bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extra-corporeal renal replacement therapies
Authors: Petitclerc Thieny , Jacobs Claude 
Published: November 2023

Abstract
The survival for an unlimited period of time of patients suffering from end-stage renal failure (ESRF), by the means of blood-purification systems, is a true and important landmark in medical history insofar as it represents the first successful long-term replacement of a human vital organ by a human-built machine. Barely four decades separate us from the pioneering endeavour undertaken by B.H. Scribner and associates, in their first attempt to apply intermittent hemodialysis to a single patient with non-reversible terminal renal insufficiency, from the contemporary scene where hundreds of thousands of patients worldwide benefit from the prolongation of their lives thanks to the ongoing advances made all over this timespan in the conceptual, pathophysiological, and techical aspects of this completely novel area of clinical medicine.
Oesophagus, stomach, and duodenum
Authors: Stonebridge Peter , Smith David , Duncan Lesley , Thompson Alastair 
Published: November 2023

Abstract
Heartburn is a very common complaint. Regurgitation of acid into the mouth is part of the same spectrum. The gastro-oesophageal sphincter fails to prevent stomach acid into the lower oesophagus giving rise to the burning retrosternal pain. A boring back pain would indicate that the patient may have developed an ulcer at the lower end of the oesophagus.
Dysphagia is an important symptom as it may indicate the development of a benign stricture or the presence of oesophageal cancer.
Small bowel
Authors: Stonebridge Peter , Smith David , Duncan Lesley , Thompson Alastair 
Published: November 2023

Abstract
This is one of the most frequent indications for urgent admission to a surgical unit. Most patients with appendicitis present like this with a history of periumbilical pain with nausea and vomiting, with the pain shifting to the right iliac fossa.
There are numerous causes of abdominal pain, especially in young women, that may cause confusion with appendicitis. A careful history and physical examination are vital. For women of child-bearing age, pregnancy (excluded by a pregnancy test), and gynaecological conditions need to be considered.
Vascular conditions
Authors: Stonebridge Peter , Smith David , Duncan Lesley , Thompson Alastair 
Published: November 2023

Abstract
‘Intermittent claudication’ is pain in muscle (calf, thigh, buttock) only associated with exercise and resolves quickly (less than 5 minutes) with stopping walking. It does not occur at rest.
Exercise requires the delivery of more oxygen as the muscle fibres perform more work. This is achieved by delivering more blood (200400%) by increasing the output of the heart.
In patients with peripheral vascular disease this increase in blood delivery is impeded or prevented by narrowing (stenosis) or blockage (occlusions) of the arteries leading to the exercising muscle (usually the calves). The muscle therefore receives less oxygen than it requires and due to muscle ischaemia becomes increasingly painful forcing the sufferer to stop.
Choosing the statistical method
Authors: Bland Martin , Peacock Janet 
Published: November 2023

Abstract
Many statistical problems involve one of the following: the comparison of two means of a continuous variable, the relationship between two quantitative variables, the relationship between two qualitative variables. Most data can be described as being one of the following types of scale: ratio, where the ratio of two quantities has a meaning, e.g. human height, interval, where the difference between observations has a meaning, though their ratio may not, e.g. calendar year,
The DRCOG examination
Authors: Neuberg Roger 
Published: November 2023

Abstract
The new format of the examination for the Diploma of the Royal College of Obstetricians and Gynaecologists (DRCOG) is not only a very thorough assess ment of your knowledge and of the skills you have gained through experience, but also of your ability to apply what you know to different clinical situations as met in General Practice. A pass in the DRCOG is a recognition of your particular interest in the subject without being a specialist qualification.
Obstetric history-taking and examination
Authors: Neuberg Roger 
Published: November 2023

Abstract
In addition to a written examination and/or OSCE, medical schools will often require their students to sit a clinical and oral examination at the end of their undergraduate attachment in Obstetrics and Gynaecology. Although these do not now feature as part of the Diploma of the Royal College of Obstetricians and Gynaecologists (DRCOG), it is still a requirement for the higher Diploma of Membership of the RCOG (MRCOG).
Risk and risk factors
Authors: Ebrahim Shah , Harwood Rowan 
Published: November 2023

Abstract
In common with most chronic diseases, strokes do not have a single cause but are due to multiple factors. Even in tuberculosis which does have a single necessary cause —Mycobacterium tuberculosis—the risk of being infected, and then of developing tuberculosis, is dependent on a chain of causal factors, some very closely related to the pathogenic process (e.g. inhaling bacilli from a close relative), while others are much further back in the causal chain (e.g. poor childhood nutrition). Epidemiologists are concerned with discovering the characteristics of people and populations that increase or decrease their chances (or risk) of suffering diseases. The mechanisms by which disease occurs in those at increased risk is often suggested by epidemiological enquiry, but working out the detailed pathological pathways is a goal for laboratory scientists.
Time, places, and people
Authors: Ebrahim Shah , Harwood Rowan 
Published: November 2023

Abstract
Stroke mortality rates have shown a consistent decline in many countries (Anonymous 1983; Bonita et al. 1990; McGovern et al. 1992; Wolf et al. 1992; Brown et al. 1996; Tuomilehto et al. 1996b; Thorvaldsen et al. 1997; Gale and Martyn 1997). In the USA the rate of decline has been about 0.5 per cent/year from 1900 to 1920, 1 per cent/year from 1920 to 1950, about 1.5 per cent/year from 1950 to 1970 and about 4-5 per cent/year from 1974 onwards (Ostfeld 1980; Whisnant 1984). In England and Wales, a similar decline starting in 1900 and affecting all age groups has been seen (Wolfe and Burney, 1992; Charlton et al. 1997; Ebrahim, 1998) and is shown in Fig. 3.1. The rise in stroke mortality rates over the war years remains unexplained but affected both men and women and is probably due to coding changes to causes of death that occurred when a new version of the International Classification of Diseases was introduced. The pattern is markedly different from that for ischaemic heart disease deaths, which increased from 1929 to the 1950s, and only started to decline in the 1980s.
Clinical disagreement
Authors: Ebrahim Shah , Harwood Rowan 
Published: November 2023

Abstract
Whenever two or more doctors are asked to assess the same patient it is unlikely that they will agree completely on their clinical findings. This phenomenon is well recognized in several fields of medicine, ranging from taking a history (Cochrane et al. 1951), examination of the pedal pulses (Meade et al. 1968), chest examination (Spiteri et al. 1988), to interpretation of exercise electrocardiograms (Blackburn et al. 1968). It is not surprising, therefore, that in the assessment of stroke patients, agreement is not absolute. Information on which doctors disagree can be considered in terms of its importance in diagnosis, management, and prognosis. If the information is crucial, every effort must be made to reduce disagreements; if the information is of little value, there is no point in wasting time collecting it, much less trying to improve its reliability. Disagreements may matter. For example, if two clinicians disagree on the presence of a carotid bruit, the patient may or may not be exposed to the risk of investigation or denied the benefits of treatment. Disagreements on factors that determine rehabilitation potential (e.g. mental state, severity of stroke, pre-stroke ability) may lead to patients being denied access to therapy and discharged to nursing homes inappropriately or before their full potential has been achieved.
Investigation
Authors: Ebrahim Shah , Harwood Rowan 
Published: November 2023

Abstract
A test is commonly considered to be of value if it alters management. This is an oversimplification of the way most doctors use investigations. The value of any investigation can be thought of at any one of six levels (shown in Table 6.1). These range from technical efficacy (how good are the pictures?) through to patient outcome and health policy considerations.
Effects of stroke
Authors: Ebrahim Shah , Harwood Rowan 
Published: November 2023

Abstract
Many of the effects of stroke are not obvious for weeks or months, and by this time the patient is often at home without the support of specialist care. Follow-up by rehabilitation teams, hospital, and family doctors after a stroke is patchy, and certainly not related to need—if impairments and disability are accepted as indicators of need (Ebrahim et al. 1987Z?)—so it is likely that many complications may go undetected. Avoidable complications of stroke are common and have been reviewed (Mulley 1982). Painful hemiplegic shoulders, spasticity, contractures, and constipation would benefit from more research examining their causes and management options. In the areas of depressed mood, cognition, dysphasia, urinary incontinence, dysphagia, deep-vein thrombosis and pulmonary embolism, quality of life, falls and fractures, and stress affecting carers, much more is now known about occurrence and causes than a decade ago, but more attention is still needed to find practical solutions to these problems.
Familial and predisposition syndromes
Authors: Sheridan Eamonn G , Woods C Geoffrey 
Published: November 2023

Abstract
Over the past 30 years a number of rare DNA repair disorder phenotypes were delineated, for example, Bloom syndrome, ataxia-telangiectasia (AT), and Fanconi anaemia. In each phenotype it was hypothesized that the underlying defect was an inability to repair a particular type of DNA damage. For a number of these disorders this hypothesis was supported by cyto genetics studies using DNA damaging agents; these tests detected the so-called chromosome breakage syndromes. More recently a number of the genes causing these phenotypes have been discovered, confirming that often one phenotype may have more than one genotype, for example, xeroderma pigmentosa.
The central and peripheral autonomic nervous system and possible implications in Rett syndrome patients
Authors: Dahlstrom Annica 
Published: November 2023

Abstract
Also in the human fetus, catecholamine (CA) nerve terminals have been demonstrated in brain areas long before birth. Thus, it is possible that also in man these ‘classical neurotransmitters’ have non-neurotransmitter actions, and should be taken into consideration whenever defects in the development and maturation of the human brain are discussed. They may also work in consort with various neurotrophic factors, by influencing intracellular common pathways. Therefore, in this section will be described what is presently known about the ‘autonomic nervous system’, its ontogeny and distribution as well as physiological aspects, in order to provide a basis for further investigations and discussions concerning the basic mechanisms that may go wrong in Rett girls.
Behavioural and emotional features of Rett syndrome
Authors: Mount Rebecca , Hastings Richard , Charman Tony , Reilly Sheena , Cass Hilary 
Published: November 2023

Abstract
Behavioural and emotional problems were assessed in 143 girls with Rett syndrome (age 18 years or younger). They were compared to 84 girls with severe and profound cognitive impairments of mixed aetiologies (age 18 years or younger). Age and level of physical ability were controlled for in the between group analyses. Behavioural and emotional problems were assessed using two parental questionnaires. The Developmental Behaviour Checklist, a well-validated measure of behavioural and emotional disturbance in children with.
The Science of Chronic Pain From Theory To Clinical Practice
Authors: Yull Derek , Munglani Rajesh 
Published: November 2023

Abstract
There always seems to be a dichotomy between academic research into pain and practical treatment. There seems to be a sense of random choice as to whether, for example, one treats back pain with drugs, injections, psychotherapy, or physiotherapy or a combination of some or all of these. Any model of pain has to explain why such different therapies may achieve similar results—lip service is given to a biopsychosocial model, but the details of this model on a neurobiological level are still be elucidated. This chapter provides a brief overview of pain mechanisms and in a small way attempts to provide a rational basis for various modalities of treatment. Some of the treatments mentioned here will be covered in more detail in other chapters but it is important to provide a framework on which to add further knowledge.
Special Groups
Authors: Speed Cathy 
Published: November 2023

Abstract
With the ever-increasing age of our population, special consideration of soft tissue complaints in older people is warranted. Older people are physiologically, structurally, and psychosocially different from younger adults in their predisposition and response to injury. Along with a greater predisposition to general medical problems and a range of cardiovascular, respiratory, renal, metabolic, and neuropsychiatric changes, a number of musculoskeletal changes occur. Many of these are at least in part related to a decline in activity levels and therefore perhaps the greatest threat to the older person is a sedentary lifestyle.
The Management of Soft Tissue Disorders: The Role of The Physiotherapist
Authors: Hunter Glenn 
Published: November 2023

Abstract
Physiotherapy can be defined as a health care profession with an emphasis on the analysis of movement, based on the structure and function of the body, and the use of physical approaches to the promotion of health, and the prevention, treatment, and management of disease and disability.(1) This definition places the emphasis on physical treatments, such as manipulation, massage, and exercise, that have been valued as ‘healing’ arts for centuries(2) and have been the mainstay of the physiotherapy profession since its formation as a professional organization in 1894.(3)
The Pelvis, Hip, and Thigh
Authors: Speed Cathy , Hackney Roger 
Published: November 2023

Abstract
Pelvic pain arising from the groin, pelvis, and hip has a very wide differential diagnosis, crossing many clinical specialist boundaries (Table 1). Potential causes of groin and pelvic pain include disorders of the abdominal and pelvic organs, referred pain from the spine, neurological complaints, and localized articular and soft tissue complaints. Symptoms can be non-specific and diffuse and may have unusual patterns of referral.(1–4) It is not surprising then that making a diagnosis can be challenging and a multispeciality approach may be necessary.(5)
Fibromyalgia and Myofascial Pain and Chronic Fatigue Syndromes
Authors: O’Gradaigh Donncha , Hazleman Brian 
Published: November 2023

Abstract
Patients with these conditions have diffuse symptoms and a paucity of clinical signs. Their presentations vary considerably, though common factors identify distinct patterns. Despite a number of theories to explain the disorders, management remains largely empirical, comprising physical, medical, and alternative approaches. Opponents of these terms argue that such labelling of ‘non-diseases’ legitimizes patients’ illness behaviour, creating a population of ‘worried well’ with the attendant adverse social and psychological consequences observed with the Australian experience of the diagnosis ‘repetitive strain injury’. The counterargument is that a positive diagnosis (e.g. fibromyalgia) relieves the anxiety and frustration of many years of unhelpful investigations and treatment (the average duration of symptoms before diagnosis of fibromyalgia is 5 years).
Prognosis of patients with lacunar infarction syndromes
Authors: Norrving B 
Published: November 2023

Abstract
As more specific therapies are developed for the prevention and treatment of stroke, definition of the pathophysiological mechanism assumes greater importance in clinical practice. For different subgroups of patients, prognostic data are needed by clinicians for counselling and managing the individual patient. Also, for the planning of treatment trials, background data on prognosis from clinical series are essential. It should be recognized that almost no prognostic study on stroke patients reflects the true natural course, but rather the prognosis in patients given some form of treatment, such as active management of risk factors and antiplatelet therapy.
Therapy for lacunar and subcortical stroke
Authors: Wright P M , Donnan G A 
Published: November 2023

Abstract
Lacunar infarction, as discussed earlier, was first recognized by Fisher following his clinico-pathological observations. With sophisticated imaging techniques, there is now evidence that the classic lacunar syndromes are usually accompanied by a compatible acute small, deep white matter infarction, and each syndrome typically is associated with specific locations, most commonly the internal capsule or pons (Schonewille et al. 1999, Lindgren et al. 2000).
The pharmacodynamic process: Is the drug producing the required pharmacological effect?
Authors: Grahame-Smith D G , Aronson J K 
Published: November 2023

Abstract
The different ways in which drugs may produce their pharmacological effects are classified in Table 4.1. As we unfold this classification, it will be seen that several of the examples we shall quote cross the boundaries of the classification. For example, the cardiac glycosides can be considered as ligands that act by binding to their receptor (the Na/K-ATPase), as inhibitors of an enzyme (the Na/K-ATPase), or as inhibitors of a transport process (the Na/K pump). However, this should not be seen as a defect of the system of classification, more a reflection of the complexities of pharmacology.
The therapeutic process: Is the pharmacological effect being translated into a therapeutic effect?
Authors: Grahame-Smith D G , Aronson J K 
Published: November 2023

Abstract
We have seen how the pharmaceutical process, involving the formulation of a drug, can affect the systemic availability of the drug, how the pharmacokinetic process determines the concentrations of the drug at its sites of action, and how in the pharmacodynamic process a pharmacological effect occurs. We can now examine how this pharmacological effect is translated into a therapeutic effect.
Drug therapy and reproduction
Authors: Grahame-Smith D G , Aronson J K 
Published: November 2023

Abstract
Contraceptive methods can be divided into two broad categories: mechanical methods (condoms, diaphragms, caps, and intrauterine devices, all of which can be combined with chemical spermicides) and hormonal methods. We shall deal here only with the hormonal methods. The practical aspects of the subject have become much more complicated during the last few years, and all GPs should have at least some specialist postgraduate training in the subject if they are to give their patients the best care.
Principles of prescribing
Authors: Grahame-Smith D G , Aronson J K 
Published: November 2023

Abstract
Good prescribing is not an easy discipline to master. By good prescribing, we mean prescribing the appropriate drug, in the correct dosage of an appropriate formulation, at the correct frequency of administration, and for the correct length of time. This definition includes not prescribing any drug at all if no prescription is called for. To achieve this requires detailed knowledge of the pathophysiology of the diseases you intend to treat and of the clinical pharmacology of the drugs you intend to use, as we shall show here in dealing with the questions you should ask before prescribing.
Drugs and the kidney and thedrug therapy of renal, urinary tract, and prostatic disorders
Authors: Grahame-Smith D G , Aronson J K 
Published: November 2023

Abstract
Alginates are often added to antacid formulations as foaming agents. They act by forming a layer of foam on top of gastric contents and are thereby supposed to reduce oesophageal reflux. In contrast, the antifoaming agent dimethicone decreases the surface tension of gastric fluid, thereby reducing bubble formation; it too is supposed to reduce oesophageal reflux.
History of pancreas transplantation
Authors: Sutherland David E R , Groth Carl G 
Published: November 2023

Abstract
The history of pancreas transplantation is intertwined with that of other organ transplants and with the evolution of treatment of diabetes mellitus. Once diabetes was recognized as a consequence of a defect in the internal secretion of the pancreas, the idea of pancreas transplantation took root. From the late 1920s to the mid-1960s, various investigators worked out some of the surgical details of pancreas allotransplantation in dogs [1–8], setting the stage for clinical application [9].
The first pancreas allograft in a human was performed by Drs William D. Kelly and Richard C. Lillihei on 16 December 1966 at the University of Minnesota, a duct ligated segmental graft done simultaneous with a kidney in an uraemic diabetic recipient that resulted in immediate insulin independence (Fig. 1.1). The graft was still functioning 2 months later when the recipient died of sepsis related to surgical complications [10].
An historical view of the development of cellular and islet transplantation
Authors: Gray Derek W R 
Published: November 2023

Abstract
In most research fields advancement comes in hesitant steps; periods of slow progress punctuated by occasional leaps forward. Each advance is built on a foundation that mixes the contributions of numerous individuals. The record of this advancement is the published literature and this is the basis on which this historical account will be largely based, each key historical reference being distinguished by superscript numbering. Which publication should be chosen for distinction? Some studies are of such quality that they stand out, but most are either flawed or inconsequential. Only those studies that are repeatable can be considered as true contributions to the development of the field, and many remarkable claims that cannot be independently confirmed must be consigned to the historical discard bin. This is a particular problem for some areas of islet transplantation research, which have suffered (the term is used deliberately) from a surfeit of commercial interest and secrecy.
Pliny the Elder
Authors: Tanford Charles 
Published: November 2023

Abstract
A Young couple moved into the house next door about the time I was writing this chapter, and I introduced myself to my new neighbors. “I know you, “ the young man said, “I ‘ve used your book. “ It ‘s a nice distinction, used rather than read, and I felt flattered. Ben Franklin had read Pliny and had smiled at what he wrote, which implies he did not use him, and modern historians of science would applaud his caution. Pliny the Elder, born at Lake Como in the reign of Tiberius, was an indefatigable reader and prolific writer, who needed little sleep, had a slave read to him even during rubdowns after his bath, and had a secretary at his side for dictation at all times.