern of care with the aim of achieving a continuous improvement of patient care. In such a peer review process explicit guidelines for what is considered to be desirable general practice care play a central role. However, it is not unusual to find general practitioners objecting to clearly formulated guidelines and criteria and the uniformity they imply. This feeling of threat is increased by poor understanding of ter-minology which is often seen to imply external imposition when it does not.
The health risks women face
Authors: Russell Cristine 
Published: November 2023

Abstract
When it comes to health, women and men are certainly not created equally. From the first breath to the last, women face different health risks than men, not only in how and when they die but in the nagging medical conditions that affect the way they Jive. Women generally have a strong advantage in terms of life span, but unfortunately they often live less healthy lives than their male counterparts.