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1
Barton, Paul E. Welfare: Indicators of dependency. Princeton, N.J: Educational Testing Service, 1998.
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2
Nigge, Karl-Michael. Life Cycle Assessment of Natural Gas Vehicles: Development and Application of Site-Dependent Impact Indicators. Berlin, Heidelberg: Springer Berlin Heidelberg, 2000.
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3
Lamonte, Jean R. Aromatase inhibitors: Types, mode of action and indications. New York: Nova Biomedical Books, 2009.
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4
Welfare dependency: Hearings before the Subcommittee on Social Security and Family Policy of the Committee on Finance, United States Senate, One Hundred Second Congress, first session, March 4 and 8, 1991. Washington: U.S. G.P.O., 1991.
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5
United States. Dept. of Health and Human Services, Hrsg. Indicators of welfare dependence: Annual report to Congress. [Washington, D.C.]: U.S. Dept. of Health and Human Services, 1997.
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6
Lensink, Robert, und Howard White. Aid Dependence. Issues and Indicators (Expert Group on Development Issues, 1998, 2). Almquiest & Wiksell Intl, 1998.
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7
Thurner, Paul W., und Wolfgang C. Müller, Hrsg. Comparative Policy Indicators on Nuclear Energy. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780198747031.003.0003.
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This chapter provides an overview of the relevance of nuclear energy worldwide and especially in Europe (EU-27 + Switzerland) in the most recent decades. It presents the number of reactors currently connected to the grid and under construction as well as their capacities. It differentiates between nuclear energy’s contribution to gross inland energy consumption and to electricity production. These patterns are contrasted with the import dependency of countries. Counter-intuitively, it can be shown that import dependency does not explain the observed extent of the usage of nuclear energy. Rather there seem to be positive feedback processes between enhanced nuclear power usage, economic growth, and further reliance on external resources.
8
Krzywdzinski, Martin. Consent. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198806486.003.0003.
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This chapter deals with the dependent variable of the study: consent. It analyses workplace consent in Russia and China using three indicators that refer to the core requirements of the production systems in automotive companies regarding employee behavior: first, standardized work; and second, compliance with expectations in terms of flexibility, cooperation, and a commitment to improving processes. The third indicator of consent (or the lack of it) is the absence or presence of open criticism, resistance, and labor disputes. The chapter reveals significant and unexpected differences between the Chinese and Russian sites on all three indicators. While the Chinese factories exhibit (with some variance between the companies), a relatively high level of consent, the Russian plants have problems with standardized work, the acceptance of performance expectations, and to some extent with labor disputes.
9
Sapiro, Gisèle. Field Theory from a Transnational Perspective. Herausgegeben von Thomas Medvetz und Jeffrey J. Sallaz. Oxford University Press, 2018. http://dx.doi.org/10.1093/oxfordhb/9780199357192.013.7.
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This chapter provides a new reading of field theory from a transnational perspective in light of the criticism taking issue with its alleged “methodological nationalism.” The field is an abstract concept that allows for the methodological autonomization of a space of activity defined in relational terms, provided that this autonomization is historically and sociologically grounded. As a result, fields are not necessarily limited to the perimeters of the nation-state. After reviewing the process of differentiation of fields and the phenomena of dependence and embeddedness, the chapter addresses the phenomena of nationalization and the role of the state in the formation of fields, then analyzes different modes and strategies of internationalization in relation to the structure of international power struggles, and to the tensions between state, market, and field borders. Finally, indicators of the emergence of transnational fields are proposed. In conclusion, the chapter comes back to the question of comparativism.
10
Jackson, Kristina M., und Carolyn E. Sartor. The Natural Course of Substance Use and Dependence. Herausgegeben von Kenneth J. Sher. Oxford University Press, 2014. http://dx.doi.org/10.1093/oxfordhb/9780199381678.013.007.
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Substance use and substance use disorders show normative epidemiological age-related trends, with typically onset in the late adolescent to young adult years, manifesting peak prevalences in emerging adulthood, and decreasing thereafter. Although less prevalent in older adults, substance misuse is more consequential when present and thus represents a public health concern. Careful examination of the population-based empirical literature indicates the necessity of viewing substance involvement in the context of development, with unique developmental factors associated with its onset, course, and resolution. Many individuals who suffer from a substance use disorder appear to “recover” without formal treatment. Despite normative age-related trends, there is considerable individual course variation, and modern statistical techniques have identified several distinct prototypic courses that appear to differ in their determinants and consequences. Research using a lifespan perspective on substance use and misuse has powerful implications for the design of effective, developmentally informed prevention and intervention programs.
11
Life Cycle Assessment of Natural Gas Vehicles: Development and Application of Site-Dependent Impact Indicators. Springer, 2011.
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12
Nigge, K. M. Life Cycle Assessment of Natural Gas Vehicles: Development and Application of Site-Dependent Impact Indicators (Wissenschaftsethik und Technikfolgenbeurteilung). Springer, 2000.
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13
Kessels, Roselinde, und Guido Erreygers. A unified structural equation modelling approach for the decomposition of rank-dependent indicators of socioeconomic inequality of health. UNU-WIDER, 2015. http://dx.doi.org/10.35188/unu-wider/2015/902-2.
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14
Cavanna, Andrea E. Zonisamide. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198791577.003.0016.
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Zonisamide is a second-generation antiepileptic drug characterized by a few antiepileptic indications, with an acceptable interaction profile in polytherapy. Zonisamide has an acceptable tolerability profile in patients with epilepsy, with depression, irritability, agitation and psychosis as the most commonly reported psychiatric adverse effects. Zonisamide has no approved indications or clinical uses in psychiatry, as initial findings from uncontrolled studies suggesting effectiveness in the treatment of patients with bipolar disorder did not find confirmation. There is preliminary evidence for possible usefulness of zonisamide in the treatment of patients with obesity and psychotropic-associated weight gain, as well as alcohol dependence and withdrawal.
15
Grinsell, D., D. R. Theile und W. A. Morrison. Replantation. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.012027.
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♦ Digital replantation is the best reconstruction available for the correct indications♦ Amputated thumbs, multiple fingers, and paediatric replants are the strongest indications♦ A functional result requires a mobile, stable, sensate digit of adequate length♦ Replant survival and functional results are dependent on multiple factors including microsurgical expertise♦ Spare part surgery is a unique opportunity to salvage tissue in an unreplantable limb.
16
Cavanna, Andrea E. Phenobarbital and primidone. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198791577.003.0009.
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Phenobarbital and primidone are first-generation antiepileptic drugs currently associated with restricted ranges of antiepileptic indications, despite their acceptable interaction profiles in polytherapy. Although phenobarbital is still widely prescribed as antiepileptic drug in the developing world, safety issues (including risks of dependence and overdose), together with the development of other antiepileptic drugs throughout the second half of the twentieth century, left little room for the use of barbiturates in patients with epilepsy. Both phenobarbital and primidone are barbiturates with an acceptable behavioural tolerability profile, but there are no approved indications or clinical uses for the treatment of behavioural symptoms in patients with psychiatric disorders.
17
R, Lamonte Jean, Hrsg. Aromatase inhibitors: Types, mode of action, and indications. Hauppauge, N.Y: Nova Science Publishers, 2009.
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18
R, Lamonte Jean, Hrsg. Aromatase inhibitors: Types, mode of action and indications. New York: Nova Biomedical Books, 2009.
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19
R, Lamonte Jean, Hrsg. Aromatase inhibitors: Types, mode of action, and indications. Hauppauge, N.Y: Nova Science Publishers, 2009.
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20
Benson, Carolyn, und G. Bryan Young. Ethical and end-of-life issues after cardiac arrest. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0067.
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Many survivors of cardiac arrest, especially out-of-hospital cardiac arrest, suffer varying degrees of anoxic-ischaemic brain injury. Accurate neurological prognostication to determine which patients will have poor neurological outcome is important to guide appropriate medical care and advise surrogate decision makers. Accurate prognostication generally requires the presence of two or more negative prognostic indicators, especially following treatment with therapeutic hypothermia. Medical care should be directed at achieving survival that the patient would consider acceptable. Poor quality survival is generally defined as severe disability with full dependency, minimally-conscious, or vegetative state. Discussions regarding prognosis and management of patients who remain unresponsive after resuscitation from cardiac arrest should be conducted in a professional manner and show respect for the individuals involved, their culture, and religion.
21
Spies, Dennis C. European Welfare Programs in the Era of Immigration. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198812906.003.0004.
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As mass immigration is a relatively recent phenomenon in Europe, it encounters states in which mature welfare regimes have already been in place for several decades. Therefore, the chapter starts with an overview of the most important welfare programs in Europe, according to their degree of universalism, the generosity of their replacement rates, means testing, and their redistributive character—asking how much they resemble the welfare or social security part of the US regime. It is shown that the institutional indicators explain a lot about the size of social expenditure budgets, and that programs with high middle-class involvement spend significantly more. Using EU-household survey data, Chapter 3 also offers an overview of how immigrants fare in the different programs, including immigrants’ welfare dependency, and discusses how this is related to the share of benefits they receive compared with the native population.
22
McAuley, Danny F., und Thelma Rose Craig. Measurement of extravascular lung water in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0140.
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The accumulation of fluid in the interstitium and alveolar space is known as extravascular lung water (EVLW). EVLW is associated with increased morbidity and mortality in critically ill patients and is elevated in patients with cardiogenic pulmonary oedema, acute lung injury (ALI), and the acute respiratory distress syndrome (ARDS). Pulmonary oedema is a consequence of increased pulmonary capillary hydrostatic pressure and/or an increased capillary permeability. The quantity of pulmonary oedema fluid is dependent on the balance of fluid formation and clearance, and this contributes to the overall dynamic net lung fluid balance. Measurement of EVLW is therefore an indirect surrogate measurement of the alveolar epithelial and endothelial damage in ALI/ARDS. The single indicator transpulmonary thermodilution technique is an available bedside technique to measure EVLW.
23
Riches, Christopher, und Peter Stalker. A Guide to Countries of the World. Oxford University Press, 2016. http://dx.doi.org/10.1093/acref/9780191803000.001.0001.
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Over 240 entriesThis invaluable A–Z provides a wealth of up-to-date information on every country in the world, including dependent territories. Each entry provides a brief history of the country and outlines its political, economic, and social issues. A quick-reference fact box provides comparative information on land area, people, language, religion, life expectancy, GDP, and gender equality and environmental performance. Invaluable supplementary material includes detailed indicator tables showing income and poverty, health and population, and a list of international organizations, such as the EU and the African Union, with essential information about these groupings.This accessible guide is an ideal reference for students and teachers of geography, politics, economics, and world history at all levels, as well as anyone wanting access to reliable information on any country of the world.
24
Williams, Jerry R. Diagnostic radiology equipment. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199655212.003.0012.
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The chapter is concerned with the features of radiographic and fluoroscopic equipment that present radiation protection issues for both patients and staff. These are managed through regulation, manufacturing standards, and adherence to safe working practices. It is different for patients who are deliberately irradiated in accordance with justification protocols not considered here. Radiation protection is based on the ALARP principle which requires the resultant dose to be minimized consistent with image quality is sufficient to provide accurate and safe diagnosis. Dose minimization is critically dependent on detector efficiency. Quality control of dose for individual examinations is particularly important to provide assurance of ALARP. It should include not only patient dose assessment but also detector dose indicators, particularly in radiography. These issues are discussed in detail together with other dose-saving features and discussion on objective methods of image quality assessment. Commissioning and lifetime tests are required for quality assurance programmes. These are described.
25
Cheng, Paul K., Tariq M. Malik und Magdalena Anitescu. Peripheral Nerve Block and Ultrasound Images. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190457006.003.0008.
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Ultrasound-guided peripheral nerve blocks can be used as the primary anesthetic for surgery involving the extremities and trunk and as a modality for opioid-sparing postoperative pain management. Success of regional anesthesia is dependent upon depositing local anesthetics in the correct plane. Advent of ultrasound has made this process more efficient, safer, and less painful for the patient More prevalent use of regional anesthesia in the perioperative setting will limit opioid prescription, development of chronic post surgical pain and is known to improve patient satisfaction by improving pain. This chapter reviews the history of ultrasound use for nerve blocks and basics of ultrasound use. It also discusses common peripheral nerve blocks of the upper extremities, trunk area, and lower extremities and summarizes indications, techniques, and key complications. Included are ultrasound images for each block.
26
Rosenhek, Raphael, Robert Feneck und Fabio Guarracino. Aortic valve disease. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199599639.003.0014.
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Echocardiography is the gold standard for the assessment of patients with aortic valve (AoV) disease. It allows a detailed morphological assessment of the AoV and thereby makes determination of the aetiology possible. In general, the quantification of aortic stenosis is based on the measurement of transaortic jet velocities and the calculation of AoV area, thus combining a flow-dependent and a flow-independent variable. In the setting of low-flow low-gradient AS, dobutamine echocardiography is of particular diagnostic and prognostic importance. The quantification of aortic regurgitation is based on qualitative and quantitative parameters. Awareness of potential pitfalls is fundamental. Haemodynamic consequences of AoV disease on left ventricular size, hypertrophy, and function as well as potentially coexisting valve lesions can be assessed simultaneously. In patients with AoV disease, predictors of outcome and indications for surgery are substantially defined by echocardiography.
27
Jardine, Alan G., und Rajan K. Patel. Lipid disorders of patients with chronic kidney disease. Herausgegeben von David J. Goldsmith. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0102.
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The risk of developing cardiovascular (CV) disease is increased in patients with chronic kidney disease (CKD) and although dyslipidaemia is a major contributory factor to the development of premature CV disease, the relationship is complex. Changes in lipid fractions are related to glomerular filtration rate and the presence and severity of proteinuria, diabetes, and other confounding factors. The spectrum of CV disease changes from lipid-dependent, atheromatous coronary disease in early CKD to lipid-independent, non-coronary disease, manifesting as heart failure, and sudden cardiac death in advanced and end-stage renal disease. Statin-based lipid-lowering therapy is proven to reduce coronary events across the spectrum of CKD. The relative reduction in overall CV events, however, diminishes as CKD progresses and the proportion of lipid-dependent coronary events declines. There is nevertheless a strong argument for the use of statin-based therapy across the spectrum of CKD. The argument is particularly strong for those patients with progressive renal disease who will eventually require transplantation, in whom preventive therapy should start as early as possible. The SHARP study established the benefits and endorses the use of lipid-lowering therapy in CKD 3-4 but uncertainty about the value of initiation of statin therapy in CKD 5 remains. There is, however, no rationale for stopping agents started earlier in the course of the illness for compelling indications, particularly in those who will ultimately be transplanted. The place of high-density lipoprotein-cholesterol raising and triglyceride lowering therapy needs to be assessed in trials. Modifying dyslipidaemia in CKD has demonstrated that lipid-dependent atheromatous cardiovascular disease is only one component of the burden of CV disease in CKD patients, that this is proportionately less in advanced CKD, and that modification of lipid profiles is only one part of CV risk management.
28
Leaver, Susannah, und Timothy Evans. Hypoxaemia in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0085.
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Hypoxaemia is a reduction in the partial pressure of oxygen in the blood below 8 kPa/60 mmHg. Hypoxaemia results from one, or several, or a combination of causes. Calculating the alveolar–arterial gradient can help to delineate the cause. Acute respiratory failure manifests in a number of ways, the most sensitive indicator being an increased respiratory rate. Diagnosis is dependent on a comprehensive history, examination in combination with appropriate blood tests, and imaging. Hypoxaemia is the final common pathway of a number of conditions and the exact cause may not be immediately apparent. Despite this, the same management principles apply. A trial of non-invasive ventilation can be used to support patients during respiratory failure who do not require immediate endotracheal intubation. However, it is recommended that this is instituted for a preset trial period (e.g. 1–2 hours) in an HDU/ICU setting where facilities for definitive airway management are available. Invasive ventilation aims to facilitate treatment of the underlying condition whilst minimizing side effects through lung protective ventilatory strategies.
29
Tandy, David. In Hesiod’s World. Herausgegeben von Alexander C. Loney und Stephen Scully. Oxford University Press, 2018. http://dx.doi.org/10.1093/oxfordhb/9780190209032.013.34.
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A close analysis of Hesiod’s scheme of production indicates that he is pursuing “extensive surplus-generating agriculture.” Thus, Hesiod is indistinguishable on a rhythmic agricultural basis from the basilēes of the Homeric epics and of his own poems. Hesiod manages the labor of slaves and other dependent workers, and his interests are in opposition to those who provide labor and value to the production process. A second divide is discernible between the polis and its basilēes on the one side and on the other all those out in Ascra who are subject to both a market disadvantage and a judicial process that is being expanded by the urban basilēes. These simultaneous divisions contribute to the ambiguous picture of Hesiod as both large landowner/exploiter and peasant/exploited. Sympotic adaptations of Works and Days meant that ancient reception of the poem seems to have been restricted to the first picture only.
30
Hooper, Timothy, und David Lockey. Assessment and management of ballistic trauma. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0340.
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The severity of ballistic trauma is dependent upon multiple factors including bullet type, velocity, tissue type penetrated, and energy transfer. Patient management needs a considered approach with careful assessment, appropriate imaging and directed treatment of the wounds found. Triage, treatment and transport form the framework of effective prehospital care. In the emergency department a rapid primary survey is essential to reveal any injuries that need immediate intervention. The decision to operate and nature of surgery is determined by the patient’s suspected injuries, physiological condition and expertise available with some patients benefiting from damage control resuscitation and surgery. Indications for intensive care admission include the need for ongoing organ support, cardiovascular instability, and injuries that require close observation. Attention should be paid to cardiovascular status, coagulation, nutrition, thromboprophylaxis, infective issues, and management of specific injuries. Patients may require protracted hospital stays and extensive reconstructive surgery. The psychological and social impact of these injuries should not be underestimated.
31
Kleinpell, Ruth, und Laura Crawford. Dressing techniques for wounds in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0280.
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The use of dressings may be indicated in the management of wounds and pressure ulcers, and is dependent on many factors, including the intended purpose of the dressing. The aetiology or cause of the wound will directly impact on the choice of dressing, as factors such as whether a pressure ulcer has undermining and requires packing to fill dead space need to be considered. Other considerations related to aetiology include whether exudates management and compression are required as is the case with venous insufficiency, or whether moisture is preferred, as is often the case with arterial ulcers. The appropriate selection of dressings for pressure ulcers can facilitate healing, although there is insufficient evidence to indicate which specific dressings are the most effective. This chapter reviews important considerations in the use of dressings for wounds and pressure ulcers. In managing the critically-ill patient, knowledge of the indications for use of currently available wound care products and dressings is important for critical care clinicians and consultation with a wound care specialist is recommended.
32
Stevens, Philip, und Paul Dark. Ileus and obstruction in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0182.
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Obstruction is the commonest cause of acute intestinal failure in critical care. Management is dependent upon whether it is adynamic or mechanical in origin. Paralytic ileus is managed conservatively by correction of electrolyte disturbances, nutritional support, and minimization of enterostatic drug use. Pharmacological agents aimed at reducing sympathetic stimuli may be useful, although widespread application is limited due to anti-muscarinic side effects. Peripherally acting μ-opioid receptor antagonists, may have a role, although data in critical illness are lacking. Prokinetic agents have not been shown to reduce ileus in clinical trials. Colonoscopic decompression may be required when conservative management fails. Rarely, surgical decompression becomes necessary if ileus arises in the context of abdominal compartment syndrome. Mechanical obstruction is more likely to require surgery, although adhesional obstruction, responsible for 80% of small bowel obstruction, may settle within 7 days of conservative management. Large bowel obstruction is more commonly due to tumours, diverticular stricture, or volvulus, and more likely to require endoscopic or surgical intervention. The hallmark of obstruction is colic, characterized by an inability to settle, in contrast to the peritonitic patient who lies completely still. Peritonitis in the presence of obstruction indicates possible perforation or necrosis for which urgent operative intervention is required. Clinical features may be absent in sedated patients hence the index of suspicion should remain high in any critically-ill patient intolerant of enteral feeding.
33
Izzedine, Hassan, und Victor Gueutin. Drug-induced acute tubulointerstitial nephritis. Herausgegeben von Adrian Covic. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0084.
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Drug-induced acute tubulointerstitial nephritis (ATIN) is the most common aetiology of ATIN and a potentially correctable cause of acute kidney injury (AKI). An interval of 7–10 days typically exists between drug exposure and development of AKI, but this interval can be considerably shorter following re-challenge or markedly longer with certain drugs. It occurs in an idiosyncratic and non-dose-dependent manner. Antibiotics, NSAIDs, and proton pump inhibitors are the most frequently involved agents, but the list of drugs that can induce ATIN is continuously increasing. The mechanism of renal injury is postulated to involve cell-mediated immunity, supported by the observation that T cells are the predominant cell type comprising the interstitial infiltrate. A humoral response underlies rare cases of ATIN, in which a portion of a drug molecule (i.e. methicillin) may act as a hapten, bind to the tubular basement membrane (TBM), and elicit anti-TBM antibodies. The classic symptoms of fever, rash, and arthralgia may be absent in up to two-thirds of patients. Diagnostic studies, such as urine eosinophils and renal gallium-67 scanning provide only suggestive evidence. Renal biopsy remains the gold standard for diagnosis, but it may not be required in mild cases or when clinical improvement is rapid after removal of an offending medication. Pathologic findings include interstitial inflammation, oedema, and tubulitis. The time until removal of such agents and the severity of renal biopsy findings provide the best prognostic value for the return to baseline renal function. Poor prognostic indicators are the long duration of AKI (> 3 weeks), a patient’s advanced age, and the high degree of interstitial fibrosis. Early recognition and appropriate therapy are essential to the management of drug-induced ATIN, because patients can ultimately develop chronic kidney disease. The mainstay of therapy is timely discontinuation of the causative agent, whereas controversy persists about the role of steroids.
34
Balik, Martin. Perioperative cardiac care of the high-risk non-cardiac patient. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0076.
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Non-cardiac surgery conveys a cardiac risk related to the status of the patient’s cardiovascular system. Cardiac-related risk of surgery can be assessed by integrating the risk and urgency of the procedure with cardiovascular risk factors, which include age, ischaemic heart disease, heart failure, stroke, diabetes mellitus, chronic obstructive pulmonary disease, and renal dysfunction. An individual assessment can include simple multivariate scoring systems, developed with the aim of evaluating cardiac risk prior to non-cardiac surgery. Patient assessment can be extended for indicated additional tests. The indications for further cardiac testing and treatments are the same as in the non-operative setting, but their timing is dependent on the urgency of surgery, and patient-specific and surgical risk factors. A delay in surgery, due to the use of both non-invasive and invasive preoperative testing, should be limited to those circumstances in which the results of such tests will clearly affect patient management. In high-risk patients, the result of the cardiac assessment helps to choose adequate perioperative monitoring and to indicate for an intensive care unit stay perioperatively. Chronic medications can be adjusted, according to the current knowledge on perioperative management. Drugs with the potential to reduce the incidence of post-operative cardiac events and mortality include beta-blockers, statins, and aspirin. Chronic platelet anti-aggregation and anticoagulation therapies have to be adapted by weighing the risk of bleeding against the risk of thrombotic complications.
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Balik, Martin. Perioperative cardiac care of the high-risk non-cardiac patient. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0076_update_001.
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Non-cardiac surgery conveys a cardiac risk related to the status of the patient’s cardiovascular system. Cardiac-related risk of surgery can be assessed by integrating the risk and urgency of the procedure with cardiovascular risk factors, which include age, ischaemic heart disease, heart failure, stroke, diabetes mellitus, chronic obstructive pulmonary disease, and renal dysfunction. An individual assessment can include simple multivariate scoring systems, developed with the aim of evaluating cardiac risk prior to non-cardiac surgery. Patient assessment can be extended for indicated additional tests. The indications for further cardiac testing and treatments are the same as in the non-operative setting, but their timing is dependent on the urgency of surgery, and patient-specific and surgical risk factors. A delay in surgery, due to the use of both non-invasive and invasive preoperative testing, should be limited to those circumstances in which the results of such tests will clearly affect patient management. In high-risk patients, the result of the cardiac assessment helps to choose adequate perioperative monitoring and to indicate for an intensive care unit stay perioperatively. Chronic medications can be adjusted, according to the current knowledge on perioperative management. Drugs with the potential to reduce the incidence of post-operative cardiac events and mortality include beta-blockers, statins, and aspirin. Chronic platelet anti-aggregation and anticoagulation therapies have to be adapted by weighing the risk of bleeding against the risk of thrombotic complications.
36
Balik, Martin. Perioperative cardiac care of the high-risk non-cardiac patient. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0076_update_002.
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Non-cardiac surgery conveys a cardiac risk related to the status of the patient’s cardiovascular system. Cardiac-related risk of surgery can be assessed by integrating the risk and urgency of the procedure with cardiovascular risk factors, which include age, ischaemic heart disease, heart failure, stroke, diabetes mellitus, chronic obstructive pulmonary disease, and renal dysfunction. An individual assessment can include simple multivariate scoring systems, developed with the aim of evaluating cardiac risk prior to non-cardiac surgery. Patient assessment can be extended for indicated additional tests. The indications for further cardiac testing and treatments are the same as in the non-operative setting, but their timing is dependent on the urgency of surgery, and patient-specific and surgical risk factors. A delay in surgery, due to the use of both non-invasive and invasive preoperative testing, should be limited to those circumstances in which the results of such tests will clearly affect patient management. In high-risk patients, the result of the cardiac assessment helps to choose adequate perioperative monitoring and to indicate for an intensive care unit stay perioperatively. Chronic medications can be adjusted, according to the current knowledge on perioperative management. Drugs with the potential to reduce the incidence of post-operative cardiac events and mortality include beta-blockers, statins, and aspirin. Chronic platelet anti-aggregation and anticoagulation therapies have to be adapted by weighing the risk of bleeding against the risk of thrombotic complications.
37
Hardt, Heidi. NATO's Lessons in Crisis. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190672171.001.0001.
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In crisis management operations, strategic errors can cost lives. Some international organizations (IOs) learn from these failures, whereas, others tend to repeat them. Given high rates of turnover and shorter job contracts, how do IOs such as NATO retain any knowledge about past errors? Institutional memory enhances prospects for reforms that can prevent future failures. The book provides an explanation for how and why IOs develop institutional memory in international crisis management. Evidence indicates that the design of an IO’s learning infrastructure (e.g. lessons learned offices and databases) can inadvertently disincentivize IO elites from using it to share knowledge about strategic errors. Under such conditions, IO elites - high-level civilian and military officials - view reporting to be risky. In response, they prefer to contribute to institutional memory through the creation and use of informal processes such as transnational interpersonal networks, private documentation and conversations during crisis management exercises. The result is an institutional memory that remains vulnerable to turnover since critical knowledge is highly dependent on a handful of individuals. The book draws on the author’s interviews and a survey experiment with 120 NATO elites, including assistant secretary generals, military representatives and ambassadors. Cases of NATO crisis management in Afghanistan, Libya and Ukraine serve to further illustrate the development of institutional memory. Findings challenge existing organizational learning scholarship by indicating that formal learning processes alone are insufficient to ensure learning occurs. The book also offers policymakers a set of recommendations for strengthening the learning capacity of IOs.
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Peacock, Linzi, und Rachel Hignett. Acquired heart disease. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0041.
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Heart disease in pregnancy is a leading cause of maternal death worldwide. In the United Kingdom and United States, heart disease in pregnancy is the commonest cause of maternal death. In Europe, over 1% of maternal deaths are attributable to structural heart disease. In addition, heart disease in pregnancy is a significant cause of severe maternal and fetal morbidity. Whilst the vast majority of women with heart disease in pregnancy have underlying congenital heart disease, most maternal deaths are due to acquired heart disease (AHD). As the risk factors for AHD become ever more prevalent, the expectation is that disease burden from AHD in pregnancy will also increase. Women with AHD benefit from preconception or early assessment in pregnancy by a multidisciplinary team including obstetricians, cardiologists, and obstetric anaesthetists. Risk assessment using the modified World Health Organization classification of cardiac disease in pregnancy will inform frequency of review in pregnancy. A detailed plan for delivery should be agreed in the third trimester. Where possible, a vaginal delivery is advised: caesarean delivery is reserved for women with obstetric indications or with specific severe underlying cardiac conditions. Slow incremental epidural analgesia is usually recommended to reduce the cardiorespiratory work of labour and an assisted second-stage delivery will limit exertion due to pushing. Neuraxial anaesthesia for operative delivery is becoming a more familiar approach and techniques such as low-dose spinal component combined spinal–epidural or slow incremental epidural top-up maximize haemodynamic stability. Invasive monitoring is often beneficial. Post-delivery care is safely delivered in a high dependency or intensive therapy setting. This chapter looks at the general principles of management of women with AHD, and then examines in detail ischaemic heart disease, arrhythmias, cardiac transplantation, aortic pathology and aortic dissection, cardiomyopathy, valvular heart disease, and infective endocarditis.