bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bioethical Principles
Authors: Lemma Alessandra 
Published: May 2023

Abstract
This chapter introduces the dominant model used in bioethics today: the Four Principles approach as described by Beauchamp and Childress. It provides a succinct overview of the four principles of bioethics, namely respect for autonomy (the obligation to respect the decision-making capacities of autonomous persons); non-maleficence (the obligation to avoid causing harm); beneficence (the obligation to provide benefits and to balance benefits against risks); and justice (the obligation of fairness). It also discusses the challenge of balancing competing duties and ethical demands. Although this bioethical model does not typically feature in psychoanalytic writings, it is suggested that it offers a foundational moral analytical framework and a common moral language that is well suited to analytic practice, with some additional specifications, which will be elaborated in Chapter 3.
A Psychoanalytic Principled Approach
Authors: Lemma Alessandra 
Published: May 2023

Abstract
Chapter 3 builds on the Four Principles model and re-interprets it for specific use by psychoanalytic clinicians, adding and introducing a fifth principle—veracity. Framed by a discussion of the telos of psychoanalytic therapy, the chapter discusses the ethical importance of addressing ‘what is psychoanalysis for?’ because this bears on the question of consent to treatment. It is suggested that the specificity of the psychoanalytic method, namely that the work is mediated by the relationship that develops between therapist and patient, means that the person of the therapist is central to its integrity and outcome. Recognizing this is fundamental to ethical practice because from this fact derive the therapist’s ethical obligations towards the patient. Ethical principles are in the service of protecting the conditions under which psychoanalytic work can be carried out for the benefit of the patient and without obstructing the process and/or harming the patient.
Motility disorders of the oesophagus
Authors: Müller Michaela , Niebisch Stefan , Gockel Ines 
Published: May 2023

Abstract
Oesophageal motility disorders comprise a group of disorders characterized by malfunction of the swallowing act due to damage to neuromuscular structures responsible for the coordination of oesophageal function. The leading symptom is dysphagia for solids and/or liquids and it is frequently associated with additional symptoms, including regurgitation, chest pain, heartburn, and weight loss. Manometry represents the gold standard for the diagnosis of motility disorders of the oesophagus which has been defined in the Chicago Classification by the introduction of high-resolution impedance manometry and will be presented in this chapter with special emphasis on motility disorders which are of particular relevance to gastroenterologists and surgeons.
Upper gastrointestinal perforation
Authors: Hendricks Alexander , Ellrichmann Mark , Schafmayer Clemens 
Published: May 2023

Abstract
Perforations of the upper gastrointestinal tract are rare events but if present, are serious conditions. Timely diagnosis and therapeutic initiation are crucial for a beneficial patient outcome. In general, endoscopic and surgical approaches are suitable methods. Endoscopically, there are multiple methodologies available dependent on the extent of the laceration and ongoingly, more innovative techniques are being introduced. Smaller and acute lesions without significant amounts of contamination can be sufficiently treated with clipping devices. Larger defects can be treated by either endoscopic stenting or the more innovative approach of endoscopic vacuum therapy. The surgical approach is usually the option of last resort. Morbidity and mortality rates postoperatively are high, hence the indication for a surgical revision of upper gastrointestinal perforations must be strict and well weighted. In sum, to guarantee the most optimal outcome for the patient, it is crucial to pursue an interdisciplinary approach involving specialists from endoscopy, intensive care medicine, and surgery.
Oesophageal cancer
Authors: Stüben Björn-Ole , Karstens Karl-Frederick , Nentwich Michael , Izbicki Jakob R. , Reeh Matthias 
Published: May 2023

Abstract
Oesophageal surgery remains a challenge for the surgeon despite rapid medical advances in the recent past. The procedures are particularly difficult because of the thoraco-abdominal localization of the oesophagus and its vicinity to vital organs. Although oesophageal operations are usually only carried out in high-volume centres which provide around-the-clock interdisciplinary care, they are still accompanied by a high number of complications. This chapter summarizes the history of oesophageal surgery and provides an overview of the conventional surgical approaches used for oesophageal resections, including transhiatal blunt oesophageal dissection and gastric pull-up, subtotal en bloc oesophagectomy—abdominothoracic approach, abdominothoracic en bloc oesophagectomy with high intrathoracic anastomosis, and limited resection of the gastro-oesophageal junction with isoperistaltic jejunal interposition.
Gastric cancer
Authors: Arigami Takaaki , Natsugoe Shoji 
Published: May 2023

Abstract
Although the occurrence of gastric cancer has gradually decreased in East Asia, it is still the fifth most common malignancy and the second leading cause of cancer-related death worldwide. The International Agency for Research on Cancer has proposed that Helicobacter pylori, rubber production, tobacco smoking, as well as X-ray and gamma radiation are risk factors for gastric cancer. Further analysis of carcinogenesis will support the early detection of gastric cancer. Since the majority of patients with gastric cancer have no signs or symptoms of the disease, it is clinically difficult to detect these patients without screening. Moreover, representative diagnostic tools that have been used to detect early gastric cancer include upper gastrointestinal barium X-ray radiography, oesophagogastroduodenoscopy, endoscopic ultrasonography, computed tomography, and fluorodeoxyglucose positron emission tomography. In particular, magnifying narrow-band imaging (M-NBI) has been a promising approach for an accurate assessment. The recent development of M-NBI is critical for the strategic utilization of treatments such as endoscopic submucosal dissection. In 2016, the Union for International Cancer Control published the eighth edition of the TNM Classification of Malignant Tumours which defined a new stage grouping for gastric cancer. It contributes to the clinical management of tumour diagnosis and treatment for patients with gastric cancer.
Credentialing, Certification, and Scope of Practice Issues for the Palliative APRN
Authors: Lappen Kerstin Lea , McGraw Matthew , Meyer Kate 
Published: May 2023

Abstract
Advanced practice registered nurses (APRNs) must understand the requirements and complexity of credentialing, certification, and licensing in order to practice safely, legally, and to the fullest extent of their scope. Standardization of APRN practice is lacking from state to state, and, to that end, the Consensus Model for APRN Regulation, Licensure, Accreditation, Certification, and Education (LACE) provides guidance for states to develop uniformity in the regulation of APRN roles. By allowing the APRN to practice to the fullest scope in accordance with their education and clinical preparation, there will be increased mobility to practice and improved access to healthcare. Specialty certification is a valuable endeavor to demonstrate the clinician’s expertise and commitment to quality care and to the profession.
The Palliative APRN in Nursing Education
Authors: Cormack Carrie L. , Lindell Kathleen O. 
Published: May 2023

Abstract
The advanced practice registered nurse (APRN) in palliative education has an important role in shaping the future generation of APRNs and specialty practice APRNs who care for individuals with serious illness and their families. These APRN educators must use their expertise and leadership to develop curriculum and facilitate education in primary and specialty palliative skills and clinical practice. Palliative APRN educators have an opportunity to address the growing workforce shortage in palliative care and answer the call for increased professional palliative care education. This chapter outlines the processes for APRN faculty and schools of nursing to prioritize palliative care and implement this necessary content into their curriculums to ensure that every nursing graduate is prepared at time of graduation to provide high-quality care to individuals with serious illness and their families. It also addresses the standards, framework, resources, and essential content for graduate faculty to development and implement a specialty palliative care program.
The Palliative APRN in the Emergency Department
Authors: Loschiavo Sarah , Starkweather Angela 
Published: May 2023

Abstract
The emergency department often serves as a port of entry to palliative care services for patients with complex symptoms and/or care coordination, individuals with chronic disease(s), and people at the end of life. This chapter outlines the role of the palliative advanced practice registered nurse (APRN) in the emergency department and highlights strategies for the successful integration of palliative care in the emergency department setting and common barriers to its implementation. Various models that may be used are described along with approaches to operationalize the provision of palliative care to patients in the emergency department. Methods to identify patients at greatest need for palliative care and guide the evaluation of palliative care services are discussed. Guidance for death notification by telephone or using other technologies is offered.
Care of Veterans with Palliative Care Needs
Authors: Foy Alice C. , Rice Robert David , Melocoton Joseph Albert 
Published: May 2023

Abstract
The Department of Veterans Affairs, through the Veterans Health Administration, is deeply committed to the service of veterans with serious illness and promotes palliative and end-of-life care as a priority. The unique demographics and experiences of veterans and their families can make end-of-life care complicated, thus requiring specialized skills and resources. As advanced practice registered nurses (APRN) working with interprofessional teams, palliative APRNs are well-positioned to direct access and implement quality palliative and hospice service delivery in a continuum of practice settings. There are subpopulations of veterans who need special attention as well as common diagnoses to assess and manage. To mitigate suffering for the veteran and to provide the best care and honor end-of-life preferences, training, education, and resources are available for the palliative APRN working with this population. These resources assist the APRN in meeting the unique biopsychosocial challenges of veterans and their families, including trauma-informed care, moral injury, suicide prevention, posttraumatic stress disorder (PTSD) management, substance use, homelessness, caregiver support, or existential distress.
Anorexia and Cachexia
Authors: Smeltz Robert , Shabin Renata 
Published: May 2023

Abstract
This chapter defines anorexia and cachexia and discusses their relationship as a syndrome. As symptoms, anorexia and cachexia are often seen in most advanced stages of disease. The assessment of anorexia and cachexia is fundamental to establishing an effective treatment plan. For the advanced practice registered nurse (APRN), setting goals and providing patient and family with education on the limits of reversing anorexia and cachexia in advanced disease is critical. A multimodal holistic approach involving pharmacologic and nonpharmacologic measures delivered by an interdisciplinary care team is essential to addressing cachexia and anorexia syndrome.
Bowel Symptoms
Authors: Chow Kimberly , Koranteng Lauren 
Published: May 2023

Abstract
This chapter discusses three common bowel symptoms that are highly prevalent and distressful for palliative care patients: constipation, diarrhea, and obstruction. These symptoms rarely occur in isolation of other clinical manifestations of disease and can affect a person’s quality of life and eligibility for treatment and even may be life-threatening. The advanced practice registered nurse must approach care with a global understanding of the patient’s individual needs, their primary illness, disease-related complications, and past and current treatments. Assessment and management is always provided with respect for the patient’s culture, privacy, and goals of care.
Depression and Suicide
Authors: Chovan John 
Published: May 2023

Abstract
Depressive symptoms are an expected response to psychosocial stress. Diagnosis of and living with a life-threatening, chronic illness cause psychosocial stress that can lead to depressive symptoms. Not all constellations of depressive symptoms, however, are of such severity or duration to constitute a depressive disorder. Irrespective of a diagnosis, depressive symptoms can impact negatively on the patient’s functioning and quality of life and that of their families. Depressive symptoms and depression are discussed across the illness trajectory, including biopsychosocial models of depression, advanced practice registered nurse (APRN) self-assessment, patient and family assessment techniques and tools, and evidence-based guidelines. Patient- and family-centered treatment approaches include pharmacological interventions and nonpharmacological techniques such as psychotherapy, complementary and alternative therapies, and wellness approaches. Because self-harm is associated with depression, patients must be assessed for suicide at every encounter, thus techniques for assessing and intervening are described.
Palliative Emergencies
Authors: Syrett Ann Quinn , Buckley Marcia J. , Carlson Beth 
Published: May 2023

Abstract
This chapter highlights four emergencies that occur in palliative care: hemorrhage, spinal cord compression, seizures, and superior vena cava syndrome. Palliative advance practice registered nurses (APRNs) should understand their etiology, pathophysiology, workup, and management so they can rapidly and expertly respond to these emergencies. Palliative APRNs possess a unique skill set that combines holistic care of patients with the ability to manage acute, often potentially devastating symptoms that often affect patients’ goals and wishes. Goals of care can be static, and the disease state needs to be considered when making treatment and management decisions for these palliative emergencies.
Evaluating and Managing the Agitated Patient
Authors: Hong Victor , Baumhauer Jennifer , Leung Stephen 
Published: May 2023

Abstract
This chapter describes all aspects of the evaluation and management of the agitated patient, one of the most common, and challenging, presentations encountered in psychiatric emergency care. Agitated behaviors range from restlessness to overt physical aggression and can escalate rapidly, placing both the patient and staff at risk of harm. Although early recognition and intervention are crucial for success, the wide variety of underlying etiologies of agitation present barriers to optimal care. This chapter will review how tailoring of treatment interventions has developed to more precisely and effectively target the behaviors while always keeping the safety of the patient and staff at the forefront of one’s mind. It will also review the rise of verbal de-escalation as a first line intervention for agitation management, as well as describing principles of pharmacologic management should verbal de-escalation be inadequate. Special population such as those with personality disorders, substance intoxication or withdrawal, and psychosis or mania, will be explored as each may have particularly effective interventions as well pitfalls to avoid. Finally, as a measure of last resort, guidelines around seclusion and/or restraint will be provided.
Emergency Psychiatry Evaluation and Treatment of Mood Disorders
Authors: Maloy Katherine 
Published: May 2023

Abstract
Mood disorders are highly prevalent and a common cause of presentations to the emergency department. Depression is highly comorbid with substance use disorders and can worsen the course of medical illness. It is also a risk factor for suicide. In addition, depression can be a frequent cause of overuse of emergency services because urgent psychiatric care can be difficult to access outside of a hospital setting. Patients with mania frequently present to the emergency department when their behavior has become so disruptive in the community that the patients are a danger to themselves or others. These patients can be difficult to manage in the emergency setting, particularly when dedicated psychiatric space is not available. The neurologic phenomenon of catatonia can feature in both bipolar illness and depression and is not solely seen in psychotic illness. Emergency clinicians should be familiar with catatonic features and act quickly to treat life-threatening complications such as malignant catatonia. The COVID-19 pandemic has worsened existing disparities in access to care and increased prevalence of mood disorders while straining health care services, particularly emergency departments. As clinicians in the emergency setting, recognizing and treating mood disorders can have a positive impact on patients.
Geriatrics
Authors: Cho Daniel , Takeshita Junji , Huynh Victor , Gomes Ishmael , Hishinuma Earl 
Published: May 2023

Abstract
Psychiatric emergencies in the geriatric population are expected to increase in the next decade and pose a unique challenge for clinicians in the emergency department or emergency consult setting. This cohort generally presents with numerous medical comorbidities and polypharmacy, and clinicians must be aware of age-related changes in physiology and pharmacokinetics. Geriatric psychiatric emergencies may also be precipitated by psychosocial factors such as retirement, grief, or elder abuse. Evaluation should initially focus on safety and typically requires utilization of collateral sources of history. Underlying medical etiologies of delirium should be ruled out, in addition to dementia screening and evaluation of depression or decompensated psychiatric illness. Medications should be used judiciously if indicated, and particular attention should be given to drug interactions and risk of toxicity. The COVID-19 pandemic has complicated the evaluation and management of psychiatric emergencies because there must now be clear procedures for screening, isolating, and treating COVID-19-positive patients. Age remains one of the most robust risk factors for both morbidity and mortality due to COVID-19. The growing use of telepsychiatry has improved access to emergency psychiatric services, geriatric patients included, but can be challenging.
On Measurement and Semantics
Authors: West Colin 
Published: May 2023

Abstract
In everyday language, well-being means different things to different people. The lack of precision resulting from this colloquial language contributes to confusion in discussions of well-being in medicine. To effectively measure and then respond to promote well-being, metrics are required that align with established conceptual frameworks for well-being. This chapter reviews concepts related to measurement instrument validity, the complexity of domains relevant and contributing to well-being, and selected instruments with the most robust evidence base for their use. It will also provide an overview of optimal survey design approaches to inform high-quality measurement. Finally, this chapter specifically discusses key elements of clear messaging around well-being issues in medicine.
What’s at Stake?
Authors: Philibert Ingrid , Konopasek Lyuba 
Published: May 2023

Abstract
This chapter aggregates information on the consequences of burnout in physicians across the continuum of education and practice, including estimates on the impact of burnout on the US health care system. Consequences include increased sick days (absenteeism), lower professional effectiveness in the workplace (presenteeism), reduced participation in team-based models of care, lower quality of care, and higher rates of errors. Physician burnout affects individual physician experience, well-being, and professional fulfillment. Burnout has important consequences for patient experience, quality of patient care, and the work experience of the interprofessional team. Burnout in attending physicians and residents may contribute to burnout and cynicism in medical students. Finally, due to effects on workforce turnover, burnout has great costs to both the health care system and society.
Individually Focused Well-Being Interventions
Authors: Hussain Farah N. , Yaden Mary Elizabeth , Tomescu Oana 
Published: May 2023

Abstract
While a system-level approach is necessary to achieve a significant positive impact on the well-being of medical students and graduate medical education (GME) trainees, individuals share a concurrent responsibility to commit to intentional and strategic self-care that promotes their own well-being. The goals of this chapter are to emphasize the importance of a shared responsibility framework using organizational and individual strategies to promote well-being, introduce an expanded framework for strategic self-care, review the data for many individual-focused strategies that can be utilized by learners when practicing strategic self-care, and provide guidance for the creative integration of individual-focused practices and wellness strategies into programmatic structures and longitudinal curricula. When training programs and schools support well-being by both improving system-level drivers of burnout and facilitating opportunities for strategic self-care, medical students and GME trainees feel valued and encouraged to better care for themselves and the populations they serve.
The Impact of Operation Bushmaster on Medical Student Decision-making in a High-Stress, Operational Environment
Authors: Cole Rebekah , Garrigan Audra G , Peters Sidney A , Conley Sean P , Rudinsky Sherri L , Tilley Laura , Vojta Leslie , Schwartz James , Weston Christopher , Goolsby Craig 
Published: May 2023

ABSTRACT

Introduction
Operation Bushmaster is a high-fidelity military medical field practicum for fourth-year medical students at the Uniformed Services University. During Operation Bushmaster, students treat live-actor and mannequin-based simulated patients in wartime scenarios throughout the five-day practicum. This study explored the impact of participating in Operation Bushmaster on students’ decision-making in a high-stress, operational environment, a crucial aspect of their future role as military medical officers.

Materials and Methods
A panel of emergency medicine physician experts used a modified Delphi technique to develop a rubric to evaluate the participants’ decision-making abilities under stress. The participants’ decision-making was assessed before and after participating in either Operation Bushmaster (control group) or completing asynchronous coursework (experimental group). A paired-samples t-test was conducted to detect any differences between the means of the participants’ pre- and posttest scores. This study was approved by the Institutional Review Board at Uniformed Services University #21-13079.

Results
A significant difference was detected in the pre- and posttest scores of students who attended Operation Bushmaster (P &lt; .001), while there was no significant difference in the pre- and posttest scores of students who completed online, asynchronous coursework (P = .554).

Conclusion
Participating in Operation Bushmaster significantly improved the control group participants’ medical decision-making under stress. The results of this study confirm the effectiveness of high-fidelity simulation-based education for teaching decision-making skills to military medical students.