bluuebunny/crossref_metadata_2025_split huggingface dataset:
Practice visiting
Authors: Schofield Theo 
Published: November 2023

Abstract
Earlier chapters in this book have described methods of auditing particular aspects of a practice and its work. This chapter will consider methods that can be used to make more global evaluations of the whole practice by visiting. The methodology was originally designed by a working party of the Royal College of General Practitioners, and described in their report ‘What sort of doctor?’ (1981). It has since been developed for assessing training practices and for practice team visiting. The remit of the first ‘What sort of doctor?’ working party was to devise a method for established general practitioners to evaluate their performance in the setting of their own practices. It was seen as an educational method which would enable doctors to receive feedback about the strengths and weaknesses of their own practice and to encourage continued development, but the potential for assessment for Fellowship or Membership of the College or for re-accreditation was also recognized.
Practice reports and profiles
Authors: Schofield Theo 
Published: November 2023

Abstract
A growing number of practices and teams produce an annual report on their activities. Some of these are intended solely for their own consumption, while others are shared with patients or other groups in the health services. Their content varies considerably from practice to practice, but many contain the results of audits that they have conducted and thus can be a focus of audit activity and a means of disseminating its results. This chapter will discuss the different purposes of practice annual reports and the contribution that they can make to team based audit.
Vitamin B6
Authors: Bender David A , Bender Arnold E 
Published: November 2023

Abstract
Vitamin B6 has a central role in the metabolism of amino acids: in transaminase reactions (and hence the interconversion and catabolism of amino acids and the synthesis of non-essential amino acids); in decarboxylation to yield biologically active amines; and in a variety of elimination and replacement reactions. It is also the cofactor for glycogen phosphorylase and a variety of other enzymes. In addition, pyridoxal phosphate, the metabolically active Vitamin, has a role, as yet inadequately defined, in the release of steroid hormone receptors from tight nuclear binding. Vitamin B6 thus affects the responsiveness of target tissues to hormone action.
Folic acid and vitamin B12
Authors: Bender David A , Bender Arnold E 
Published: November 2023

Abstract
Folic acid functions in the transfer of one-carbon fragments in a wide variety of biosynthetic and catabolic reactions; it is therefore metabolically closely related to vitamin B12, which also functions in onecarbon transfer. Deficiency of either vitamin has similar clinical effects, and the main effects of vitamin B12 deficiency are exerted by effects on folate metabolism.
Iron
Authors: Bender David A , Bender Arnold E 
Published: November 2023

Abstract
The total body content of iron is about 800-1040 mmol (45-60 mg)/kg body weight in men, and 630- 730 mmol (35-41 mg) in women. The distribution of this iron in metabolically active and storage pools is shown in Table 24.2. Men have considerable iron reserves (equivalent to up to 50 per cent of the functional body pool), and as discussed in section 24.5 are potentially at risk of iron overload. By contrast, women have low reserves of iron (from almost none to 16 per cent of the functional pool) and, as discussed in section 24.4 are at considerable risk of iron deficiency.
Symposium: non-immune fetal hydrops
Authors: Weiner Carl P 
Published: November 2023

Abstract
Non-immune hydrops (NIH) is defined as fetal oedema plus free fluid within one or more of the body cavities. It is a morphologic description whose identification is the beginning not the end of the investigation. The list of abnormalities associated with NIH is lengthy (Table 4A.1). However, there is no need to review them individually. More important is the approach to the evaluation and treatment.
How students learn: the process of learning
Authors: Coles Colin 
Published: November 2023

Abstract
In this chapter we will look at how people learn. Drawing on theories of learning, we will explore the practical implications for educators, and address the following questions: How do medical students learn? What makes them learn the way they do? How should they be learning? What can educators do to help? In what ways should educational events be arranged so that learners can learn as they should?The chapter is arranged as follows: first, there is a review of studies on how medical students learn, and then a discussion of the mechanisms that link the curriculum arrangement and learning outcomes. Following this, we shall examine educational theories, and establish a number of principles. Out of this we will derive and explain a model of learning, and finally discuss some of the implications for medical educators. Throughout the chapter we shall see that learning is something that only learners can do.
The problem of pain
Authors: Coniam S W , Diamond A W 
Published: November 2023

Abstract
We have the means and the skills to relieve pain but we do not always use them. Why not? There are several reasons. We believe that other things are more important, we believe that the relief of pain may not always be a good thing, we do not believe people who are in pain, and we believe that it is a good thing to endure pain uncomplainingly.
The assessment of pain
Authors: Coniam S W , Diamond A W 
Published: November 2023

Abstract
Pain is a subjective experience, and therefore it cannot be measured by an observer. It is essentially what the person experiencing pain says it is. The expression ‘real pain’ is meaningless. It suggests existence of pain which is not real, although nobody can describe a personal experience of pain which was not real. We therefore have to accept that when another person complains of pain, it is a real sensation which causes distress. We may consider that the pain described is inappropriate for a given degree of injury or disease. We may feel that the sufferer is not behaving in the way in which we expect someone in pain to behave. We may be unable to explain in terms of pathology why the sufferer is experiencing pain at all, or we may decide that a psychological disorder is responsible for or aggravating the pain. Nevertheless, the pain is a personal experience of the sufferer and we only have that person’s description of it.
Analgesic drugs
Authors: Coniam S W , Diamond A W 
Published: November 2023

Abstract
Analgesic drugs are generally the first-line approach to managing pain in both acute and chronic situations. They are not always effective, and may have undesirable side-effects which limit their usefulness. An analgesic drug may act peripherally at the site of pain generation, it may affect the transmission of painful stimuli to or in the CNS, or it may affect the way in which painful stimuli are processed in the spinal cord and brain.
Spiritual issues
Authors: Faulkner Ann , Maguire Peter 
Published: November 2023

Abstract
In recent years, there has been an increase in concern about the spiritual care of patients who are suffering from fear-provoking diagnosis or prognosis. A major difficulty appears to be the interpretation of the phrase ‘spiritual care’. At a basic level, it is interpreted as meaning that ‘spiritual’ equals ‘religious’; but this over-simplifies a very important area. Stoter (1991) makes the point that ‘So often spiritual care is seen as religious care for the few who request it and therefore becomes dismissed as a footnote.’ By believing that spiritual care is tied in in some way with religion, it is very easy for health professionals to delegate such care and concern to members of the clergy.
Fluid, nutritional, metabolic and haematological support in critically ill children
Authors: Morton N S , Munro F 
Published: November 2023

Abstract
The composition of the intracellular and extracellular compartments changes significantly during fetal and neonatal life and for a considerable period there after (Fig. 8.1). The preterm infant has a very high proportion of its total body weight as water, with two-thirds residing in the extracellular fluid compartment. As the cells grow and multiply and organs develop, the intracellular proportion of the total body water increases with a corresponding reduction in the extracellular water.
Ethnic groups
Authors: Modell Michael , Mughal Zulf , Boyd Robert 
Published: November 2023

Abstract
Britain has become a multi-racial, multi-cultural and multi-lingual society. Naturally this has implications for the planning and delivery of health care. Irish migration to Britain on a large scale began in the eighteenth and nineteenth centuries followed by Jews from eastern Europe and then, amongst others, Poles, Italians, Germans and Ukrainians, Greek and Turkish Cypriots. The most recent large migration was that of people from the Indian subcontinent and the West Indies. This began after the Second World War as a response to the demand for labour in Britain. Migrants in smaller numbers include the Maltese, Chinese, Vietnamese, and Iranians. In addition, the majority of more recent arrivals from Africa are political refugees from Somalia, Ethiopia and Za”ire (French speaking). In 1992, there were an estimated 25 000 asylum seekers in Britain, a third from Europe, mainly the former Yugoslavia (Social Trends 1994).
The gut
Authors: Modell Michael , Mughal Zulf , Boyd Robert 
Published: November 2023

Abstract
When faced with diarrhoea and vomiting, especially in an infant, the GP’s initial tasks are to decide whether gastro-enteritis is indeed the diagnosis and to assess the state of hydration. The latter is the most important factor in deciding whether the child with gastro-enteritis should be treated at home or in hospital. Several conditions can be confused with gastro-enteritis. First, normality. Diar-rhoea is usually defined as the too frequent passage of too fluid stools, but the stools of breast-fed babies are not formed, may be frequent, explosive, and sometimes contain mucus-however, true gastro-enteritis is rare in fully breast fed babies. Parents often seem to worry unnecessarily if the colour of the faeces deviates from the standard brown. A green colour is not important, although a jet-black or red stool is another matter.
.The eye
Authors: Modell Michael , Mughal Zulf , Boyd Robert 
Published: November 2023

Abstract
At birth the size of an infant’s eye is about three-quarters that of an adult, full size being reached at puberty. In infants the sclera is relatively thin and translucent, giving the eye a bluish tinge. When this is very marked osteogenesis imperfecta is a possible diagnosis. A clear red reflex, best demonstrated using a + lens on an ophthalmoscope, rules out a significant congenital cataract. A white reflex suggests a retinoblastoma. Screening for visual acuity is discussed on p. 29. Occasionally developmental abnormalities affecting the eyes and eyelids may occur. These include congenital ptosis and haemangioma (which may extend to the face, scalp or conjunctiva). Both will need treatment if there is a risk of vision being obscured. As limited acuity in one eye, and even blindness, may be overlooked by both a child and his parents, it is important to test visual acuity in each eye separately.
Urinary problems and diabetes mellitus
Authors: Modell Michael , Mughal Zulf , Boyd Robert 
Published: November 2023

Abstract
Approximately five per cent of girls and two per cent of boys will suffer from at least one symptomatic urinary tract infection (UTI). Thus, girls are more likely to develop UTI than boys, except in the neonatal period, when the reverse is true. The hall marks of childhood UTI are their, difficulty in diagnosis in infancy, recurrent nature, and association with renal tract malformation and with risk of renal damage. Antibiotics for an imaginary UTI, and failure to diagnose a genuine one are common errors. The former results from treating all dysuria as urinary infections, or from taking the growth found in poorly collected or poorly stored specimens to be a positive culture; the latter because symptoms of UTI in childhood are commonly non-specific.
Clinical types of homosexuality
Authors: Limentani Adam 
Published: November 2023

Abstract
In recent years there has become apparent an increasingly marked division in the attitude to homosexuality: at a time when there is a growing tendency for people in all walks of life to regard homosexuality as normal, there remain many who use the term in a derogatory and insulting manner, quite often with an implication of social menace. The view presented in this chapter is that homosexuality is a syndrome, and that it is not sufficient to regard it only as an adjustive process, as was proposed by Sullivan (1955).
A model for peer review and audit
Authors: Grol Richard , Lawrence Martin 
Published: November 2023

Abstract
Medical audit and peer review are concepts which have gradually gained currency among general practitioners, although many do not know exactly what is meant by these terms nor what they involve precisely. The many terms related to audit have reached a stage where they can be seen merely as confusing jargon (Shaw 1980): clinical audit, peer audit, quality assessment, quality control, quality improvement, quality assurance, quality management, etc.
Effects of peer review: the evidence
Authors: Grol Richard , Lawrence Martin 
Published: November 2023

Abstract
What is the evidence from the literature concerning audit, feedback, and peer review? Do these really have any impact on the quality of care in medical practice and on the performance of care providers? In this chapter a brief overview is presented of available studies in this area. One project is presented as an example of a continuous peer review process: ‘Peer review in The Netherlands’.
Use of data on clinical performance i n peer review
Authors: Grol Richard , Lawrence Martin 
Published: November 2023

Abstract
All general practitioners have developed fixed routines of clinical performance in the course of running their practices. This may mean routinely carrying out certain physical examinations, ordering a certain laboratory test, or prescribing a particular medication for a condition. These routines will be rational in part and based on the most recent scientific information from the literature. In part they may be irrational or represent outdated behaviour or lack of understanding. It is virtually impossible for a practising GP to keep up to date continuously with all the new developments in the field.
Evolving role of women and children in our society
Authors: Avery Mary Ellen 
Published: November 2023

Abstract
Towards the end of the twentieth century, we have reason to celebrate the great advances of child health throughout the industrialized world. Consider the eradication of smallpox world-wide and the eradication of polio in the western hemisphere in 1992. Immunization against diphtheria, tetanus, measles, and now Haemophilus infiuenzae has prevented untold thousands of deaths of infants and children, so that now among the industrialized nations infant mortality rates are at an all-time low level. Central to this remarkable achievement has been a substantial and continuing improvement to the standard of living, which brings with it sanitation, nutritious foods, and the benefits of health education, including family planning.
Female adolescent health care: international perspective
Authors: Gardner Roxane 
Published: November 2023

Abstract
Attention has long been directed towards improving the health status of infants and children. The time has come to focus a greater portion of this attention towards improving the health of adolescents, especially female adolescents. This chapter is a discussion of demographics and socio-economic issues which affect the health of teenagers throughout the world, and a review of specific reproductive health issues. It has been said that children are our future. With adolescents, this statement becomes more cogent and immediate because adolescents are our tomorrow.
Contraception
Authors: Mastroianni Luigi 
Published: November 2023

Abstract
Methods designed to prevent pregnancy have been the subject of intense social and religious scrutiny. Although the earliest medical writings refer to efforts to control reproduction, debate did not intensify until methods became available that were at least somewhat effective. Firm positions were taken based on an evolving religious dogma relating to sexuality and the family. There continue to be widely diverging opinions on the appropriateness of contraception. Earlier, rerhaps because of a need to increase the population and because of high infant mortality, the position against contraception was almost universal. This nearly unanimous position has been supplanted by a more liberal stance that takes i1nto account the effect of uncontrolled population growth on quality of life and survival on an increasingly crowded planet.
Induced abortion
Authors: Henshaw Stanley K , Gold Rachel Benson 
Published: November 2023

Abstract
Induced abortion has been practiced for thousands of years. Descriptions of methods of inducing abortion have been found in writings from ancient Egypt, China in the twenty-eighth century bc, and Rome (David 1981). Abortion was common in nineteenth century Europe and North America and is usually considered to have been an important factor in the sharp reduction in birth rates that began in that century in France and other countries. In the twentieth century, abortion has become one of the most common surgical procedures in industrialized countries.
Assisted fertilization
Authors: Wood Carl , Dawson Karen 
Published: November 2023

Abstract
Despite the long history of IVF and embryo transfer (ET) in animals (Westmore 1984), the modern approach to human fertility problems—which involves exposing the human ovum to spermatozoa outside the mother and transferring the resulting embryo to her uterus—has been in use for a relatively short time. The first reports of pregnancies following the use of this technique in humans were published during the 1970s (de Kretser et al. 1973; Steptoe and Edwards 1976, 1978), and the use of JVF, ET, and gamete intrafallopian transfer (GIFr) have since resulted in many live births for couples with infertility problems. The recent rapid growth of these techniques has demonstrated their potential for treating a range of infertility conditions and has required considerable hack-up support. Perhaps more than most therapies, assisted fertilization has relied for its development and growth on a favorable social and scientific climate.
Cesarean section
Authors: Nielsen Thorkild F 
Published: November 2023

Abstract
Cesarean section is an operation of great antiquity. It was practiced by the early Romans, the ancient Hindus, and the ancient Hebrews. These first abdominal deliveries were performed only after the death of the mother, however and it is impossible to ascertain when the operation was first done on a living woman. The first documented cesarean section performed on a living woman in Europe was carried out on 22 April, 1610 by a German surgeon, Jeremias Trautman of Wittenberg. The operation was described in detail by Professor Daniel Sennert who was present during the procedure. The mother died 24 days later; the child survived (Bailer 1982).
Evaluation of monitoring techniques in pregnancy
Authors: Freeman Roger K 
Published: November 2023

Abstract
With the advances in technology emanating primarily from the space, biochemical, and electronics industries, there has been an understandable desire to apply this new knowledge to health care. Medical researchers have been aiming to use new scientific methods to develop new strategies that can improve outcomes for many previously devastating diseases. In obstetrics, there certainly have been great benefits seen from the introduction of antibiotics, the understanding, treatment and prevention of rhesus disease, amniocentesis and the ability to prevent the birth of children with Down syndrome, and the use of blood and blood products to replace substances necessary for the sustenance of life.
Substance abuse in pregnancy
Authors: Chavkin Wendy 
Published: November 2023

Abstract
In recent years illicit drug use by pregnant women has garnered an unprecedented level of medical and popular concern. In part this is a direct result of a dramalic increase in their drug use. It also results from heightened medical sophistication. Advances in pcrinatology and epidemiological research have led to recognition of a wider range of consequences of in utero exposure to drugs.
Doctors’ and patients’ roles
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
To understand more clearly how doctors and patients interact, it is helpful to specify what is special about the doctor-patient relationship. Just as the pattern of communication affects a relationship, so the relationship, in a circular interaction, shapes and influences the manner of communication. How do the doctor and the patient, as they interact, view themselves and one another?
Pendlenton et al. [19] describe and discuss six ways of studying the interation between doctor and patient. These are (1) medical; (2) sociological; (3) anthropological; (4) transactional; (5) social psychological; (6) psychoanalytical. The different behavioural sciences direct attention to particular features of the roles and behaviours of the doctor and the patient. Interviews may be studied by categorization of utterances and phrases; by finely focused discourse analysis; by psychoanalytic interpretations, or by study of non-verbal behaviour. Given this diversity of viewpoints, a panoramic catholic approach seems appropriate here, to provide a broad basis of understanding. Let us consider the patient first.
Communication in the setting of primary care
Authors: Hewitt A N M 
Published: November 2023

Abstract
The doctor–patient relationship is the cornerstone of general practice, and places great influence in the practitioner’s hands. Most patient care starts in general practice, and most long-term care occurs in the community. Most patients have a general practitioner, who maintains a unique record of their medical history from cradle to grave. Having a long-term knowledge of and relationship with patients, their families and friends, within a social setting, gives a special insight into patients’ problems. The doctor-patient relationship rests on good communication-the ability of practitioners to talk and listen to their patients and to appreciate their individual problems. The medical, social, and psychological setting is of paramount importance in understanding the patient as a whole person, and not just as a disease or a condition.
Talking to children
Authors: Speirs A L 
Published: November 2023

Abstract
Many doctors, other than paediatricians, have to deal with sick children. General practitioners, orthopaedic and ENT surgeons, eye and skin specialists all find that children make up a significant proportion of their patients. Therefore, most clinicians need to learn how to conduct a consultation with parent and child with consideration, care, and understanding. This is an essential requirement if the consultation is to achieve its objectives. Some doctors are regarded as naturally good with children, but through training, experience, and patience these skills can be developed and improved.