bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment: trick or treat?
Authors: Dickenson Donna , Fulford Bill (Kwm) 
Published: November 2023

Abstract
With treatment, we come full square to those issuew that are at the heart of traditional bioethics — automomy, consent, confidentiality, equal access, dual (indeed multiple!) responsibility, rationing, advance directives, and so forth.
Besides an extensive general literature, a good deal has been written about the ethical problems of treatment choice specifically in psychiatry (see Reading Guide to Chapter 2 and at the end of this chapter). One ‘big issue’ for psychia try is involuntary treatment. Psychiatry is ethically unique in that it is only for mental disorders that treatment without the consent of a fully conscious adult patient of normal intelligence is sometimes justified, not just for the protection of others, but in the interests of the person concerned. This is a ‘big issue’ prac tically: the boundary between justified and unjustified uses of involuntary treatment is the boundary between good practice and some of the worst abus es of psychiatry as a means of social control.
Psychiatric ethics: an international open society
Authors: Birley Jim 
Published: November 2023

Abstract
The basic education of doctors now lays less emphasis on stuffing them with facts (which may rapidly become irrelevant) and much more on teaching them attitudes about themselves, their patients and families, and their colleagues — which they will require to function as ‘good doctors’ throughout their profes sional lives. Much of this teaching will come, for better or worse, not from for mal occasions but from attitudes displayed or implied by their teachers. Attitudes are, of course, related to skills. A person’s attitude to a swimming pool, particularly to its deep end, will be affected by his or her ability to swim. This book is an introduction to the deeper end of ethics, beyond the shallows of autonomy and beneficence, which encourages the reader to develop the skills required to enjoy the experience and to communicate this enjoyment to others.
Management in the acute stage
Authors: Wrightson Philip , Gronwall Dorothy 
Published: November 2023

Abstract
In Chapter 2 we offered a definition of mild head injury in the acute stage. It specified that there should have been an injury to the head with a disturbance of neurological function, that when first assessed there should be a GCS score of 13–15 which was steady or improving, and that there should be no focal neurological signs. In such a patient, after looking at any other injuries and at their general condition, the question of management will be decided largely on the possibility of complications, principally intracranial haemorrhage.
Clinical picture after mild head Injury
Authors: Wrightson Philip , Gronwall Dorothy 
Published: November 2023

Abstract
Most people who have had a mild head injury experience unpleasant symptoms for a few days, usually of headache, lethargy, and irritability, but will be back to their normal activities in two or three weeks. In some these symptoms fail to resolve. Their headache continues and their sight and balance may be disturbed. They have difficulty with concentration and memory which prevents their returning to work, and there may be changes in their behaviour and personality. Lastly there is a small group of patients who have had less marked but still disabling symptoms for months or years before it is realized or accepted that they have been caused by a head injury.
Magnetic Stimulation of the Human Nervous System
Authors: Mills K R 
Published: November 2023

Abstract
This book provides comprehensive coverage of the technique and clinical applications of magnetic brain stimulation. It begins with an account of the invention of the technique and considers the technical aspects of how magnetic stimulators work. The anatomy and physiology of cortical motor areas are covered in sufficient detail to interpret the findings. There then follows a discussion of the effects of magnetic brain stimulation in healthy subjects, covering the visual and motor systems, and the effects of repetitive transcranial stimulation. A chapter on the practical aspects of the technique's use in a clinical setting is followed by coverage of specific clinical applications in patients with demyelinating diseases, motoneurone diseases, cerebrovascular diseases, degenerative neurological diseases, movement disorders, spinal cord and peripheral nerve diseases. The final chapters deal with the use of brain stimulation in neurosurgical monitoring and discuss potential developments of the technique in investigating neural plasticity and in treatment of psychiatric conditions. Kerry Mills is an authority, pioneer and active worker in the field; he is uniquely positioned to review the technique, from its invention through to the very latest clinical applications.
Motor Effects of Brain Stimulation
Authors: Mills K R 
Published: November 2023

Abstract
When the human brain is stimulated with either electrical or magnetic stimuli, a complex sequence of events ensues. The effects depend critically on the stimulus intensity and the ambient excitability of the cortex and the spinal cord. Because a large volume of cerebral tissue is exposed to current, it is not surprising that both excitatory and inhibitory effects are encountered. This chapter sets out in detail the effects in different muscles, the topography of the effects, the conditions for evoking excitatory and/or inhibitory responses, and also considers the effects of stimulating parts of the central nervous system other than the cerebral cortex, such as the cerebellum and brainstem.
Stimulation of peripheral nerves
Authors: Mills K R 
Published: November 2023

Abstract
Electrical stimulation of peripheral nerves has been used in clinical neurophysiology for decades. However, a number of features of electrical stimulation render it less than ideal in several clinical situations. For instance, the painful nature of stimulation can be unacceptable to patients and there is difficulty in exciting deeply placed nerves such as the femoral or sciatic. Furthermore, it is known that electrical stimuli preferentially excite large-diameter myelinated fibres, limiting the usefulness of electrical stimulation in investigating the gamut of peripheral nerve disorders. The finding that magnetic stimuli could also excite peripheral nerves therefore provoked a re-examination of nerve stimulation and a comparison of the two techniques (Chokroverty 1989). The first nerve to be studied with magnetic stimulation was the facial (Schriefer et al. 1988); this was because magnetic stimulation over the lateral parts of the scalp frequently led to facial twitches, the origin of which required investigation.
Cerebrovascular diseases
Authors: Mills K R 
Published: November 2023

Abstract
The diagnosis of cerebrovascular disease where there is an acute onset of hemiparesis together with the typical clinical signs and imaging findings is usually straightforward. Central motor conduction studies have, therefore, little to offer in terms of diagnosis. The principal applications of transcranial magnetic stimulation (TMS) have been as a predictor of outcome and as a way of investigating the adaptive changes in the brain following an ischaemic insult. Many patients with stroke have absent responses to magnetic brain stimulation, but of the patients in whom a response is obtained, central motor conduction time (CMCT) is usually only marginally prolonged (see Table 11.1). The weighted average ratio of CMCT in stroke patients to healthy controls from the studies listed in Table 11.1 is 1.19, that is there is on average a 19% increase in CMCT. Fewer studies have examined muscle of the lower limb where the prolongation of CMCT appears to be greater than in the arms, the weighted ratio being 1.45. A markedly prolonged CMCT, however, should result in a reassessment of the diagnosis. Corticomotor threshold has been formally measured in stroke (Catano et al. 1996) and was found to be commonly raised irrespective of the site of the lesion.
Miscellaneous neurological conditions
Authors: Mills K R 
Published: November 2023

Abstract
This chapter includes the results of central motor conduction studies in conditions which do not fit happily into the classifications of earlier chapters. The effects of a large number of drugs on motor evoked potentials (MEPs) have been documented and these are included here but a discussion of anaesthetic and paralysing agents is included in Chapter 18.In this rare syndrome, attacks of transient unilateral weakness occur beginning in the first year oflife. Attacks may occur on either side at different times, may last minutes to hours and may occur up to several times per week. A slowly progressive neurological deficit may develop comprising intellectual impairment, dysarthria and dystonia. The cause of the condition is unknown, but the similarity with familial hemiplegic migraine is striking. Another possibility is mitochondrial cytopathy. The origin of the progressive deteriora tion has been suggested to be due to accumulated microvascular lesions, but there is no evidence for this on magnetic resonance imaging (MRI) or magnetic resonance spectro scopy. A 23-year-old patient with this condition has been investigated between attacks and during an attack ofleft hemiplegia (Nezu et al. 1997b). Interestingly, the patient had also developed episodic ataxia (see Chapter 13) which occurred independently of the hemiplegia. Between attacks, central motor conduction time (CMCT) to the first dorsal interosseous (FDI) muscle was normal (right, 7.8 m; left, 7.3 ms). During the attack, CMCT to the left FDI was prolonged at 10.9 ms. Corticomotor threshold and peripheral nerve conduction were unchanged during the attack. Because of the transient nature of attacks, slowing of central conduction cannot be due to demyelination. The normal corticomotor threshold argues against a large shift in cortical or spinal excitability. The most likely explanation is an alteration in temporal summation at the spinal motoneuron.
Measuring Psychopathology in Specific Subject Groups
Authors: Farmer Anne , McGuffin Peter , Williams Julie 
Published: November 2023

Abstract
Measuring psychopathology in particular groups of subjects may require diagnostic assessments, instruments or rating scales that are tailor made to their requirements. Such subjects include children and adolescents, those with a learning disability (mental retardation), and the elderly, especially those who are cognitively impaired. Self-expression and awareness may be limited in these groups and so observer information assumes greater importance than in subjects who can give a more detailed self-report. Also the mental health problems, syndromes and disorders experienced by these three subject groups can be somewhat different to those we have already discussed in relation to non-intellectually impaired adults. For example, while the presentation of obsessive-compulsive disorder is similar in children and adults, the clinical features of depression are rather different in these two age groups (see table 8.1) (Hill 1997).
A personal view
Authors: Brewin Thurstan 
Published: November 2023

Abstract
Thurstan Brewin is a Fellow of the Royal College of Physicians who, after war service, trained at Guy’s Hospital, London; spent five years in Canada with the Ontario Cancer Foundation; 26 years as a Consultant in Clinical Oncology in Glasgow; and has since worked with three medical charities: Marie Curie Cancer Care, the Sue Ryder Foundation, and Healthwatch. He is the main author of two books: Relating to the Relatives and The Friendly Professional, and has written in medical journals on various subjects including clinical trials, medical ethics, and complementary medicine.
Beyond the image: art therapy and a note on poetry
Authors: Connell Camilla 
Published: November 2023

Abstract
Camilla Connell introduced and developed the art therapy service at the Royal Marsden from 1988 until 2000. In 1998 she published a book entitled Something understood: art therapy in cancer care (Wrexham Publications). Art therapy, or art psychotherapy, is in brief the use of art materials for the purpose of image-making in the presence of a trained art therapist.
Complementary therapies in palliative care
Authors: Barnett Mandy 
Published: November 2023

Abstract
This chapter will consider the place of complementary therapies in palliative care, focusing on the use of particular therapies, the evidence base for their use in the palliative care setting, and the problems encountered in evaluating their benefit. The field of palliative care has developed rapidly in the UK over the last 30 years or so 1, in recognition of the need for a more holistic approach to patients who are facing death. The aim within palliative care is to offer optimum care for a patient’s physical condition, and in addition to address psychological, social, and spiritual issues, in order both to maximize the quality of life remaining and to achieve a dignified and peaceful death. This is summarized by the definition from the European Association of Palliative Care: the active total care of a person whose disease is no longer amenable to curative therapy. Initially much of the development of palliative care took place in the voluntary sector, but there has been a steady increase in NHS involvement and funding. Alongside these developments has come the recognition of palliative medicine as a medical subspecialty2, with the subsequent creation of standards of practice and training programmes to improve the provision of specialist care across all regions.
Messages from the research
Authors: Buchanan Ann 
Published: November 2023

Abstract
Then, in the UK, came Child protection: messages from research (Department of Health 199 5). This summarised over 20 research studies into the workings of procedures to protect children. The key message was that, although children in dangerous situations should be protected, the focus of interven tion should change to improving the emotional well-being of much larger numbers of children damaged by living in families ‘low in warmth and high in criticism’.
Nuclear medicine in rheumatology
Authors: Ell P J 
Published: November 2023

Abstract
For over 30 years bone-seeking radiopharmaceuticals have been used in man to investigate skeletal metabolism, localize disease, and make a contribution to the assessment of the extent and severity of the pathology under investigation. Initial work involved the use of calcium-47 and strontium-85 in the investigation of skeletal metabolism (bone accretion and destruction) in man but radionuclides were soon applied to the investigation of pathology.
Localized pain in the lower limb
Authors: Binder Allan I , Brooks Peter T 
Published: November 2023

Abstract
Localized pain presents a considerable diagnostic challenge as, with few exceptions, any joint condition can present in this way. It is, however, essential to identify as early as possible those patients who are at risk of rapid deterioration and hence require vigorous early investigation and treatment. For the remainder of patients, a more measured and systematic assessment is usually acceptable.
Imaging of crystal arthritis
Authors: Forrester Alistair W , Bálint Péter V , Sturrock Roger D 
Published: November 2023

Abstract
The crystal arthropathies consist of a group of conditions that are characterized by the deposition of crystals both within joints and in periarticular tissues. This results both in acute inflammation and a chronic inflammatory reaction leading to tissue destruction and chronic arthritis. Crystal arthritis may be the consequence of metabolic disorders such as gout, hyperparathyroidism, and haemochromatosis but frequently is a feature of osteoarthritis where local factors are responsible for crystal formation and shedding.
Antiphospholipid antibody syndrome
Authors: Gordon Patrick A , Khamashta Munther , D’Cruz David , Hughes Graham R V 
Published: November 2023

Abstract
The antiphospholipid syndrome (APS) was originally described in the 1980s and comprises vascular thrombosis and/or pregnancy morbidity in the presence of antiphospholipid antibodies (aPL) (lupus anticoagulant (LA) or anticardiolipin antibodies (aCL)). When associated with an underlying systemic autoimmune disease it is defined as secondary antiphospholipid syndrome and when in isolation as primary antiphospholipid syndrome.
Imaging in metabolic bone disease
Authors: Marshall Tarnya , Marshall A T , Bearcroft P W B , Crisp Adrian J 
Published: November 2023

Abstract
Despite recent advances in radiological investigations, the most important technique in the evaluation and management of metabolic bone disease remains the plain radiograph, and the classical radiographic findings will be described. The roles of other imaging techniques, for example, isotope bone scintigraphy, and magnetic resonance imaging (MRI) will be discussed.
Forgotten patients – adults abused as children
Authors: Cloke Christopher 
Published: November 2023

Abstract
The recognition of child abuse, especially child sexual abuse, and the development of professional responses, have occurred comparatively recently. Physical abuse and the battered baby syndrome were first identified in the 1960s. Child sexual abuse shot to prominence in the late 1980s, particularly at the time of the Cleveland cases. More recently consideration has been given to the phenomenon of ‘organized abuse ‘. Over the last two decades (1980–2000) guidance for professionals working with children who are at risk or who have been abused has been issued by government and the appropriate professional bodies. Recognition of and responses to the needs of adultswho were abused as children has lagged a long way behind meeting the needs of children who have been abused. This is a very serious omission, since it is known that child abuse can have very damaging long term consequences, affecting both emotional and physical well being.
Legal aspects of child abuse
Authors: Clift Fran 
Published: November 2023

Abstract
The purpose of this chapter is to provide guidance for primary health care practitioners on legal aspects of the child protection process. The Children Act 1989 ( ‘the Act ‘) is the relevant statute. However, there are areas where common law still applies, for example, consent to treatment and confidentiality. Sometimes there are no strictly ‘legal ‘ provisions and in this case, guidelines from the Department of Health, the Medical Royal Colleges and other professional bodies are of great importance for informing best practice.Where important principles have been established by case law rather than statute, the case names are given in the text in brackets with the full legal reference at the end of the chapter.
Roles and responsibilities
Authors: Hendry Enid 
Published: November 2023

Abstract
Working Together to Safeguard Children(Department of Health et al.1999) makes it clear that safeguarding children from harm is everyone ‘s responsibility, and not simply an issue for professionals. This is an important shift in thinking and reflects the view expressed so memorably by Hilary Clinton, that to bring up a child requires a whole village. However, there are specific responsibilities, spelt out in statute and in guidance, that rest with three public sector agencies in particular: the social services, health services and the police. Other statutory and voluntary agencies and professional groups also play important roles in the prevention of abuse and the protection of children, and together form a protective network for the most vulnerable children. When this protective network is functioning effectively it can provide a vital safety net for children, preventing abuse and triggering early responses to concerns.Individual children need (A) coordinated help from all those who are in contact with them and with their parents and carers, when they are experiencing or are at risk of neglect or abuse.
Child protection and primary care organizations (PCOs)
Authors: Bastable Ruth 
Published: November 2023

Abstract
Rita, in Willy Russell ‘s Educating Rita(1996) was asked how she would present Ibsen ‘s very long and complex play Peer Gynt. Her essay in its entirety was, ‘Do it on the radio ‘. Asked how I would put child protection on the Primary Care Organization (PCO) agenda, I would reply in a similar vein – ‘Put it in the HImP ‘ (Health Improvement Programme). But like Rita, I have discovered there ‘s more to it than that. This chapter describes the latest reorganization of the NHS in England, with particular emphasis on the changes affecting primary care. This reorganization is then related to how change in primary care, and particularly change in general practice, can be brought about. Finally, the potential for change is related specifically to child protection issues. Most of the comments, particularly with respect to accountability and governance, apply to Scotland and Wales as well as England. The chapter will have interest for all those working in primary care, but will be especially relevant for those wishing to see change in how child protection issues are managed within the general practice setting.
Assessment and psychosocial support of patients with advanced GI malignancies
Authors: Borreani C , Miccinesi G , Tamburini M 
Published: November 2023

Abstract
In the advanced stages of oncological diseases a quality of life (QoL) assessment becomes necessary for the monitoring of the quality of assistance or the evaluation of the efficacy of a specific treatment, and it is useful in facilitating communication between patient and caring staff regarding specific problems and symptoms.
Thanks to the 1980s, which marked an important period for the definition of QoL theories in cancer patients and the development of instruments for QoL assessment, the use of self-rated, cancer-specific, and concise questionnaires is now recommended. The questionnaires set out to prove psychometric properties and assess the functional, physical, psychological, and social conditions of the patient as well as his/her global health.
Malignant ascites
Authors: Keen Jeremy , Fallon Marie 
Published: November 2023

Abstract
A recently reported survey of physicians involved in the management of malignant ascites produced comments such as ‘generally impossible to manage’, ‘it is a frustrating clinical situation’, and ‘a practical and effective solution is needed’ (1).
This chapter aims to review briefly the pathophysiology of ascites formation in malignant disease and then to examine the prevalence, associated symptoms and, in more detail, the reported methods of clinical management.
The main frustrations in the management of ascites relate to questions such as the role of diuretic therapy, imaging, and the method of paracentesis, each of which remains poorly tested in formal trials. However, new work in the pathophysiology of ascites formation may lead to more individualized and novel methods of management.
Artificial nutrition I: General approach and parenteral nutrition
Authors: Bozzetti Federico 
Published: November 2023

Abstract
For over 30 years artificial nutrition (AN) has had a major impact in many fields of medicine, including surgery, oncology, intensive care, gastroenterology, and transplantation.
Except in patients with primary undernutrition, who account for a small percentage in Western countries and are usually elderly individuals unable to provide themselves with adequate oral intake, AN has been used in clinical conditions in which, for a variety of reasons, the normal intake of food was impossible or contraindicated, while maintenance of nutritional status was essential for the patient to allow the primary therapy to control the disease and eventually to achieve full recovery.