bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing change and planning care
Authors: Havelock Peter 
Published: November 2023

Abstract
The process of bringing about change is based on simple, common sense theory, but the implementation of that theory is complex and riddled with hazards. It involves a move from collecting, collating, and presenting data to an alteration of behaviour in the practice to improve the quality of care (Rogers 1971). In the introduction to Part II the characteristics of a healthy practice were outlined. Those characteristics allow a practice to perform effectively and the time and effort expended in attaining them are well rewarded. Often such ideal circumstances are unobtainable; for instance, due to a long history of resistance to change within the practice, or due to one powerful partner blocking all progress. If these or other similar circumstances apply to you, do not be put off introducing audit. Often the process of examining the quality of the care you provide, including team work, discussion, planning, and effective meetings can help to bring about the metamorphosis to a healthier practice. If you are the person trying to introduce change into your practice do not get too disheartened by initial resistance and failures, but use the ideas and principles in the following chapter to help ‘sell’ your ideas to the other members of your practice.
Preventive care: cardiovascular disease
Authors: Farmer Andrew 
Published: November 2023

Abstract
Cardiovascular diseases are the most common cause of premature death in the UK. Heart disease leads to disability and a restricted life-style for those suffering from angina and heart failure. The economic cost of treating established heart disease is high. Intensive care for those suffering myocardial infarction is expensive, new drugs such as streptokinase offer improved survival but at great cost, and coronary artery bypass grafting is an increasingly common procedure. Developing a coherent strategy for the prevention of cardiovascular disease has been a priority of many groups, including the government, royal colleges, and district and regional health authorities.
Standardized concentrations
Authors: Cruickshank Steven 
Published: November 2023

Abstract
Antagonists are classified as competitive or non-competitive. There are various ways in which the non-competitive antagonists may act but the most familiar exemplified by phenoxy benzamine at the a-receptor—is the irreversible (or only very slowly reversible) reaction with a receptor site. The effect is essentially a depletion of the receptor pool [R] and hence a reduction in [DR] for any given agonist concentration. We concentrate on the more familiar competitive antagonism.
Masses and springs: Hooke’s Law
Authors: Cruickshank Steven 
Published: November 2023

Abstract
Oscillating systems are seen everywhere. Anaesthetists are particularly interested in cyclical physiological processes such as the cardiac and respiratory cycles. As in previous modelling examples, we shall start quite simply and build up only such complexity as we need to describe the systems that concern us. We shall build a model of a typical arterial pressure waveform and see how this model relates to the physical behaviour of the clinical measurement systems that we use to display it. We start with the simplest ideal oscillating system, in which no frictional forces are involved.
Modelling real oscillations: frictional forces and damping
Authors: Cruickshank Steven 
Published: November 2023

Abstract
We have studied the behaviour of a model system without considering frictional forces. The SHM oscillations continue undiminished for ever in such a model; the energy imparted to the system at the outset remains within the system. This is evidently quite unrealistic, since in reality we observe a progressive diminution in the amplitude of the excursion of the mass. If we suspended the mass-spring system in oil rather than air, we would expect the oscillations to be more sluggish (longer period of cycle) and to die away quickly (rapid diminution in amplitude.) We need to incorporate a frictional element into the model to account for this energy dissipation. The dissipation of energy from oscillating systems is damping.
Integrals
Authors: Cruickshank Steven 
Published: November 2023

Abstract
If we have a differentiable function, we can find its derivative and hence the gradient at any point on the graph. Our modelling equations are frequently expressed in terms of the rate of change or gradient of a quantity, and our task is to recover the original function. This process is integration, and is the reverse process of differentiation. The function the derivative of which we know is called a primitive. This is expressed in function notation as: F(x) is a primitive of f(x) which in turn has a derivative f(x). This also means that F’(x) = f(x) and F”(x) = f(x).
Thiamin (vitamin B1&gt;
Authors: Bender David A , Bender Arnold E 
Published: November 2023

Abstract
The peripheral nervous system disease beriberi, due to thiamin deficiency, has been known sporadically for some 1300 years; it became a major problem of public health in the Far East in the nineteenth century with the introduction of the steam-powered rice mill, which resulted in more widespread consumption of highly milled (polished) rice. Thiamin was discovered as the factor in the discarded polishings which protected against the disease, and was initially called aneurine, the anti-neuritic vitamin.
Symposium: neural tube defects
Authors: Bell Jeanne E 
Published: November 2023

Abstract
Defects of the central nervous system (CNS) are among the most common of the severe congenital malformations. Abnormalities such as spina bifida and anencephaly have been recognized since antiquity and have been the subject of historical pathology studies (Cleland 1883; von Recklinghausen 1886). Despite this the causes of these abnormalities, and therefore the means to total prevention, remain poorly understood. From observation of human embryos (Frazer 1921; de Vries 1927; Patten 1952; Erskine 1955; Dekaban 1963; Lemire et al. 1965; Bell and Gosden 1978; Bell 1979; Smith et al. 1993), it is clear that these malformations have their origin very early in development. It is for this reason that the generic term, neural tube defects (NTD), has been given to conditions such as anencephaly, spina bifida, and some other rarer CNS abnormalities.
Litigation and obstetric ultrasound
Authors: Pearce J Malcolm 
Published: November 2023

Abstract
For more than a decade now most pregnant women have had at least one ultrasound examination during the course of their pregnancy. As an imaging modality ultrasound is unique in at least two respects. Firstly, it is mostly carried out by radiographers who are then expected to talk to both the pregnant woman and the managing clinicians, often without the intervention of or reinterpretation by a doctor. Secondly, ultrasound is both a screening and a diagnostic test. The main role of routine ultrasound examination in the first half of pregnancy is to confirm or establish the gestational age. Secondary roles include the diagnosis of multiple pregnancy, the localization of the placenta, early maternofetal bonding, and a survey of fetal anatomy. Unusual appearances or measurements should lead to a detailed examination by an appropriately trained doctor who will attempt to make a diagnosis and give a prognosis.
Charting the course: designing a medical curriculum
Authors: Jolly Brian 
Published: November 2023

Abstract
In this chapter we shall look at why a curriculum needs to be designed, who should be involved, and different methods and approaches to designing it. We will also look at some of the effects that such decisions have in practice. However, a detailed discussion of course planning is not envisaged here. The title of this sub-chapter is ‘charting the course’, not ‘trimming the sails’. We will take a global approach. A few simple models to help curriculum designers will be presented and the implications of ignoring the interactivity of curriculum decisions discussed. Within each section we will try to identify useful principles for curriculum design in medicine. Finally we will make some remarks on the difficulty of curriculum maintenance in the face of rapid and far-reaching developments in health care.
Pain in cancer
Authors: Coniam S W , Diamond A W 
Published: November 2023

Abstract
The relief of the physical, mental, and social symptoms of disease in the dying has become the basis of palliative care. Among the most distressing of these symptoms is pain associated with malignant disease. Relieving it is not curative treatment and does not alter the disease process, and yet it is not necessarily ‘terminal care’. Relief of distressing symptoms should begin whenever they arise and not be reserved for the terminal stages. Although pain is often thought to be the main symptom in cancer, and will be the main consideration in this chapter, palliative care should aim to ameliorate all the distressing symptoms in a patient with malignant disease.
Intercostal nerve block
Authors: Mather S J 
Published: November 2023

Abstract
The intercostal nerves are the ventral branches of the first 11 thoracic segmental nerves (Fig. 8.1). In the paravertebral space the nerve passes very close to thepleura. At the costal angle it enters the subcostal groove. Themajor part of nerve runs with the blood vessels in the intercostalspace, protected by the subcostal groove of the rib (Fig. 8.2).
Nerve blocks for inguinal herniotorny and orchidopexy
Authors: Mather S J 
Published: November 2023

Abstract
The ilioinguinal nerve (Tl2, LI) runs below the ventral branch of the iliohypogastric nerve (Tl 2, Ll). The iliohypogastric nerve lies between the transversus abdominis and internal oblique muscles, dose to the anterior superior iliac spine, and supplies the skin in the area of the inguinal ligament. The ilioinguinal nerve runs through the superficial inguinal ring to supply the skin of the scrotum in the male and the labia majora in the female.
Monitoring progress
Authors: Faulkner Ann , Maguire Peter 
Published: November 2023

Abstract
Assessment is not a ‘one-off’ activity carried out only when the patient is first seen, but is a dynamic ongoing activity, which allows progress to be monitored. Soon after admission, the patient’s problems should have been identified, and their care planned in the light of the presenting problems, whether these are physical, social, or psychological. The patient will still be attempting to come to terms with the illness and its sequelae and treatment, which can be frightening and unpleasant. Fears and worries do not disappear overnight, and nursing and medical staff will need to review both social and psychological problems.
Handling conflict in cancer care
Authors: Faulkner Ann , Maguire Peter 
Published: November 2023

Abstract
The health professional will inevitably encounter situations in daily practice where the potential for interpersonal conflict is high. This chapter seeks to provide guidelines to help deal with these situations constructively. A common requirement is the willingness to confront individuals promptly once conflict arises, in a way that makes resolution reasonably likely. If health professionals are to be able to confront in this way they have to be willing to be assertive and represent their own views firmly, without alienating other people.
Training in communication skills
Authors: Faulkner Ann , Maguire Peter 
Published: November 2023

Abstract
In the past, conventional medical and nursing curricula have contained little, if any, input on communicating with patients. Faulkner (1985) found that a majority of nurse educators believed that such skills were inherent in health professionals, and there is lively debate in medical schools on whether to include communication as a subject in the curricula. However, when the ability of doctors and nurses to elicit cancer patients’ concerns was assessed by asking them to interview simulated patients, recording their interviews, and rating transcripts of audiotapes many were found to be lacking in the behaviours which promote disclosure (Chapter 4). In contrast, behaviours which inhibit disclosure were used more frequently. When the ratio of desired to undesired interviewing behaviours was compared it was found to be one to three. This ratio was not affected by the age of the health professionals, the length of time they had been working with cancer patients, or their professional discipline or training.
The Spectrum, of Paediatric Intensive Care
Authors: Sinclair J 
Published: November 2023

Abstract
A paediatric intensive care unit (PICU) is a facility specially designed, staffed and equipped for the treatment and management of critically ill children from early infancy to adolescence. Because PICUs are tertiary referral centres based at major paediatric teaching hospitals, large numbers of children are cared for, at least initially, outwith the tertiary centre in adult intensive care units (ICUs). The aims of this chapter are to introduce some of the wide spec trum of illnesses seen in the PICU, to highlight the differences between the management of patients in PICUs and adult ICUs, and to explain the reasons behind these differences. The spectrum of disease seen in any given PICU depends on the population from which it receives its patients. The presence of a cardiac surgery programme or organ transplant programme within the hospital will have major implications for the PICU.
Sedation and analgesia for critically ill children
Authors: Hansen T G , Morton N S 
Published: November 2023

Abstract
Critically ill children undergoing mechanical ventilation frequently require sedation and/or analgesia.1-4 The main purpose of this treatment is to improve the efficacy of mechanical ventilation but sedation and analgesia are also required to alleviate unpleasant experiences faced by children in the paediatric intensive care unit (PICU) (Table 10.1). Sedation and analgesia can also be used as therapy in patients with increased intracranial pressure, status asth maticus, status epilepticus and to attenuate pulmonary hypertension. l,z,s-s Sedation should always be performed without compromising the child’s haemodynamic stability.
Stabilization and transport of the critically ill child
Authors: Morton N S 
Published: November 2023

Abstract
Centralization of paediatric intensive care facilities means that more children will need to be moved to specialist units. It has been clearly shown that this results in improved morbidity and mortality rates for the sickest children1 and that properly conducted transportation does not cause a deterioration in the patient’s condition and outcome. By recognizing critically ill children early, by thoroughly assessing and stabilizing their condition prior to transfer and by ensuring that appropriately experienced personnel accompany the child using appropriate equipment, secondary insults during transport can be avoided.
.Growth and its problems
Authors: Modell Michael , Mughal Zulf , Boyd Robert 
Published: November 2023

Abstract
Growth is a very sensitive indicator of a child’s well-being. There is rarely anything serious chronically amiss with a baby or a child who is growing well physically and mentally. Unfortunately, a healthy growth is not always found. Failure to thrive is a time-honoured phrase which merely means failure to gain weight at the expected rate. It is best diagnosed by plotting sequential weights, and, ideally, length and head circumference measurements (often overlooked) on a suitable centile chart. The weight of the child who is failing to thrive will fall across centile lines, or away from the second centile. In essence, the rate of growth is more important than a single weight measurement which lies below the second centile. Edwards et al. (1990) have suggested that the child’s ‘genetic weight centile’ is achieved between four and eight weeks rather than at birth. This is a better predictor of his centile at 12 months than the birth centile, which is partially determined by maternal influences and the fetal well-being during pregnancy.
Fetishism
Authors: Greenacre Phyllis 
Published: November 2023

Abstract
The concept of the fetish rests on a very broad base. The term seems to have originated in the 15th century, when Portuguese explorers in West Africa applied it to carved wooden figures or stones. It was thought that the natives regarded these as having magic value, and that they might have been considered as the habitations of gods or, spirits. This interpretation may have been derived in part from the regard and worship of relics of the saints or other holy persons, already familiar to the explorers.
Advances in the psychoanalytic theory and therapy of male homosexuality*
Authors: Socarides Charles W 
Published: November 2023

Abstract
In a new era of sexual permissiveness and intensive sociopolitical activism threatening to remove homosexuality as a psychopathological disorder and even proscribe its treatment, it is well to begin this chapter by a definition of homosexual and homosexuality, preceded by definitions of the words ‘sexual’, ‘heterosexual’, and ‘heterosexuality’.
Biological factors in the organization and expression of sexual behaviour
Authors: Michael Richard P , Zumpe Doris 
Published: November 2023

Abstract
No single physical, chemical, educational, cultural, biological, or ethical factor is responsible for the expression of sex. On the contrary, the more complex the organism, the more numerous are the factors influencing the phenomenon. In some simple forms of motile, water-dwelling plants, the addition of a chemical to the medium causes the population to divide into two groups: those which attract and those which repel each other. This simple chemistry no longer holds in more complex forms; and in the human, powerful cultural as well as subtle educational influences may be just as important in determining sex role and orientation as are the genetic and endocrine factors.
Observing practice and evaluating care in peer review
Authors: Grol Richard , Lawrence Martin 
Published: November 2023

Abstract
After setting criteria and target standards for evaluating general practice care the next steps in the peer review process are concerned with observing practice and collecting data on the actual care provided to patients. What kind of care is delivered and to what extent does it meet the quality criteria? Assessing patient care is a crucial activity in quality improvement. Care providers often overestimate what they do. Providing information about what actually happens makes performance clear to doctors themselves, to their peers, and to others.
Improvement and change through peer review
Authors: Grol Richard , Lawrence Martin 
Published: November 2023

Abstract
Improving and changing practice performance is definitely the most complex step in medical audit. It is also an aspect which is often undervalued or neglected (Pringle et al. 1991). Nevertheless, there is a lot of evidence that, even if care providers are well informed about what they should be doing, they often do not perform in accordance with their knowledge or skills (Kosecoff et al. 1987; Sanazaro 1983), so behaviour change is desirable.
Methods for observing and reviewing practice with peers: some principles
Authors: Grol Richard , Lawrence Martin 
Published: November 2023

Abstract
In this part of the book the development of performance review with peers and colleagues in a practice or in a local or regional group is taken a step further. In this chapter the model for peer review, presented in Chapter 1, is made more explicit and general principles of the peer review process are described. In the remaining chapters of this part of the book some methods of peer review process are described.
Developing guidelines and criteria in peer review
Authors: Grol Richard , Lawrence Martin 
Published: November 2023

Abstract
In Chapter 2 of this book we highlighted the importance in peer review of having explicit criteria based on recognized guidelines. In this chapter three methods for developing such criteria and guidelines in a peer group are presented (see box on pp. 63-4) Being involved in developing guidelines for high quality in patient care using consensus discussions can be a very valuable, educational experience (see example, North of England Study of Standards and Performance 1992). When it is carried out on a local or practice level, it may help care providers to develop a sense of ‘ownership’ of the guidelines. Developing guidelines should take place in a rigorous way, through a standardized procedure, in order to prevent obsolete performance being selected as an objective so reinforcing the status quo, or dominant group members with outspoken convictions forcing their ideas on a peer group. This demands specific interpersonal and technical skills and skills with regard to analysing the available literature.
Reproductive cycles in women: quality of life impact
Authors: Kessel Bruce 
Published: November 2023

Abstract
Through menarche, the reproductive years, and the menopause, both normal and abnormal gynecologic events influence women’s health and have an impact on quality of life. The events that most significantly alter psychosocial adjustment include premenstrual syndrome, infertility, childbirth, pelvic pain, abnormal uterine bleeding, and the menopause. Undoubtedly the medical aspects of repro ductive health and disease receive far more attention than the psychosocial and cultural aspects. There is only limited knowledge of the impact of reproductive cycles on work, family, and personal sense of well-being. A further limitation to the ability to address health policy issues for women has been the relative disre gard for women in much medical research, which is conducted mainly on men, resulting in conclusions that are of little relevance to women. As gynecologic pro cesses are chiefly age related, the effect of reproductive events on quality of life in women may be considered with respect to age-related reproductive milestones.
AIDS in women
Authors: Cotton Deborah 
Published: November 2023

Abstract
In the USA, the acquired immunedeficiency syndrome (AIDS) was the fifth lead ing cause of death in women of childbearing age in 1990 (Chu et al. 1990a), and almost 80 000 women were estimated to be infected (Gwinn et al. 1991). World wide the specter of AIDS is even more sobering, with estimates that 20–50 million women may be infected by the year 2000 (Mann et al. 1992). Despite the enormity of the problem, until recently little attention has been paid to the unique aspects of HIV infection in women, and there are inadequate data on the natural history of the disease in women. Few AIDS-related programs are gender specific in their approach to disease detection or management, and women as a group have had less access than men to state-of-the-art therapies and experimental drug trials.
Maternity-related health the USA
Authors: Kleeman Lorraine V , Merkatz Irwin R 
Published: November 2023

Abstract
The four components of maternity-related care are preconception care, pre natal care, labor and delivery management, and postpartum follow-up. The postpartum visit should lead to continuing gynecological care, whether or not further pregnancies are planned. Although in the USA there is general consensus on the value of each component of this sequence, in reality the delivery of these services is often greatly influenced by financial and political considerations. Consequently, the quality and quantity of care that women receive varies according to their economic status, geographic location, and other factors. These inequities contribute to low birth weight and infant mortality, pregnancy outcomes whose rates are higher in the USA than in many countries with similar degrees of industrialization (Liu et al. 1992).