bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiotherapy In The Management Of Muscle-Invasive Bladder Cancer
Authors: Harrington K J , Sikora K 
Published: October 2023

Abstract
The patient population that presents with bladder cancer offers a number of specific challenges. These patients are frequently elderly, with a poor performance status and a number of concurrent medical conditions, often related to prior or ongoing tobacco smoking. Such patients are often unfit for radical surgery, either by virtue of the extent of the disease or the risk posed by the anaesthesia, and may not tolerate combined bladder-conserving therapeutic approaches using radiotherapy and chemotherapy. Careful selection of the most appropriate treatment strategy can result in effective palliation of symptoms and even complete resolution of the disease process before death due to an inter-current illness intervenes (1–3).
Integration Of Cytotoxic Chemotherapy Into Management Of Muscle-Invasive Bladder Cancer
Authors: Raghavan Derek , Andavolu Murthy 
Published: October 2023

Abstract
Approximately 10 000 cases of invasive bladder cancer are diagnosed in the United States each year, representing about 20% of incident cases of urothelial malignancy (1). Invasive bladder cancer is now considered to be a systemic disease as more than half of the presenting cases will eventually relapse with distant metastases (2), presumably because micrometastases are present early in the course of the disease. With this in mind, systemic chemotherapy has been added to locoregional treatment in an attempt to improve cure rates (3).
Palliative Care For Patients With Bladder Cancer
Authors: Harrington K J , Syrigos K N 
Published: October 2023

Abstract
To many the term palliative care is synonymous with the treatment of patients in the terminal phase of a disease process, usually cancer. However, this is a narrow view and fails to embrace the wide variety of clinical scenarios which can justifiably be included under this heading. It is more useful to consider that palliative care is the specific treatment given to patients with incurable disease with the aim of relieving disease-related symptoms and promoting physical, psychological, and spiritual well-being. In the sphere of malignant disease, palliative care legitimately includes active therapeutic manoeuvres such as the use of surgery, chemotherapy, and radiotherapy, as well as the more widely recognized palliative therapies such as pain relief. Many patients present with disease too advanced to allow for the possibility of cure and others may have concomitant medical conditions that preclude the use of aggressive therapy which might, under different circumstances, have offered the chance of a cure. In these patients the aim of treatment from the very outset is to achieve symptom palliation and, if possible, prolongation of their lives. Therefore, palliative care of patients with cancer is a challenging and diverse discipline in which palliative care physicians, oncologists, and surgeons can play an important part. In addition, the involvement of a variety of healthcare professionals including nurses, social workers, counsellors, physiotherapists, and occupational therapists as part of a multidisciplinary team allows important psychosocial issues to be addressed as part of the overall care package.
The Role Of The Research Nurse In The Management Of Bladder Cancer Patients
Authors: Bowerbank M M 
Published: October 2023

Abstract
As previous chapters have already suggested, the treatment of bladder cancer depends on the extent of the patient’s disease, as does the overall aim of treatment. For some, one treatment modality is enough, for others, a combination of surgery, chemotherapy or radiotherapy will be needed. Although advances have been made in the treatment of bladder cancer, overall management of this disease in all its stages, remains controversial. Unless current treatment modalities for this disease are evaluated within the auspices of large scale, prospective, randomized clinical trials, treatment is likely to remain controversial (1,2).
Your Spinal Pain —Top To Toe
Authors: Burn Loïc 
Published: October 2023

Abstract
There are two important, potentially confusing facts about the spine and pain. Firstly, problems in the spine can, and frequently do, lead to pain felt in almost any part of the body. When such pain is felt at a distance from its true source it is called ‘referred’ pain. With spinal pain this is very common indeed and, unfortunately, can make the diagnosis difficult. Tenderness can be referred in exactly the same way, and is as unreliable in indicating its source. The problems created by referred pain are discussed in the next chapter.
Self-Help —What You Can Do About Your Chronic Pain
Authors: Burn Loïc 
Published: October 2023

Abstract
In Chapter 8 we showed how crucial self, help is in the management of acute back and neck pain. Many believe it to be, together with manipulation, the main way to prevent loss of work and chronic pain. In the last chapter we demonstrated how pain clinics manage, basically by programmes of increasing exercise and activity, to often relieve chronic pain and, much more significantly, to reduce the level of disability caused by it. Thus, the same methods are used nowadays in the management of both acute and chronic pain-and for thesame reasons (less time off work, less pain, and less disability).
Treatments That May Help You
Authors: Burn Loïc 
Published: October 2023

Abstract
We have seen that it is difficult both to find the cause of back or neck pain and to give an accurate diagnosis. This means that it is also difficult to plan treatment. Indeed treatment is often a matter of trial and error! It is important that you are aware of and consider all the available treatments, particularly if surgery is contemplated. There are many treatments on offer; the one you are given will depend largely on to whom you go for help. (The next chapter looks at the people who may help you.)
Clinical interventions for fatigue
Authors: Ream Emma , Stone Paddy 
Published: October 2023

Abstract
Healthcare professionals are becoming increasingly aware of the difficulties patients with cancer face when they experience fatigue. A growing body of research portrays the relentlessness of this symptom for this group of patients, and describes the challenges associated with its successful management. Clinicians themselves have reported difficulties with assisting patients to cope with fatigue, and allude to their frustration when their intervention fails (Copp and Dunn 1993).
Fatigue and everyday function in people living with cancer
Authors: Mallinson Trudy , Cella David 
Published: October 2023

Abstract
Fatigue is becoming recognized as one of the most common and most devastating side-effects from cancer treatment. Previous research has identified that 70–80% of cancer patients will experience debilitating fatigue during the course of treatment (Portenoy et al. 1994). Further, fatigue does not always resolve with the termination of cancer therapy (Ferrell et al. 1996). Its impact on patients’ daily lives can range from difficulty completing simple tasks such as shopping, to resuming productive roles such as working and childcare (Messias et al. 1997).
Muscular dystrophy - an evolving concept
Authors: Emery Alan E H 
Published: October 2023

Abstract
Muscular dystrophy is one of the fastest growing fields in medicine, at both the clinical and laboratory level. Over the last 50 years or so, many important innovations in medical science have actually been initiated in studies of muscular dystrophy (Emery and Emery 1995). For example, the first application in medicine of discriminant function statistical analysis was in the 1950s for resolving clinical and genetic heterogeneity in these diseases. A little later the first application of Bayseian statistics was in risk calculations in muscular dystrophy, a statistical method of reverse genetics or, more precisely, positional cloning. This technique has subsequently been applied with great success to other forms of dystrophy as well as to many other genetic disorders.
Developing a role for counselling in the primary health care team
Authors: Dammers Jane , Wiener Jan 
Published: October 2023

Abstract
This chapter describes our view of past, present and possible future directions for counselling and its relationship to general practice. We have worked together as GP and psychotherapist for two decades, exploring how to build bridges across our two professions to bring medical and psychological models of work together to help patients with mental health problems. Our thinking, writing and the conferences and workshops we have helped to convene have emerged from a common starting point a belief in the value of a psychodynamic approach to work in a general practice set ting. GPs and psychodynamic counsellors share a longitudinal approach to acquiring information and understanding about their patients relatively slowly over time.
Counselling across social, sexual and ethnic differences
Authors: Zarbafi Ali 
Published: October 2023

Abstract
In this setting, the GP is the ‘gatekeeper’. By this I mean the key decision-maker, who either treats the patient or decides where the patient should go for tests or more specialized help. As the GP has very little time, there is a sense of speed. The short time spent on individual consultations, and the medical model, which prioritizes checking for physical symptoms for any complaint, defends the doctors from being overwhelmed and thus contains their anxieties and enables them to work effectively.
Ethical theory and principles
Authors: Miller Ronald Baker 
Published: October 2023

Abstract
The purpose of this chapter is twofold: (1) to provide an overview of ethical issues of concern to patients with kidney disease and to the physicians and other health care professionals who care for them; and (2) to review both theoretical and practical approaches for the analysis and resolution of clinical ethical problems. It is only in the 1980s and 1990s that ethics has been taught explicitly in medical schools, internal medicine residencies, and nephrology training programs.
India
Authors: Jha Vivekanand , Chugh Kirpal S 
Published: October 2023

Abstract
Organ transplantation in India is mostly confined to transplantation of kidneys using living-related and unrelated donors and, in a small number of patients, cadaver donors. With the recent development of split transplant technique, a few liver trans plants have also been performed successfully in some centers using living-related donors. The lack of infrastructure for harvesting cadaver organs has not only pre vented the growth of cadaver renal donor transplant programs but also of unpaired vital organs like heart, pancreas and liver. This communication highlights the ethical aspects of kidney transplantation in developing countries in general and India in particular.
Developmental dysplasia of the hip: natural history, results of treatment, and controversies
Authors: Morcuende Jose A , Weinstein Stuart L 
Published: October 2023

Abstract
Developmental dysplasia of the hip (DOH) is one of the most common problems in paediatric orthopaedics, and one of the most fascinating. DOH represents a spectrum of conditions that range from a simple neonatal instability to an established dislocation. The term developmental is now preferred to congenital because it is more encompassing as it is taken in the literal sense of organ growth and differentiation, which includes fetal, neonatal, and infantile periods.
Decision analysis: utility for everyday use?
Authors: Elwyn Glyn , Edwards Adrian , Eccles Martin , Rovner David 
Published: October 2023

Abstract
The final chapter in this section examines some of the background and issues arising from the decision making approach known as ‘decision analysis’. It is conceptually quite different from the other models or approaches just presented, ·although it includes the values of both professional and patient. Patient-centred medicine, shared decision making, and risk communication concern either the skills to engage the patient more directly in decisions about their treatment or care, or the nature of the information which may be most usefully provided or discussed with the patient. These approaches entail a transfer of responsibility from the professional more towards the patient.
Education and training of health care professionals
Authors: Towle Angela , Godolphin William 
Published: October 2023

Abstract
Hope (1996) defines the focus of evidence-based patient choice (EBPC) as the use of evidence-based information to help people make choices when they, or those close to them, are in need of health care. Neither he, nor other writers, have identified the knowledge, skills, and attitudes which health professionals require in order to practice EBPC nor described the ways in which EBPC can be implemented within the doctor-patient encounter. Our work has been based on the concept of informed shared decision making. We believe there are many similarities in terms of the knowledge, skills, and attitudes needed for both. We will therefore use our work on shared decision making as a model for exploring the teaching and learning of EBPC, the problems likely to be encountered, and possible solutions. In this chapter we focus particularly on the education and training of physicians. However, our preliminary work with dentists, pharmacists, physiotherapists, and occupational therapists suggests that the competences required for physicians are generalizable to other health care professionals.
Moving to the mainstream
Authors: Holmes-Rovner Margaret , Llewellyn-Thomas Hilary , Elwyn Glyn 
Published: October 2023

Abstract
Evidence-based patient choice (EBPC) may well be the future framework for health care, but it is definitely not yet in place in the clinical settings we observe. Evidence-based medicine (EBM) has had unparalleled influence over medicine, but its recent extension to encompass the realm of patient choice has not yet gained widespread acceptance. It may be an even more arduous journey than that faced by the pioneers of EBM.
The future
Authors: Coulter Angela 
Published: October 2023

Abstract
In September 1999 the British Medical Journal published a special theme issue entitled ‘Embracing patient partnership’. Following its publication visitors to the BMJ’s website were asked to respond to a brief questionnaire asking their views on consulting styles (BMJ 16/10/99). The survey ran over a two-week period from 17 September to 4 October. The results are shown in Table 18.1.
Managing thoughts, stress, and pain
Authors: Crossman Jane 
Published: October 2023

Abstract
In the sport psychology literature there is a well-known adage that states: “how you think is how you perform’. For injured athletes, the phrase can be translated to ‘how you think can affect how you progress in rehabilitation’. The thoughts that injured athletes have regarding their injury will influence their perception of it and its potential impact on their future athletic careers, their lives, and the length of time it takes to make a successful return to action. Negative mental preoccupations almost always affect stress levels and may lead to physical reactions such as muscle tension and pain.
Editors’ note to Chapter 5
Authors: Downie R S , Macnaughton Jane , Randall Fiona 
Published: October 2023

Abstract
To illustrate the applicability of our central thesis—that evidence and judgement form a seamless garment—we invited a hospital consultant to consider how far this thesis might be relevant to a currently controversial area of health care: resource management, prioritizing, or rationing. We are particularly grateful to Dr Fiona Randall for agreeing to write this chapter. First, she is able to offer the perspective of a hospital consultant, and it is hospital consultants who are perhaps most aware of resource constraints. Second, we were interested to see how our general line of argument would work out in an area at the rock-face of current controversy. Her views on this important topic are much wider than can be expressed within the constraints we have imposed on her. No doubt she will have occasion to publish a more extended version of them.
Educating judgement: the humanities
Authors: Downie R S , Macnaughton Jane , Randall Fiona 
Published: October 2023

Abstract
This book has so far attempted to describe the knowledge, skills, and attributes required for someone to make good clinical judgements. It is clear that the doctor needs to understand his patient through a scientific knowledge of how the body works and appreciate how scientific research can help him make decisions about how best to treat a patient. But we have also discussed the ways in which this evidence-base must be modified in the clinic; a ‘humane’ doctor is required with the understanding (the interpretative ability and insights), governed by ethical sensitivity, to apply, in the particular clinical situation, scientific evidence and skills. As we shall see, a broad education is also required. This chapter is concerned with providing more detail on this capacity for humane judgement, and with considering how far it can be learned. Before we embark on this we should note that little will be said here directly about education for scientific judgement. This is because it is a large and important topic on its own, with a large literature.
Bandolier’s Little Book of Pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Acute and chronic pain place a huge burden on our society. Approximately 10% of the population in Western countries report suffering from chronic pain, and both chronic and acute pain are responsible for high absenteeism in the workplace. It is therefore crucial that we have effective ways of treating pain. Unfortunately though, we have no objective measures of pain - no blood tests, no urine dipsticks. We have to rely on what the patient tells us. So how then do we know what are and what are not effective pain treatments? It is here that the principles of evidence-based medicine have been of great value - helping us to understand the most effective forms of pain treatment. Bandolier’s Little Book of Pain is a unique portable guide to evidence-based pain treatments. For each possible treatment, the book provides the evidence supporting the efficacy of the treatment, along with a clinical bottom line, for those requiring immediate information. Written by world leaders in the field of evidenced-based pain treatments, the book will be indispensable for the multi-disciplinary professionals managing acute and chronic pain in primary and secondary care.
Clinical trial methods
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
If trials are not done properly, any results they produce will be worthless. We call this validity. What constitutes a valid trial depends on many factors, and so there are no absolute hard and fast rules that can cover every clinical eventuality. But for pain, we can make some important observations about what to look for in a valid clinical trial. We randomise trials to exclude selection bias. Trials are usually performed where there is uncertainty as to whether a treatment works (is better than no treatment or placebo), or whether one treatment is better than another. We start from a position of intellectual equipoise. But trials are often done by believers, and belief, even subconscious belief, might influence our choice of patients to have one treatment or another if we could choose.
Systematic review and meta-analysis
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Systematic reviews identify and review all the relevant studies, and are more likely to give a reliable answer. They use explicit methods and quality standards to reduce bias. Their results are the closest we are likely to get to the truth in the current state of knowledge. We will see (section 1.6) that even the best trials designed to tell us that an analgesic is better than placebo can give the wrong result just by the random play of chance. Systematic reviews (and meta-analysis, the statistical combining of information from many trials) are our best defence against making incorrect decisions based on inadequate data.
Injected morphine in postoperative pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Clinical bottom line. A 10-mg intramuscular dose of morphine is an effective analgesic. It has an NNT of 2.9 (2.6–3.6) for at least 50% pain relief over 4–6 h compared with placebo in pain of moderate to severe intensity. The incidence of minor adverse effects is significantly higher with 10 mg intramuscular morphine compared with placebo. Few trials of acceptable quality have been carried out. This is especially true for subcutaneous and intravenous studies. Morphine is the archetypal analgesic for use in moderate or severe pain. It is the principle alkaloid of opium, and is given by many different routes. Morphine is the ‘gold standard’ against which other injected analgesics are tested.
Dihydrocodeine in postoperative pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Clinical bottom line. A single 30 mg oral dose of dihydrocodeine does not provide effective analgesia. A 60-mg dose is significantly less effective than ibuprofen 400 mg. Quality data do not exist for a placebo comparison. Patients should be offered a more effective analgesic in the treatment of postoperative pain. Dihydrocodeine is a synthetic opioid analgesic which was developed in the early 1900s. Its structure and pharmacokinetics are similar to codeine, and it is used for the treatment of postoperative pain and as an antitussive. Nearly one tenth of all analgesic preparations issued in England were for dihydrocodeine in 1995.
Intramuscular pethidine in postoperative pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Clinical bottom line. Intramuscular pethidine is an effective analgesic. A single dose of intramuscular pethidine 100 mg had an NNT of 2.9 (2.3–3.9) for at least 50% pain relief over 4–6 h in patients with moderate or severe pain compared with placebo. This is similar to intramuscular morphine 10 mg which has an NNT of 2.9 (2.6–3.6). Based on small numbers of patients, pethidine 50 mg does not appear to offer effective pain relief. Pethidine 100 mg was associated with significantly more adverse effects than placebo. The NNH for a single intramuscular dose of pethidine 100 mg was 2.6 (2.1–3.6).
Topically applied non-steroidal anti-inflammatory drugs in acute pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Clinical bottom line. Topical NSAIDs are effective in the relief of pain caused by soft tissue injury, sprains, strains and trauma. Ketoprofen, felbinac, ibuprofen and piroxicam have proven efficacy. The NNT was 3.9 (3.4–4.3) for at least 50% pain relief after one week of topical NSAID use compared with placebo. Benzydamine and indomethacin did not appear to be effective. No significant local or systemic adverse effects are associated with topical NSAID use. Oral NSAIDs are associated with increased risk of adverse effects such as gastrointestinal problems. The question arises therefore whether topical NSAIDs, which are widely available without prescription, are more suitable for a number of conditions. However, it has also been argued that topical NSAIDs have no action other than as rubefacients.