bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of the patient with CFS
Authors: Wessely Professor Simon , Hotopf Dr Matthew , Sharpe Dr Michael 
Published: October 2023

Abstract
The management of the patient with CFS is in many ways the culmination of this book. Treatment of the individual patient is based on the findings of the assessment outlined in Chapter 16, the knowledge of the efficacy of treatments reviewed in Chapter 17, and on an awareness of the biological, psychological, and social issues discussed in the other chapters. We hope that this penultimate chapter will add to those that have gone before, by providing the reader with additional guidance on the practical administration of treatment.
Evidence For Reduced Fecundity In Female Smokers
Authors: Baird Donna Day 
Published: October 2023

Abstract
Cigarette smoking has been linked with several adverse reproductive outcomes (Rosenberg 1987). The most consistently reported effect is reduction in birth weight (reviewed by Hogue and Sappenfield 1987). The question of whether smoking adversely affects a woman's ability to become pregnant has received less attention. Data on smoking and fertility are available from several epidemiological studies, but only one of these was designed specifically to address this question. In a 1986 review article on the subject, Stillman et al. (1986) claimed that: ‘this literature clearly demonstrates a reduction in fecundity of women who smoke.’ Yet, in the accompanying editorial, Wentz (1986) stated: ‘There are few good hard data that show that smoking impairs fertility. Published data are weighted in the direction of showing no deleterious effect on fertility in the woman.’ Clearly a controversy existed. Additional reports published after 1986 do not resolve this controversy.
Ectopic Pregnancy And Smoking: Confounding Or Causality?
Authors: Campbell Oona 
Published: October 2023

Abstract
Renewed interest in ectopic pregnancy began in the mid-1970s with observations of a marked increase in the rate of ectopic pregnancies (Beral 1975; Rubin et al. 1983). Around the same time, awareness of the reproductive consequences of smoking was growing and, by the early 1980s, reports of an association between smoking and ectopic pregnancy emerged. The question posed in the title of this chapter-whether the association between ectopic pregnancy and smoking is a causal one or whether it is due to confounding by unmeasured variables-is one that frequently arises in relation to smoking. The argument for confounding runs as follows: smoking is a 'lifestyle' variable, an exposure associated with systematic differences, not just in smoking behaviour but in overall characteristics and 'lifestyle' of the smoker (Pederson and Stavraky 1987). Associations observed between smoking and adverse outcomes may be attributable to this 'lifestyle' rather than to smoking per se. A well known example where consensus has not been reached is the controversy over the role of smoking and potential confounding by sexual and reproductive behaviour in the aetiology of cervical cancer (Winkelstein et al. 1984; Clarke et al. 1985). In different circumstances, Yerushalmy (1971, 1972) and Hickey and colleagues (1978) argue that low birth weight is caused by attributes of the smoker rather than by smoking itself. Hickey et al. (1978) go further and claim that both smoking and low birth weight are ‘symptoms of deficient maternal bioenergetic systems’.
Exposure To Passive Cigarette Smoking And Child Development: An Updated Critical Review
Authors: Rush David 
Published: October 2023

Abstract
While maternal cigarette smoking during pregnancy is closely related to the growth and survival of the fetus (Rush and Kass 1972), the nature and extent of effects on later development of the child are not clearly understood. In an attempt to clarify current knowledge, this review (an update of Rush and Callahan 1989) describes the design and some of the strengths and weaknesses of each of the studies known, and then summarizes, across studies, relationships with somatic, cognitive, and behavioural development.
Prevention Of Smoking In Pregnancy: Results Of Intervention
Authors: MacArthur Christine , Knox George 
Published: October 2023

Abstract
Smoking during pregnancy has been shown repeatedly to be associated with adverse outcomes of pregnancy, in particular with reduced birth weight and corresponding higher rates of perinatal mortality (Butler et al. 1972; Surgeon General 1980). The early findings all came from observational studies comparing smokers with non-smokers and ex-smokers. These groups, however, might be different in ways other than their smoking and it was not certain that the associations were causal. Only a randomized intervention, demonstrating that increased birth weight results directly from persuading pregnant smokers to reduce their smoking, would allow a firm inference that the association was causal (Butler et al. 1972); and at the same time indicate the pragmatic value of the intervention.
Ankylosing spondylitis
Authors: Rigby Alan S 
Published: October 2023

Abstract
As a remarkable and, it would seem, peculiar condition, we might now draw anention, in passing, to a form of morbidity ln which there supervenes, progressively and without pain, a complete ankylosis of the entire spine and of both ilio-femoral joints, in such a manner that the head, the trunk and the thighs become fused to one another and completely rigid, while other joints preserve their normal mobility. It goes without saying that, as a result of this fusion, very peculiar alterations in posture and gait develop.
Systemic lupus erythematosus*
Authors: Silman Alan J , Hochberg Marc C 
Published: October 2023

Abstract
Systemic lupus erythematosus (SLE) is a multisystem disorder characterized by an abundance of immunologic abnormalities including loss of self-tolerance, polyclonal B-lymphocyte activation and the production of auto-antibodies to a variety of cellular constituents. The clinical features of SLE are well described and include, in descending order of frequency, constitutional symptoms (malaise, fever, and weight loss), skin and mucous membrane involvement, arthritis and/or arthralgia, pleurisy and/or pericarditis, renal involvement, central nervous system involvement, Raynaud’s phenomenon, peripheral vasculitis, and inflammatory myositis.
Introduction to chronobiology
Authors: Reilly T , Atkinson G , Waterhouse J 
Published: October 2023

Abstract
Evolution has resulted in humans being anatomically, physiologically, and behaviourally adjusted to their environment. Thus, they show adaptation to an upright posture, they control their body temperature in spite of large swings in ambient temperature, and they control the composition of their plasma in spite of the dehydrating effects of the atmosphere and taking in food and drink discontinuously. Ecologically, humans have responded to environmental demands, whether these be due to gravity, temperature or dehydration. Another influence - that of time - is equally important, and humans, like all other living organisms, have also responded to the changes produced by time in their bodies.
Sleep and exercise
Authors: Reilly T , Atkinson G , Waterhouse J 
Published: October 2023

Abstract
One of the more fundamental human circadian rhythms is the sleep wakefulness cycle. While asleep, the organism is virtually unresponsive to external stimuli; this is in sharp contrast with a state of extreme alertness. In this sense, the states associated with the sleep-wakefulness cycle constitute a continuum from deep sleep to high excitement. The biphasic rhythm in human lives is in most cases matched to the light and dark cycles in the environment caused by the rotation of the earth around its long axis.
Time-zone transitions
Authors: Reilly T , Atkinson G , Waterhouse J 
Published: October 2023

Abstract
Since the Earth is spinning on its axis, for anybody standing on the Earth’s surface, the sun rises in the east and sets in the west, and is at its highest point in the sky at noon by local time. However, these events must occur in the UK after they have taken place in countries to the east and before they have taken place in countries to the west. In order to resolve this problem, the world has been divided into 24 time-zones centred around Greenwich and separated by lines of longitude 15° apart. These time-zones determine the relationship between Greenwich Mean Time (GMT) and local time, those to the east of the UK being advanced and those to the west being delayed.
Endocarditis
Authors: Mrcp J B Salmon 
Published: October 2023

Abstract
A 25-year-old man was admitted with a pyrexial illness and confusion. Temperature was 39.5°C; GCS 13; he had a severe digital v sculitis and evidence of mild aortic regurgitation: There were no focal neurological abnormalities and no meningism. Heart rate was 105/min with a normal pulse character and BP was 135/80 mmHg. He had a: soft ejection systolic murmur and a short early diastolic murmur of grade 2/4 intensity. A CT brain scan was normal and an echocardiogram showed mild aortic regurgitation with no evidence of vegetations. Blood, urine, and cerebrospinal fluid cultures all yielded a heavy, pure growth of a penicillin-sensitive Staphylococcus aureus. A search for obvious sources of infection was negative and there was no history of drug abuse. He was treated with benzylpenicillin, flucloxacillin, and gentamicin but deteriorated acutely 48 hours later. He became hypotensive, breathless, and hypoxaemic such that he required intubation and ventilation.
Sepsis
Authors: Frca C J Hinds Frcp 
Published: October 2023

Abstract
A 56-year-old man with chronic nephrolithiasis and recurrent urinary tract infections underwent nephrolithotomy. A few hours after returning to the ward he was reviewed by the surgical registrar who noted that he was febrile (38°C), tachycardic (100/min), and tachypnoeic (30 breaths/min), with a poor urine output. The patient also appeared to be confused. Blood and urine were sent for microscopy, culture, and sensitivities, and antibiotics (gentamicin and ampicillin) were given intravenously. Two hours later the patient became hypotensive and was referred to the intensive care team.
Guillain-Barré syndrome
Authors: Frca N Hirsch 
Published: October 2023

Abstract
A 70 kg, 55.:year-old man was admitted to A&E with a 24-hour history of increasing shortness of breath and difficulty in swallowing, One week previously he suffered an upper respiratory tract infection, followed by pain and paraesthesiae in both feet and weakness in both legs, making it difficult for him to walk without help.
Diabetic ketoacidosis
Authors: Md R Woolfson Mrcp 
Published: October 2023

Abstract
A 35-year-old nurse with no previous medical history was admitted from home with a 3-day history of vomiting and diarrhoea, abdominal pain, and progressive confusion. On admission, he was apyrexial and unkempt with signs of urinary incontinence. Examination revealed a respiratory rate of 35/min; pulse 120/min; BP 80/40 mmAgjugular venous pressure not seen. His extremities were cyanosed and cool to touch. Abdominal examination revealed moderate epigastric tenderness without guarding or rebound’.but bowel sounds were absent. On catheterization, the bladder was empty.
Introduction
Authors: Lader Malcolm , Herrington Reginald 
Published: October 2023

Abstract
Psychopharmacology is both an old and a new subject. Old, because mankind has resorted to mmd-altering drug for the whole of recorded history and probably for thousands of year before that. New, because the study of mind-altering drugs using modern scientific methods essentially dates from around 1950, culminating in the discovery of the modern drugs used in psychiatry. Only the tcchnolog1cal revolution separates neolithic man finding out that fermented wild grapes intoxicated him from the synthesizer of and experimenter with LSD, Albert Hoffmann. The unknown Sterne Age man who first discovered the analgesic and psychotropic effect of the opium poppy ranks with the chemists, pharmacologists and dimcians who developed chlorpromazine, imipramme, lithium, and the bcnzodiazcpines and discovered their therapeutic effects.
Behavioural studies in animals and humans
Authors: Lader Malcolm , Herrington Reginald 
Published: October 2023

Abstract
As well as providing techniques for use in the development of new drugs and other therapies, psychopharmacology has used those techniques to derive a large body of knowledge concerning the effects of drugs. This chapter will focus on the former and outline behavioural methods used in the assessment of psychotropic drugs in animals and humans.
Paediatric resuscitation
Authors: Skinner David V , Vincent Richard 
Published: October 2023

Abstract
Paediatric resuscitation follows the same essential principles as adult resuscitation. The difference is that paediatric resuscitation events occur over a wide range of size and weight, varying from the small baby, at 2.5 kg, to the average teenager, at 70 kg. With this wide range, it is obvious that the paediatric resuscitator must have knowledge of and confidence in the methods appropriate to the size of child. This chapter will deal mainly with the small infant weighing between 5 and 10 kg. Patients at the other end of the range can be dealt with as small adults. It will not deal with resuscitation of the newborn, as this is a specialist, planned recovery event occurring in the delivery room. Suggested further reading on resuscitation of the newborn is given at the end of the chapter.
Poisoning
Authors: Morton Rosemary J , Phillips Barbara M 
Published: October 2023

Abstract
Suspected poisoning in children results in about 40 000 attendances at A & E departments per year in England and Wales. Less than half these children are admitted to hospital for treatment or observation.
Deaths are uncommon; there are usually less than 10 per year in England and Wales. The most common fatal poisons in children are the tricyclic antidepressants (TCAs).
The most frequently ingested drugs are analgesics (particularly paracetamol), anxiolytics, cough medicines, oral contraceptives, and dietary drugs such as vitamins. The most frequently ingested household products are bleaches, detergents, disinfectants, and petroleum distillates.
There has been a fall in the incidence of admissions for analgesic poisonings since the introduction of child-resistant containers for these drugs in the mid-1970s.
Child abuse
Authors: Morton Rosemary J , Phillips Barbara M 
Published: October 2023

Abstract
1 If abuse is suspected, ask for a senior paediatric opinion.
2 Particularly consider the possibility of abuse when examining injured babies of less than one year of age.
3 In a child with suspected sexual abuse, genital examination constitutes further abuse and should be undertaken by one experienced doctor only unless life-threatening bleeding requires immediate aid.
The management of suspected child abuse should be directed to the following:
• treat the child’s injuries, including the psychological ones
• cooperate with others to ensure the child’s safety.
Neonatal problems
Authors: Morton Rosemary J , Phillips Barbara M 
Published: October 2023

Abstract
Occasionally an asphyxiated baby, newly born in an ambulance or at home, may be brought to the A & E department for resuscitation. A baby who il’l born quickly and unexpectedly and is asphyxiated is very likely to be a preterm baby. Staff in the A & E department should be able to resuscitate such an infant before transferring him to the special care baby unit or neonatal intensive care unit.
Menstruation, surgery, and women
Authors: Voda Ann M , Mansfield Phyllis Kernoff , Root Jan L 
Published: October 2023

Abstract
And did we find regularity in the menstrual cycle? Anything but! Variation so clearly characterized every history that we wondered how the word regular had come to be applied; not only that, but so firmly entrenched. As biometricians, we were prone to define a term like regular in a strictly mathematical sense, as straight lines of circled onset dates, which never appeared on the cards as we studied them individually, and in great numbers each new year. Surely, if we were persistent enough in assembling data, we could convince those who were apt to regard the menstrual cycle as ‘regular’ as the superlative of falsehood. (from Alan E. Treloar’s diary ∼1930s)
Definition and epidemiology of menorrhagia
Authors: Coulter Angela 
Published: October 2023

Abstract
Menorrhagia is ‘excessive’ menstrual blood loss or, in lay terms, heavy periods. The widely accepted clinical definition is a blood loss of 80 ml or more per period. This cut-off point was derived from a community study of menstrual blood loss conducted in Gothenberg, Sweden, in the 1960s, in which 80 ml represented the 90th centile of the distribution (Hallberg et al. 1966). These researchers found that the incidence of anaemia was significantly increased in women with blood losses over 60 ml and they recommended that a blood loss greater than 80 ml should be regarded as pathological. However, this apparently clear-cut definition masks a tangle of scientific debate and clinical uncertainty.
The pathophysiology of menorrhagia
Authors: Smith Stephen K 
Published: October 2023

Abstract
Menorrhagia is the subjective complaint of heavy periods. Its cause in the vast majority of cases is unknown. As one of the commonest referrals for gynaecological consultation (Bradlow et al. 1992) this statement may appear surprising. Yet when one considers the burden of proof needed to identify the cause of such a complex disease and when one views the highly pragmatic means used in the past to deal with the problem it is perhaps less surprising. However, a new urgency to this conundrum is now with us. Regular menstruation is the consequence of the use of wide spread fertility regulation and thus in the past has only been a problem of the developed world, about 20 per cent of the total population of women of reproductive age. However, with the spread of effective fertility regulation worldwide and the global reduction of family size, the rest of the world’s population will for the first time experience regular menstruation.
Pathophysiology and medical treatment of uterine fibroids
Authors: Vollenhoven Beverley J , Healy David L 
Published: October 2023

Abstract
Uterine leiomyomas are the commonest solid tumours in women. They are tumours of the smooth muscle of the uterus, but they also contain varying amounts of fibrous tissue. They are said to occur in 20–25 per cent of females over the age of 30 years. However, the figure is probably an underestimate and they are more likely to occur in about 50 per cent of women (Thompson and Rock 1992).
Oligomenorrhoea and polycystic ovary syndrome
Authors: Franks Stephen 
Published: October 2023

Abstract
Oligomenorrhoea is conventionally defined as an intermenstrual interval of greater than 42 days and is usually indicative of anovulation. Although the focus of this chapter is on oligomenorrhoea, it should be noted that its causes and management are very similar to those of secondary amenorrhoea or irregular menses which are also manifestations of anovulation. Anovulatory menses carries the implication that the ovary is producing oestrogen concentrations which are in the mid-follicular phase range but that progesterone secretion will be deficient. A series of anovulatory menses may, however, be interspersed by the occasional ovulatory cycle, a phenomenon which is relevant when considering the management of patients with oligomenorrhoea, as will be discussed later.
Pre-menstrual syndrome: aetiology and clinical management
Authors: Joshi Changulanda Medappa , Govind Abha , O’Brien P M Shaughn 
Published: October 2023

Abstract
Since the first documentation of pre-menstrual syndrome (PMS) by Frank in 1931, numerous treatment methods have been advocated. The syndrome has no known aetiology and an uncertain and variable course. None the less a psychoneuroendocrine mechanism triggered by the normal endocrine events of the ovarian cycle seems the most plausible explanation. No single intervention will uniformly eradicate symptoms in all patients presenting with PMS. Logical approaches to treatment would therefore include modulations or elimination of the ovarian cycle or correction of a neurotransmitter metabolic abnormality. Women with PMS present with heterogeneous symptoms; therefore management approaches must be designed on an individual basis.
Administrative and organizational aspects
Authors: Beattie B L , Bucks R S , Matthews J 
Published: October 2023

Abstract
As the number of elderly people increases, so does the demand for services aimed at diagnosing and managing cognitive impairment, especially dementia. There is a stronger imperative than ever to study changing cognitive and functional ability in order to improve understanding, treatment, and quality of life. Though a small number of memory teams see patients who do not have dementing disorders (e.g. epilepsy, head injury, or amnesia; see Kopelman and Crawford 1996), most concentrate on older patients. For convenience this chapter focuses on patients with dementia, although the general principles apply whichever group is being served.
The role of the speech and language therapist
Authors: Stevens Susan , Ripich Danielle 
Published: October 2023

Abstract
Communication, defined as the sharing or imparting of information, is integral to the process of building and maintaining relationships. It can be verbal or non-verbal, and is often a combination of the two. Effective communication depends on shared language and semantic (knowledge) memory, adequate physical skills, and a common code of behaviour, including body language and gestures. Language as a cognitive function underpins many other aspects of cognition, including memory. Any breakdown in language is likely to affect both other cognitive skills and the ability to test those skills.
Research potential
Authors: Gauthier S , Byrne J , Byrne L 
Published: October 2023

Abstract
Research into Alzheimer’s disease has greatly advanced in the past decade (High, 1993). This has resulted in improvements in understanding the disease process, patient care, and in diagnosis. Indeed, it is now estimated that misdiagnosis of probable Alzheimer’s disease is less than 10 percent (Katzman and Jackson, 1991). The need to use humans as research participants in Alzheimer’s disease is greater than in many other areas of research because there is no successful animal model of Alzheimer’s disease, although the transgenic mouse model may change this. Therefore, unlike other diseases where valid animal models exist, the prospect of effective diagnosis and treatment will be greatly reduced if research using human subjects is not undertaken. If it is accepted, therefore, that there is a scientific and ethical imperative to undertake research into Alzheimer’s disease and related disorders (Kapp, 1994), then the question of how best to conduct such research is raised.