bluuebunny/crossref_metadata_2025_split huggingface dataset:
The boundary between therapeutic and non-therapeutic research
Authors: Tyson Jon 
Published: October 2023

Abstract
The obstetric faculty in a large perinatal center decide to order a cord blood pH determination at birth routinely. This decision was made partly to help assess the quality of obstetric and neonatal care, partly to understand better the problems of individual infants, partly to increase knowledge about the physiology of birth asphyxia and the relationship of cord blood pH to perinatal outcome, and partly to avoid unjustified malpractice litigation. (A normal pH value indicates that severe asphyxia was not present at birth.) Cord blood pH determinations are part of ‘standard care’ in many teaching hospitals, and a low pH value may prompt immediate therapy of the infant for acidosis. Yet it is unclear whether such treatment would improve, worsen, or have no effect on outcome. No special effort will be made to obtain and report the pH determinations as quickly as possible.
The economics of perinatal care in the United States
Authors: Harvey Birt 
Published: October 2023

Abstract
Appropriate prenatal and newborn care should minimize low birthweight, lower newborn mortality and morbidity, and--consequently--decrease sub sequent chronic illness and handicapping conditions. Barriers to appropriate prenatal and newborn care are not only financial; but lack of financial access is a major deterrent. Insurance coverage (status) influences both quality of care and outcome.
Preparation Of The Patient And Preoperative Checks
Authors: Hosie H , Holmes E 
Published: October 2023

Abstract
The ward staff start preparing the patient for anaesthesia and surgery by assessing the patient. Theatre staff continue this process but also take on the responsibilities of caring for a patient whose judgement may be impaired due to premedicant drugs or who may be unconscious. The role of the anaesthetic assistant includes acting as the patient’s advocate, protecting the patient’s dignity and rights, and ensuring that the correct procedures are adhered to. Many units have designed a checklist to record the preparation of the patient (an example is shown below). Unfortunately, most checklists are based on physical measurements and assessments and may have little or no space to document the psychological preparation or effects of premedication on the patient, although this is of great importance.
Breathing
Authors: Hosie H , Morton N S 
Published: October 2023

Abstract
Respiratory arrest or apnoea is the cessation of breathing. Breathing is controlled by the respiratory centre, which is found in the brainstem. There are three separate areas of function, the inspiratory centre, the pneumotaxic centre and the expiratory centre. In normal inspiration (breathing in) there is increasing electrical activity in the inspiratory centre. Nervous impulses are conducted along the phrenic and intercostal nerves and cause contraction of the diaphragm and sometimes the intercostal muscles. This causes a negative intrathroacic pressure, air enters and expands the lungs. As the lungs stretch and expand, stretch receptors are activated which send impulses to the pneumotaxic centre. This inhibits the inspiratory centre and stops further expansion of the lungs. Normally air is then expelled passively with the elastic recoil of the lung tissue. Occasionally the expiratory centre becomes active, contracting expiratory muscles and causing air to be blown out.
Diagnosis And Management Of Early Postoperative Problems
Authors: Holmes E , Gillies G 
Published: October 2023

Abstract
An early feature of most respiratory problems when the patient is breathing room air is a fall in oxygen saturation revealed by the pulse oximeter. This can be treated by administering oxygen whilst further help is summoned. If the patient is apnoeic or is making very little respiratory effort, positive pressure ventilation by self-inflating bag and mask should be given by the assistant or anaesthetist or a tracheal tube should be inserted by the anaesthetist without delay.
Transplantation
Authors: Morton N S 
Published: October 2023

Abstract
Transplantation surgery is a highly specialized field where advances are limited by the shortage of donor organs. Organs for transplantation are usually preserved by being filled with a special fluid solution while being cooled. This reduces the cell metabolism and preserves the cell function. Kidneys can be preserved for up to 48 hours, the liver for up to 24 hours, lungs for about 8 hours and the heart for 4 to 6 hours. Organs are obtained from certified brain dead patients after consent has been obtained from relatives. The donor operation can be upsetting to theatre staff but, although the patient is certified as brain dead, they are afforded the same care and respect given to all patients.
Poisoning
Authors: Singer Mervyn , Webb Andrew R 
Published: October 2023

Abstract
Usually the history is obvious. Physical signs may be absent or confused due to ingestion of mixed poisons. Urgent advice should be sought from a poisons information centre. Some poisons may cause toxicity without ingestion, e.g. by inhalation or through the skin. Blood levels of salicylate and paracetamol are required in all cases of poisoning since active treatment will be required. A qualitative drug screen is a useful aid to diagnosis. In some cases the effects of poisoning are late (e.g. paracetamol, paraquat).
Ultrasonography of the joints
Authors: Jadoul Michel , Berg, Bruno Vande , Malghem Jacques 
Published: October 2023

Abstract
Ultrasonography (US) of joint capsules and tendons has been proposed as a potentially useful instrument for the diagnosis of dialysis-related amyloidosis (van Ypersele et al. 1988). In this chapter we review the rationale of this proposal, the methodology of ultrasonographic examination of capsules and tendons, and the results obtained with this technique in dialysed patients. The sensitivity and specificity of US for the diagnosis of dialysisrelated amyloidosis are reviewed and the potential pitfalls, limitations, and reproducibility of the technique are discussed. Finally, the perspectives for the use of US in the diagnosis and monitoring of dialysis-related amyloidosis are considered.
Composition of β ß2-microglobulin deposits
Authors: Gejyo Fumitake , Nishi, Shinichi , Arakawa Masaaki 
Published: October 2023

Abstract
Dialysis-related amyloidosis (Af32m) occurs predominantly in the articular synovial membrane. Common findings in such patients are arthralgias and carpal tunnel syndrome (CTS). When the deposits are studied by light microscopy, the amyloid initially shows a granular deposition which then gradually spreads along the synovial membrane of the tendon to form nodular deposits. These deposits are characterized by: (1) an amorphous appearance on light microscopy; (2) Congo red positivity; (3) apple-green birefringence of the Congo red-stained material in polarized light; and (4) amyloid fibrils measuring 6-12 nm observed on electron microscopy. Dialysis-related amyloid fibrils are relatively short and aligned in one direction to form a bundle (Fig. 7.1), whereas AA- and AL-type fibrils are randomly arrayed running in all directions. Dialysis-related amyloid fibrils are therefore easily distinguishable from those of other types of amyloidosis.
Characteristics of ß2-microglobulin metabolism
Authors: Deppisch R , Ritz, E , Stein G 
Published: October 2023

Abstract
Beta 2-microglobulin ([32m) derived amyloid is found in patients with impaired renal function either as urinary concretions or as systemic, mostly osteoarticular, deposits. Such amyloid is rarely seen in the predialysis phase (Linke et al. 1986; Moriniere et al. 1991), but is a very common complication after institution of dialysis (Campistol et al. 1990; Ritz and Bommer 1988). Generation of amyloid is dependent on increased plasma [32m concentrations. The increase of plasma [32m concentration is mainly due to diminished renal excretion of the 11.8 kDa microprotein which is normally eliminated via glomerular filtration (Vincent and Revillard 1980). The high plasma [32m concentrations in dialysed patients may not simply be the result of renal retention.
Physiological rhythms at rest
Authors: Reilly T , Atkinson G , Waterhouse J 
Published: October 2023

Abstract
The existence of physiological rhythms at rest must be taken into consideration by the exercise scientist. First, measurements at resting state should be controlled for the time of day to avoid potential misinterpretation later. Second, the time of day may influence the preparedness of the subject for submaximal and maximal exercise performance. As a background to understanding circadian rhythms in human performance, the rhythms of relevant physiological systems at rest are briefly described in this chapter.
Epilepsy
Authors: Hopkins Anthony , Appleton Richard 
Published: October 2023

Abstract
Epilepsy: The Facts, written by a neurologist and a pediatric neurologist, explains in clear and simple terms everything about the causes and effects of epilepsy. This book, strengthened by the contributions of a new new coauthor, has been considerably revised for the new edition. Intended for sufferers of epilepsy and their relatives, the authors explain what is meant by epilepsy, describe different types of epileptic seizure and of epilepsy syndromes in childhood and adult life, and offer an explanation of how epilepsy is investigated. Recent advances in the management of epilepsy by the use of drugs and therapy are considered in depth, as is the impact of new imaging techniques. The authors emphasize throughout the positive possibilities for people with epilepsy as well as advising on how to cope with problems as and when they arise in day-to-day living. They take many aspects of a normal life such as schooling, pregnancy, driving, and work, and describe how epilepsy can affect these. In the final chapter, the future of epilepsy is covered. The authors have succeeded in making this complex field interesting and understandable for people with epilepsy and their relatives.
Acute Respiratory failure
Authors: Frca R F Armstrong 
Published: October 2023

Abstract
A 60-year-old male patient was admitted with a 5-day history of malaise, cough with purulent sputum, and increasing breathlessness. Central cyanosis; dyspnoea; using accessory muscles of respiration; tongue dry; temperature 38°C; pulse irregular 140/min. Blood pressure (BP) 80/60 mmHg; respiratory rate :40/min. Chest dull to percussion on left with reduced air entry. Central venous pressure (CVP) 0 mmHg. Chest X-ray revealed opacification of the whole of the left lung.
Acute respiratory distress syndrome (ARDS)
Authors: Phd T W . Evans Md Frcp , Frcs R Sayeed 
Published: October 2023

Abstract
A 26-year-old woman approaching term during her first pregnancy developed a widespread vesicular rash with associated dyspnoea of effort. Chest radiography revealed bilateral reticular shadowing. She was admitted to ITU because of refractory hypoxaemia, where a clinical diagnosis of varicella pneumonitis was made, and she proceeded to an emergency Caesarean section.
The high-risk surgical case
Authors: frca o. boyd mrcp 
Published: October 2023

Abstract
A 75-year-old female presented to the surgical team with a 12-hour history of abdominal pain. She took regular NSAIDS. for osteoarthritis. One year previously she was admitted to the same hospital with a myocardial infarction, since when she had taken regular frusemide and enalapril for shortness of breath. She lived in a bungalow with social services support. Pulse rate 120/min; BP 100/50 mmHg; temperature 38°C; respiratory rate 25/min with shallow breaths and decreased air entry at the bases. Auscul tation revealed a gallop rhythm and the abdomen was tense and silent.
Myocardial infarction
Authors: Mrcp M Singer Md 
Published: October 2023

Abstract
A 55-year-old man is admitted with a 1-hour history of crushing central chest pain and breathlessness. There is a past history of duodenal ulcer surgery 5 years previously and recent onset anginal symptoms. On arrival he is drowsy, tachypnoeic (30/min), tachycardic (120/min), and hypotensive (70/45 mmHg). Auscultation. reveals widespread end-inspiratory crackles and a gallop rhythm.
Tuberculosis
Authors: Frcp S G Spiro Md 
Published: October 2023

Abstract
A 24-year-old Sierra Leonese lady was admitted to hospitalwith a 1-week history of increasing dyspnoea, fever, cough, and no sputum. Her last menstrual period was 3 months ago as she had had a Caesarian section and was breast-feeding her baby. She entered the United Kingdom to live with her cousin also 3 months ‘ago. She was single arid was previously healthy. She was on no medication and did not appear to be oh any drugs of addiction.
Legionnaires’ disease
Authors: Frcpath. G L Ridgway Md Mrcp 
Published: October 2023

Abstract
A 64-year-old chronic bronchitic consulted his GP complaining of increas ing dyspnoea, and a cough producing yellow sputum. He smoked 15-20 cigarettes daily, and drank 20 units of alcohol per week. It was noted that he kept a budgerigar. The GP prescribed oral amoxycillin; 36 hours later he was referred to hospital as he had become peripherally cyanotic, severely dyspnoeic at rest, and mentally confused.
Toxic shock syndrome
Authors: Fanzca B D Sharpe 
Published: October 2023

Abstract
A 17-year-old girl presented to a district hospital with a 2-day history, of mild fever and abdominal discomfort Examination revealed a rise in temperature to 37.8°C; mildly tender abdomen; and a WCC of 12 000 x 109/f. She was transferred to theatre for appendicectomy and 5 minutes post-induction had a cardiac arrest in ventricular fibrillation which was successfully treated with 1 mg of adrenaline and a 200 J shock.
Head injury
Authors: Frca P S Withington 
Published: October 2023

Abstract
A previously fit, 22-year-old man was admitted to the intensive care unit following a road traffic accident. On arrival at A&E he was in a corna (GCS of 6) and was noted to have a head injury and fractured pelvis. A head CT scan revealed diffuse brain swelling with no focal lesion. lntracranial pressure (ICP) monitoring was instituted and external fixation applied to stabilize the pelvic fractures. Treatment included mannitol 100 g, gelofusine 2 litres, anaesthesia, and ventilation. Midazolam, fentanyl, pancuronium were used for sedation and muscle relaxation.
Renal failure
Authors: Frcp A Short 
Published: October 2023

Abstract
A 69-year-old male patient was admitted to hospital 12 hours after discharge following gall bladder surgery. He had a past history of hypertension for many years and took bendrofluazides and a calcium channel-blocker. Prior to his last admission he complained of episodes of abdominal pain and jaundice. He was referred for surgery by his GP. In hospital, ultrasound investigation revealed stones in the gall bladder but no evidence of stones in the common bile duct.
Phaeocromocytoma
Authors: Mrcp G Bellingan 
Published: October 2023

Abstract
A 29-year-old male was admitted with a 6-hour history of nausea, vomiting, and abdominal pain. On examination he was pyrexial and sweating with a heart rate of 70/min and BP of 155/85 mmHg. There was mild epigastric tenderness only. Apart from a white cell count of 18 X 109/1, his admission haematology, biochemistry, and microbiology tests were entirely normal as was his chest X-ray and ECG. The next morning he developed acute pulmonary oedema requiring mechanical ventilation. He suffered two asystolic arrests and was eventually stabilized on an adrenaline infusion. His chest X-ray was consistent with pulmonary oedema; PAOP was 24 mmHg; and cardiac output was 5.5 I/min. His ECG remained normal and there was no rise in his cardiac enzymes. An echocardiogram demonstrated mild ventricular hypokinesia and abdominal ultrasound showed a 6 cm mass over the right kidney.
Respiratory failure in the infant
Authors: Mrcp M Peters , Frcp R C Tasker 
Published: October 2023

Abstract
A 4 month-old Asian infant was admitted from the general paediatric ward. She had been an inpatient for 3 days with a respiratory illness, but was now requiring increasing oxygen supplementation and looked tired. Weight 3.5 kg; temp 37°C; respiratory rate 80/min; heart rate 175/min; BP 60/40 mmHg; SpO 82% (70% head box oxygen); palpable 2cm liver edge.
Pre-operative assessment and checks
Authors: Armstrong R F , Aveling W , Grundy E M 
Published: October 2023

Abstract
Patients at low risk of heart disease do not require a pre-operative ECG. If performed a normal ECG does not exclude heart disease; and an abnormal ECG can be very difficult to interpret in a fit asymptomatic patient. However pre-operative ECGs should be done whenever suspicion of myocardial disease exists. Previous myocardial infarction (MI) is a major predictor of peri-operative MI.However the clinical diagnosis of MI can be difficult. In a recentstudy 28% of Mis were discovered only through the appearances of newECG changes. Hollenberg et al. identified five pre-operative factors which predictedpost-operative myocardial ischaemia. These were left ventricularhypertrophy on the ECG, history of hypertension, diabetes mellitustreated with drugs, coronary artery disease, and treatment withdigoxin. Raby et al. demonstrated that pre-operative ischaemia on the ECGpredicted post-operative and intra-operative ischaemia as well aspost-operative cardiac events. These were more likely to occur in patientsover the age of 70 years with a history of angina or coronary disease.98% of the post-operative ischaemic events occurred within 48 hours of operation. Two of Goldman’s pre-operative cardiac risk factors are identified bythe ECG: rhythm other than sinus, and ventricular ectopy with five ormore premature ventricular beats per minute. (But note that in contrastto Goldman’s findings, O’Kelly and associates found no correlationbetween ventricular arrhythmias and post-operative cardiac morbidityand death.)
Cardiovascular
Authors: Armstrong R F , Aveling W , Grundy E M 
Published: October 2023

Abstract
Although fusion or capture beats help to identify VT, it is sometimes impossible to distinguish SVT from VT. In the presence of haemodynamic compromise it is safer to assume it is ventricular in origin and treat with lignocaine and/or DC shock. Response to a test dose of adenosine is diagnostic of SVT. Always treat the cause. Adenosine has a rapid onset and a short duration of effect (approx. 10 seconds). Thus any hypotension is shortlived and doses can be given atfrequent intervals. Verapamil is contraindicated in beta blockade and should be avoided injunctional rhythm. Verapamil-induced hypotension can be treated with 10 ml 10% calciumchloride . Hypoxia is a potent cause of bradycardia. Too many patients have beengiven atropine when oxygen was needed. Always check oxygenation in thesecircumstances. In an emergency intravenous potassium chloride can be given at a rate of1 mmol/min. A common dilution in these circumstances is 40 mmol in100 ml saline. A more dilute solution (40 mmol/1) is safer and should beused whenever possible at a slower rate (40 mmols in 1 litre over 2 hrs). Whenever potassium is used intravenously continuous ECG monitoring and frequent checks of K+ are mandatory. If using intravenous boluses make sure each administration is in the circulation before giving more.
General medical
Authors: Armstrong R F , Aveling W , Grundy E M 
Published: October 2023

Abstract
There is an increase in cardiac output and stroke volume in the obese patient. This may lead to LVH. Right ventricular malfunction may result from pulmonary vasoconstriction caused by chronic hypoxia. Hypertension, ischaemic heart disease, CVAs, acute Mis, cardiac arrhythmias, and sudden deaths are also more common in this group of patients. Oxygen consumption and carbon dioxide excretion are both increased. Lowcompliance leads to increased respiratory work. Intra-operatively the FRCcan fall to such low levels that it is within the closing capacity thus causingV/Q mismatch, increased shunting, and hypoxia. Post-operatively there isprolonged hypoxaemia and a high percentage of patients developrespiratory complications. There is a high incidence of hiatus hernia and gastro-oesophageal reflux.This is compounded by high intra-abdominal pressure. Because of highresting gastric volumes and low gastric pH, anti-aspiration prophylaxis(ranitidine 150 mg p/o) should be prescribed the night before surgeryand repeated 2 hours before surgery. Metoclopramide may be addedpre-operatively and 30 ml sodium citrate (0.3 molar) drunk 3 minutes beforeinduction. A rapid sequence induction is recommended. Ensure a comprehensive pre-operative assessment is carried out including ECG, blood gases, CXR, and respiratory function tests. Exclude medical illnesses associated with obesity. Be prepared for difficult airway problems. Avoid opiates as premedication. Positioning the patient is important. Head down, supine, or prone positions may not be tolerated. Lateral or head and shoulders up will allow better respiratory function.
General
Authors: Armstrong R F , Aveling W , Grundy E M 
Published: October 2023

Abstract
The question of the epidural in patients with pre-existing back pain is controversial. Although epidurals are often used to treat acute back pain, there is retrospective data to suggest that back trouble is more common in women who have had an epidural for labour but not for an elective section. The current view is that it is not the epidural per se but the position adopted during prolonged motor block that is harmful. It is thought that epidurals with minimal motor blockade are unlikely to lead to later back problems. It is traditional to be wary of CNB in patients with pre-existing neurological disease in case worsening neurology might be blamed on the block. Thereseems little evidence to support this view. The possible risks should bediscussed with the patient. Where there is risk of coagulopathy a normal clotting screen is comforting.Platelets &gt;100 x 109/l are regarded as safe but function rather than numbersare affected by drugs such as aspirin. Bedside estimation of bleeding timehas not proved to be an easy or reproducible method of assessing plateletfunction. The risk of spinal haematoma formation after CNB in association withanticoagulation and DVT prophylaxis has been authoritatively reviewed byVandermeulen et al. (1994). After low-dose heparin and low molecular weight heparin the risk of CNBis acceptable but blocks should not be done or catheters removed within 4 hours of the last dose of heparin or 10 hours after low molecular weightheparin.
Social and economic aspects of prescribing
Authors: Lader Malcolm , Herrington Reginald 
Published: October 2023

Abstract
Treatment with psychotropic drugs is mostly initiated by family doctors. In considering the social function and consequences of this, some attention must be paid to what leads people to seek help from their doctor in the first place and what factors predispose to the inclusion of a prescription in the management package eventually offered, before attempting to assess the consequences, both good and bad, for society at large. The impact of specialist psychiatric opinion on the use of drugs in the treatment of nervous disorder, especially minor disorder, is not readily determined. However, any influence is presumably mainly through advice to general practitioners, at least in the United Kingdom where direct access to specialists is unusual. Psychiatrists themselves are, of course, exposed to similar psychosocial pressures as other doctors and the following analysis draws on evidence from several areas of medical practice.
Pharmacokinetics
Authors: Lader Malcolm , Herrington Reginald 
Published: October 2023

Abstract
Pharrnacokinetics is the study of the body’s effects on drugs and determines whether the drug gets to its site of action and in what concentrations. As both a theoretical and practical topic it has become increasingly important in recent years. An excellent detailed account is given by Grahame-Smith and Aronson (1992).