bluuebunny/crossref_metadata_2025_split huggingface dataset:
Case 14
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 40-year-old woman in her first pregnancy with no past medical history presented at 35 weeks of gestation with a 3-day history of a sore throat. She had not been able to eat or drink anything for 24 hours and had also intermittently vomited. She did not report diarrhoea and no other family members were unwell. She had been entirely well until this point in her pregnancy, with normal blood pressure and BMI at booking. She was not on any medications. She was a non-smoker and did not drink alcohol. On examination she was unwell and dehydrated with a heart rate of 100 bpm and respiratory rate 40 breaths/min. She had 4+ ketones in her urine.
Case 26
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 36-year-old woman in her second pregnancy presented at 25 weeks of gestation with shortness of breath and lethargy. She also reported headache, visual disturbances, and feeling dizzy. Her pregnancy had been complicated by protracted nausea and vomiting beyond the first trimester, severely limiting her oral intake. Anaemia had been identified on her booking bloods and she had been treated with oral iron. Her first pregnancy had also been complicated by nausea and vomiting throughout pregnancy, and she had an uncomplicated vaginal birth at term. On examination she was pale, her heart rate and blood pressure were normal and she had 3+ protein on urine dipstick.
Case 28
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 41-year-old woman was seen in the maternal medicine clinic at 20 weeks of gestation. She was being reviewed regularly due to a background history of Crohn’s disease for which she took azathioprine. Ten years prior to pregnancy she had had small bowel obstruction with subsequent laparotomy and ileal resection. Her last flare was 18 months ago, and she had previously had a perianal fistula, but this had healed. At this appointment she described feeling generally unwell, with extreme fatigue, loss of appetite, and had lost 8 kg of weight unintentionally in the preceding few weeks. She described intermittent diarrhoea and constipation, intermittent abdominal pain but no blood or mucus in the stool and no vomiting.
Case 31
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 33-year-old woman attended for pre-pregnancy counselling. She had a history of end-stage renal failure, having presented at the age of 18 with severe hypertension. She had been found to have bilateral small kidneys on ultrasound and a biopsy had not been performed. She was started on peritoneal dialysis via Tenckhoff catheter at the age of 21 and had a non-related donor transplant at the age of 26. She had remained very well since the transplant with no episodes of rejection. Her maintenance treatment was tacrolimus and azathioprine. She remained normotensive and had no proteinuria. She was planning a cycle of in vitro fertilization because of a history of polycystic ovarian syndrome and anovulation. Previous ovulation induction with letrozole had not been successful.
Case 32
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 29-year-old woman presented at 11 weeks of gestation with a lump in her right breast, which she had first noticed when having a shower a week prior to presentation. There were no associated skin changes, pain, nipple discharge, or other lumps. She had never had anything similar before. Her first pregnancy 3 years previously had been uncomplicated, and she had a vaginal birth after the spontaneous onset of labour at term. She had no past medical history. She was taking pregnancy vitamins and had no known allergies. There was a family history of breast carcinoma in her sister and maternal aunt. She had never smoked and did not drink alcohol.
Case 33
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 20-year-old woman in her first pregnancy presented at 29 weeks of gestation with repeated generalized tonic-clonic seizures. She had been unwell in the preceding 24 hours with vomiting and significantly reduced oral intake. In childhood she had been diagnosed with juvenile myoclonic epilepsy, for which she had been on 75 mg lamotrigine twice daily prior to pregnancy. This dose had not been increased during pregnancy. Prior to this she had had no seizures for over a year. She had no other past medical history and was not taking any other medications. There was no family history of significant illnesses. She had never smoked.
Case 36
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 43-year-old woman presented to the Emergency Department at 37 weeks of gestation with central chest and epigastric pain as well as shortness of breath on exertion. She had had similar symptoms intermittently from 20 weeks. She had seen her GP and started antacid therapy. On the day of presentation, the pain and breathlessness had started when she had climbed some stairs but had persisted for an hour when she stopped. She had taken some antacid liquid, but this had not improved her symptoms. At its worse, the pain was 8/10 in severity. She felt nauseated and had vomited once. She felt sweaty and unwell.
Case 37
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 29-year-old woman in her first pregnancy presented in early labour at 38 weeks of gestation. Her pregnancy had been complicated by nausea and vomiting in the first trimester and heartburn later in pregnancy. She had been well and continued to work as a primary school teacher until the preceding week. Initial observations were normal, and she was admitted to the labour ward. She was progressing well, but then started to feel unwell and mentioned this to her midwife. She then started to have a rigor, but her temperature remained normal.
Case 39
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 23-year-old woman in her first pregnancy presented at 32 weeks of gestation with severe chest pain, shortness of breath, and bilateral lower limb pain. She was known to have sickle cell disease (HbSS), and prior to pregnancy she had had several admissions with vaso-occlusive crises, including two episodes of chest crisis requiring intensive care support. Whilst regular exchange transfusions had been planned in pregnancy, she had not attended for these since 20 weeks of gestation. Her last vaso-occlusive crisis was 5 weeks prior to this presentation, and she had managed this at home with analgesia. She was prescribed regular aspirin, phenoxymethylpenicillin, and folic acid, however she did not take all of these every day. There was a family history of sickle cell disease. She did not smoke.
Case 40
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 35-year-old woman presented to the Maternity Assessment Unit at 34 weeks of gestation with a 12-hour history of reduced fetal movements, on a background of three days of right upper quadrant and epigastric pain, and then vomiting. Her pregnancy had been otherwise uncomplicated with a normal blood pressure at booking (110/65 mmHg). She had a family history of pre-eclampsia. The midwife was unable to auscultate the fetal heart on initial assessment. On examination she was unwell, tachycardic (118 beats per min) and hypertensive (150/90 mmHg). Urine dipstick showed 4+ protein and 2+ blood.
Case 41
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 28-year-old woman presented to the Emergency Department with a 1-day history of vomiting blood, following 10 days of profuse vomiting. She reported vomiting a large spoonful of bright red blood on 2 occasions over the last day. The first time was at the end of a bout of vomiting and the blood mixed with vomitus. The second time was before any further vomiting, and she described fresh, bright red blood. She reported vomiting more than 6 times each day, retching many times each day, and feeling nauseated for most of the day. She found it increasingly hard to eat and vomited after eating and drinking fluids. She had also experienced some epigastric tenderness for 2 days. She had not opened her bowels for 2 days but prior to that reported normal stool.
Case 43
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 36-year-old woman in her first pregnancy presented to hospital in spontaneous labour at 38 weeks of gestation. She had no past medical history and had taken only simple analgesia prior to labour. Her booking BMI was 38 kg/m2. An oxytocin infusion was started for failure to progress, and she had an epidural. Antibiotics were administered as she had previously had a urine sample that showed group B streptococcus. In the moments before birth, she had complained of chest pain and breathlessness and had become increasingly agitated and incoherent. A forceps delivery was performed for fetal bradycardia. Shortly after the birth she became unresponsive with no cardiac output. Cardiac arrest was confirmed, and cardiopulmonary resuscitation was commenced.
Case 54
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 37-year-old woman presents to the maternity assessment unit at 34 weeks of gestation with a 4-day history of vomiting, dizziness, and fatigue. She had been found to have SARS-CoV2 infection 9 days previously, when she had developed a dry cough, myalgia, and intermittent high fevers. The fevers and cough had stopped 6 days ago, but she had continued to feel unwell. She then developed vomiting, fatigue, and dizziness, which had progressively worsened. She did not have any abdominal pain or diarrhoea, had no shortness of breath, cough or coryza, and had no urinary symptoms. She had a history of sarcoidosis for which she was taking prednisolone regularly.
Case 55
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 28-year-old woman with no past medical history was pregnant for the first time. She booked with her midwife at 9 weeks of gestation. Her blood pressure and BMI were normal, and she was scheduled for low-risk midwifery-led care. She has been taking pregnancy vitamins for more than 3 months prior to conception. Her booking bloods, however, were significantly abnormal and she was referred for further review in clinic.
Difficult Personality Traits and Disorders in Palliative Care
Authors: Wynn John 
Published: January 2023

AbstractThis chapter focuses on how clinicians can assess, understand, and care for patients with difficult personality traits and personality disorders. A minority of terminally ill patients respond to crisis with self-defeating, alienating strategies that confuse and trouble clinicians. Staff may find them aggravating, aggrandizing, chaotic, dramatic, or odd. Their dysfunctional responses may foil treatment or monopolize resources. Staff may feel anger, disinterest, neglect, guilt, even hatred toward these patients or family members. Despite attempts to cope with such strong and “unprofessional” feelings, clinicians may label the patient as uncooperative, bizarre, dramatic, demanding, or simply “impossible.” Blaming or dismissing such patients may ensue, with adverse consequences for all involved. Labeling or blaming is of little help. This chapter provides insight and practical information for working with these puzzling patients. DSM diagnostic categories and the hazards of diagnostic labeling are explained. A clinical system is presented to identify patients’ coping strategies. Staff responses are seen as typical, understandable, and modifiable with consultative input. Realistic responses—to help patients, families and staff weather the cancer experience—are explained. The roles of palliative care clinicians as well as psychiatric consultants are considered, including necessary jargon but focusing on practical understanding and tools.
Screening for Psychological Distress in the Palliative Care Setting
Authors: Gascon Bryan , Rodin Gary , Zimmermann Camilla , Li Madeline 
Published: January 2023

Abstract
Screening for distress, the sixth vital sign, has gained international momentum in the past decade. It is increasingly being established as an accreditation requirement by medical regulatory bodies. It plays an important role in palliative care populations, where psychological distress may often be missed. The management of psychological distress is facilitated by routine screening for emotional distress, mood and trauma symptoms, and existential distress using patient-reported outcome measures (PROMs) validated in these populations. This chapter describes successful strategies for distress screening implementation in the palliative care setting. The authors also provide an overview of the psychometrics of screening tools and guidance on brief PROMs that can be used to screen for psychological distress in palliative care. Future work in this area is needed to validate screening tools in the palliative care setting, expand the evidence base for effective distress screening practices in this population, and demonstrate its effect on health outcome of patients and their families.
Building Interdisciplinary Teams of Excellence
Authors: Salman Jaroslava , Kotwal Juee , Loscalzo Matthew 
Published: January 2023

AbstractInterdisciplinary teams are now considered a standard of care in the field of supportive and palliative medicine. Forming a successful team requires careful consideration of patients’ and families’ needs, institutional resources, and expectations for effective teamwork. Assembling a team of experts in no way guarantees creating a successful team. Close attention must be paid to the recruitment of the right staff as well as to intra-team dynamics and functioning. The staff leadership model is one such strategy to enhance effective interdisciplinary teamwork, emphasizing personal accountability and compassion directed not only to patients and families but also to colleagues. Only a well-functioning team can provide the right environment for educational, professional, and personal development of its team members while maintaining its commitment to its mission and values of excellent clinical care.
Psychosocial Benefits of Early Palliative Care Intervention
Authors: Wu Carrie C. , Temel Jennifer , Pirl William 
Published: January 2023

Abstract
There is increasing recognition that palliative care interventions should be offered concurrent to cancer diagnosis and treatment. The model of service delivery has evolved throughout the years, from a primarily inpatient and crisis-driven service model to a model that encompasses both inpatient and ambulatory settings. This shift has allowed for the progression and development of early integrated palliative and oncology care. Studies using a variety of palliative care interventions, from traditional provider-based referrals to educational and case-management interventions, have shown clinically significant benefits for patients. Patients receiving early palliative care services demonstrate a more proactive approach-oriented coping style, report reduced rates of depression, report better quality of life, and use less aggressive treatments at the end of life, without detriment to survival. Although psychiatry has not been formally included in early palliative care trials, collaborative efforts with psychiatrists may offer creative ways of addressing psychosocial issues at the onset of cancer diagnosis.
Cultural Diversity and Palliative Care
Authors: Pelleg Ayla , Smith Cardinale B. , Blackhall Leslie 
Published: January 2023

Abstract
Palliative care is standard of care for all patients with serious illness, including culturally diverse patients who often experience racial and ethnic health disparities. Healthcare disparities lead to patients receiving care at more advanced stages of illnesses, getting more fragmented care, and often resulting in increased morbidity and mortality. This chapter focuses on cultural diversity in regard to patient values, access to care, and receipt of care, and it discusses next steps in how to mitigate cultural differences to provide equitable care to all patients. Though cultural diversity can be defined in many ways and is often self-determined, this chapter focuses on health inequalities within the United States and for Black and Hispanic minority patients, and it touches on health disparities among Asian minority patients.
Palliative Aesthetics
Authors: Miller B. J. , Glaser Johanna , Burke Justin 
Published: January 2023

AbstractThis chapter serves as an introduction to palliative aesthetics, a long unnamed therapeutic approach in serious illness care that draws on philosophy, medical history, current medical practices, the arts, and design. Aesthetics is the branch of philosophy traditionally associated with the nature of art and beauty, but these elements do not exhaust its full scope. Here the authors disengage the concept of the aesthetic from its domination by cosmetic pleasantry, thereby opening it up and simultaneously returning to its foundation in sensation, perception, and experience more broadly and deeply. Thus conceived, the authors present palliative aesthetics as the application of philosophical aesthetics to the aims, practices, and therapeutic modalities of hospice and palliative medicine. The chapter begins by introducing the philosophy of aesthetics and providing an inventory of its application in historical medical practice, meaning-based therapy, dignity therapy, and integrative medicine. The concept of aesthetic knowing, the grounding of truth in the body, and aesthetics’ therapeutic potentials are discussed, with an emphasis on its self-sufficient, experiential, accessible, and immediate nature, along with its capacity to establish connection, provide a sense of wholeness, and safely render narratives of meaning unnecessary. The authors offer palliative aesthetics as a tool to address various forms of suffering in serious illness, especially in the face of existential distress and experiences of meaninglessness. Aesthetics has the capacity not only to diminish suffering but to actively augment aliveness, thereby expanding the impact of palliative medicine and making good on its promise to realize quality of life.
Narrative Medicine
Authors: Steinhauser Karen E. , Winger Joseph G. 
Published: January 2023

Abstract
Stories allow us to exchange contexts, causes, and consequences of illness and suffering as well as sources and paths of healing. In palliative care, stories hold data informing an understanding of whole-person pain. The capacity to elicit a patient’s narrative—including illness understanding, history, hopes, and fears—is a central competency in the service of facilitating medical decision-making, informing a plan of care, and, in short, reducing suffering and increasing quality of life. In this chapter, the authors discuss the tradition of narrative medicine and its specific relationship to palliative care as both a clinical competency and an intervention for impacting patient, family caregiver, and provider well-being. They make recommendations for future work in the field including the importance of identifying a standard definition of what constitutes narrative methods, conceptual frameworks linking narrative methods with outcomes, and core validated outcomes that can be part of the conceptual framework and future studies. Furthermore, the field would be improved by the addition of rigorously conducted trials of patient- and caregiver-focused narrative medicine interventions in palliative care populations representing a variety of illness types and stages and narrative interventions in populations of clinicians to test its efficacy as a means of mitigating burnout and deepening professional meaning. Finally, the field would benefit from training and evaluation of narrative competencies for palliative care clinicians.
Special Care Considerations for the Seriously Ill Older Adult
Authors: Pelleg Ayla , Morrison R. Sean , Meier Diane E. 
Published: January 2023

AbstractAlmost all current and future medical providers will take care of older adults in their careers, thus knowing how to approach this patient population is essential. The current, fragmented US healthcare system often does not meet the needs of older adults with serious illnesses, which results in frustrating and confusing experiences for patients; high costs for society, patients, and families: and harms from under- and overdiagnosis and treatment. Although geriatrics and palliative medicine are specialties designed to improve the experience and outcomes of care for older persons, access to these services is inadequate and variable. This chapter focuses on optimizing healthcare during serious illness for adults 65 years old or older within the United States with a review of the influence of the physiology and biology of aging on treatment, the implications of aging demographics on healthcare systems, common geriatrics syndromes and their interaction with coexisting serious medical illness, and the range of evidence-based models shown to improve experience and outcomes of care during serious and complex illness. This chapter also discusses the rapidly spreading “4M’s” framework (focusing on Mobility, Mentation, Medications, and what Matters) for organizing care delivery for older people.
The problems of pain in Western society
Authors: Sullivan Mark D. , Ballantyne Jane C. 
Published: January 2023

Abstract
This chapter examines the different kinds of problems that pain has posed over the past millennium. Until about 1500, pain was primarily understood as a religious problem. Pain and suffering challenged the truth of religious belief and the legitimacy of the Church. All pain and suffering happened for a reason. As our society became more secular over the next 300 years, pain came to be understood primarily as a social problem. Our modernizing society aimed to create the best environment for human flourishing by reducing the pain and suffering of everyone to the minimum possible. At least since 1900, we have separated pain as a medical problem from the remainder of human suffering. Now pain has causes rather than reasons. We have aimed to reduce this problem to a minimum through medical treatment. This quest has led us to our opioid epidemic.
The medical dream of conquering pain
Authors: Sullivan Mark D. , Ballantyne Jane C. 
Published: January 2023

Abstract
This chapter tells the story of pain shifting from being inevitable and essential suffering to becoming inessential suffering that did not need to be borne. The story begins with the birth of anesthesia, hailed as the conquering of pain. That event alone opened up many possibilities beyond opioids and alcohol for controlling pain, and changed the minds of many who saw pain as something that morally must be endured. The story continues with the pioneers of pain medicine, the narrowing of the goal of pain relief into simple intensity reduction, and the commandeering of the vision of pain medicine’s pioneers into a huge commercial venture that misunderstood the limitations of pain intensity reduction if divorced from the wider suffering caused by pain.