bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vitamin K
Authors: Bender David A , Bender Arnold E 
Published: November 2023

Abstract
Vitamin K was originally discovered as a result of a haemorrhagic disease in cattle fed on silage made from sweet clover, and chickens fed on solventextracted fat-free diets. The problem in the chickens was a lack of the vitamin in the diet, while in the cattle it was due to the presence of dicoumarol, which is an anti-metabolite of vitamin K. It soon became apparent that vitamin K was required for the synthesis of several of the proteins required for blood clotting. It was only in 1974 (Stenflo et al 1974) that the metabolic role of vitamin K was elucidated, when γ-carboxyglutamate (often abbreviated to Gla) was found to be present in the vitamin K-dependent proteins, but absent from the abnormal precursors which circulate in deficiency. γ-Carboxyglutamate is chemically unstable, and undergoes spontaneous decarboxylation to glutamate under the conditions traditionally used for protein hydrolysis and amino acid analysis.
Riboflavin (vitamin B2&gt;
Authors: Bender David A , Bender Arnold E 
Published: November 2023

Abstract
Riboflavin has a central role as a redox cofactor in energy-yielding metabolism. Dietary deficiency is relativly widespread, yet is apparently never fatal; there 1s not even a clearly characteristic riboflavin deficiency disease. This does not seem to be the result of intestinal bacterial synthesis of the vitamin rather there is very efficient conservation and reutilization of riboflavin in tissues in deficiency. Riboflavin coenzymes are tightly enzyme bound, in some cases covalently, and control of tissue flavins is largely at the level of synthesis and catabolism of flavin-dependent enzymes.
Ectopic pregnancy: imaging and modern concepts of management
Authors: Cacciatore Bruno 
Published: November 2023

Abstract
The clinical spectrum of ectopic pregnancy has changed dramatically in recent years. The incidence has risen sharply due to not only an increasing incidence of risk factors for this condition, such as pelvic inflammatory disease, use of an intrauterine contraceptive device, pelvic operations, and tubal surgery, but also to improved detection of ectopic pregnancies which might have gone unrecognized in the past (Makinen 1988). The mortality rate, as well as the frequency of tubal rupture and other severe complications, have decreased concomitantly, thanks to improved diagnostic modalities. The major clinical concern now is poor reproductive performance following ectopic pregnancy. Only about half of affected patients will conceive again, with a risk of a second ectopic pregnancy of 10-20% (Stabile and Grudzinskas 1990).
Amniotic fluid volume disorders: diagnosis and therapeutic approaches
Authors: Ahn Myoung Ock , Phelan Jeffrey P 
Published: November 2023

Abstract
For centuries, amniotic fluid has been presumed to serve as nourishment for the developing fetus (Denman 1815). With a greater understanding of amniotic fluid dynamics, (Hellman and Pritchard 1971; Lind et al. 1972; Seeds 1980; Queenan 1990), this concept has been discounted. For example, the accumulation of amniotic fluid provides a medium in which the fetus can readily move. At the same time, this fluid acts as a cushion to protect the fetus from the risk of limb and facial malformations and from possible cord compression during fetal activity or uterine contractions. In addition, it is a means of maintaining euthermia. But most of all, fetal status appears to be correlated with the quantity of amniotic fluid.
Symposium: clinical trials of obstetric ultrasound
Authors: Duley Lelia 
Published: November 2023

Abstract
Pregnancy, childbirth, and the neonatal period are physiological events, not illnesses. Yet, most women having children in Western Europe and North America attend the health services for antenatal and intrapartum care. One reason for this remarkable compliance is that, regardless of their health or social status, women believe the care they receive will improve the outcome for themselves and for their child. Given that they have been encouraged in this belief by those who provide care, the onus is on the care givers to ensure that they do more good than harm.
The aims of the curriculum: education for health needs in 2000 and beyond
Authors: Towle Angela 
Published: November 2023

Abstract
In recent years, a variety of sources—government, foundations, educators, the media, and, perhaps most importantly, those who use medical care—have begun to focus on what is required to produce a good physician. Both internal and external forces are encouraging medical schools to alter their curricula and even their basic structure. Accrediting bodies have imposed new standards that call for measuring and evaluating medical school graduates according to a variety of educational outcomes. In some instances, funding has been coupled with the attainment of mandated outcome objectives (Jonas et al. 1992).
Opportunities outside hospitals
Authors: Field Jenny 
Published: November 2023

Abstract
Doctors of the future must provide health care which is responsive to the needs of all the people in the region which they serve. Medical students, who will become those doctors, are traditionally trained in hospitals, concentrating on the needs of a much smaller and sicker part of this population. The tension created here has been most clearly recognized in parts of the world where there is a major disparity between the provision of high technology care in hospitals and the priority health care needs of much of the population, which may lie mainly in primary care. In the United Kingdom appreciation of this same tension has been precipitated by recent changes in the delivery of health care. The revolution in the provision of care, involving minimally invasive surgery and investigations, shorter hospital stays for acute disease, and the transfer of care for many chronic diseases into general practice means that patients in hospital are even fewer and sicker than before. In order to deliver a curriculum which can prepare doctors to care for the health needs of all, students must be given opportunities to learn where all types and severity of disease present and are managed, that is, both inside and outside hospitals.
Assessment
Authors: Newbie David 
Published: November 2023

Abstract
It is impossible to overestimate the importance of assessment. Involvement of teachers in developing assessment procedures is almost certainly the most critical educational task they will undertake. The methods they select and the content they include will have profound effects not only on what students learn but also on how students learn. Yet, in many institutions, assessment practices misdirect student learning activities in ways that may seriously undermine the aims of the curriculum. In addition, the organization and preparation of undergraduate examinations are often left to junior members of staff who have neither the experience, training, resources, nor the authority to produce tests of high quality. In the process of curriculum or course review, assessment is frequently something which is little more than an afterthought, following detailed consideration of the aims, objectives, teaching methods, and timetabling.
Clinical work and teaching
Authors: Dacre Jane 
Published: November 2023

Abstract
Most working doctors teach. In a ‘teaching’ hospital environment, there is an increased emphasis on this and, indeed, the Trust is paid a sum of money (service increment for teaching, SIFT) to allow teaching to continue. However, there are problems related to the career development of junior doctors. At the moment, progress through the medical ranks is based more on a doctor’s research output than their teaching ability or experience. Promotions and appointments are biased towards candidates with a large number of publications on their curriculum vitae. There is no recognition of teaching other than in an informal way within each medical school (Dacre et al. 1996) The financial support given to an academic department by the local university is based on the number of papers produced, and the number of grants awarded to that department. This kind of assessment reduces the priority given to student teaching, Departments with a poor teaching record (at least as far as students are concerned) are often those that concentrate their efforts in research areas, and so generate a high income for the medical school. This difficulty has been appreciated by many medical colleges, but the system is still pervasive and biases academic departments against putting significant resources into their teaching programmes.
Staff development in UK medical schools
Authors: Towle Angela 
Published: November 2023

Abstract
A conference held a few years ago brought together medical teachers, educationists, and staff developers from UK medical schools to highlight key issues in effecting change through staff development based on the presentation of case studies and the sharing of ideas and experience (Towle 1993). Using information from the conference report and personal experience in three medical schools, I have attempted to summarize below the main issues in staff development in medical education in the UK, some key experiences so far and the lessons which have been learned.
Medical education into the next century
Authors: Rees Lesley , Jolly Brian 
Published: November 2023

Abstract
In Chapter 1 a rationale that will govern our vision of medical education in the next century was portrayed. In this chapter we summarize, using examples from our own experience, the most notable trends that have taken place in medical education. We will attempt to locate them in the context of other changes that have engulfed the medical world in general, and the UK in particular. The most notable of these, and the most pressing for many engaged in the continual process of curriculum change are the widespread developments associated with the publication by the GMC (1993) of the document Tomorrow’s doctors. By 1999 most schools will have implemented new curricula, but it is sobering and even disenchanting to acknowledge that many of the young doctors produced by these new systems will not emerge until 2005 and, indeed, will have ceased practising before the century is halfway through. Hence, in a rapidly evolving environment, the challenge of the future will not be in how to manage change but in how to perpetuate it.
Stimulation to relieve pain
Authors: Coniam S W , Diamond A W 
Published: November 2023

Abstract
The development of scientific medicine meant that efforts to relieve pain were concentrated on the pharmacological approach, or attempts to block the neuronal pathways associated with pain using local anaesthetics or destructive lesions. However, older methods of treating pain and disease-including acupuncture, electric shock, vibration and massage, poultices, and painful stimuli such as cupping and scarifying-had aimed at stimulating part of the nervous system. Because such methods could not be explained by the scientific knowledge of the last century, they generally fell out of favour with the medical establishment.
Musculoskeletal pain
Authors: Coniam S W , Diamond A W 
Published: November 2023

Abstract
The largest group of patients presenting with symptoms of pain suffer from some form of musculoskeletal pain. Some causes of musculoskeletal pain and disability are related to clearly defined diseases, for example inflammatory disease such as rheumatoid arthritis, or well recognized metabolic or degenerative conditions such as osteoarthritis or osteoporosis.
General aspects of regional anaesthesia in children and babies
Authors: Peutrell J M 
Published: November 2023

Abstract
Regional techniques are usually combined with light general anaesthesia in children. Regional blocks provide prolonged and reasonably predictable postoperative pain relief which is particularly advantageous for children having day-case surgery. Additional analgesia (e.g. non-steroidal anti-inflammatory drugs or paracetamol) can be given to obtain adequate blood concentrations before the block has worn off.
Topical anaesthesia of skin and mucous membranes
Authors: Peutrell J M 
Published: November 2023

Abstract
The epidermis is a stratified epithelium without nerve endings or blood vessels. It consists of several distinct layers. The outer horny layer of skin is called the stratum comeum and over most of the body surface is 75-100 µ,mthick. It is a dense layer consisting of cells containing mainly keratin and extracellular tissue with a high lipid content. The dermis is a vascular layer with specialized pain receptors (nociceptors) lying at, or, just above the dermo epidermal junction.Cutaneous pain receptors are probably formed from free nerve endings. They are of two principal types:
Nerve blocks for dental surgery
Authors: Ball I 
Published: November 2023

Abstract
A careful painless injection technique is one of the most import ant aspects of administering dental local analgesia to children because, unlike adults, it is rare that a hurt child who becomes frightened and distraught will allow one to continue with treatment, let alone permit a second attempt at such an injection. Equally important is a simple straightforward explanation to the child to reassure him or her about the procedure, avoiding reference to frightening or emotive words such as needle or injection. It is usually sufficient to tell the child that the tooth and face will ‘go to sleep but wake up later’. Because of the disconcerting sensation it is also good practice to reassure the child by showing him with the aid of a mirror that although his face feels different his appearance remains unaltered.
Penile block
Authors: Peutrell J M 
Published: November 2023

Abstract
AnatomyThe nerve supply to the penisThe penis is supplied by sensory nerves from the lumbosacral plexus and autonomic fibres from the inferior hypogastric plexus:(1) the two dorsal nerves of the penis innervate the glans and the distal two-thirds of the body of the penis;(2) the ilioinguinal and genitofemoral nerves supply the base of the penis;(3) autonomic fibres accompany either the dorsal nerves or the blood vessels.The dorsal nerves of the penis (S2-S4) arise as terminal branches of the pudenda nerves. They run along the ischial ramus and then the lower border of the pubic ramus. They enter the subpubic space (see below) by passing between the perineal membrane and the inferior pubic ligament.
Percutaneous intervention in ischaemic heart disease
Authors: Banning Adrian P 
Published: November 2023

Abstract
Charles Dotter and Melvin Judkins were the first physicians to attempt to use catheters for a therapeutic purpose when they used a coaxial system of catheters in patients with peripheral arterial disease in 1964 (1). The term ‘transluminal angioplasty’ was coined but, despite initially encouraging results, application of the technique was limited by problems with puncture site haematoma and distal emboli. Andreas Gruentzig, trained by Zeitler in Germany, continued to refine the angioplasty technique in peripheral arteries and in 1974 he developed a double lumen catheter with a distensible PVC balloon which revolutionized angioplasty. This catheter applied circumferential pressure to the stenosis rather than the axial pressure of the previous catheters and it also created a smaller puncture site, thus reducing procedural complications. By 1976, Gruentzig had successfully miniaturized the catheter and he was performing coronary angioplasty in dogs and in human cadavers.
Systemic effects of cardiopulmonary bypass
Authors: Dunning John J 
Published: November 2023

Abstract
Without cardiopulmonary bypass, cardiac surgery as we know it today would not be possible. Yet the very technology which enables the surgeon to perform complex surgery on the heart is itself damaging and exerts effects on the patient which manifest themselves in every system of the body. Although temporary dysfunction of various systems is usual, most of the systemic side effects are well tolerated and rapid postoperative correction is the rule. However, under certain circumstances the systemic effects on one or more organ systems may be more pronounced, resulting in distressing symptoms and iatrogenic conditions which are difficult to correct.
Myocardial protection
Authors: Pepper John 
Published: November 2023

Abstract
The concept of placing new grafts to bypass obstructions in coronary arteries is attractively simple. The objective of every operation should be a technically perfect result without producing myocardial damage. Currently only a minority of surgical patients present with normal left ventricular function; most have damaged ventricles but the damage may in part be reversible. Until recently the attention of surgeons had fallen almost exclusively on the myocyte but it is becoming clear that protection of the coronary endothelium and the specialized conduction tissue are also important in the pursuit of a perfect result. From the practical viewpoint the prerequisites for optimal protection are uniform and adequate distribution of a protective agent, excellent visualization of the operative field, a simple technique that does not distract the surgeon, and optimal protection of the brain and kidneys.
Myocardial reperfusion injury
Authors: Gorman Robert C , Gardner Timothy J 
Published: November 2023

Abstract
Early in the history of cardiac surgery, it was recognized that some patients who underwent technically successful operations suffered from a syndrome of low cardiac output in the early postoperative period. It was also apparent that the perioperative mortality was increased in these patients. Autopsy and clinical studies in the late 1960s and early 1970s documented that myocardial necrosis (particularly in the subendocardial region) was common after cardiac surgery. This intraoperative loss of myocytes was believed to be the cause of the low cardiac output syndrome. The fact that myocardial necrosis occurred in patients with normal coronary arteries suggested that better intraoperative protection of the myocardium would improve operative results.
Anaesthesia for coronary artery bypass surgery
Authors: Feneck R O , Duncan F 
Published: November 2023

Abstract
Although the first coronary artery bypass graft operation was performed by Sabiston in 1962 (1), delay in publishing the report has led to some confusion as to who carried out the first successful procedure. Garret (2), Favaloro (3), and Johnson (4) have all been credited as pioneers of the technique. However, others rapidly followed and by the end of the 1970s coronary artery bypass graft (CABG) surgery was commonly undertaken in hospitals throughout the world, and was certainly the most common major surgical procedure requiring admission to an intensive care unit for postoperative care. The early literature on cardiac anaesthesia is a little clearer.
Ventricular fibrillation with intermittent aortic cross clamping in coronary heart surgery
Authors: Wright Ravi Pillai ,J E C 
Published: November 2023

Abstract
Ventricular fibrillation induced either by electrical stimulation or by cooling is a long established technique used for surgery on the heart. Indeed, its use was widespread before the advent of a variety of solutions, both crystalloid and containing blood, that are currently used to arrest the heart and provide protection by hypothermia. The technique continues to be used in the setting of surgery for ischaemic heart disease by a small minority of surgeons in the world. The technique relies upon short periods of acute myocardial ischaemia, interrupted by normal coronary perfusion. Traditionally it is believed that as long as the periods of ischaemia are sufficiently short (6-12 minutes) complete myocardial recovery is obtained during the period of reperfusion. The practice of this technique has been supported more recently by the latterly observed myocardial protection effects of ischaemic preconditioning.
Technical aspects of coronary artery surgery
Authors: Pillai Ravi , Wright J E C 
Published: November 2023

Abstract
Since the description of the use of saphenous vein for coronary artery bypass grafting by Favaloro in 1967 the procedure has been widely adopted across the world. Today it is the most common adult cardiac surgical operation. Its relative simplicity has led to the massive increase in the number of centres performing cardiac surgery in several countries. The fact that ischaemic heart disease is responsible for the largest number of deaths in most western countries has ensured that coronary artery surgery, as well as other interventional procedures for treating ischaemic heart disease, has occupied a position of importance alongside preventive measures as far as allocation of resources are concerned.
Cardiac transplantation for ischaemic heart disease
Authors: Murday Andrew 
Published: November 2023

Abstract
Cardiac transplantation offers patients with end-stage cardiac disease the prospect of increased life expectancy and a return to a good functional life. This prospect is available only at some risk to the potential transplant recipient. Cardiac transplantation carries a relatively high operative mortality. In addition to this there is a considerable practical burden for the recipient and their supporters resulting from continued dependency upon immunosuppressive drugs and the concomitant frequent hospital attendance for the supervision of these regiments. There is also the ongoing risk of postoperative morbidity resulting from the dual hazards of rejection and infection. Finally, there is a definitive time-limited prognosis following cardiac transplantation.
What is pain?
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva 
Published: November 2023

Abstract
Pain is felt by all human beings on occasions. Usually it is of a minor nature (such as a headache or muscle strain) and improves quickly without pharmacological intervention. Rarely it is severe, usually following injury or after a surgical operation, and intensive pharmacological efforts may be needed to relieve the pain and distress. Thus we are all familiar with what pain is. In scientific terms pain has been defined by the International Association for the Study of Pain (IASP) as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage., or described in terms of such damage’. A painful stimulus is a protective response for the individual. Those with diminished or altered pain sensitivity may sustain severe joint injury and deformity or other tissue damage like burns because of the lack of pain sensation.
Principles of analgesic drug administration
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva 
Published: November 2023

Abstract
This section briefly introduces important pharmacological terms which apply to the following chapters on analgesic drug use and administration. The terms have been subdivided under their respective headings—pharmacokinetic terms and pharmacodynamic terms. Pharmacokinetic terms refer to how the body deals with the drug (that is, how the drug is absorbed, metabolized, and eliminated); pharmacodynamic terms describe the effects of the drug on the body (for example, how the drug binds to its receptor and produces effects).
Intramuscular administration of analgesics
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva 
Published: November 2023

Abstract
The commonest, current practice, on most hospital wards, is to prescribe an analgesic drug on an ‘as required’ basis. Generally opioid analgesics are administered by the intramuscular route with a dosage interval varying from four to six hours. Many studies have reported the poor quality of analgesia provided by these standard regimes. Intramuscular administration has gained acceptance because it is relatively simple to perform and does not require nurses with specialist training or medical staff. The ‘as required’ prescription has achieved popularity for reasons which include the following.