bluuebunny/crossref_metadata_2025_split huggingface dataset:
An evaluation of maternity services
Authors: Beard R W , Chapple Jean 
Published: November 2023

Abstract
Pregnancy has become a relatively safe event for the mother and her baby, so why is it that Western societies continue to make a substantial investment in providing health care? This question highlights an ambivalence of approach that spreads from government to all professions involved in maternity care and to the public. Pregnancy is a natural and important event and most women remain well through out their pregnancy.
Introduction
Authors: Myerscough Philip R , Ford Michael J , Currie C T , Doyle D , Hewitt A N M , Laing I A , Speirs A L , Wrate R M 
Published: November 2023

Abstract
Most medical students approach their training with a desire to help people. Thus, from the very beginning of their studies, students look forward to clinical involvement—to meeting ‘real’ patients and learning to interact with them. After qualifying, most doctors spend a great deal of their working time communicating with patients—speaking, listening, responding. This face-to-face interaction, with exchange of information, is essential if the doctor is to be effective in his or her work.
Accordingly, skilful communication has become widely recognized as a primary component of medical education, something that the student should learn about as a basic part of professional training. However, this is the very aspect of doctors’ professional skills that is still the most common cause of complaint from patients or their relatives, an apparent weak point in doctors’ professional competence [1,9,10,11,12,l3].
Other aspects of doctor–patient communication
Authors: Myerscough Philip R , Ford Michael J , Currie C T , Doyle D , Hewitt A N M , Laing I A , Speirs A L , Wrate R M 
Published: November 2023

Abstract
Up to this point is has been tacitly assumed that communication between doctor and patient takes place ‘on the level’, that the exchanges are always characterized by honesty and openness. This is certainly not invariably the case, and sometimes lies or half-lies, deceptions, and denials are at the heart of the dialogue.
Deceit by the patient may take many forms, ranging from flagrant to subtle. Even the patient’s initial complaints may be falsified. An unusual skin lesion (for example) may be factitious. Sometimes the motivation is obscure or psychopathic, as in Munchausen’s syndrome (p. 8).
Talking to the dying patient
Authors: Doyle D 
Published: November 2023

Abstract
Those who are dying, contrary to what one might expect, seldom want their diagnosis discussed or repeatedly explained. But they do ask, in one way or another, for confirmation that they are dying; they are then ready to tackle the business in hand, that of living out what is left of life with minimal suffering, with a dignity that is defined by them and respected by their attendants, and with an unclouded mind. As death approaches, whether they are young or old, they seem to invite the doctors and nurses caring for them to change their roles from ‘professional advisers and attendants’ to intimate companions on the loneliest journey a human being ever takes.
Some years ago, I and a nursing colleague visited a woman at her doctor’s request. She had advanced oesophageal carcinoma with considerable pain and almost total dysphagia. As is my custom, I did not immediately take a history, but rather asked the patient in what way she felt I could help her: ‘Ease my pain, show me what I can eat, and reassure me that you will always answer my questions honestly. I must be fit enough to finish some unfinished business.’
Aspects of transcultural munication
Authors: Myerscough Philip R , Ford Michael J , Currie C T , Doyle D , Hewitt A N M , Laing I A , Speirs A L , Wrate R M 
Published: November 2023

Abstract
With travellers, visitors, and immigrants from many countries of the world very much part of the everyday scene, doctors need to broaden their understanding of how best to communicate with patients from other cultures, avoiding the difficulties that can arise through ignorance of their customs and beliefs.
In a short chapter, there is a risk of seeming to sketch stereotypes. This I have tried to avoid, but it is only possible to attempt very incomplete outlines of certain general cultural patterns.
lmmunopathogenesis of cresccntic glomerulonephritis
Authors: Holdsworth Stephen R , Erhch Jonathan H , Tipping Peter G 
Published: November 2023

Abstract
The characteristic and unifying feature of crescentic glomerulonephritis is the extracapillary accumulation of cells within Bowman’s space. The consequent shape of the accumulating cells within this space surrounding and compressing the residual capillary loop resembles that of a crescent when cut in section and viewed under the microscope.
Clinical aspects of systemic vasculitis
Authors: Gaskin Gillian , Pusey Charles D 
Published: November 2023

Abstract
Necrotizing inflammation of small blood vessels is the hallmark of the primary systemic vasculitides associated with rapidly progressive glomerulonephritis. Other primary vasculitic syndromes affect larger vessels, and vasculitis may also occur as a variable accompaniment to other systemic diseases, including rheumatoid arthritis, systemic lupus erythematosus, and infective endocarditis. This chapter will deal principally with the small vessel vasculitides, Wegener’s granulomatosis and microscopic polyangiitis.
Rapidly progressive glomerulonephritis 1n children
Authors: Dillon Michael J 
Published: November 2023

Abstract
As discussed in previous chapters, crescentic glomerulonephritis can accompany most forms of primary glomerulonephritis in childhood. However, in this age group it is associated also with various systemic diseases, such as systemic lupus erythematosus and several forms of systemic vasculitis (SPNSG 1985; Niaudet and Lèvy 1983). The severity of the condition, the multiple aetiologies, and the associated poor prognosis have led to the use of multiple treatment regimens, the efficacy of which has been difficult to assess (Haycock 1988), and there has been lack of clarity in identifying variables with possible therapeutic and prognostic implications.
The Community Module:adopting a community-oriented approach ,n partnership with the community
Authors: Wykurz Geoff 
Published: November 2023

Abstract
In these words Janet Richardson of the City and Hackney Community Health Council (CHC) sums up the impetus for the introduction of the Community Module and alludes to the way the innovation was introduced (Wykurz 1992). The CHC’s ambitions coincided with the emerging alliance between the local medical colleges of the St Bartholomew’s and Royal London School of Medicine. Although students entered medical school motivated to meet people, no programmed involvement in the community existed to tap and channel this enthusiasm. Restructuring of the curriculum created the opportunity to introduce a community-based clement for first-year students. Consulting community organizations and public health departments at the outset ensured that the module reflected local health issues. This approach reflects the principles adopted by the World Health Organization for community-based educational programmes that have been valuable reference points during the module’s development (WHO 1987).
An integrated course in public health and primary care
Authors: Graham-Jones Susanna , Lawrence Martin 
Published: November 2023

Abstract
Until recent years, medical students at Oxford University had very little structured teaching in primary care. Each student had two practice attachments of a fortnight each, at the beginning and the end of the three-years clinical course. These were popular, but there was no curriculum as such, and little in the way of staff development for the general practitioners involved. Apart from a single seminar at the end of each attachment, there were no timetabled opportunities for students to reflect with teachers on their very diverse experiences. Similarly, the public heailh course was run in the traditional manner as a teaching block for 14 to 16 students at a time, covering the fundamentals of epidemiological methods and community medicine. As in most other medical schools, it was difficult to interest medical students, preoccupied with the acquisition of clinical skills, in public health.
Teaching cultural aspects of health
Authors: Gill Paramjit S , Adshead David 
Published: November 2023

Abstract
The United Kingdom is a multiracial, multicultural society, with a large black and ethnic minority population (Balarajan and Soni Raleigh 1992), with variations between different ethnic groups both in health care needs, and in the delivery of services (Hopkins and Bahl 1993; Department of Health 1992). Both doctors and patients experience difficulties when dealing with someone from a different ethnic group (Chugh et al. 1993; Eisenbruch 1989). These difficulties arc widely recognized, and have been expressed by junior hospital doctors who felt inadequately trained to assess patients from the different ethnic groups they encountered (Poulton et al. 1986).
Shadowing other professionals: a short course introducing preclinical students to other health care professions
Authors: Biran Len 
Published: November 2023

Abstract
Among the objectives proposed by the General Medical Council (1993) (p. 37-39) are an understanding of the importance of communication . . with other professionals (1 (j)), respect for colleagucs (J(a)), and the ability to work effectively as a member of a team (3(h)). At Leeds Medical School a short course was designed to address these objectives. It ran within a communication skills course in the second (preclinical) year of the medical course. As with the course on ‘teaching cultural aspects of health’ (sec Chapter 22), it ran over only four afternoons but evaluation suggested that it had a significant impact on the students.
Mental health in the community
Authors: Dowrick Chris 
Published: November 2023

Abstract
British health care is moving from a hospital focus to a community orientation, and from a doctor-centred approach to one based on collaboration and multidisciplinary teamwork. However, conventional hospital-based medical education and training have failed in the task of enabling new generations of doctors to develop the psychological experience and emotional maturity to cope with the stresses of clinical practice. Some have argued that traditional medical education encouraged the suppression rather than the acknowledgement of feelings (Ross and Stanley 1985), and the search for certainty rather than the acceptance of complexity and ambivalence (Light 1979). These contradictions are acute in the field of mental health. The rapid growth of communications skills-training (Marteau et al. 1991) and the creative use of behavioural science courses (de Groot 1987) have gone some way towards redressing these deficiencies, but emotional issues probably still receive less attention in undergraduate medical education than they deserve.
The purpose of assessing medical students
Authors: Holsgrove Gareth 
Published: November 2023

Abstract
Students may be assessed for three different reasons, to measure their potential, their progress, or their attainment. As already mentioned, formative assessment is used to inform students and their teachers about areas of strength and weakness as they progress through the course, while summative assessment counts towards their final mark or grade. Traditionally, assessment throughout the educational system has placed strong, sometimes overpowering, influence on summative assessment of attainment, with comparatively little attention to monitoring progress and virtually none at all to assessing potential. Where consideration is given to a student’s potential, for example, during the selection process for entry to a course, it is usually on the presumption that previous performance indicates aptitude and predicts future performance. In other words, the results of earlier tests of attainment are used as indicators of potential. Although aptitude tests need not differ significantly from tests of achievement, except in their application and interpretation, the latter are often used without much evidence that the interpretation is correct.
Assessing communication skills
Authors: Southgate Lesley 
Published: November 2023

Abstract
There is now general agreement amongst medical educators about the importance of learning communication skills as part of undergraduate medical education (Canadian Medical Association 1992). In Tomorrow’s doctors the Education Committee of the General medical council emphasized that good communication with patients was a core skill for clinicians and this has been discussed previously, especially in Chapters 4 and14. People have reported the rapid increase of complaints against doctors directed at the quality of the doctor-patient relationship rather than poor clinical skills. However, although there is some evidence (Simpson et al. 1991) about the negative effect of poor communication on the outcomes of patient care, some clinicians and life scientists remain unconvinced that a significant amount of time in the curriculum should be devoted to improving the communication skills of medical students. Others pay lip service to such initiatives but undermine them by allowing the students to realize that in their view it is not the really important business of medical education.
Guidelines for assessing clinical competence
Authors: Southgate Lesley 
Published: November 2023

Abstract
The assessment of competence, what the student ‘knows how’ to do, is the task of all those who develop and engage in the undergraduate curriculum. It is important for the support of students as they graduate and enter the world of work, it is important for the public who are protected via the requirements of the GMC and it is important for the teachers and learners in the medical school who will suffer frustration and disappointment if the assessed hidden curriculum and the published taught curriculum are not congruent.
Vascular and lymphatic systems
Authors: Smith Francis W 
Published: November 2023

Abstract
The popularity of radionuclide first-pass studies has diminished in recent years due to the improvements in echocardiography, digital subtraction angiography (DSA), and the advent of magnetic resonance angiography. Prior to these developments, radionuclide first-pass studies were popular and often used for the initial assessment of children with congenital heart disease to ascertain the degree of intracardiac shunt before proceeding to X-ray angiography. Today these patients are usually assessed by echocardiography prior to angiography, and no radionuclide first-pass study is performed. However, there are occasions where a relatively noninvasive method for assessing the degree of intracardiac shunt is necessary, and it is important to understand how to perform a radionuclide first-pass angiogram.
Musculo-skeletal problems with no history of recent injury
Authors: Wardrope Jim. , English Bryan 
Published: November 2023

Abstract
The spectrum of diagnoses in non-traumatic musculo-skeletal problems encompasses almost the whole of acute medicine. The misdiagnosis of these problems gives rise to complications that may be life- or limb-threatening. All medical students are taught that the limping adolescent with pain in the knee is the classical presentation of a slipped upper femoral epiphysis, but such cases are regularly missed in A&E departments. Shoulder pain is a ‘classical’ site for referred pain from the chest or abdomen but it may be disregarded with lifethreatening results. The diagnosis of these conditions is difficult and often time consuming, but more time must be spent on these cases, just as there is an expectation to properly assess a case of chest pain.
The elbow joint
Authors: Wardrope Jim. , English Bryan 
Published: November 2023

Abstract
The joints of the elbow (including the proximal radioulnar joint) have strong ligaments. The main movements of the elbow joint are flexion and extension while forearm pronation and supination occur at the radioulnar joints.TraumaFractures are common but may be hard to detect on X-ray leading to a misdiagnosis of a soft-tissue injury. (Especially radial head fractures and children’s fractures.)The presence of a traumatic effusion within the elbow joint often indicates an occult fracture.
Hip and thigh
Authors: Wardrope Jim. , English Bryan 
Published: November 2023

Abstract
Trauma—Falls in patients over 50 years of ageHip fractures are common—always X-ray patients.Fractures may not be visible on initial films, admission/ follow-up, bone scan may be required.Elderly patients, living alone, rendered immobile by a fall may require admission or nursing-home care.Trauma—Direct blow to the thigh May cause large intramuscular haematoma.Refer if patient unable to flex knee beyond 90 degrees.
Cervical spine
Authors: Wardrope Jim. , English Bryan 
Published: November 2023

Abstract
Problems of the neck and cervical spine account for approximately 2 per cent of accident and emergency attendances. There is a high incidence of presentation with non-traumatic problems, a low incidence of fractures, and almost half the patients will have injured their neck in a road traffic accident. Many soft-tissue injuries of the neck give rise to significant problems that may take many months to settle. A small minority of patients will have severe damage to the soft tissues that may lead to spinal cord injury, even in the absence of any evidence of fracture or dislocation.
Introduction
Authors: Williams J R , Thwaites D I 
Published: November 2023

Abstract
The beginnings of radiotherapy followed quickly on the discovery of ionizing radiations. X-rays were identified by Roentgen in 1895 and radioactivity by Becquerel in the following year. It was recognized at a very early stage that these radiations produced dramatic effects on normal tissues and it was a natural progression that within a few years of the discovery of radioactivity the effects of radiation should be investigated on superficial tumours. In the early days, progress in radiation therapy was largely determined by the production of satisfactory sources. The isolation of radium by the Curies was one key to this development, as was the improvement in the technology associated with X-ray production. In parallel with the developments of radiation sources, there came the recognition that it was essential to be able to define and measure the quantity of radiation being delivered. The formation of the International Committee on Radiological Units (ICRU), now called the International Commission on Radiation Units and Measurements, in 1925 was a key element in this area.
Relative dosimetry
Authors: Horton J L 
Published: November 2023

Abstract
After a therapy machine is accepted and before it can be placed in clinical service the physicist must acquire an extensive set of radiation measurements that characterize its performance. All measurements discussed in this chapter will be relative to the calibrated output that is described in Chapter 3. This chapter will discuss relative measurements that are required before a high-energy linear accelerator with photons and electrons can be placed in clinical service. A high-energy linac has been chosen because it demands the most measurements, but this schema can easily be modified for low-energy photons-only linacs or cobalt units.
Antihypertensive therapy in type 2 diabetes with nephropathy
Authors: Villarosa Imelda P , Bakris George L 
Published: November 2023

Abstract
Data from epidemiological studies clearly indicate that diabetes confers more than an additive risk for development of both cardiovascular events as well as renal disease in people who are hypertensive. This is particularly true among women. Moreover, the protection against cardiovascular events offered by oestrogens to pre-menopausal women is eliminated in the presence of diabetes.
The uraemic patient with type 2 diabetes: therapeutic approaches and perspectives of renal replacement therapy—a view from the other side of the Atlantic
Authors: Friedman Eli A 
Published: November 2023

Abstract
Retrospective and prospective observation of kidney function during the course of type 1 and type 2 diabetes indicates an equivalent risk of progression of diabetic nephropathy to ESRD. Nephropathy in diabetes—when suboptimally managed—follows a predictable course starting with microalbuminuria evolving to proteinuria and azotaemia, culminating in ESRD (Fig. 15.3). Elsewhere in this volume details of contemporary management of type 2 diabetes are presented. Regimens that slow renal functional decline in diabetes include: normalization of hypertensive blood pressure, establishment of euglycaemia, and restricted dietary protein intake.
The 75-and-over screening programme and the Community Care act - one step forwards, two steps back?
Authors: Iliffe Steve , Drennan Vari 
Published: November 2023

Abstract
In 1990 the government unilaterally changed the conditions of service for general practitioners, introducing a contractual obligation on members of primary health care teams to offer annual assessments of health to patients aged 75 and over.1 These offers of assessment, which have to be made in writing, should be based on a home visit unless otherwise requested by the patient, and should include the following headings: Whilst there had been extensive research into the possible benefits of regular screening or assessment of older people (see Chapter 1), at the time of the introduction of the 75-and-over checks there was still a lack of conclusive evidence that routine screening of whole populations was worthwhile. Nor was there a consensus on the best methods for such a screening approach, despite nearly 40 years of study.
Chronic obstructive pulmonary disease and asthma
Authors: Iliffe Steve , Drennan Vari 
Published: November 2023

Abstract
Mr X. retired from his caretaker’s job six years ago and moved to a new flat further up the hill from his general practitioner’s surgery. Every month he would walk down to the surgery for a check on his lung function, his blood pressure (for he also had essential hypertension), and his weight. He had always been ‘large’, he said, but was mostly unconcerned about his obesity, (which gave him a BMI of 31), unless his clothes would not fit. The diagnosis of non-insulin dependent diabetes mellitus (NIDDM) at 68 years came as no great shock to his GP, although it seemed to make Mr X. think very hard about what he ate, at least for a while. During the war and for the first part of his working life he had been a heavy smoker, never smoking less than one packet a day and sometimes two when he could afford to.
Changing primary care for older people
Authors: Iliffe Steve , Drennan Vari 
Published: November 2023

Abstract
The previous chapter examined the process of health needs assessment for a population of older people. This chapter explores the issues in changing services and ends with an agenda for change for primary care groups. A health needs assessment process identifies the problems in individuals and whole populations but a separate process is required to identify the most appropriate solutions. The pressures of the daily workload invariably make practitioners draw on their immediate knowledge in identifying solutions, rather than focus outward to use other sources for generating ideas and solutions. Without a wider perspective we are destined to fail to learn from past experience and ignore sources of potential creativity. The ethos of looking outward for knowledge is inherent in many current policy documents, for example in continuing professional education for doctors and nurses, and is cited as an aspect of clinical governance.