bluuebunny/crossref_metadata_2025_split huggingface dataset:
Other acute pain interventions without evidence of efficacy
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
This section looks at a number of other interventions for acute pain where there is some evidence that they do not work. What is not included are interventions that could come under the heading of complementary therapy, which are dealt with in a later section. The format is a title, clinical bottom line, reference, and a brief commentary for each. Clinical bottom line. In renal colic NSAIDs act faster when given intravenously compared with intramuscular or rectal routes. This may be clinically relevant. In all other pain conditions there is no evidence that injected NSAIDs were better than oral. There is, however, increased reporting of adverse effects with intravenous and rectal administration.
Introduction
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
In chronic pain relief, just as in other therapeutic areas, there are often many ways to tackle a particular problem. There may be more or less evidence of benefit for each of the alternatives. The task facing us is to have a way of ranking the relative effectiveness of these interventions, and to couple that with knowledge of any hazards, minor or major. Then we can make informed decisions about which should be offered to patients. In an ideal world there would be large randomised trials comparing the various interventions. In practice what we have is a relatively small number of small studies. This section is not about how clinical trials are performed in chronic pain, but rather to set a scene in which the available evidence may be placed.
TENS for chronic pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Inclusion criteria were randomised trials in which the analgesic effect of repeated or continuous use of TENS was studied in patients with chronic pain (defined as pain of at least three months’ duration). Various sorts of TENS were included, with sham-TENS, or no treatment controls, or comparisons between different sorts of TENS, with different voltage, frequency or type of machine. Parallel, cross-over, or partial cross-over designs were accepted. Trial quality was generally poor because blinding was deemed impossible (active TENS causes tingling sensations). Studies were generally small, with poorly defined treatments and outcomes. Duration of use was variable.
Epidural corticosteroids for back pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Clinical bottom line. Epidural administration of corticosteroids is effective in the management of sciatica, with a NNT of 7.3 (4.7–16) for greater than 75% pain relief in the short-term (1–60 days), and a NNT of 13 (6.6–314) for greater than 50% pain relief in the long-term (12 weeks to one year). Epidural corticosteroids are commonly used in the treatment of low back pain and sciatica, although steroids are not currently licensed for epidural use in the UK. Steroids have a number of anti-inflammatory properties and an inhibitory effect on C-fibre conduction.
Cannabis for pain relief and for spasticity
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Chronic non-malignant pain. Two trials in two patients (both N of 1 trials with one patient in each) tetrahydrocannabinol 5 or 10 mg was better than placebo and about equivalent to codeine 50 mg. Cancer pain. Five trials with 128 patients. Tetrahydrocannabinol was roughly equivalent to codeine 60 mg in one trial.An analogue was also found to be equivalent to codeine 60 mg. Higher doses of tetrahydrocannabinol produced many adverse effects. At lower doses adverse effects were still more frequent than with standard analgesics.
NSAIDs for treating Osteoarthritis
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Clinical bottom line. NSAIDs effectively relieve pain by about half and increase mobility in about 60% of people with osteoarthritis. There is insufficient information to rank their effectiveness, but what information we have suggests that daily doses of diclofenac (100–150 mg) and naproxen (500–750 mg) are more effective than low doses of ibuprofen, and more effective than paracetamol. Non-steroidal anti-inflammatory drugs (NSAIDs) have become the common choice for treating rheumatological conditions like osteoarthritis, rheumatoid arthritis and gout.About 25 million prescriptions are written in the UK every year and most general practitioners will write a number of prescriptions every day because these are common conditions.
Paracetamol (acetaminophen) for Osteoarthritis
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
There were only four trials that fulfilled these inclusion criteria, and the main results are outlined in Table 5.7.1. Paracetamol 4000 mg daily was better than placebo in one trial, about the same as ibuprofen, but inferior to diclofenac and rofecoxib at usual daily doses. Total discontinuations in 345 patients over 4–6 weeks were 27%, 8% because of adverse events and 9% because of lack of efficacy. Based on this paucity of information it is hard to draw any sensible conclusions, other than such trials as we have broadly confirm clinical judgement, that paracetamol 4000 mg daily is effective for some patients, but will generally be inferior to top doses of NSAIDs.
Fish oil for rheumatoid Arthritis
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
The main inclusion criteria were that trials had to be randomised and double blind, to have a placebo control with results reported at baseline and follow up, and with a parallel or cross-over design. One quasirandomised study was included. This study used a search of MEDLINE from 1991, supplemented with additional searches and contacts to manufacturers. The review also obtained individual patient results and looked at results from an analysis of mean results of published material, and from an individual patient basis.
Strontium 89 therapy for painful bony metastases
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Clinical bottom line. Strontium 89 is useful in prostatic and breast cancer. Although it may not necessarily reduce pain from existing bony metastases, it appears to decrease the number of new sites developing. Strontium 89 appears to have similar clinical response rates to other radiopharmaceuticals with selective bone localisation. Most secondary bone lesions arise from primary carcinoma of the prostate, breast or lung, and external beam radiation therapy palliates 70% of lesions. However, this is not always adequate treatment for patients with multiple lesions and end-stage disease. In such cases pain relief is an important aspect of treatment.
Intracerebroventricular opioid therapy compared with epidural and subarachnoid opioids for intractable cancer pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Clinical bottom line. Intracerebroventricular (ICV) opioid therapy appears to be at least as effective as epidural or subarachnoid opioid therapy in patients with intractable cancer pain. Adverse effects and catheter/system related problems do not clearly favour one route. These should be carefully weighed when making a decision about method of delivery, but more rigorous data are needed in order to assess whether ICV is an appropriate first-line neuraxial treatment. Central or neuraxial opioid treatments have been used for the small number of cancer patients who do not respond to systemic treatment.
Complementary therapy at the end of life
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Six electronic databases were searched for papers about pain, dyspnoea, and nausea and vomiting at the end of life. The intention was to find papers that clearly studied interventions for these conditions, rather than surveys. The authors found 21 studies, 11 of which were randomised trials, two non-randomised controlled studies, and eight case series. Most of the studies investigated highly individual treatments in highly individual situations, so the likelihood of data pooling was low.
Pyschodynamic theories in conversion hysteria
Authors: Shoenberg P J 
Published: October 2023

Abstract
A 19-year-old girl with an alteration in the pattern of her epileptic fits was admitted to a neurology ward. Originally these had been grand mal fits in childhood; more recently she developed a new form of fit: she appeared to suddenly lose consciousness and become lifeless or else become violent. Sometimes during an attack she put her hands up to her throat as if to strangle herself. Physical examination was normal. On the ward her fits increased in frequency. We moved her into a room where she was placed beside an oxygen cylinder and given oxygen whenever she had a fit. We increased her dose of anti- convulsants. One day during a ward round she had a fit in front of the consultant neurologist, who surprised us all by speaking to her.
Introduction
Authors: Szarewski Anne , Guillebaud John 
Published: October 2023

Abstract
Despite St Augustine, contraceptive methods of one sort or another have been used for thousands of years. Many ancient remedies were poorly effective and some downright dangerous. However, even with all our modern technology no one has yet managed to produce the perfect contraceptive method. In an ideal world, a contraceptive would provide complete protection against pregnancy, be entirely free of health risks and side-effects, not involve any action either during or immediately before intercourse, be completely reversible, not rely on the user’s memory, and not involve the medical profession. Nowadays it would be welcome if, in addition to all these things, it prevented the transmission of sexually transmitted diseases. It is likely to take a very long time before this ideal becomes a reality.
How the pill was developed
Authors: Szarewski Anne , Guillebaud John 
Published: October 2023

Abstract
Hormonal contraception is not a new idea, although the earliest experimenters did not realize that was what they were trying to achieve. Swallowing things as contraceptives, rather than using barriers, was advocated in many ancient civilizations. In China, for example, women were advised to swallow live tadpoles! In India one prescription among many suggested that large quantities of three-year-old molasses should be eaten every day for a fortnight. If any woman succeeded in doing this she was supposed to remain childless for the rest of her life. Another way of becoming permanently childless was to drink a potion made up of the Kallambha plant mixed with the feet of jungle flies.
Which pill will suit me best?
Authors: Szarewski Anne , Guillebaud John 
Published: October 2023

Abstract
In this chapter we will consider the so-called ‘minor’ side-effects of the pill, which are of course not at all minor to those who experience them. Indeed, women often do stop the pill not because of worries about health risks, but precisely because they are fed up with some nagging, ‘trivial’ side-effect. So, in fact, these side-effects are of great importance. In most cases the balance of oestrogen and progestogen in a particular pill formulation is responsible: we saw in Chapter I that each of these hormones has its own specific effects in the body, although these are modified when the two are combined in the pill. Your experience of any given brand will depend on which of the two hormones is dominating the combination.
Injectable progestogens and implants
Authors: Szarewski Anne , Guillebaud John 
Published: October 2023

Abstract
Injectable progestogens consist of the hormone progestogen given in the form of an injection. Because no oestrogen is contained in them people often believe that they must work and behave like the progestogen-only pill (POP); however, although some similarities exist, there are also some very significant differences. How do injectable progestogens work? The method is exactly the same as that of the combined pill; they stop ovulation. You may find this surprising, since the POP is, after all, also a progestogen-only method, but depends more heavily on thickening the cervical mucus so that it becomes impenetrable to sperm, and on making the lining of the womb thin, so that the fertilized egg cannot implant itself. Injectable progestogens perform both these functions, but since they work primarily by preventing ovulation, they are far more effective, having a failure rate of only 0.1 per hundred woman-years. This means that if 1,000 women used this method for a year, only one would be expected to become pregnant.
The neuropathophysiology of delirium
Authors: Trzepacz Paula , Mast Roos van der 
Published: October 2023

Abstract
Introduction
Multiple higher cortical functions and neural circuits are affected in delirium, hence Lipowski’s description of the disorder as ‘acute brain failure’. With its characteristic abrupt onset and fluctuating symptom severity, delirium is a severe neuropsychiatric disorder. It is usually associated with generalized EEG slowing, consistent with widespread cortical dysfunction causing a range of symptoms arising from different functional brain regions. Additionally, evoked potential abnormalities suggest involvement of subcortical areas including the brainstem and thalamus (Trzepacz 1994). Lack of primary motor and sensory signs (unless related to specific aetiologies, like asterixis) suggests that association cortices (secondary and tertiary), limbic structures and ascending neurotransmitter systems are principally affected in delirium. Neuroimaging and lesion reports suggest that prefrontal cortex, anterior thalamus, non-dominant parietal and fusiform cortex are also involved (Trzepacz 1999).
Oh to be a volunteer
Authors: Tyrrell David , Fielder Michael 
Published: October 2023

Abstract
The founding of the CCU somehow caught the public imagination. And this, of course, was because of the volunteers. There was nothing like it, or them, anywhere else in the world. When the Crown Film Unit produced a series of wartime films entitled Britain can make it, one of the last of these featured the CCU. It began with a woman sneezing at a conveyer belt in an armaments factory and ended with cheerful volunteers in their rooms, and a scientist handling vials of possible virus.
Musculoskeletal and autoimmune manifestations of non-rheumatic disorders
Authors: Peterson Karin S 
Published: October 2023

Abstract
The aim of this chapter is to provide a comprehensive discussion of disorders that may occasionally manifest with secondary musculoskeletal complaints and mimic Juvenile Idiopathic Arthritis. Musculoskeletal pain, arthritis or autoimmune phenomena are some- times encountered in a child already diagnosed with another disorder, such as diabetes, cystic fibrosis, or an immunodeficiency. In most instances this is not the occurrence of a second disease but a symptom related to the underlying disorder or, occasionally, its treatment.
Rheumatoid Factor Negative Polyarthritis
Authors: Martini Alberto 
Published: October 2023

Abstract
According to the revised International League of Associations for Rheumatology (ILAR) classification criteria [1] (Table 2.5.1), Rheumatoid Factor (RF) Negative Polyarthritis is defined as any form of arthritis which meets criteria for Juvenile Idiopathic Arthritis (JIA) (unknown origin, onset before the 16th birthday, at least 6 week duration), lacks circulating RF, and affects five or more joints during the first 6 months of disease. It is the least defined and possibly the most heterogeneous form of JIA. Patients who meet the criteria for the diagnosis of Systemic Arthritis, RF Positive Polyarthritis, Psoriatic Arthritis, and Enthesitis Related Arthritis are excluded.
Environmental factors in the pathogenesis of Juvenile Idiopathic Arthritis
Authors: Prakken Berent J , Albani, Salvatore , Kuis Wietse 
Published: October 2023

Abstract
The aim of this chapter is to provide an overview of the importance of the environment (especially the microbial environment) and its inter- action with the immune system in immunopathogenesis and disease susceptibility in Juvenile Idiopathic Arthritis (JIA). Juvenile Idiopathic Arthritis (JIA) consists of a complex of diseases with a multi-factorial pathogenesis [1]. Although genetic predisposition does play a role in disease susceptibility, JIA is not a monogenetic disease [2–4] (See Part 2, Chapter 2.10 “Genetic and Cytokine Associations in JIA”). Aside from genetic susceptibilities, environmental factors play an additional role in the pathogenesis of the disease.
Introduction
Authors: Malleson Peter N 
Published: October 2023

Abstract
Juvenile Idiopathic Arthritis (JIA) is a difficult condition to treat for a number of reasons. As has been discussed in the previous section JIA is not a single disease, but several conditions linked by the presence of a chronic arthritis affecting one or more joints in a child. A child with Oligoarthritis who has one inflamed knee is going to require a different management approach to a child who has Systemic Arthritis associated with severe daily fevers and pericarditis. Even within any particular subtype, the management may vary substantially for different individuals.
Physiotherapy and occupational therapy
Authors: Kuchta Gay , Davidson Iris 
Published: October 2023

Abstract
The aim of this chapter is to discuss the multiple roles of phyiotherapists and occupational therapists in the assessment and management of children with JIA as the disease evolves over time. The chapter emphasizes that the role of therapists is not only to address the physical functioning of the child, but working with other health care professionals to help optimize the child’s overall wellbeing and psychosocial health. Occupational therapists (OTs) and physiotherapists (PTs) comple- ment the drug therapy of Juvenile Idiopathic Arthritis (JIA), by focusing on the symptoms of rheumatic diseases and attempting to prevent disability.
The Mediterranean in the Age of the Renaissance 1200-1500
Authors: Denley Peter 
Published: October 2023

Abstract
In 1202 a learned hermit, Joachim of Fiore, died in his native Calabria. His writings were to rank amongst the most influential of the later Middle Ages. Joachim envisaged a reclassification of the ‘ages of the world’. To the conventional two ages of the Father and of the Son he added a third, that of the Spirit, which would be the equivalent of Paradise on earth. According to Joachim’s calculations man was coming to the end of the second age. The transition to the third age, scheduled for the year r 260, would come about through a monumental struggle between the forces of good and evil, and would involve the appearance of the Antichrist. Interest in apocalyptic soon grew with the diffusion of these texts, which of course were capable of many interpretations, making them just as influential when r 260 had come and gone.
Greek Drama
Authors: Levi Peter 
Published: October 2023

Abstract
There is plenty of drama in everyday life, and the experience of life is the source of everything that succeeds in the theatre. Almost every human society has formal drama of one kind or another, if we define the word loosely. We know the Greeks sat on theatre benches to watch sacred rituals. The ceremonies of state and of religion, and the moments of birth, death, marriage, harvest, and so on, have a great deal in common with theatrical drama, but we recognize drama strictly speaking because it uses actors, takes place in something like a theatre, an area defined by an audience, and probably has a plot, and more importantly an inner form, that we have learnt to expect. Once there is a theatre, there will be many other conventions: applause, competition, a style of speech, maybe the mask and the dance.
Cicero and Rome
Authors: Griffin Miriam 
Published: October 2023

Abstract
If we know more about these years than about any other period of Roman history, it is due principally to one man, Marcus Tullius Cicero. We have an abundance of speeches and letters written when he was deeply involved in day-to-day politics, either holding the highest offices of state or in contact with the men who were settling the future of the Mediterranean world. But it is not only political history that his works illuminate so brilliantly. When not at the centre of the stage, Cicero turned to literature of a more reflective sort and composed a corpus of theoretical works on philosophy and rhetoric richly adorned with contemporary examples and redolent of contemporary attitudes. Precisely because he was not an original thinker, Cicero helps us to recapture the intellectual habits of his generation.
Introduction: Remembering the Second World War in Italy
Authors: Morgan Philip 
Published: October 2023

Abstract
Most continental European countries, with the exception of the neutrals Sweden and Switzerland, have lived through one or all of the experiences of fascist dictatorship, and war, defeat, and foreign occupation. Even though West European countries had not become fascist before the outbreak of war, they suVered military defeat and Nazi German occupation. Some people collaborated with the occupier, some resisted, and the reasons for collaboration and resistance varied greatly. In other Nazi-occupied countries, as in Italy, during and after liberation, the resisters and the people took sometimes bloody revenge on those who collaborated with the Nazis.
Fascist Italy at War, 1940–1943: Propaganda and Reality
Authors: Morgan Philip 
Published: October 2023

Abstract
Italy’s ‘Fascist’ war, from June 1940 to July 1943, used to be something of a blank in the country’s historical consciousness. Most writing—and certainly most written-up memoirs—has tended to give more attention and significance to the events of 1943 to 1945 than to the events of 1940 to 1943. There are good reasons for giving preferential treatment to how the country left the Second World War, ahead of how Italy entered and fought a Fascist war. For the country as a whole, the years 1940 to 1943 were ones of almost continuous military defeat, a national humiliationfelt by all Italians.
Fascist Italy at War, 1940–1943: Collapse of the Home Front
Authors: Morgan Philip 
Published: October 2023

Abstract
Measured in terms of the physical, psychological, and political damage they inflicted, the Allied bombings of Italy during the Second World War must count as one of the most successful bombing campaigns ever. It would be pushing things too far to say that Allied bombing was responsible for the downfall of Mussolini in July 1943. But the bombings, together with the food situation, certainly caused a widespread loss of confidence in Mussolini and the Fascist regime and turned many Italians against the war.
Life Cheapens: The Descent into War
Authors: Mulholland Marc 
Published: October 2023

Abstract
As early as 1966 a shadowy paramilitary group, the Ulster Volunteer Force (named after the 1912 UVF), with some connections to the extremes of mainstream unionism, attempted to scupper O’Neillism by imitating republican violence. The UVF hoped to entrench existing polarities between communities and destroy illusions that Catholics could be loyal to the state. This coolly rational plan collapsed due to the sectarian enthusiasm of its members. In May it targeted a Catholic pub, mistakenly killing a Protestant woman; when in June it assassinated a Catholic man, Terence O’Neill declared the UVF illegal.