bluuebunny/crossref_metadata_2025_split huggingface dataset:
Simulating random events: anaphylactoid reactions to anaesthesia
Authors: Cruickshank Steven 
Published: November 2023

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Abstract
The past is another country, from which there are visitors among us. They are the elderly. For them, many things are different: money,* transport, communications, newspapers, public and private behaviour, even the landscape of the streets. Most older people have adapted quite well to the gradual transition from the familiarities of the period in which their attitudes were formed, but young people dealing with elderly patients should at least be aware of just how much change is involved.
People in their twenties today who are looking after people almost as old as the century should know that in their generation childhood death from infectious illness was commonplace, that the men could have been among the younger participants in the First World War, and that the women were among the first to have the vote.
Talking about sexual function
Authors: Myerscough Philip R , Ford Michael J , Currie C T , Doyle D , Hewitt A N M , Laing I A , Speirs A L , Wrate R M 
Published: November 2023

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

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

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

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

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

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