bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronic disease management
Authors: Hasler John 
Published: November 2023

Abstract
Chronic disease is one of the key areas for audit in primary health care, for several reasons. It uses up a substantial amount of resources, both in time and money; it is often possible to draw conclusions about outcome from the examination of process, by reference to published evidence; some of the parameters are easily measurable (for example, blood pressure levels, blood glucose measurements, serum phenytoin measurement, and peak flow rates); the data are easily extractable, provided that the manual or electronic records systems are designed appropriately; chronic diseases are frequently supervised by nurses as well as doctors and therefore it is possible to audit team care rather than simply medical care. In this section we will examine two common chronic diseases, although the principles are the same for most chronic diseases and readers should constantly consider the applicability of the messages to other long-term conditions in which they have an interest.
The role of the Medical Audit Advisory Group
Authors: Forbes Alan , Lawrence Martin 
Published: November 2023

Abstract
In 1987 the Government began changes to the NHS with a White Paper entitled ‘Promoting better health’ (Secretaries of State 1987). A second White Paper, ‘Working for patients’, was followed by the imposition of a new general practitioner contract, and relations between the profession and government became very hostile, with general practitioners angry, distrustful, and dispirited (Secretaries of State 1989; Department of Health 1989). Yet within this legislation were proposals for the enhancement of audit in the health service in general and in primary care in particular. Even opponents of the new contract usually agree that this initiative offered great opportunity for the profession, but even this benefit may be lost unless the opportunity is taken up.
Mathematics and Statistics in Anaesthesia
Authors: Cruickshank Steven 
Published: November 2023

Abstract
Anaesthetic trainees often have enormous trouble understanding the quantitative aspects of the basic sciences underlying clinical anaesthetic practice. The subjects of pharmokinetics and statistics are often unpopular with trainees, and studied with little enthusiasm. In spite of their reluctance, this is an area that they are required to study and understand as a core part of their training for postgraduate exams. Mathematics and Statistics for Anaesthetists presents simple mathematical ideas, and explains how these can be used to model and understand problems which arise in clinical anaesthesia. The common features of the underlying mathematics are emphasized through a pictorial/graphical approach, in preference to vast amounts of algebra. The book presents statistics in an informal and less intimidating style that most standard statistical texts, incorporating illustrations and cartoons throughout. The book will be valuable to anaesthetists, in guiding them through what can be an intimidating part of their training.
Models and modelling
Authors: Cruickshank Steven 
Published: November 2023

Abstract
The idea of modelling physiological processes by mathematics is an ambitious one. Physiology is hugely complex and poorly understood in many aspects, but this does not mean that we should just shrug our shoulders and give up. There are things we can achieve and insights we cahgain, but we must remain critical at all times of what we do. The most important part of the process is the modelling, not the mathematics. The intention in this book is to concentrate on the modelling process, using simple examples and giving enough of the mathematical back ground for the solutions to be understood. The mathematical equations may look quite impressive when written out, but if the model on which they are based is a bad one, even clever manipulations of the equations ‘Nill still produce nonsense; garbage in-garbage out.
Modelling steady states: VA and Paco2
Authors: Cruickshank Steven 
Published: November 2023

Abstract
We continue with a straightforward example that will form the basis of the more complex models that we shall develop later. The steady state relationship of alveolar ventilation VA and the Paco2 is well known: increase the ventilation and the Paco2 falls, reduce it and the Paco2 rises. But what is the exact relationship and how can we model it? In order to start modelling we need to make some assumptions about the physiological problem. We want to describe the steady state Paco2 which results from any chosen value of VA after the system has had time to ‘settle down’ from any change.
Flux and fluxoids
Authors: Cruickshank Steven 
Published: November 2023

Abstract
Consider a pipe carrying a solution of salt at concentration 1 g/1, flowing at a rate of Q= 10 I/min. We collect the effluent from the pipe for 10 min in a bucket. How much salt have we collected? The answer is trivially easy-100 g, which we obtain quite easily by multiplying the three quantities together: We have transferred a mass of salt from one end of the pipe to the other, and the magnitude of this mass is given by the triplet product above, which is termed the flux. Flux is a transfer of a quantity from one region to another. We shall normally be concerned with mass transfer, but we shall also model one example of an energy flux.
Apnoeic oxygenation
Authors: Cruickshank Steven 
Published: November 2023

Abstract
The technique of apnoeic oxygenation is most frequently employed during the apnoea test in assessment of brain stem function in the intensive care unit. It has uses in anaesthesia where there is competition for the airway, e.g. in bronchoscopy or laryngoscopy, or in emergency when ventilation is impossible. In the technique, the intubated apnoeic patient-perhaps from muscle relaxants, perhaps because of brain stem destruction-is kept oxygenated by means of a catheter inserted through the tube into the trachea, through which oxygen is passed at about 4 I/min. No positive pressure is applied. Under ideal circumstances, adequate haemoglobin saturation can be maintained for a considerable period, measured in tens of minutes. How does it work and what are these ideal circumstances? As usual, the key to modelling is the IOP.
Basics
Authors: Cruickshank Steven 
Published: November 2023

Abstract
This part on mathematical background should be viewed as a toolbox, from which the necessary implements are picked for a particular purpose; it is not meant to be read through from start to finish. There are certain patterns of relationship which occur frequently in modelling applications and we need a general familiarity with their behaviour. The emphasis is graphical and pictorial and relies heavily on the notion of the tr&lt;1nsformation which allows us to modify a basic pattern function to produce another related function. We also find composite functions arising by combining these basic pattern functions; for instance, a damped oscillation is a product of a sinusoid and an exponential function ( 1.17).
Polynomial functions
Authors: Cruickshank Steven 
Published: November 2023

Abstract
Quadratics, cubics, and quartics
where a, b, c, d, are constants. They are sums of powers of x multiplied by constants —the coefficients of the powers of x. Polynomial functions are extremely important in modelling and statistical analysis. We shall not be concerned in any detail with any polynomials involving powers greater than x2 Polynomial functions are classed according to the highest power of x in the equation.
Functions of more than one variable
Authors: Cruickshank Steven 
Published: November 2023

Abstract
We have concentrated largely on situations in which the function value (the dependent variable) is determined by the value of a single independent variable. However, there are many circumstances in which we have functions that are dependent upon a number of variables. The first model that we constructed for the relationship of Paco2 and VA assumed a fixed value of CO2 production, Vco2• We later allowed this to change and produced a 3-D graph, the surface of which showed all possible combinations of VAco2, V co 2, and the resulting Paco2 according to the model.
The derivative and differentiation
Authors: Cruickshank Steven 
Published: November 2023

Abstract
Modelling processes frequently give rise to equations that describe the rate of change of a quantity. We saw this in the applications of the IOP to time-dependent variables such as step change in ventilation, nitrogen washout, pharmacokinetics, and simple harmonic motion. The simplest rate of change to deal with is when this is zero-the system is in steady state and the value of the quantity remains constant.
Summary measures: location and dispersion
Authors: Cruickshank Steven 
Published: November 2023

Abstract
When faced with a list of data, we naturally want to make sense of them, and this will involve making some sort of summary assessment of the data. We have seen a few examples of random phenomena and noted some of the features-the shape of the distribution of the data, whether we are dealing with discrete or continuous data, and so on. We need to describe summary measures of location of the data where they are on the number line. This requires some measure of where the ‘centre of gravity’ of the data is-a measure of central tendency-and how spread they are about this central value-a measure of dispersion.
Samples of unknown mean and variance
Authors: Cruickshank Steven 
Published: November 2023

Abstract
Like the other distributions we have met, the t-distributions form a family. These are defined by a single parameter, the degrees of freedom, 11. The value of v required for any application depends upon the sample size(s) n and how many parameters have been estimated from the data. We shall see particular examples of this. In general, the larger the sample size, the greater the value of vis, and the more nearly does the t-distribution become like the standard normal.
Related variables: linear regression
Authors: Cruickshank Steven 
Published: November 2023

Abstract
Look at the data list (simulated data) and the plot of these points. If this is all the information that we have, then we can calculate a mean x = 10.14 and TSS = 75.79 for the data and hence derive a value for the sample variance and standard deviation. We know from our study of error functions that we cannot make the TSS about a chosen ‘fit’ any smaller than that about the mean value. Using the techniques of (3.16.2) we can calculate a CI for the mean at a chosen level, and this is about all we can do..
Energy balance and an overview of metabolism
Authors: Bender David A , Bender Arnold E 
Published: November 2023

Abstract
The primary need of the body is for a source of metabolic fuels (fat, carbohydrate, protein and alcohol) to meet energy expenditure. Food in excess of immediate requirements for energy-yielding metabolism is stored as reserves of glycogen in muscle and liver, and as fat in adipose tissue. There is also an increase in tissue protein synthesis after a meal. In the fasting state, or when energy intake is inadequate to meet expenditure, these reserves, and labile tissue protein reserves, are used as metabolic fuels. Normally, energy expenditure and food intake are closely balanced, at least when averaged over several days. The result of a prolonged positive energy balance (an excess of intake over expenditure) is the accumulation of excessive amounts of body fat-the development of overweight and obesity, see Chapter 11. Prolonged negative energy balance (an intake less than expenditure) is protein-energy malnutrition wasting and emaciation, see section 12.2. As discussed in section 6.5, the physiological mechanisms by which people are able to adjust their food intake to meet energy expenditure are not known.
Protein nutrition
Authors: Bender David A , Bender Arnold E 
Published: November 2023

Abstract
In 1860 Voit measured the difference between the intake of nitrogenous compounds (mainly protein, but also including nucleic acids) and the urinary excretion of nitrogenous compounds. He showed that dogs fed less than 1.5 kg of meat per day were unable to maintain nitrogen balance, but suffered a net loss of nitrogen from the body, thus establishing the technique of nitrogen balance studies that still provide the basis of estimates of protein requirements.
The psychological costs of caring for cancer patients
Authors: Faulkner Ann , Maguire Peter 
Published: November 2023

Abstract
The main thrust of this book has been concerned with helping health professionals, and all those involved in caring for cancer patients and their families, to improve their communication skills and their ability to work with people who are often distressed and visibly upset. In this chapter, the needs of the health professionals are considered. ‘The cost of caring’ has become almost a cliche in health care, but nevertheless it has to be accepted that there is a cost to working effectively with cancer patients and their families, and that this needs to be addressed if individual members of staff are to survive to continue caring at a high level. It might be argued that the prime consideration in cancer care is the patient and his or her family, and that it is selfish to worry about the professional’ s personal need for survival. The other side of this argument is that if health carers do not consider their own needs and take some steps to meet them, then they may not be able to go on working in the field.
A general psychiatric approach to sexual deviation
Authors: Bee Brockman , Bluglass Robert 
Published: November 2023

Abstract
Developments in the understanding of normal human sexual behaviour in the 1960s and 1970s coincided with a more tolerant social attitude and healthier climate in which to encourage the scientific study of the sociological, physiological and endocrinological aspects of sexuality. Wakeling (1979), for example, reviewed the development of sexual dysfunction clinics, describing how change in social attitudes enabled patients with sexual deviancy to come forward and seek help.
Integrating the general psychoanalytical theory of perversion
Authors: Rosen Ismond 
Published: November 2023

Abstract
This chapter collates current psychoanalytical research with the existing general theory of perversion. See also chapter reviews in previous editions by Gillespie (1964), Rosen (1979) and recent work by Socarides (1988) and Chapter 11, and Etchegoyen (1989). The last fifteen years have produced many advances in the psychoanalytical understanding and treatment of perversion.
Reflections on homosexuality in women
Authors: McDougall Joyce 
Published: November 2023

Abstract
Freud’s revolutionary discoveries concerning the psychology and the dynamic importance of human sexuality in child and adult life are now almost a century old. They are so much an established part of Western thought today that we take them for granted and are highly critical of Freud’s conceptual limitations, above all his theories on female sexuality. This is, in fact, an area of research in which Freud is particularly vulnerable. However, it is interesting to recall that Freud owed to women the initial insights that led him to the concept of the ‘unconscious’.
Dynamic psychotherapy with sex-off enders
Authors: Cox Murray 
Published: November 2023

Abstract
Returning to a chapter written seventeen years ago is a salutary experience for an author. As it is reprinted verbatim in the present edition, certain introductory comments are called for. There are several matters of fact which are obviously now out of date. Since the 1979 edition the following changes have occurred. Broadmoor Hospital is now managed, not by the Department of Health and Social Security, but by the Special Hospitals Service Authority, which may become a ‘purchaser’ of that which a special hospital ‘provides’ if ‘Trust status’ is achieved.
The adult sequelae of childhood sexual abuse
Authors: Rosen Ismond 
Published: November 2023

Abstract
This chapter briefly reviews the clinical consequences and psychodynamic treatment in adults who have experienced sexual abuse in childhood. (See also the recent review by Green 1993.)
No specific syndrome exists for the adult consequences of child sexual abuse, the contributory factors and responses being so varied. Psychiatric symptoms may occur such as anxiety, phobias, depression, and low self-esteem, together with physical manifestations of a psychosomatic kind.
Peer review by means of audio or video recordings
Authors: Grol Richard , Lawrence Martin 
Published: November 2023

Abstract
Peer review employing audio or video recordings of patient encounters has acquired a considerable tradition and has shown its value in a variety of situations. Large studies on general practice performance were carried out on the basis of such material (for example, Yerby et al. 1979; Grol et al. 1988b; Smith et al. 1991). Exceptionally good experiences have been acquired with audiotapes in peer review and in the instruction of GP trainees (Grol et al. 1988a). In Great Britain a tradition of audit with videotapes has been developed (for example, Pendleton et al. 1984). Both methods offer a very good basis for the audit of consultation skills in a group of care providers in general practice (5-10 participants). The audit is livened up due to the fact that the participants are directly confronted with a real consultation situation. Initially, it may prove threatening: having recording apparatus in the consulting room takes some getting used to, as does asking the patient’s permission to record and having one’s personal performance evaluated in the peer review group. In our experience, the difficulties soon fade, and the use of video- or audiotapes gradually becomes a greatly prized aid in the quality improvement process.
Structured peer group methods: quality circles, case analysis, and critical incident analysis
Authors: Grol Richard , Lawrence Martin 
Published: November 2023

Abstract
In previous chapters some specific methods for peer review in a group of general practitioners or care providers in general practices have been presented in some detail. There are, of course, many other methods for peer review which may be very helpful in improving patient care. From the various methods we have selected three which will be described here briefly with some examples: Practice-based quality circle method: this is a structured group method, aimed at improving patient care and solving problems in general practice by involving all the relevant people related to a certain problem (GPs, staff, other care providers, patients, policy-makers).
Screening for cancer in women
Authors: Niloff Jonathan , Chamberlain Jocelyn 
Published: November 2023

Abstract
It cannot necessarily be assumed that screen-detected cancers will behave in exactly the same way as symptomatic disease and one cannot infer that simply by detecting early disease one has improved prognosis. It is first necessary to find out by research what proportion of women can be helped by screening, before offering it to all women as a means of reducing their risk. As in all forms of preventive medicine which offer a service to well people (as opposed to patients), there is a particular ethical responsibility on the health care providers to be certain that the benefits of screening outweigh the disadvantages (Fig. 6.1).
Female sterilization
Authors: Peterson Herbert B , Wilcox Lynne S 
Published: November 2023

Abstract
The health of women and infants the world over is affected by the ability of women to control the numher and timing of their pregnancies. Although maternal mortality has decreased dramatically in recent decades in developed countries, the risk of death and serious morbidity from pregnancy remains high in much of the developing world. Even in developed countries. maternal morbidity and mor tality are important considerations for women’s health. It is estimated that, some where in the world, a woman die every minute from pregnancy-related causes. Infant health is inextricably related to maternal health. Further, the health of infants has been conclusively linked to child spacing (Park 1986; Klebanoff 1988).
Maternal health care in the developing world
Authors: Philpott R H 
Published: November 2023

Abstract
Many policy makers and over-extended health workers in the developing world treat maternal health as an isolated issue, such as oral health or leprosy control, failing to recognize its complexity and the need for a comprehensive approach. When I joined two other doctors in a busy mission hospital in West Africa in the early 1950s, I was given charge of the maternity unit because I had done a 6 month obstetric job since qualifying 18 months previously as a doctor. That was 6 months more experience than either of my colleagues, but woefully inadequate for the enormity of the task. Fortunately, a team of midwives was kind enough to protect their patients from me and at the same time introduce me to both obstetrics and the much wider concepts of motherhood and quality of life.
Infections in pregnancy that may affect the development of the baby
Authors: Peckham Catherine S 
Published: November 2023

Abstract
About one in 20 women is likely to experience an infectious illness in pregnancy. Mo t of these infections are harmless, but a small minority may cause damage to the fetus or newborn infant. The fetus may become infected in utero (congenital infection), or the newborn may acquire infection at the time of birth through con tact with infected blood or vaginal secretions (intrapartum infection). Maternal infections that are associated with congenital or intrapartum infection and which may result in damage arc listed in Table 20.1 and include rubella (German mea sles), cytomegalovirus, toxoplasmosis, hepatitis B, and herpes simplex infection.
Professional liability and the practice of obstetrics
Authors: Pinshaw Alan , Hiatt Howard 
Published: November 2023

Abstract
The first American medical malpractice suit was filed in Connecticut in 1794 (Stetler 1957) Even then, the issue of medical professional liability was not new, having had its humble beginnings in England over 400 earlier (Stetler 1957). Ever since, and particularly over the last 20 years, professional liability issues have gained momentum, having an impact on society, on physicians’ clinical decision making, on physician—patient relationships, and even on the availability of health care itself. In 1970, one in 25 American physicians had been sued (Jacobs 1980). Twenty years later, in 1990, over 75 per cent of all obstetricians practicing in the USA had been sued.
Obstacles to 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
The time available for an interview varies from doctor to doctor, and from day to day. The conduct of the interview is bound to be influenced by this constraint, but the doctor must not let the pressure of time cramp his interviewing style in a way that inhibits open communication. In contemporary hospital practice, more rapid turnover in the wards, the growth of high-technology, high-dependency care, and expanding day-case care have all progressively increased the pressures on staff. Doctors and nurses alike are often short of time, have to watch over monitors as well as patients, and may be, at times, short of sleep. The quest for cost-efficiency itself involves many obstacles to communication.