bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cultural Perspectives of Mental Health and Traumatic Stress
Authors: Goforth Anisa N. , Pham Andy V. 
Published: January 2023

Abstract
The purpose of this chapter is to provide a culturally responsive framework for assessing students who experience difficulties related to mental health and traumatic stress. The chapter highlights the cultural perspectives of mental health and traumatic stress. One such perspective is considering how the construct of mental health or a “life well lived” is shaped by the values of our society. It is critical to consider these cultural factors, including expressions of distress and beliefs about help seeking, within a culturally responsive assessment. There are five steps within culturally responsive assessment: (1) engaging in critical reflexivity, (2) developing relationships and earning trust with the student and family, (3) obtaining background information, (4) conducting interviews with caregivers, (4) administering tests and measures, and (5) providing written and oral feedback to the student and caregivers.
The Couple as “Client”
Authors: Starks Tyrel J. 
Published: January 2023

AbstractThis chapter outlines core concepts of interdependence theory and describes their application to Motivational Interviewing with couples. Dependence is defined as a state in which partners are reliant on one another to achieve desired outcomes. In such situations, when partners’ preferences, priorities, or goals conflict, those in high-functioning relationships have relatively more motivation to set aside a focus on personal gains to consider the consequences of their actions for their partner and the relationship as a whole. This transformation of motivation increases the likelihood of adaptive accommodation responses that minimize conflict and create the opportunity to negotiate consensus or joint goals in which both partners have an investment. The process of facilitating dyadic functioning and techniques such as dyadic reflections and relationship affirmations therefore emerge as novel mechanisms by which the counselor can catalyze the couples’ capacity to identify and work toward shared goals for change.
Session 1: Trichotillomania (TTM) Education, Therapy Overview, Expectations, and Assessment of Pulling Triggers
Authors: Woods Douglas W. , Twohig Michael P. 
Published: January 2023

Abstract
This chapter introduces trichotillomania, which is chronic hair pulling resulting in noticeable hair loss. Scalp hair, eyebrows, and beards are some of the common hair-pulling areas. People diagnosed with trichotillomania experience substantial distress or impairment in important areas of their life. They tend to feel an increasing sense of tension immediately before pulling out the hair and when trying to resist pulling and feel a sense of gratification when pulling hair. Some people tend to use automatic hair pulling, which occurs when hairs are pulled outside of the person’s awareness, while others use focused hair pulling to control private experiences like urges, sensations, thoughts, or emotions. The chapter discusses how trichotillomania can be treated through habit reversal training and trigger reduction procedures and offers ways of self-monitoring trichotillomania.
Session 2: Habit Reversal Training (HRT) and Trigger Reduction Strategies
Authors: Woods Douglas W. , Twohig Michael P. 
Published: January 2023

Abstract
This chapter focuses on habit reversal training (HRT) and trigger reduction strategies for trichotillomania. Habit reversal training helps the patient to stop pulling hair through awareness training and competing response training. Awareness training requires the patient to describe the sensations and behaviors that precede pulling. Competing responses are used to make it physically impossible for the patient to pull their hair. They must be easy to perform and not noticeable. The chapter discusses ways to reduce the triggers to pull in varying environments, such as bathrooms and bedrooms and while playing video games. Trigger reduction strategies should be simple, should make pulling more difficult, and should not be used to avoid uncomfortable experiences.
Session 1: Trichotillomania (TTM) Education, Therapy Overview, Expectations, and Assessment of Pulling Triggers
Authors: Woods Douglas W. , Twohig Michael P. 
Published: January 2023

Abstract
This chapter outlines the first session of the Acceptance and Commitment Therapy (ACT) Enhanced Behavior Therapy for Trichotillomania (AEBT-T). It highlights the purpose of psychoeducation, which is to make sure the client has a basic understanding of trichotillomania (TTM) and knows they are not alone in experiencing the disorder. Clients with TTM often have urges to pull, feel pressure in pulling sites, and experience both pleasure and anger from their pulling. Clients are taught that pulling is a complicated action made up of individual and powerful factors. Clients are introduced to the weekly self-assessments of pulling that they will be asked to complete throughout treatment.
Session 4: Can Pulling-Related Inner Experiences Be Controlled?
Authors: Woods Douglas W. , Twohig Michael P. 
Published: January 2023

Abstract
This chapter covers the fourth session of the Acceptance and Commitment Therapy (ACT) Enhanced Behavior Therapy for Trichotillomania (AEBT-T) treatment package. It outlines ways to help the client see their struggle with urges, other unpleasant inner experiences, or cravings for pleasurable sensory experiences more clearly. The therapist emphasizes that attempts to stop one’s private experiences are ineffective, so other means of dealing with them are needed. The therapist explains why the urge to pull and the feelings associated with it often show up larger than necessary. Examples are provided to illustrate what is meant by finding a way to live with the urge to pull, as well as finding a way to live with something that is a little difficult and how life might improve if one can do so.
Case 15
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 30-year-old woman presented to her GP with a two-day history of dysuria, urinary frequency, and an offensive smell to her urine. She was 28 weeks pregnant in her first pregnancy. Her pregnancy had been uncomplicated apart from a previous urinary tract infection with similar symptoms 6 weeks prior to this presentation. A urine culture at this time had confirmed E. coli, sensitive to amoxicillin, so she was given a 5-day course, which led to resolution of her symptoms. She was otherwise fit and well with no past medical history, and was not taking any regular medications. She lived with her husband, worked as an accountant, and had never smoked.
Case 16
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 25-year-old woman attended her 16-week antenatal appointment with her midwife and mentioned she had developed intermittent pain affecting the small joints of both hands and wrists 10 months prior to this appointment, but they had become more problematic in the preceding 5 weeks. In addition, she had developed a facial rash, intermittent chest discomfort, and shortness of breath. This was her first pregnancy. Her booking BP was 117/70 mmHg and BMI was 27 kg/m2. She took no medication, and she had no significant past medical history or family history. She did not smoke or drink alcohol. She was referred for urgent review.
Case 23
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 45-year-old woman in her second pregnancy presented to the maternity assessment unit at 35 weeks of gestation. She reported flashing lights in her eyes as well as a dark spot in the periphery of her vision. The symptoms started when she woke in the morning and had progressed so that the vision in her left eye was very blurred. She also had a dull frontal headache and a swollen face and ankles. Her first pregnancy 5 years previously was uncomplicated. Her past medical history included type 2 diabetes mellitus and she was taking metformin and insulin in pregnancy as well as aspirin. Her blood pressure at booking had been normal (118/70 mmHg). Home blood pressure monitoring during this pregnancy had not identified any high readings. Her sister had suffered with hypertension in pregnancy, but there was no other family history of note. She was a non-smoker.
Case 25
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 21-year-old woman with type 1 diabetes mellitus attended the obstetric diabetes clinic at 35 weeks of gestation. She reported that she had been woken by the alarm on her continuous glucose monitor on four occasions over the last week due to early morning hypoglycaemia. She had also had two hypoglycaemic episodes during the day over the last 2 days, despite a reduction in basal insulin rate on her pump over the last week. Other medications included regular aspirin and vitamin D. Her HbA1c at the start of pregnancy was 53 mmol/mol and was 49 mmol/mol at 28 weeks of gestation. She had no other medical conditions.
Test Accuracy, Sensitivity, and Specificity
Authors: Boyles Tom 
Published: January 2023

Abstract
This chapter explains how to use a 2×2 table to calculate test accuracy, sensitivity, and specificity, with the latter being calculated from the columns. It then explains the drawbacks of each statistic including that none answer questions that are directly relevant to patients, rather focusing on the performance of tests in populations already known to either have, or not have, the condition. It then explains that these statistics retain some value, particularly when approaching 100%, but otherwise it is not intuitively obvious what test results mean for patients. The chapter then describes the receiver operator characteristic (ROC) curve, which illustrates the accuracy of a test with continuous, rather than binary, outputs and can be summarized with the area under the ROC (AUROC or C-statistic). It explains that AUROCs are unhelpful when a population is imbalanced between those with and without the condition, in which case a precision–recall curve may be more appropriate.
Decision Thresholds
Authors: Boyles Tom 
Published: January 2023

Abstract
This chapter draws on the classic papers by Pauker and Kassirer to describe a basic method of determining whether a test is likely to influence the management of a patient and is therefore worthwhile. It begins by defining the therapeutic threshold which is the probability of disease at which the clinician experiences equipoise between treating and not treating the patient when no more tests are available. It explains the major influencers of therapeutic threshold and how it might be calculated either empirically or using experience. The chapter then explains how therapeutic threshold relates to testing by informing the test threshold and test–treatment threshold, which describe the probability above and below which a test result will not change the decision to treat or not treat a patient.
Frameworks for Evaluating Medical Tests
Authors: Boyles Tom 
Published: January 2023

Abstract
This chapter describes ways of evaluating tests so that they can be assessed for inclusion in public health programmes, rather than for use on individuals. It details the key principle of medical test evaluation, which is to show improved health outcomes, or other benefits such as reducing costs, or simplifying healthcare delivery without compromising the well-being of patients. It uses the example of the standard four-phase approach to drug evaluation to highlight the lack of such a consensus for test evaluation. Instead, multiple frameworks have been suggested, notably by Fryback and Thornbury and by Sackett and Haynes. Rather than choose a proposed framework, the chapter explains that three basic phases of test evaluation will be covered: ‘test research’ as outlined in Chapter 1, ‘diagnostic research’ which draws together as much relevant information about a patient as possible to develop diagnostic strategies, and ‘diagnostic intervention research’ to determine if diagnostic strategies improve real-world outcomes of patients and at what cost.
Impact Studies
Authors: Boyles Tom 
Published: January 2023

Abstract
This chapter describes studies designed to determine how well the outputs of diagnostic and prognostic research can improve patient outcomes and reduce costs. It explains the differences between assistive and directive methods of influencing healthcare provider and patient behaviours. It then covers multiple possible trial designs beginning with cheap and fast methods such as cross-sectional studies measuring changes in healthcare provider behaviours, through decision analytic modelling studies to randomized controlled trials drawing on the example of the High-STEACS study of high-sensitivity cardiac troponin. Potential complications with trial design are then discussed using theoretical examples of test/treatment combinations.
Healing and Whole-Person Care
Authors: Hutchinson Tom A. , Hutchinson Nora 
Published: January 2023

AbstractWhen Cicely Saunders set up St. Christopher’s Hospice in 1967, she created whole-person care for patients who were dying and a model for the transformation of healthcare. This model of care, which combined healing and curing, has key aspects that needed to be addressed if the full potential of palliative medicine is to be realized. (1) Healing is a complex powerful process that is unpredictable and difficult to measure. (2) Curing is a radically different process, the impact of which is easier to quantify. These two processes synergize, but, in the tension between them, curing tends to be favored over healing. (3) The efficiency promoted by most healthcare institutions focuses primarily on the measurable actions and outcomes related to curing, further decreasing the time and attention to healing. (4) The authors have taught an approach to care based on mindfulness and congruence (mindful clinical congruence) to all medical students in all 4 years at McGill University that promotes a way of relating to patients that makes space for both healing and curing. (5) For this approach to succeed, both in palliative care and healthcare generally, will require a new kind of medical professionalism, where healing is seen as the bedrock of practice and curing as the context in which healing takes place. Communities of trust will be necessary for this transformation, which the authors believe will benefit both professional caregivers and the patients to whom they deliver care.
Diagnosis and Management of Depression in Palliative Care
Authors: Fairman Nathan , Irwin Scott A. 
Published: January 2023

Abstract
Depression occurs frequently in individuals with advanced disease, and its consequences can be serious. A profoundly painful experience, depression can cause significant physical, emotional, and social disability. It can deprive patients of the ability to experience joy and pleasure; it can create feelings of worthlessness and meaninglessness; it can cause distress for loved ones; it can amplify physical symptoms and undermine the response to disease treatment; it even has the power to make death itself appealing. This chapter provides a succinct review of the approach to identifying and addressing depression in palliative care settings. Because several different conditions share the common feature of depressed mood, distinguishing among these different conditions requires a careful approach to assessment. Fortunately, even in the context of serious illness, including near the very end of life, individuals with depression can often experience relief through management strategies that include psychosocial interventions, various psychotherapies, and a variety of evidence-based medication treatments.
Suicide and Desire for Hastened Death in the Terminally Ill
Authors: Walsh Leah E. , Polacek Laura C. , Heule Marjorie , Rosenfeld Barry 
Published: January 2023

Abstract
Patients in the palliative care setting are often faced with thoughts of a threatened or limited life expectancy due to their illness. The transition from curative to palliative treatment can signify to the patient that recovery from the illness is no longer possible and the most that medical care can offer is physical comfort. In some patients, this realization can lead to a desire for a more rapid death or even thoughts of suicide, as evidenced by elevated rates of suicide in patients with advanced medical illnesses. Understanding a patient’s expressions of the wish to hasten death in the context of serious medical illness has become more complicated over the past decades, particularly given the growing trend toward legalization of physician-assisted dying. Thus, it is crucial for healthcare providers to understand the risk factors for suicide and desire for hastened death in order to properly assess and respond to these patients. This chapter provides a broad overview of the reasons behind and risk factors for suicide and desire for hastened death, as well as how to assess and respond to these expressions in patients with advanced medical illness.
Palliative Care in the Patient with Substance Use Disorder
Authors: Amaram-Davila Jaya S. , Arthur Joseph A. 
Published: January 2023

AbstractOpioids remain the mainstay for the treatment of pain among patients with advanced disease. Unfortunately, its nonmedical use and associated substance use disorder (SUD) have become of utmost concern among the medical community, especially in this era of the opioid crisis. There is an emerging need for palliative care among this subset of patients who develop these comorbid conditions. Current evidence suggests that nonmedical opioid use may be more prevalent among patients with advanced illness than previously thought. Data suggest that pain continues to be undertreated even among patients at the end of life. Clinicians therefore face the challenge to prescribe opioids to alleviate patients’ symptom burden while making all efforts to safeguard its appropriate use and mitigate the development of SUD. To overcome these challenges, clinicians can utilize a universal precautions approach while prescribing opioids. This chapter describes the scope of nonmedical use and SUD among patients with advanced disease and outlines practical strategies to ensure safe opioid prescribing practice. These may include obtaining comprehensive patient histories, screening all patients receiving opioid therapy using validated risk assessment questionnaires, and intensifying patient education on safe use, storage, and disposal of opioids. Best practices recommend using urine drug tests and prescription drug monitoring programs to monitor inappropriate opioid-related behaviors during routine chronic opioid therapy. Ultimately, the goal of all healthcare providers is to achieve the optimal risk-benefit ratio in opioid prescribing and provide improved quality care for palliative care patients with SUD.
Bereavement in Palliative Care
Authors: Lichtenthal Wendy G. , Fadalla Carol , Singer Jonathan , Roberts Kailey E. , Rosa William E. , Watsula Amanda , Prigerson Holly G. 
Published: January 2023

Abstract
Grieving often begins at the time of a diagnosis, continuing as the patient faces numerous role and functional losses, surging when death is anticipated, and most often manifesting most intensely for the family after the patient’s death. This chapter focuses on how palliative care clinicians may support those who are grieving, describing adaptive and pathological grief reactions and risk factors for poor bereavement outcomes. Additional information is provided on how to identify family members at greatest risk for debilitating grief reactions and how to assess and diagnose different bereavement-related mental disorders. The impact of patient loss among professionals is also reviewed.
Physical Symptom Management in the Terminally Ill
Authors: Portenoy Russell K. , Bruera Eduardo 
Published: January 2023

Abstract
Physical symptoms, such as pain, breathlessness, and fatigue, are highly prevalent in all populations with serious chronic illness. The distress accompanying symptoms that remain poorly controlled as disease progresses commonly affects both the patient and family. Symptom management is a key objective of palliative care, and all clinicians involved in the care of those with chronic illness can contribute by recognizing symptom distress, participating in a comprehensive assessment, and guiding the safe and effective use of both nonpharmacologic and pharmacologic therapies. This chapter describes the principles of symptom assessment and the management of a common group of physical symptoms based on the best evidence available.
Eating Issues in Palliative Cancer Patients
Authors: Hopkinson Jane B. , Amano Koji , Baracos Vickie E. 
Published: January 2023

AbstractEating issues are common in palliative care cancer patients. They accompany cancer cachexia, the debilitating syndrome associated with muscle wasting, involuntary weight loss, physical decline, fatigue, and poor appetite. These symptoms have emotional and social impact. They can adversely affect health-related quality of life in patients with advanced and progressing disease. The health and well-being of family members of patients with the syndrome can also be adversely affected. This chapter gives a brief overview of cancer cachexia syndrome, considers treatments, its emotional and social impact, and the measurement of associated distress. The authors draw on a systematic search of literature about psychosocial support for patients with cachexia to present a framework of factors that can influence quality of life and present a measure of cachexia-related distress in patients with advanced cancer. The chapter concludes by considering the implications for palliative care clinicians. In the absence of treatment for cancer cachexia, attention to psychosocial factors affecting cachexia-related quality of life is key to improvement in cachexia care.
Fatigue at End of Life
Authors: Hays Meredith , Santisi Han Le , Mahon Margaret M. 
Published: January 2023

Abstract
Fatigue is common in people with serious illness but is greatly underrecognized. Fatigue has been studied most commonly in people with cancer, although it has also been described (albeit still underrecognized) in people with HIV/AIDS, heart disease, lung disease, and others. Though people with fatigue tire easily, the symptom is much broader, typically including physical weakness and mental fatigue (difficulty concentrating and emotional lability). Fatigue limits one’s ability to participate in activities of daily living, and the implications for family or other caregivers are significant. Fatigue is poorly understood by clinicians, which undoubtedly contributes to lack of understanding by patients and families. Researchers have developed multiple tools to assess fatigue, some unidimensional, some multidimensional. Given the complex nature of the condition, while multidimensional tools may more accurately capture the patient’s experience. Fatigue can be caused by disease or treatment. Though incompletely understood, hypothesized causes include immune, inflammatory, hematologic, endocrine, and other causes. It is unlikely that any single treatment, nonpharmacologic or pharmacologic, will completely relieve fatigue. Many nonpharmacologic interventions have been studied: exercise and energy conservation have been most successful. Data about the efficacy of pharmacologic modalities are similarly mixed: methylphenidate, corticosteroids, and placebo have been beneficial in some studies. Patients and families will benefit from an interdisciplinary approach, enabling exposure to experts with expertise in a range of areas and tools.