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1
International Workshop on Epileptic Seizure Prediction (3rd 2007 Freiburg im Breisgau, Germany). Seizure prediction in epilepsy: From basic mechanisms to clinical applications. Weinheim: Wiley-VCH, 2008.
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2
Chistyakova, Guzel, Lyudmila Ustyantseva, Irina Remizova, Vladislav Ryumin, and Svetlana Bychkova. CHILDREN WITH EXTREMELY LOW BODY WEIGHT: CLINICAL CHARACTERISTICS, FUNCTIONAL STATE OF THE IMMUNE SYSTEM, PATHOGENETIC MECHANISMS OF THE FORMATION OF NEONATAL PATHOLOGY. au: AUS PUBLISHERS, 2022. http://dx.doi.org/10.26526/monography_62061e70cc4ed1.46611016.
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The purpose of the monograph, which contains a modern view of the problem of adaptation of
children with extremely low body weight, is to provide a wide range of doctors with basic information
about the clinical picture, functional activity of innate and adaptive immunity, prognostic criteria
of postnatal pathology, based on their own research. The specific features of the immunological
reactivity of premature infants of various gestational ages who have developed bronchopulmonary
dysplasia (BPD) and retinopathy of newborns (RN) from the moment of birth and after reaching
postconceptional age (37-40 weeks) are described separately. The mechanisms of their implementation
with the participation of factors of innate and adaptive immunity are considered in detail. Methods
for early prediction of BPD and RN with the determination of an integral indicator and an algorithm
for the management of premature infants with a high risk of postnatal complications at the stage
of early rehabilitation are proposed. The information provided makes it possible to personify the
treatment, preventive and rehabilitation measures in premature babies. The monograph is intended for
obstetricians-gynecologists, neonatologists, pediatricians, allergists-immunologists, doctors of other
specialties, residents, students of the system of continuing medical education.
This work was done with financial support from the Ministry of Education and Science, grant of
the President of the Russian Federation No. MK-1140.2020.7.
3
Hochman, Michael E. Identifying Children with Low-Risk Head Injuries Who Do Not Require Computed Tomography. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190223700.003.0002.
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This chapter, found in the headache section of the book, provides a succinct synopsis of a key study examining the use of computed tomography (CT) scans for children with low-risk head injuries. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. This study derived and validated prediction rules that can accurately identify children at very low risk for ci-TBI; the authors provide several guidelines for applying these rules depending on the severity of predictive features, patient history, and clinician’s judgment. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.
4
Langton, Calvin M. Contrasting approaches to risk assessment with adult male sexual offenders: An evaluation of recidivism prediction schemes and the utility of supplementary clinical information for enhancing predictive accuracy. 2003.
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5
Lee, Christoph I. Repeat Bone Mineral Density Screening and Osteoporotic Fracture Prediction. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190223700.003.0035.
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This chapter, found in the bone, joint, and extremity pain section of the book, provides a succinct synopsis of a key study examining the need for repeat bone densitometry screening and prediction of fractures from osteoporosis. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. The study showed that a repeat bone mineral density test within 4 years adds little additional value beyond the baseline test when assessing hip fracture risk. Moreover, a repeat test within 4 years may not improve fracture risk stratification used for clinical management of osteoporosis. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.
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Seshadri, Sudha, and Stéphanie Debette, eds. Risk Factors for Cerebrovascular Disease and Stroke. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199895847.001.0001.
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Risk Factors for Cerebrovascular Disease and Stroke describes environmental and genetic determinants for cerebrovascular disease and stroke from the perspective of an international group of neurologists, epidemiologists, and geneticists who are at the forefront of research and education on these issues. Unlike other books in the field, which solely deal with physiology, diagnosis, and management of stroke, this essential book discusses prevention factors as well as the causes. This unique book takes a comprehensive approach to risk prediction while integrating epidemiological, genetic, and statistical principles explained in a way that is easy for the clinical trainee to understand. The section on genetic risk factors for various types of stroke is unique in its depth and up-to-date information. Clinicians, residents, fellows and academics in neurology, geriatrics, internal medicine, epidemiology, genetics, public health professionals, and preventative cardiologists, as well as nurses, practitioners and physician assistants will find this a handy source for years to come.
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Eder, Lihi. The clinical course and outcome of psoriatic arthritis. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198737582.003.0021.
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In contrast to early reports, it is now appreciated that psoriatic arthritis (PsA) can present as a destructive, progressive, and disabling arthritis with consequences as severe as those of rheumatoid arthritis. Longitudinal cohort studies of PsA patients contributed important knowledge about long-term outcomes, such as development of structural joint damage, remission achievement, and physical function. These studies identified predictors for improved outcomes including male gender and lower burden of inflammation at presentation while delayed diagnosis, disability, and joint damage are associated with worse long-term outcomes. These findings suggest early diagnosis and aggressive control of inflammation are important as they may prevent the occurrence of subsequent joint damage. The latter is strongly correlated with long-term outcomes, such as reduced physical function and increased mortality. Development of prediction models using clinical measures, laboratory biomarkers, and imaging is warranted to stratify patients with early disease into risk groups for long-term outcomes.
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Inherited Susceptibility To Cancer Clinical Predictive And Ethical Perspectives. Cambridge University Press, 2009.
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9
1960-, Foulkes William D., and Hodgson S. V, eds. Inherited susceptibility to cancer: Clinical, predictive, and ethical perspectives. Cambridge: Cambridge University Press, 1998.
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10
Wunsch, Hannah, and Andrew A. Kramer. The role and limitations of scoring systems. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0028.
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Scoring systems for critically-ill patients provide a measure of the severity of illness of patients admitted to intensive care units (ICUs). They are primarily based on patient characteristics, physiological derangement, and/or clinical assessments. Severity scores themselves allow for risk-adjusting outcomes, but they can also be used to provide a prediction of the overall risk of death, length of stay, or other outcome for critically ill patients. This allows for comparison of outcomes between different cohorts of patients or between observed and predicted ICU performance. There are a number of general ICU scoring systems that are in use. All scoring systems have limitations. Future scoring systems may include prediction of longer-term outcomes, and assimilation of granular data temporally and at the molecular level that could result in more personalized severity scores to help guide individual care decisions.
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Arribas-Ayllon, Michael. Genetic Counseling in Psychiatry. Edited by John Z. Sadler, K. W. M. Fulford, and Werdie (C W. ). van Staden. Oxford University Press, 2014. http://dx.doi.org/10.1093/oxfordhb/9780198732372.013.54.
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This chapter offers a sober analysis of the history and prospects of genetic counseling in psychiatry. The present intersection of genetics and psychiatry is complex and limited in scope. The argument is made that recent genomic discoveries are unlikely to revolutionize genetic counseling because the complex nature of psychiatric conditions are not reducible to models of prediction. Susceptibility testing for psychiatric disorders is not a stable platform for clinical psychiatry because tests based on “common variation” are clinically unhelpful. Nevertheless, there are expectations that genetic counseling for psychiatry will be an area of growth and potential. The rest of the chapter focuses on the practical work of individuals and experts as they manage their moral or professional obligations to communicate and understand genetic risk in psychiatry.
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(Editor), William D. Foulkes, and Shirley V. Hodgson (Editor), eds. Inherited Susceptibility to Cancer: Clinical, Predictive and Ethical Perspectives (Cambridge Cancer Series). Cambridge University Press, 1998.
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13
O’Mahony, Constantinos. Hypertrophic cardiomyopathy: prevention of sudden cardiac death. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0354.
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Sudden cardiac death (SCD) secondary to ventricular arrhythmias is the most common mode of death in hypertrophic cardiomyopathy (HCM) and can be effectively prevented with an implantable cardioverter defibrillator (ICD). The risk of SCD in HCM relates to the severity of the phenotype and regular risk stratification is an integral part of routine clinical care. For the primary prevention of SCD, risk stratification involves the assessment of seven readily available clinical parameters (age, maximal left ventricular wall thickness, left atrial diameter, left ventricular outflow tract gradient, non-sustained ventricular tachycardia, unexplained syncope, and family history of SCD) which are used to estimate the risk of SCD within 5 years of clinical evaluation using a statistical risk prediction model (HCM Risk-SCD). The 2014 European Society of Cardiology Guidelines provide a framework to aid clinical decisions and consider patients with a 5-year risk of SCD of less than 4% as low risk and recommend regular assessment while those with a risk of 6% or higher should be considered for an ICD. In patients with an intermediate risk (4% to <6%) ICD implantation may also be considered after taking into account age, co-morbid conditions, socioeconomic factors, and the psychological impact of therapy. Survivors of ventricular fibrillation arrest should receive an ICD for secondary prevention unless their life expectancy is less than 1 year. Following device implantation, patients should be followed up for device- and disease-related complications, particularly heart failure and cerebrovascular disease.
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Hromek, Cynthia Miller. PREDICTING RISK OF DEPRESSION IN RURAL CANCER PATIENTS AND THEIR SPOUSES. 1995.
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15
Lee, Christoph I. Efficacy of Screening Breast MRI for High-Risk Women. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190223700.003.0039.
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This chapter, found in the cancer screening and management section of the book, provides a succinct synopsis of a key study examining the efficacy of screening breast magnetic resonance imaging (MRI) for high-risk women. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. Breast MRI screening has higher sensitivity than mammography for high-risk women, but both the specificity and positive predictive value are lower than for mammography screening. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.
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Elbogen, Eric B., and Robert Graziano. Assessing Acute Risk of Violence in Military Veterans. Edited by Phillip M. Kleespies. Oxford University Press, 2015. http://dx.doi.org/10.1093/oxfordhb/9780199352722.013.15.
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Research has shown aggression toward others is a problem in a subset of military veterans. Predicting this kind of aggression would be immensily helpful in clinical settings. To our knowledge, there currently are no risk assessment tools or screens that have been validated to specifically evaluate acute violence among veterans. This chapter reviews what we do and do not know about violence in veterans so that clinicians who are making decisions about acute violence can be informed by the existing scientific knowledge base. Examining these empirically supported risk and protective factors using a systematic approach may optimize clinical decision making when assessing acute violence in veterans.
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Rocco, Gaetano. Risk Prediction and Outcome Analysis in Thoracic Surgery, An Issue of Thoracic Surgery Clinics. Saunders, 2007.
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18
Lee, Christoph I. Management of Lung Nodules Detected by CT. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190223700.003.0045.
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This chapter, found in the cancer screening and management section of the book, provides a succinct synopsis of a key study examining the management of lung nodules detected by computed tomography and their risk of developing into lung cancer. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. Virtual colonoscopy, using a primary 3D approach for polyp detection, was shown to be a minimally invasive procedure that is an accurate method for screening average-risk individuals. The likelihood of a clinically significant adenoma being missed on virtual colonoscopy was extremely low given the high negative predictive value. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.
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Feist, Eugen, and Gerd-R. Burmester. Rheumatoid arthritis—clinical features. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0111.
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Rheumatoid arthritis (RA) presents with variable clinical features, making this most frequent chronic systemic autoimmune disease with characteristic joint involvement a diagnostic and therapeutic challenge. This chapter describes in detail the different clinical, laboratory and imaging findings in patients with RA. In addition to the characteristic arthritic involvement, which can lead to severe joint changes with progressive destruction and loss of function, other systemic disease manifestations as well as an increased risk for cardiovascular events and non-Hodgkin's lymphoma with relevance for patients' prognosis are described. Recent approaches to early diagnosis and stratification of patients by predictive factors for a severe course of disease are discussed. These patient profiles include increased inflammatory markers, the presence of autoantibodies, and erosive changes at the time of diagnosis. The novel classification criteria for RA and the significance of autoantibody status, namely seropositivity for antibodies against citrullinated antigens as highly specific diagnostic markers, are highlighted to further promote early differentiation of RA from other arthritic disease entities.
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Sabharwal, Nikant, Parthiban Arumugam, and Andrew Kelion. Myocardial perfusion scintigraphy: clinical value. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198759942.003.0010.
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Myocardial perfusion scintigraphy (MPS) is most commonly used to diagnose or exclude obstructive coronary disease in patients presenting with chest pain. This chapter covers the value of MPS in this context, as well as providing detail on the guidelines which help the clinician choose what investigations are appropriate for the patient presenting with chest pain. It also details a number of considerations related to the use of MPS, such as its cost-effectiveness and the prognosis value in the diagnosis of coronary artery disease compared to exercise ECG, X-ray computed tomographic coronary angiography, and other imaging investigations. Risk assessment prior to elective non-cardiac surgery is covered, with detailed attention paid to the challenges of assessing coronary artery disease special groups including women and patients with diabetes or renal disease. This chapter also covers assessment in known stable coronary artery disease, predicting the value of coronary revascularization and hibernating myocardium.
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Bongar, Bruce, Glenn Sullivan, Victoria Kendrick, and Joseph Tomlins. Evaluating and Managing Suicide Risk with the Adult Patient. Edited by Phillip M. Kleespies. Oxford University Press, 2015. http://dx.doi.org/10.1093/oxfordhb/9780199352722.013.10.
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Suicide and suicidal behavior are major medical and social problems in many parts of the world, despite a growing understanding of how to adequately prevent suicide. Many health-care professionals do not have a sufficient knowledge base and the training to provide adequate suicide assessment, nor do they have an understanding of the protocols necessary for management of suicidal patients. Without validated predictive tools to use in cases of suspected suicidal ideation, it is usually left to the clinician to make a decision regarding risk and potential harm. In this chapter we describe how to identify a suicidal patient and the procedures necessary to adequately provide services.
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Philip, Pierre, Stephanie Bioulac, Patricia Sagaspe, and Jean-Arthur Micoulaud-Franchi. Drowsy driving. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198778240.003.0021.
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Drowsy driving increases risk of traffic accidents. A major problem remains in the identification of drowsy drivers at risk for traffic accidents. Drowsy driving is the consequence of various behavioural factors (e.g. sleep duration, work duration, shift-work schedules) combined or not with sleep and iatrogenic disorders (e.g. obstructive sleep apnoea syndrome, hypersomnia, drug-induced sleepiness). Severity of sleep disorders is a non-linear predictor of traffic accident risk. In comparison, sleepiness at the wheel (SAW) can be considered as a reliable indicator of a combination of behavioural and sleep disorder factors, and is a better risk predictor. It remains thus very important to question patients about SAW when clinicians have to determine the medical fitness to drive of such patients. Because of the potential risk of under-reporting of SAW, especially in professional drivers, objective measures can help to complement the clinical evaluation. Further researches are needed to optimize objective measures able to predict the risk of traffic accidents due to drowsy driving.
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Thapar, Anita, and Stephanie van Goozen. Conduct disorder in ADHD. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198739258.003.0020.
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Conduct disorder (CD) is an important marker of ADHD clinical and cognitive impairment and neurodevelopmental multimorbidity. It is also predictive of poor psychiatric and functional outcomes. Although traditionally considered as a consequence of ADHD, association of ADHD and CD can be explained at multiple levels—in terms of enriched familial/genetic risks, higher levels of psychosocial adversity, a likely different pattern of cognitive and neural correlates that involve emotional processes components, earlier temperamental risk characteristics, and additional neurodevelopmental burden such as language impairments and lower cognitive ability. The presence of CD does not alter current ADHD guideline recommendations on treatment but should be taken into account when making decisions upon the intensity and nature of follow-up.
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Vlachopoulos, Charalambos, and Nikolaos Ioakeimidis. Erectile dysfunction as a marker and predictor of cardiovascular disease. Edited by Charalambos Vlachopoulos. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0245.
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Erectile dysfunction (ED) is defined as the inability to obtain or maintain a penile erection to support satisfactory sexual performance. It is considered an early manifestation of generalized vascular disease and recognized as a marker of increased cardiovascular risk both acutely and chronically by predicting all-cause mortality, cardiovascular mortality, coronary events, stroke, and peripheral artery disease in men with and without known coronary artery disease. The link between ED and cardiovascular disease might reside in the interaction between androgen level, chronic inflammation, and cardiovascular risk factors that determine endothelial dysfunction and atherosclerosis both in the penile and coronary circulation. Because penile artery size is smaller compared with coronary arteries, the same degree of endothelial dysfunction and atherosclerotic burden causes a more significant reduction of blood flow in erectile tissues compared with that in coronary circulation. From a clinical standpoint, because ED may precede cardiovascular disease, it can be used as an early marker to identify men at higher risk of cardiovascular events. The average 3-year time period between the onset of ED symptoms and a cardiovascular event offers the opportunity for detailed cardiological assessment and intensive treatment of risk factors.
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Pierard, Luc A., and Lauro Cortigiani. Stress echocardiography: diagnostic and prognostic values and specific clinical subsets. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0015.
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Stress echocardiography is a widely used method for assessing coronary artery disease, due to its high diagnostic and prognostic value. While inducible ischaemia predicts an unfavourable outcome, its absence is associated with a low risk of future cardiac events. The method provides superior diagnostic and prognostic information than standard exercise electrocardiography and perfusion myocardial imaging in specific clinical subsets, such as women, hypertensive patients, and patients with left bundle branch block. Stress echocardiography allows effective risk assessment also in the diabetic population. The evaluation of coronary flow reserve of the left anterior descending artery by transthoracic Doppler adds diagnostic and prognostic information to that of standard stress test. Stress echocardiography is indicated in the cases when exercise electrocardiography is unfeasible, uninterpretable or gives ambiguous result, and when ischaemia during the test is frequently a false-positive response, as in hypertensive patients, women, and patients with left ventricular hypertrophy. Viability detection represents another application of stress echocardiography. The documentation of a large amount of viable myocardium predicts improved ejection fraction, reverse remodelling, and improved outcome following revascularization in patients with ischaemic cardiomyopathy. Moreover, stress echocardiography can aid significantly in clinical decision-making in patients with valvular heart disease through dynamic assessment of primary or secondary mitral regurgitation, transvalvular gradients, and pulmonary artery systolic pressure, as well as before vascular surgery due to the excellent negative predictive value. Finally, stress echocardiography allows effective risk stratification in patients with hypertrophic cardiomyopathy through evaluation of inducible ischaemia, coronary flow reserve, and intraventricular gradient.
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Illes, Judy, ed. Neuroethics. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780198786832.001.0001.
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We have new answers to how the brain works and tools which can now monitor and manipulate brain function. Rapid advances in neuroscience raise critical questions with which society must grapple. What new balances must be struck between diagnosis and prediction, and invasive and noninvasive interventions? Are new criteria needed for the clinical definition of death in cases where individuals are eligible for organ donation? How will new mobile and wearable technologies affect the future of growing children and aging adults? To what extent is society responsible for protecting populations at risk from environmental neurotoxins? As data from emerging technologies converge and are made available on public databases, what frameworks and policies will maximize benefits while ensuring privacy of health information? And how can people and communities with different values and perspectives be maximally engaged in these important questions? Neuroethics: Anticipating the Future is written by scholars from diverse disciplines—neurology and neuroscience, ethics and law, public health, sociology, and philosophy. With its forward-looking insights and considerations for the future, the book examines the most pressing current ethical issues.
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Koczo, Agnes, Reshad Mahmud, and Belinda Rivera-Lebron. Pulmonary Embolism (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0020.
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This chapter examines the diagnosis, risk stratification, and breadth of treatment options for pulmonary embolism (PE). It reviews the decision pathways based on degree of clinical suspicion of PE and assessing pre-test probability using the Geneva and Wells’ Score. It also reviews the Pulmonary Embolism Rule-out Criteria (PERC) and D-dimer with high negative predictive values. Imaging and cardiac biomarkers, which allow classification and risk stratification of PE, are discussed in how they guide management. Options for parenteral anticoagulation including bridging to novel oral anticoagulants or vitamin K antagonists for long term therapy are discussed, as well as clinical situations where systemic or catheter based thrombolysis should be considered. Hemodynamic support involving vasopressors are reviewed. The options for surgical embolectomy, as well as special cases including clot in transit, are discussed.
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McCrea, Michael A., and Lindsay D. Nelson. Effects of Multiple Concussions. Edited by Ruben Echemendia and Grant L. Iverson. Oxford University Press, 2014. http://dx.doi.org/10.1093/oxfordhb/9780199896585.013.10.
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There is growing concern that suffering multiple sport-related concussions may increase an athlete’s risk of cumulative neurocognitive and neurobehavioral impairment. Many concerns have not been well-validated, however, owing to limited samples of repeatedly concussed players. In this article, we review the theoretical risks and current evidence regarding the extent to which repeat concussions impact players’ experience of and recovery following successive injuries. Concussion effects are considered at multiple levels (e.g., self-reported physical and psychiatric symptoms, neuropsychological performance, and neurophysiological measures) across both the acute and chronic phases of recovery. Recommendations for applying findings to injury management decisions are provided. Although repeat concussions appear to have the potential for cumulative neurophysiological burden, a number of factors (e.g., individual risk for experiencing or responding poorly to injury, recovery time between injuries) appear important to explain discrepant findings among studies and to translate general scientific principles into clinical decisions for individual players. Future work that accumulates larger, prospective samples will allow for clearer delineation of the factors that appear important for predicting how recurrent concussions impact individual athletes.
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Riley, Richard D., Danielle van der Windt, Peter Croft, and Karel G. M. Moons, eds. Prognosis Research in Health Care. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198796619.001.0001.
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What is going to happen to me, doctor?’ ‘What outcomes am I likely to experience?’ ‘Will this treatment work for me?’ Prognosis—forecasting the future—has always been a part of medical practice and caring for the sick. In modern healthcare it now has a new importance, with large financial investments being made to personalize clinical decisions and tailor treatment strategies to improve individual health outcomes based on prognostic information. Prognosis research—the study of future outcomes in people with a particular health condition—provides the critical evidence for obtaining, evaluating, and implementing prognostic information within modern healthcare. This new book, written and edited by experts in the field, including clinicians, epidemiologists, statisticians, and other healthcare professionals, is a comprehensive and unified account of prognosis research in the broadest sense. It explains the concepts behind prognosis in medical practice and prognosis research, and provides a practical foundation for those developing, conducting, interpreting, synthesizing, and appraising prognosis studies. It recommends a framework of four basic prognosis research types, pioneered by the PROGRESS group, and provides explicit guidance on the conduct, analysis, and reporting of prognosis studies for each type. Key topics are overall prognosis in clinically relevant populations; prognostic factors associated with changes in prognosis across individuals; prognostic models for individual outcome risk prediction; and predictors of treatment effects. Examples are given of the impact of prognosis research across a broad range of healthcare topics, and the book also signals the latest developments in prognosis research, including systematic reviews and meta-analysis of prognosis studies, and the use of electronic health records and machine learning in prognosis research.
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Feinstein, Robert E., and Brian Rothberg. Violence. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199326075.003.0013.
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Potentially violent patients need immediate attention and evaluation to determine their risk of imminent violence. A past history of violence is the best predictor of future violent behavior, and individuals who have committed violent acts in the past and have been arrested for assaultive behavior represent the highest risk; people who carry weapons or have access to weapons are of relatively high risk. Individuals with violent impulses who are either intoxicated or are in withdrawal have the most extreme risk for imminent violence. The treatment of acute aggression or agitation involves the judicious use of sedative-anxiolytics or low doses of second-generation antipsychotics. SSRIs have been used to treat aggressive, impulsive, and violent symptoms, particularly in individuals with head injuries, and lithium carbonate can reduce impulsive aggression to extremely low levels in some aggressive patients. Two Tarasoff decisions have become national standards for clinical practice regarding “duty to warn” and “duty to protect” all potential victims of life-threatening danger from a homicidal patient.
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Turner, Neil, and Stewart Cameron. Proteinuria. Edited by Neil Turner. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0050.
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Excess protein in the urine almost always comes from the kidney. Proteinuria up to 150 mg/day in an adult (protein:creatinine ratio (PCR) up to 15 mg/mmol) is considered normal. Daily average excretion is 80 mg, of which about 30 mg is albumin that has been filtered and not reabsorbed. Other components comprise low-molecular-weight filtered proteins that have escaped reabsorption, and proteins secreted or lost into urine from cells of the nephron. Increased permeability of the glomerulus to high-molecular-weight proteins is the most common cause of the clinically detected proteinuria, and albumin is the major component of excess glomerular proteinuria. Even small amounts of proteinuria are associated with increased cardiovascular risk and long-term renal risk. In patients with renal disease, regardless of type, proteinuria is a strong predictor of loss of glomerular filtration rate and proteinuria at levels higher than an equivalent of 1 g/24 hours can be considered high renal risk. This limit should be lowered in young patients, and if microscopic haematuria is also present. For both cardiovascular and renal outcomes, risk is graded with severity of proteinuria. In routine clinical practice, ratios of albumin or total protein to creatinine level (ACR or PCR) in spot urine samples are usually more pragmatic and useful than 24-hour collections. ACR is more sensitive as a screening test (normal range up to 2.5 mg/mmol in men, 3.5 mg/mmol in women).
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Thompson, Norris B., and SreyRam Kuy. Multivariable Predictors of Postoperative Surgical Site Infection after General and Vascular Surgery. Edited by SreyRam Kuy. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199384075.003.0013.
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This landmark study proposed a model for predicting surgical site infections (SSI). Using logistic regression analysis, variables independently associated with increased risk of SSI were identified, which included smoking, alcohol use, comorbidities, disseminated cancer, weight loss greater than 10%, emergency surgery, and length of operative time. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.
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Kendrisic, Mirjana, and Borislava Pujic. Endocrine and autoimmune disorders. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0047.
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Advanced maternal age and increasing numbers of women of childbearing age with endocrine and autoimmune disorders have become the challenge for both anaesthetists and obstetricians. Genetic studies have provided new insight into underlying causes of endocrine disorders and prenatal prediction of inheritance. The expression of endocrine disease may influence the interpretation of diagnostic laboratory testing during pregnancy. Better understanding of the pathophysiological mechanisms enables new therapeutic approaches which can compromise pregnancy outcome. Although only a small number of drugs have been shown through clinical studies to be safe for use in pregnancy, intensive therapy for chronic disease is usually needed. Thus, anaesthetic management of women with endocrine disorders in pregnancy has become more complex. The most frequently encountered endocrine disorders during pregnancy include gestational diabetes mellitus and thyroid and adrenal disorders. Gestational diabetes has become increasingly common in pregnant women. Not only does it influence pregnancy outcome, but it also carries a risk for mother and offspring of developing type 2 diabetes later in life. Intensive glucose control may prevent maternal and fetal complications and improve long-term outcome. Pregnancy itself has been found to influence the course of autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus. However, autoimmune diseases may have adverse consequences for maternal, fetal, and neonatal health. There is a relative paucity of literature concerning anaesthetic management of autoimmune diseases. Early recognition and immediate treatment of the common complications have been the key elements to achieving the ultimate goal—good pregnancy outcome.
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Patel, Sameer, and Julia Wendon. Diagnosis and assessment of acute hepatic failure in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0195.
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Establishing the aetiology of acute hepatic failure is essential for correct and timely management. An exhaustive history and examination is crucial in targeting investigations and initiating management. Clinical assessment allows risk stratification, identifying those patients who can be managed locally from those best served in a specialist centre with liver transplantation capability. History should focus on the presenting problem, time of onset and speed of deterioration, and establish features consistent with hyperacute, acute or subacute ALF to guide prognostication. Examination should initially focus on rapid assessment and resuscitation before searching for signs leading to more specific differential diagnoses. Investigations should encompass the variety of potential causes, ranging from basic to more specialist studies. Prognostication is critical for stratification of those patients who may benefit from a potentially life-saving transplantation. Several risk stratification and predictive tools exist to differentiate those patients likely to recover, those unlikely to survive despite maximal intervention, and those who would potentially benefit from transplantation.
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Masuda, Atsuro, Masanao Naya, Keiichiro Yoshinaga, and Nagara Tamaki. Imaging of Myocardial Innervation. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199392094.003.0023.
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Cardiac autonomic innervation imaging has been focused on assessing molecular, electrophysiologic, and pathophysiologic processes of various cardiac disorders. Iodine radiotracer (I-123)-labeled metaiodobenzylguanidine (MIBG), as a marker of adrenergic neuron function, plays an important role in risk stratification and treatment monitoring of heart failure patients. In addition, MIBG has a potential value for predicting fatal arrhythmias that may require implantable cardioverter-defibrillator treatment. Among various positron emission tomography (PET) tracers for probing autonomic neuronal function, C-11 hydroxyephedrine (HED), has been used for precise assessment of heart failure and arrhythmias, similar to MIBG. More studies are needed to confirm the clinical utility of these molecular imaging modalities for the management of patients with heart failure, coronary artery disease and arrhythmias.
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Hechtman, Lily, ed. Attention Deficit Hyperactivity Disorder. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190213589.001.0001.
Full textAbstract:
The book provides a comprehensive summary of the best known and most highly respected well-controlled long-term prospective follow-up studies in Attention Deficit Hyperactivity Disorder (ADHD). These studies followed children with ADHD and matched controls into young adulthood (mean age 20–25 years) and middle age (mean age 41 years). They explore a wide variety of clinically relevant outcome areas, such as education, occupation, emotional and psychiatric functioning, substance use and abuse, sexual behavior, and legal problems. One chapter focuses particularly on the outcome of girls with ADHD. The book also explores possible predictors of adult outcome. A whole chapter is devoted to treatment (medication and psychosocial) as a predictor of outcome. In addition to treatment, predictors explored include characteristics of the child (e.g., IQ, severity of initial ADHD symptoms, initial comorbidity) and characteristics of the family (e.g., socioeconomic status, single parenthood, parental pathology, and family functioning). A summary chapter explores the impact and importance of these predictors in various outcome areas, such as education, occupation, emotional/social functioning, antisocial behavior, substance use and abuse, and risky sexual and driving behaviors. Professionals and the general public will come away with a clear view of what can happen to children with ADHD as they proceed through adolescence and adulthood. The book also addresses important prognostic and predictive factors in treatment approaches to ensure better long-term outcome in patients with ADHD.
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Rosenblatt, Elizabeth. Peritonitis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0032.
Full textAbstract:
Peritonitis, or inflammation of the serosal membranes lining the abdominal cavity, is used predominately to describe primary peritonitis (spontaneous bacterial peritonitis [SBP]) and secondary peritonitis—two conditions with distinct pathophysiologies that require different diagnostic and therapeutic approaches. Tertiary peritonitis is characterized by persistent symptoms or signs of infection despite appropriate treatment of primary or secondary peritonitis. Patients undergoing peritoneal dialysis are at risk for catheter-associated peritonitis, which is sometimes considered an additional category of peritonitis. The most common manifestation of SBP is fever. In addition, patients often endure abdominal pain, general malaise, fatigue, and hepatic encephalopathy. One-third of patients with SBP develop renal dysfunction, which is an independent predictor of mortality. In patients with ascites and high clinical suspicion for infection, empiric antibiotic therapy should be started immediately following blood cultures and diagnostic paracentesis.
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Glannon, Walter. Psychiatric Neuroethics II. Edited by John Z. Sadler, K. W. M. Fulford, and Werdie (C W. ). van Staden. Oxford University Press, 2015. http://dx.doi.org/10.1093/oxfordhb/9780198732372.013.31.
Full textAbstract:
I discuss ethical issues relating to interventions other than intracranial surgery and psychopharmacology for psychiatric disorders. I question the distinction between “invasive” and “non-invasive” techniques applying electrical stimulation to the brain, arguing that this should be replaced by a distinction between more and less invasive techniques. I discuss electroconvulsive therapy (ECT); it can be a relatively safe and effective treatment for some patients with depression. I consider transcranial magnetic stimulation (TMS) and transcranial current stimulation (tCS); the classification of these techniques as non-invasive may lead to underestimation of their risks. I discuss how placebos can justifiably be prescribed non-deceptively and even deceptively in clinical settings. An analysis of neurofeedback as the neuromodulating technique most likely to promote autonomy/control for some conditions follows. Finally, I examine biomarkers identified through genetic screening and neuroimaging; they might contribute to more accurate prediction and diagnosis, more effective treatment, and possibly prevention of psychiatric disorders.
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Todd, Stacy, and Nick Beeching. Fungal infection. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0315.
Full textAbstract:
Fungi, comprising yeasts, moulds, and higher fungi, have a worldwide distribution and are uncommon causes of disease in healthy individuals. However, over the last 20 years, invasive fungal disease (IFD) has become an increasing cause of morbidity and mortality. This is probably due to the increasing numbers of patients with underlying host conditions, which predispose to opportunistic IFD (e.g. transplant and anti-tumour necrosis factor immunosuppression, HIV, or chronic lung disease), and to increased recognition of endemic IFD (e.g. histoplasmosis), which cause disease in both immunocompetent and immunocompromised hosts in selected geographic locations. Diagnosis of IFD remains a challenge. Symptoms are often non-specific, and a definite diagnosis requires invasive sampling with appropriate laboratory testing of these samples. Non-invasive tests are being developed, but their positive and negative predictive values still need validation. Diagnostic criteria (‘proven, probable, and possible’) established primarily for use in research and clinical trials can also prove useful in clinical environments. However, the most important step in identifying patients with IFD is to consider the diagnosis in those at risk. This chapter will focus on the commonest causes of IFD (Candida spp., Aspergillus spp., Cryptococcus spp., and histoplasmosis).
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Kissane, David W. Psychosocial care of families in palliative care. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198806677.003.0007.
Full textAbstract:
The families of patients in the palliative care setting have a range of educational and care needs that form part of the basic responsibility of the hospice service. Routine family meetings are an important way to address these needs. Additionally, up to one third of families have some level of dysfunction in their relationships, which prove predictive of morbid bereavement outcomes—prolonged grief and major depressive disorders. These families who carry risk of poorer outcomes need additional care, optimally commenced during palliative care, and continued into bereavement to provide continuity of service. Assessment of family strengths and relational functioning provide insight into clinical targets to support a family. The needs of children, the elderly, disabled, or mentally ill family members need to be addressed alongside those of patients with complex illnesses. A preventive model of family-centred care may involve six to ten family therapy sessions across nine to 18 months.
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Quarrell, Oliver. Huntington's Disease. 3rd ed. Oxford University Press, 2020. http://dx.doi.org/10.1093/oso/9780198844389.001.0001.
Full textAbstract:
Huntington’s disease (HD)―the facts provides an overview of the condition aimed at families and carers understanding the condition. It describes the key features of: a movement disorder, disturbance of mood (affect), and problems with thinking (cognition) and behaviour. The movement problems of chorea, dystonia, and bradykinesia are explained but there is equal emphasis on depression impulsive behaviour and temper outbursts. Understanding the cause of these may help families cope better when they arise. The genetic change is discussed as is its effect on the protein huntingtin. Options for genetic testing of those at risk (predictive testing) as well as options for tests in pregnancy (prenatal diagnosis) and preimplantation genetic diagnosis (PGD) are described. Currently treatment is symptomatic and supportive. There is a discussion of clinical trials in general and the current huntingtin lowering studies using anti-sense oligonucleotides (ASOs) in particular. The book also includes vignettes written by family members.
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Lambert, Heather. Urinary tract infection in infancy and childhood. Edited by Neil Sheerin. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0180_update_001.
Full textAbstract:
Urinary tract infection (UTI) in childhood is a common problem, which is frequently dismissed as trivial because most children with UTI have a good outcome. However, UTI is an important cause of acute illness in children and causes a considerable burden of ill health on children and families. In addition, UTI may be a marker of an underlying urinary tract abnormality. UTI in a few may cause significant long-term morbidity, renal scarring, hypertension, and renal impairment that may not present until adult life. Predicting which children will go on to have long-term sequelae remains a challenge.The risk of renal scarring is greatest in infants, the very group in whom diagnosis is often overlooked or delayed because clinical features are non-specific. Delay in treatment is associated with an increased risk of scarring in susceptible children. Thus accurate and rapid diagnosis of UTI is essential and requires a very high index of suspicion particularly in the youngest.The role of vesicoureteric reflux in acquired scarring is not fully understood though there is clearly an association, possibly because it is a risk factor for acute pyelonephritis. Scarring when it occurs is in the areas affected by acute pyelonephritis. Higher grades of reflux are associated with a worse outcome.Management and investigation of children with UTI consumes considerable healthcare resources. Limited understanding of the natural history and basic pathophysiology, variations in strategy with time and setting, and lack of evidence on long-term outcomes have resulted in considerable uncertainty. Some propose a minimal approach doing little investigation unless there is clear evidence for it; others favour an approach of continuation of current practice based on clinical experience until further evidence evolves. Some of the themes behind these controversies are explored.
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Coghill, David, Maggie Toplak, Sinead Rhodes, and Nicoletta Adamo. Cognitive functioning in ADHD. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198739258.003.0010.
Full textAbstract:
Inhibition, memory, temporal discounting, decision-making, timing, and intraindividual variability in reaction time have emerged as key cognitive domains for understanding neurocognitive deficits in individuals with ADHD. In the domain of inhibition, motor inhibition has been studied most extensively, with deficits demonstrated in both restraint and cancellation. Working memory difficulties have been identified using a broad range of tasks. Decision-making has been less well studied, but risky decision-making and temporal discounting have displayed relatively consistent effects. Motor timing, duration discrimination, duration reproduction, and variability on all of these tasks have also been implicated in ADHD. From a clinical perspective, whilst ADHD is clearly associated with a broad range of neuropsychological deficits, there is considerable heterogeneity and none of these deficits is required or necessary for a diagnosis. However, neuropsychological measures may help define cognitive subgroups within ADHD and these may in turn be useful in predicting course, outcome, and treatment response.
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Schelbert, Heinrich R. Image-Based Measurements of Myocardial Blood Flow. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199392094.003.0024.
Full textAbstract:
Image-based measurements of myocardial blood flow afford the assessment of coronary circulatory function. They reflect functional consequences of coronary stenoses, diffuse epicardial vessel disease and microvascular dysfunction and structural changes and thus provide a measure of the total ischemic burden. Measured flows contain therefore clinically important predictive information. Fundamental to flow measurements are the tissue tracer kinetics, their description through tracer kinetic models, high spatial and temporal resolution imaging devices and accurate extraction of radiotracer tissue concentrations from dynamically acquired images for estimating true flows from the tissue time activity curves. A large body of literature on measurements of myocardial blood flow exists for defining in humans normal values for flow at baseline and during hyperemic stress as well as for the myocardial flow reserve. The role of PET for flow measurements has been well established; initial results with modern SPECT devices are encouraging. Responses of myocardial blood flow to specific challenges like pharmacologic vasodilation and to sympathetic stimulation can uncover functional consequences of focal epicardial coronary stenoses, of conduit vessel disturbances and disease and impairments of microvascular function. Apart from risk stratification, flow measurements may allow detection of early preclinical disease, influence treatment strategies and identify therapy responses.