bluuebunny/crossref_metadata_2025_split huggingface dataset:
The evaluation of treatment
Authors: Lader Malcolm , Herrington Reginald 
Published: October 2023

Abstract
The evaluation of treatment accounts for much of the decision making of everyday clinical practice. It combines naturalistic observation of the individual patient with past personal experience, general clinical consensus and that frac tion of accumulated scientific information known to the clinician. In psychiatry it is not as straightforward or efficient as in many other branches of medicine partly because of the mtncacics of the treatment process described in Chapter 2. The biological and social forces acting on the patient quite mdcpendenrly of his attendance at the clinic, his expectations and reaction to contact with the clinic, the intimacies of the interaction between patient and doctor and the expertise of the latter are all potent forces at work before pharmacological agents are introduced into the transaction.
Psychoses and antipsychotic medication
Authors: Lader Malcolm , Herrington Reginald 
Published: October 2023

Abstract
This topic encompasses a large part of psychiatric phenomenology and classification and a detailed account is inappropriate here. The basic division is into the organic psychoses and the functional psychoses but antipsychotic medication is used to combat disturbed behaviour and psychotic symptoms in whatever context they arise. Thus, the acutely psychotic patient is given large doses of chlorpromazine, haloperidol, or a similar drug whether the underlying psychopathology is mania, brain tumour, epilepsy, agitated depression, or schizophrenia.
Electroconvulsive therapy and brain surgery
Authors: Lader Malcolm , Herrington Reginald 
Published: October 2023

Abstract
In the 1930s several physical treatments were introduced including insulin shock, sleep narcosis, leucotomy and camphor, metrazol and shock-induced electroconvulsive therapy. Chemically induced convulsions were initially used, based on the mistaken premise that epilepsy and schizophrenia were mutually incompatible in the same person, and, ergo, fits would ameliorate schizophrenic illnesses (Meduna 1938). Electrically produced convulsions were found to be more easily controlled and more acceptable to the patient (Cerletti and Bini 1938), and soon it was recognized that it was usually depressed patients who showed the most gratifying responses to electroconvulsive therapy (ECT).
Minor trauma
Authors: Morton Rosemary J , Phillips Barbara M 
Published: October 2023

Abstract
One of the most common reasons for a child attending an A & E department is a wound. The treatment given will vary with the type of wound. The main points to be considered are the following.
• Is the wound suitable for primary suture?
• Is there any damage to deep structures?
• Are there foreign bodies in the wound?
• Is the wound dirty?
• Is the wound suitable for management in the A & E department?
If possible the parents should be allowed to accompany the child throughout all procedures.
Children brought in dead
Authors: Morton Rosemary J , Phillips Barbara M 
Published: October 2023

Abstract
1 All children brought to hospital who may be dead should be admitted to the resuscitation room and unless contra-indications are very clear, for example rigor mortis or injuries incompatible with life, resuscitation should be initiated.
2 Sensitive and caring management of the bereaved family in the A & E department will aid the long-term grieving process.
3 Ensure that all relevant community health workers are informed of the child’s death.
4 Ensure that the arrangements are made for later counselling of the family.
The practical assessment of endometrial morphology and function
Authors: Russell Peter , Fraser Ian S 
Published: October 2023

Abstract
The central role of the endometrium in reproduction has been increasingly recognized in the past decade as its complexity as an organ has begun to be defined. The endometrium is highly sensitive to changes in hormonal exposure, as are the interactions of its different tissue components. These interactions are regulated by a series of complex molecular changes with a range of effects on morphology and function.
Menstrual problems in adolescence
Authors: Edmonds D Keith 
Published: October 2023

Abstract
During adolescence, girls become preoccupied with the physical and emotional changes which occur over a number of years, and which translate the girl into a fully sexually and reproductively competent adult female. These changes are also associated with changes in emotional and intellectual status, which identify the adult female as different from the adult male. The outward changes of breast growth, pubic hair and axillary hair growth, and the attainment of full adult height usually precede the outward manifestation of maturity, i.e. the menarche. For many girls their first menstrual period is truly the sign of adulthood and psychologically extremely important to achieve. However, it is also associated with times of stress and the absolute wish to be normal. Thus, changes that occur which are abnormal may have a very serious impact on psychological well-being. Being normal as an adolescent and accepted as a normal member of that peer group is extremely important. In differentiating the range of normality from true abnormality, an understanding of the onset and control of puberty is essential, as in many cases, misinformation leads these adolescent teenagers to states of anxiety which can be well avoided, and a deep knowledge and understanding of the adolescent will make management effective and help her to achieve normal adulthood. In fact, in some cases, poor management of menstrual problems at the time of adolescence may leave her with a life-long menstrual phobia which may be used in later life as a prop against adversity.
The role of synthetic progestogens in the medical management of menorrhagia
Authors: Andersson Kerstin , Rybo Gōran 
Published: October 2023

Abstract
Synthetic progestogens have been widely used in the treatment of heavy menstrual bleeding. The physiological background for this is the change of the endometrium which occurs after administration of progestogens indicative of endometrial suppression: small depleted glands lined with a thin epithelium and a more or less pronounced decidual transformation of the stroma.
Amenorrhoea
Authors: Zreik Tony G , Olive David L 
Published: October 2023

Abstract
Amenorrhoea, defined as the absence or cessation of menstrual flow, is the end result of a number of different pathological states, some congenital, others benign, and occasionally one of several that are life-threatening. For this reason, correct diagnosis is of critical importance. Amenorrhoea is a relatively common disorder, with an estimated prevalence of 1.8-3 per cent in the general female population during the reproductive years (Petterson et al. 1973), and as high as 8.5 per cent in an unselected adolescent population (Johnson and Whitaker 1992). Although a number of classification schemes for amenorrhoea are available, it is conventional to subdivide the patients initially into those with primary versus those with secondary amenorrhoea.
Menstrual disturbance and contraceptive steroids: mechanisms and management
Authors: Hickey Martha , Fraser Ian S 
Published: October 2023

Abstract
Contraceptive steroids are used by an estimated 100 million women worldwide (Olive and Schlaff 1992), and provide safe, reliable, and affordable protection against unwanted pregnancy. All contraceptive steroids have the capacity to alter normal menstrual bleeding patterns, and the majority of women using these methods will notice some change in their regular menstrual cycle. For those contraceptive methods containing oestrogen and a progestogen, the change may be minor and quite acceptable to the user. For those using progestogen-only methods, the disruption of menstrual bleeding pattern may be profound, and dissuade the woman from utilizing these methods or from continuing with them (Odlind and Fraser 1990). As progestogen-only contraceptives have a number of distinct advantages over oestrogen and progestogen combinations - including safety, high efficacy, simplicity, flexibility of delivery systems, and cost-breakthrough bleeding constitutes a major problem for contraceptive providers.
Multidisciplinary teamwork in maternity care
Authors: Dowell Anthony , Price Helene 
Published: October 2023

Abstract
The current provision and outcomes of community-based maternity care demonstrate how effectively multidisciplinary teams of health professionals can work together. Collaboration and team working between midwives, GPs, obstetricians, health visitors, paediatricians, and public health professionals has provided a framework of care which has witnessed significant reductions in obstetric and perinatal morbidity and mortality over the last 30 years.
The economics of maternity care
Authors: Twaddle Sara , Young Denise 
Published: October 2023

Abstract
This chapter introduces the basic concepts of economic evaluation before discussing their particular relevance to maternity services. It begins by defining the terminology used by economists, the techniques used in economic appraisals, and briefly discussing issues in costing and the measurement and evaluation of outcomes of maternity care. The cost effectiveness of different forms of maternity care is then reviewed. The chapter concludes by identifying areas where further work is required.
Auditing care
Authors: Maresh Michael 
Published: October 2023

Abstract
Before discussing precisely how maternity care can be audited it is necessary to clarify what is and is not audit. It is often claimed that audit in the maternity services has existed for many years. It has been commonplace to have local reports on clinical activity and outcome from maternity units and from those general practitioners supervising significant numbers of pregnant women. These have been supplemented by both regional and national reports such as the Confidential Enquiries into Maternal Deaths, The National Birthday Trust Surveys, and more recently the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI).
Narrowing the gap: social class, age, and ethnic differences in maternity outcomes
Authors: Hirst Janet , Eisner Maggie 
Published: October 2023

Abstract
Readers will be aware that it is not easy to define the terms used in this area, and that there are problems in collecting statistics. Although mortality seems to be an unambiguous term, it is difficult to differentiate between those maternal deaths directly caused by pregnancy and childbirth and those due to related or coexistent medical problems. Estimates of the annual number of maternal deaths worldwide vary between 585 000 (WHO 1995) and 1.3 million (reported by Population Action International, quoted in Dillner 1995).
The use of technology in maternity care
Authors: Neilson James P 
Published: October 2023

Abstract
This chapter will concentrate on the use of machines to complement or replace the clinical care of women during pregnancy or childbirth by doctors and midwives. The use of equipment is not necessarily bad if it clearly produces tangible benefits compared with standard clinical care alone, but it is the responsibility of proponents of new techniques and/or equipment to demonstrate such benefits before these are accepted into practice. It has been realized belatedly that the rigorous processes of evaluation that are necessary before a new drug can be given to patients have not been applied to new machines or techniques. In consequence, many uses of technology are of questionable value and others may be downright harmful.
Born too soon or too small or both
Authors: MacPhail Sheila , Walkinshaw, Stephen , Walton Stuart 
Published: October 2023

Abstract
One in every 200 births occurs at less than 28 weeks’ gestation, and three in 200 at less than 32 weeks’ gestation. Over 11000 babies are therefore born before 32 weeks in the UK, with 3750 of these before 28 weeks. Almost a half of all deaths occurring in live born infants in the first month of life in England, Wales, and Northern Ireland are the consequence of premature birth and, in 1994, over 1500 babies died because they were born too soon.
New thoughts on the physiology of pregnancy
Authors: Walker James J , Simpson Nigel A B 
Published: October 2023

Abstract
Pregnancy produces considerable physiological changes in the mother to accommodate the developing baby, to allow growth and development to occur in a favourable environment, and to deliver the baby at the optimal time. These changes have traditionally been regarded in terms of the maternal response to the developing needs of her baby. However, the majority of physiological processes are determined and implemented well in advance of their needs and are driven separately by the mother’s body and the placenta.
Psychological health before, during, and after childbirth
Authors: Clement Sarah , Elliott Sandra 
Published: October 2023

Abstract
Pregnancy and childbirth are major life events which bring with them emotional challenges and the potential for psychological distress. Since women’s contact with the health services is greater during maternity than at any other time in their lives, this period presents an ideal opportunity for promoting psychological health and preventing psychological problems (Royal College of Midwives 1987; Prince and Adams 1990; Royal College of General Practitioners 1995). The importance of pyschological care was also emphasized in Changing Childbirth (Department of Health 1993).
Breastfeeding
Authors: Inch Sally , Fisher Chloe 
Published: October 2023

Abstract
Since 1975 the Office of Population Censuses and Surveys (now the Office of National Statistics) has carried out national infant feeding surveys at five yearly intervals. The 1995 survey found that 67% of all women who gave birth started breastfeeding. By the end of the first week only 57% of women were breastfeeding, by the end of the second week 53%, and by the end of the sixth week only 43%. By four months only 28% of babies were receiving any breast milk (White et al. 1992; Foster et al. 1997).
Medical assessment
Authors: Wilcock G K , Skoog I 
Published: October 2023

Abstract
Although more than 70 diseases can cause dementia, three are probably responsible for 70 to 80 per cent of all cases: Alzheimer’s disease; vascular dementia; and dementia associated with Lewy bodies. Most other causes are by themselves uncommon, but together they may constitute 10 to 25 per cent of patients referred for a dementia evaluation, and they are important to recognize as several of them are potentially treatable or involve a process which may be retarded by appropriate treatment. Furthermore, several potentially treatable physical and mental disorders may be superimposed on a primary dementia and thus aggravate this condition. In patients with a primary dementia, these conditions are often neglected. In people under 65, up to 20 per cent may have a treatable or remediable aggravating factor, although the proportion decreases with age to less than 5 per cent in those aged 65 and over (Smith and Kiloh 1981). All comorbid conditions, which may aggravate the dementia, become more common with age.
Investigations—laboratory, radiological, and neurophysiological
Authors: Jobst Kim A , Suarez Rodolfo , Miller Bruce L 
Published: October 2023

Abstract
Dementia is a clinically-defined syndrome. It may be caused by a plethora of conditions (see Chapters 4, 14, and 15). Making the diagnosis of dementia is important because some causes are treatable, and because accurate diagnostic information can help patients and their families to plan for the future and come to terms with their condition (Jobst 1996; Smith et al. 1988). Since it is obviously impractical to exclude all possible causes of dementia in each case, the specific and differential diagnosis of dementia is a challenge to the astute clinician. If the memory disorders team is to be clinically effective and financially viable, good clinical judgement is the cornerstone upon which to determine which laboratory tests and special investigations should be requested (Larson et al. 1986; Terry et al. 1994).
Neuropsychological assessment
Authors: Bucks Romola S , Loewenstein David A 
Published: October 2023

Abstract
Neuropsychological assessment offers the clinician the means to measure an individual’s cognitive performance in a standardized way using normative data gathered for persons of that age, education, gender, and cultural/ language background. It therefore forms an important means of quantifying the NINCDS-AD RDA (McKhann et al., 1984) criteria for a diagnosis of probable Alzheimer’s disease, which require that there is impairment in memory functioning plus at least one other cognitive domain such as language, praxis, perceptual skills, problem-solving abilities, attention, or orientation, supported by the Folstein Mini-Mental State Evaluation (MMSE) (Folstein et al., 1975), Blessed Dementia Rating Scale (BDRS) (Blessed et al., 1968), or a similar evaluation. These difficulties must interfere with everyday functional capacity. A diagnosis of possible Alzheimer’s disease is rendered when a patient presents with only a single progressive cognitive deficit, an atypical presentation, or when there is a medical or neuropsychiatric condition that might account for observed deficits but is not considered to be the cause of the dementia.
Functional assessment
Authors: Carswell A , Spiegel R 
Published: October 2023

Abstract
The measurement of function is integral to the assessment and diagnosis of individuals with suspected dementia (Blessed et al. , 1968). With the gradual decline in cognitive abilities, there is an accompanying decline in role, social, and physical abilities. Nevertheless, traditional mental status screening tools such as the Mini-mental State Examination (MMSE) (Folstein et al., 1975) which focus on cognitive functions are not suited for monitoring the progression of the everyday manifestations related to cognitive impairment.
The assessment of dementia in the community setting
Authors: Mallery Laurie Herzig , Page Sean , Burns Alistair 
Published: October 2023

Abstract
Dementia is a medical syndrome with important psychosocial implications for the patient, family, and community at large. Assessment of dementia is commonly conducted in a clinic, where, in most cases, an accurate diagnosis can be made efficiently. However, the needs of the patient and/or caregiver cannot always be fully appreciated in a clinic setting. Behavioural disturbances, such as delusions and agitation, may worsen when patients leave the familiar home environment. As well, patients may not be willing to come to a clinic. In such cases, properly conducted community assessment can clarify unresolved issues and uncover specific needs. This chapter reviews the relative advantages and disadvantages of evaluating dementia in the home.
Assessment
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K 
Published: October 2023

Abstract
When a patient presents with an injury to the hand it is essential to take an adequate history and carry out a thorough examination if injuries and complications are not to be overlooked. It is possible to carry out a fairly comprehensive examination of the hand in a very short time if a well-practised systematic approach is employed. The principles of look, feel, move, X-ray apply. When the hand is injured, have a low threshold for ordering an X-ray.
High-pressure injection injuries
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K 
Published: October 2023

Abstract
Uncommon but important industrial injury frequently affecting the index fingertip of the non-dominant hand. High pressure injection of foreign material (e.g. wax, grease, paint, solvent, oil). The patient has frequently been cleaning the nozzle of a high-pressure gun when material is inadvertently injected.
Thermal burns
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K 
Published: October 2023

Abstract
In children always consider non-accidental injury. Small burn + NAI-refer to the paediatricians. Do not use Flamazine if the depth of the burn needs to be assessed at 48 hours to consider early surgery. If in doubt, use a paratulle dressing or a plastic bag.
Phalangeal fractures
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K 
Published: October 2023

Abstract
Painful swollen digit with decreased movements. Check for rotation or angulation caused by the fracture (Fig. 34.l(a)). Look at the fingertips end on with the MPJs at 90° and the IPJs at 0°-this will show any rotation. Then ask the patient to flex the fingers-angulation will cause scissoring (Fig. 32.l(a) ).
Cellulitis
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K 
Published: October 2023

Abstract
Consider admission for IV antibiotics Streptococcal infection of the skin and subcutaneous tissues. Patient presents with a spreading area of redness and tenderness on the hand or forearm. There may or may not be a history of injury, a puncture wound, or a scratch. Possible malaise.
The context
Authors: Rogers Wendy Stainton 
Published: October 2023

Abstract
Something strange happened in the USA in 1875. A little girl called Mary Ellen was presented to a court as an ‘animal’ in need of protection from the cruel treatment she was suffering from her guardians. You may wonder why she had to be identified as an ‘animal’ rather than a child. The answer is that, in the USA at that time, while there was legislation to protect animals (such as horses and dogs) from cruelty, there was none to protect children. The reason for that is that there was then—in Britain as well as in the USA—a strong belief that the family was a private sphere in which nobody had any right to intervene.
The aftermath
Authors: Mayer Vera 
Published: October 2023

Abstract
Having concluded a child protection investigation pursuant to Section 37 of the Children Act, or after obtaining an emergency protection order (see Chapter 6b), the local authority will have to decide whether they need to intervene in the life of a family by way of applying for a (further) statutory order. This is a drastic step, in as much as it takes any proceedings concerning children out of the realm of private law (which deals, in the main, with disputes between a child’s relations about residence and contact, and protection of a parent and a child from violence of another parent) and into the realm of public law-i.e. the state intervening in family life.
The meaning of domestic violence
Authors: Heath Iona 
Published: October 2023

Abstract
In 1990 a Home Office Circular to police forces, advising on their role in responding to violence in the home, declared: Violent assaults, or brutal or threatening behaviour over a period of time by a person to whom the victim is married or with whom the victim lives, are no less serious than a violent assault by a stranger. In September 1991, speaking 1 year after the issuing of the circular, John Patten, the then Home Office Minister, said: We wish to dispel for good any lingering notion that a man who attacks a woman in the home is somehow automatically less deserving of society’s censure than one who assaults a woman he doesn’t know in the street. I hope that approach has been consigned to the dustbin of social attitudes.
Onward referral
Authors: Heath Iona 
Published: October 2023

Abstract
While, as detailed in the preceding chapter, there is much that the general practitioner can and should do for a woman presenting with a history of having been subjected to domestic violence, there is little scope for direct intervention (Fig. 13.1). Perhaps this is appropriate, because the medical profession is notorious for taking action on behalf of patients, whereas the key to escaping from domestic violence is through promoting the autonomy and self-determination of women themselves. None the less, however limited the practitioner’s scope for providing direct help, members of the primary health care team are very well placed to provide information and to refer on to other agencies.