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1
Bradley, Clare. Injury risk factors, attitudes, and awareness: A submission to the CATI-TRG. Canberra: Australian Institute of Health and Welfare, 2004.
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2
Harrell, W. Andrew. Accident history, perceived risk of personal injury, and job mobility as factors influencing occupational accident fatalism. Edmonton, Alberta: Department of Sociology, The University of Alberta, 1985.
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3
O'Sullivan, Kieran. The role of muscle strength in hamstring injury. Hauppauge, N.Y: Nova Science Publishers, 2010.
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Hudock, S. D. Risk profile of cumulative trauma disorders of the arm and hand in the U.S. mining industry. Washington, D.C: U.S. Dept. of the Interior, Bureau of Mines, 1992.
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5
Johnson, Urban. The long term injured competitive athlete: A study of psychosocial risk factors. Stockholm: Almqvist & Wiksell International, 1997.
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6
Hoste, Eric A. J., John A. Kellum, and Norbert Lameire. Definitions, classification, epidemiology, and risk factors of acute kidney injury. Edited by Norbert Lameire. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0220_update_001.
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The lack of a precise biochemical definition of acute kidney injury (AKI) resulted in at least 35 definitions in the medical literature, which gave rise to a wide variation in reported incidence and clinical significance of AKI, impeded a meaningful comparison of studies.The first part of this chapter describes and discusses different definitions and classification systems of AKI. Patient outcome and the need for renal replacement therapy are directly related to the severity of AKI, an observation that supports the use of a categorical staging system rather than a simple binary descriptor. The severity of AKI is commonly characterized using the relative changes in serum creatinine and urine output. Recently introduced staging systems including the RIFLE classification and the Acute Kidney Injury Network (AKIN) use these relatively simple and readily available parameters allowing the assignment of individual patients to different AKI stages. More recently, a Kidney Disease: Improving Global Outcomes (KDIGO) workgroup developed a consensus-based AKI staging system drawing elements of both RIFLE and AKIN. The potential pitfalls and limitations of the proposed definitions and classifications are briefly described.The second part of the chapter describes the epidemiology of AKI in different clinical settings; the intensive care unit (ICU), the hospitalized population, and the community. The different spectrum of AKI in the emerging countries is discussed and the most important causes and aetiologies of the major clinical types of AKI, prerenal, renal, and post-renal are summarized in table form. Finally the patient survival and renal functional outcome of AKI are briefly discussed
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Pickett, Charles William Lawrence. Medications as risk factors for non-fatal agricultural injury in Ontario. 1995.
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8
Lameire, Norbert. Prevention of acute kidney injury. Edited by Norbert Lameire. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0224_update_001.
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The prevention of acute kidney injury (AKI) should start with an assessment of the risk to develop AKI, by identification of co-morbidities, use of potentially nephrotoxic medications, and early recognition of acute reversible risk factors associated with AKI. This chapter discusses first the most relevant general risk factors for AKI and describes the recent introduction of several surveillance systems. In addition, some specific risk factors play a role in the pathogenesis of post-cardiac surgery AKI. Finally risks associated with commonly used drugs such as non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statins, and warfarin are considered.
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Diagnostics, Risk Factors, Treatment and Outcomes of Acute Kidney Injury in a New Paradigm. MDPI, 2020. http://dx.doi.org/10.3390/books978-3-03936-087-1.
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Abhishek, Abhishek, and Michael Doherty. Epidemiology and risk factors for calcium pyrophosphate deposition. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0048.
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Calcium pyrophosphate crystal deposition (CPPD) is rare in younger adults but becomes increasingly common over the age of 55 years, especially at the knee. Ageing and osteoarthritis (OA) are the main attributable risk factors. Hyperparathyroidism, hypomagnesaemia, haemochromatosis, and hypophosphatasia are other less common risk factors. Rare families with familial CPPD have been reported from many different parts of the world, and mainly present as young-onset polyarticular CPPD. Recent studies suggest that CPPD occurs as the result of a generalized constitutional predisposition and may also associate with low cortical bone mineral density. Previous meniscectomy, joint injury, and constitutional knee malalignment are local biomechanical risk factors specifically for knee chondrocalcinosis. Although associated with OA, current evidence suggests that CPPD does not associate with development or progression of OA.
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Turbeville, Sean David. Risk factors for injury in middle school and high school football players living in Oklahoma City. [s.n.], 2002.
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Crowell, Sheila E., Mona Yaptangco, and Sara L. Turner. Coercion, Invalidation, and Risk for Self-Injury and Borderline Personality Traits. Edited by Thomas J. Dishion and James Snyder. Oxford University Press, 2015. http://dx.doi.org/10.1093/oxfordhb/9780199324552.013.16.
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Self-inflicted injury (SII) is defined as a deliberate act in which a person seeks to cause bodily harm or death. The etiology and developmental course of SII are unclear. Converging evidence suggests coercive family processes may heighten risk for SII and related clinical problems among vulnerable youth. This chapter outlines a developmental theory of SII with particular attention to contextual risk factors. It proposes that risk for SII is highest when vulnerable youth are exposed repeatedly to coercive and invalidating family environments. Evidence in support of this theory is drawn from longitudinal studies of SII and borderline personality traits. The chapter also reviews data involving conflict discussion tasks with self-injuring and depressed adolescents and their mothers. Accumulating evidence suggests that coercive processes are a leading contextual mechanism that shapes behavioral and physiological dysregulation, ultimately heightening risk for self-injury and borderline personality disorder.
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Lameire, Norbert. Renal outcomes of acute kidney injury. Edited by Norbert Lameire. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0238_update_001.
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This chapter summarizes the accumulating evidence that incomplete or even apparent complete recovery of renal function after acute kidney injury (AKI) may be an important contributor to a growing number of incident chronic kidney disease (CKD) and end-stage renal disease (ESRD) cases, largely in excess of the global growth in CKD prevalence. Evidence based on epidemiologic studies supports the notion that even after adjustment for several important covariates AKI is independently associated with an increased risk for both CKD and ESRD. Several risk factors for the subsequent development of CKD among survivors of AKI have been identified. Besides well-known risk factors for CKD in general, such as hypertension, older age, congestive heart failure, diabetes, and proteinuria, AKIN staging and duration also predict longitudinal CKD development. These characteristics may identify a category of at-risk AKI patients at the time of hospital discharge that will need long follow-up times for appropriate screening and surveillance measures for CKD.
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Andover, Margaret S., Heather T. Schatten, and Blair W. Morris. Suicidal and Nonsuicidal Self-Injury in Borderline Personality Disorder. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199997510.003.0008.
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Individuals diagnosed with borderline personality disorder (BPD) are at an elevated risk for engaging in self-injurious behaviors, including suicide, attempted suicide, and nonsuicidal self-injury (NSSI). The purpose of this chapter is to provide an overview of research on self-injurious behaviors among individuals with BPD. Definitions and prevalence rates are provided for NSSI, suicide, and attempted suicide. Clinical correlates of and risk factors for the behaviors, as well as associations between specific BPD criteria and self-injurious behaviors, are discussed, and a brief overview of treatments focused on reducing self-injurious behaviors among BPD patients is provided. By understanding risk factors for attempted suicide and NSSI in BPD, we can better identify patients who are at increased risk and focus treatment efforts on addressing modifiable risk factors.
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Wise, Matt, and Paul Frost. ICU treatment of acute kidney injury. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0151.
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Traditionally, the etiology of acute kidney injury (AKI) is considered in terms of prerenal, renal, and obstructive causes. However, this categorization is less useful in the ICU, where the etiology of AKI is usually multifactorial and often occurs in the context of multi-organ failure. Hypotension, nephrotoxic drugs, and severe sepsis or septic shock are the most important identifiable factors. Less frequently encountered causes include pancreatitis, abdominal compartment syndrome, and rhabdomyolysis. Primary intrinsic renal disease such as glomerulonephritis is extremely uncommon. A previous history of cirrhosis, cardiac failure, or haematological malignancy, and age >65 years, are important risk factors. This chapter covers symptoms, complications, diagnosis, investigations, prognosis, and treatment of renal failure in the ITU.
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Steggerda, Justin, Eric Simms, and Miguel Burch. Bile Duct Injury in Laparoscopic Cholecystectomy. Edited by Danny Sherwinter and Miguel A. Burch. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199384075.003.0041.
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This chapter provides a summary of a landmark study in performance of laparoscopic cholecystectomy. Can we improve safety and reduce the risk of bile duct injury during laparoscopic cholecystectomy? Starting with that question, it provides information 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 reviews identified risk factors and describes technical aspects the authors identified to increase safety, notably defining the critical view of safety. The chapter also provides a brief critique, review of other notable studies, and concludes with a relevant clinical case regarding possible treatment of a patient with ERCP.
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J, Sanders Martha, ed. Management of cumulative trauma disorders. Boston: Butterworth-Heinemann, 1997.
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Kuramoto-Crawford, S. Janet, and Holly C. Wilcox. Substance Use Disorders and Intentional Injury. Edited by Kenneth J. Sher. Oxford University Press, 2014. http://dx.doi.org/10.1093/oxfordhb/9780199381708.013.002.
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Intentional injuries affect millions of lives worldwide. The authors provide an overview of the epidemiological and preventive evidence on the relationship between substance use disorders (SUD) and intentional injuries. Emphasis is placed on suicide and intimate partner violence, as each area has received substantial research attention in relation to SUD. There is robust epidemiological evidence on the relationship between SUD, notably with alcohol use disorders, and most intentional injuries. Research has focused on the identification of factors that distinguish individuals with alcohol use disorders who are at particularly high risk for intentional injuries. Characterization of those with other drug use disorders who are at risk for engaging in intentional injuries and the role of SUD in intentional injuries has been less extensively investigated. The authors conclude with a discussion of public health approaches to the prevention of intentional injuries among individuals with SUD.
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Bryant Miller, Adam, Maya Massing-Schaffer, Sarah Owens, and Mitchell J. Prinstein. Nonsuicidal Self-Injury Among Youth. Edited by Thomas H. Ollendick, Susan W. White, and Bradley A. White. Oxford University Press, 2018. http://dx.doi.org/10.1093/oxfordhb/9780190634841.013.34.
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Nonsuicidal self-injury (NSSI) is direct, intentional harm to one’s own body performed without the intent to die. NSSI has a marked developmental onset reaching peak prevalence in adolescence. NSSI is present in the context of multiple psychological disorders and stands alone as a separate phenomenon. Research has accumulated over the past several decades regarding the course of NSSI. While great advances have been made, there remains a distinct need for basic and applied research in the area of NSSI. This chapter reviews prevalence rates, correlates and risk factors, and leading theories of NSSI. Further, it reviews assessment techniques and provides recommendations. Then, it presents the latest evidence-based treatment recommendations and provides a case example. Finally, cutting edge research and the next frontier of research in this area are outlined.
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Ahmed, Mohammed, and Sean M. Bagshaw. Management of oliguria and acute kidney injury in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0213.
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Acute kidney injury (AKI) remains a challenging clinical problem for clinicians caring for critically-ill patients due largely to the paucity of specific therapeutic interventions aimed at mitigating poor outcome. Those patients most at risk for the development of AKI can often be identified by an assessment of demographic, clinical, diagnostic, and procedure-related factors couple with early and intensive bedside monitoring. Importantly, critically-ill patients are often exposed to multiple discrete risks that can accumulate during their course that can negatively impact not only the duration and severity of AKI, but also probability of recovery, and long-term functional decline and risk of development of chronic kidney disease. All critically-ill patients at risk of or with milder forms of AKI should have support individualized. A clear understanding of the scope, complexity, and general principals of prevention and management of AKI are indispensable in the care of these patients and will discussed in this chapter.
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Pearse, Rupert, and Stephen James. Identification of the high-risk surgical patient. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0360.
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The low overall post-operative mortality rate conceals the existence of a sub-group of high-risk patients, which accounts for over 80% of post-operative deaths. Age, co-morbid disease, limited functional capacity, and an emergency presentation for major surgery are hallmarks risk. The magnitude, duration, and consequences of post-operative morbidity are determined by a complex interplay between the indication for surgery, the resulting tissue injury, and patient factors. A number of methods including risk scoring and cardiopulmonary exercise testing can be used to identify the high-risk group. Efforts should be made throughout the peri-operative period to prevent the occurrence of any post-operative complications, as they all carry significant long-term implications.
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Merry, Alan F., Simon J. Mitchell, and Jonathan G. Hardman. Hazards in anaesthetic practice: general considerations, injury, and drugs. Edited by Jonathan G. Hardman. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0044.
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The hazards of anaesthesia should be considered in the context of the hazard of surgery and of the pathology for which the surgery is being undertaken. Anaesthesia has become progressively safer since the successful demonstration of ether anaesthesia in Boston, Massachusetts, United States in 1846 and the first reported death under anaesthesia in 1847. The best estimation of the rate of anaesthesia-related mortality comes from the anaesthesia mortality review committees in Australia and New Zealand, where data have been collected under essentially consistent definitions since 1960, and reports are amalgamated under the auspices of the Australian and New Zealand College of Surgeons. An internationally accepted definition of anaesthetic mortality is overdue. Extending the time for inclusion of deaths from 24 h to 30 days or longer substantially increases estimated rates of mortality. Attribution of cause of death may be problematic. Even quite small degrees of myocardial injury in patients undergoing non-cardiac surgery increase the risk of subsequent mortality, and in older patients, 30-day all-cause mortality following inpatient surgery may be surprisingly high. Patients should be given a single estimate of the combined risk of surgery and anaesthesia, rather than placing undue emphasis on the risk from anaesthesia alone. Hazards may arise from equipment or from drugs either directly or through error. Error often underlies harmful events in anaesthesia and may be made more likely by fatigue or circadian factors, but violations are also important. Training in expert skills and knowledge, and in human factors, teamwork, and communication is key to improving safety.
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Prowle, John, and Rinaldo Bellomo. Acute kidney injury in severe sepsis. Edited by Norbert Lameire. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0244_update_001.
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Septic acute kidney injury (S-AKI) accounts for close to 50% of all cases of AKI in ICU and, in its various forms, affects between 15% and 20% of ICU patients. Patients typically present with clinical evidence of severe sepsis and septic shock, developing oliguria or anuria, and rapidly rising serum creatinine concentration. The pathophysiology of S-AKI is poorly understood. Although haemodynamic factors might play a role in the loss of glomerular filtration rate, this may not be through the induction of renal ischaemia. Inflammation, microvascular shunting, and changes in glomerular arteriolar tone may play important roles. Much evidence suggests that clinically urinalysis fails to provide useful diagnostic or prognostic information in this setting but novel biomarkers and urine microscopy may provide more useful prognostic information.The treatment of S-AKI remains based on the treatment of the aetiology of sepsis with source control and appropriate antibiotics, supportive treatment of systemic illness including, in severe cases, renal replacement therapy (RRT). Because most patients with S-AKI requiring RRT are critically ill and haemodynamically unstable, RRT in these patients is best provided as continuous RRT.Approximately 50% of patients with severe S-AKI survive to hospital discharge and, among those who survive, approximately 85–90% recover to dialysis independence. However, those patients who recover appear to be at increased risk of developing chronic kidney disease over the following years.
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Tsai, Ching-Wei, Sanjeev Noel, and Hamid Rabb. Pathophysiology of Acute Kidney Injury, Repair, and Regeneration. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0030.
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Acute kidney injury (AKI), regardless of its aetiology, can elicit persistent or permanent kidney tissue changes that are associated with progression to end-stage renal disease and a greater risk of chronic kidney disease (CKD). In other cases, AKI may result in complete repair and restoration of normal kidney function. The pathophysiological mechanisms of renal injury and repair include vascular, tubular, and inflammatory factors. The initial injury phase is characterized by rarefaction of peritubular vessels and engagement of the immune response via Toll-like receptor binding, activation of macrophages, dendritic cells, natural killer cells, and T and B lymphocytes. During the recovery phase, cell adhesion molecules as well as cytokines and chemokines may be instrumental by directing the migration, differentiation, and proliferation of renal epithelial cells; recent data also suggest a critical role of M2 macrophage and regulatory T cell in the recovery period. Other processes contributing to renal regeneration include renal stem cells and the expression of growth hormones and trophic factors. Subtle deviations in the normal repair process can lead to maladaptive fibrotic kidney disease. Further elucidation of these mechanisms will help discover new therapeutic interventions aimed at limiting the extent of AKI and halting its progression to CKD or ESRD.
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Wald, Ron, and Ziv Harel. The Long-Term Outcomes of Acute Kidney Injury. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0015.
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Recent research has provided important insights on the long-term outcomes of patients who develop acute kidney injury (AKI) in the setting of critical illness. Large epidemiologic studies have demonstrated compelling associations between episodes of AKI and progressive kidney disease and death, respectively, although such studies do not establish causality due to the potential for confounding. Whether AKI is intrinsically toxic or a mere by-product of serious comorbidities (e.g. prior chronic kidney disease, heart failure, diabetes), there is no doubt that AKI survivors are a high-risk group who would likely benefit from close post-discharge follow-up. Recent studies have shown that a minority of patients with AKI receive specialized nephrology follow-up after discharge, suggesting an opportunity for quality improvement. Emerging research is evaluating factors that predict chronic kidney disease, end-stage renal disease, and death among AKI survivors. This work will, it is hoped, suggest new targets for prevention and treatment, with the goal of enhancing the likelihood of recovery following AKI.
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Spirito, Anthony, Kimberly O'Brien, Megan Ranney, and Judelysse Gomez. The Evaluation and Management of Suicide Risk in Adolescents in the Context of Interpersonal Violence. Edited by Phillip M. Kleespies. Oxford University Press, 2014. http://dx.doi.org/10.1093/oxfordhb/9780199352722.013.4.
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In this chapter, risk factors for suicidal ideation and behavior are reviewed, including sociodemographics, prior suicidal behavior, nonsuicidal self-injury, depression, anxiety, substance use, family factors, physical and sexual abuse, sexual orientation, and access to firearms. Special emphasis is placed on the intersection of suicidality and interpersonal violence in terms of reciprocal risk. A review of the core areas to address in the acutely suicidal adolescent or the adolescent who has recently attempted suicide is also provided. Clinical questions regarding the adolescent’s current emotional state, suicidal ideation/intent, reasons for suicidality, access to means, and capability of the environment to keep the adolescent safe are suggested. The chapter concludes with a discussion of safety planning.
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Christopher J. L. Murray (Editor) and Alan D. Lopez (Editor), eds. Global Burden of Disease: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020 (The Global Burden of Disease and Injury). Harvard School of Public Health, 1996.
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Kendrick, Denise. Unintentional injuries and their prevention. Edited by Alan Emond. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198788850.003.0014.
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This chapter quantifies the burden of childhood injuries; describes risk factors for child injury, levels and approaches to injury prevention, and recommendations for effective behaviour change; summarizes evidence for preventing child injuries at home and on the roads; discusses putting injury prevention into practice for practitioners and commissioners; makes recommendations for the injury prevention content of the Healthy Child Programme; and provides a resource list for practitioners, parents, and commissioners.
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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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Feinman, Jared W., and John G. Augoustides. Neuroprotection for Aortic Surgery and Stenting. Edited by David L. Reich, Stephan Mayer, and Suzan Uysal. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190280253.003.0017.
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Despite recent advances, aortic surgery and stenting for an array of diseases still pose a significant risk of permanent and severe injury to the brain and/or spinal cord. These neurological risks are best understood in terms of the primary disease pathology, the extent of aortic involvement, mechanisms and risk factors, the role of neuromonitoring modalities, and the surgical techniques required for repair. This chapter will present an overview of perioperative practice in aortic surgery and stenting based on this framework and the latest guidelines and trials in order to describe best practices and promising options for neuroprotection in this challenging clinical setting.
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Kostka, Tomasz, and Joanna Kostka. Injuries in sports activities in elderly people. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198701590.003.0077.
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Regular physical activity in old age is widely recommended as an effective way to prevent chronic diseases and maintain well-being. Nevertheless, sports participation carries the risk of injury. In elderly people, the risk of injury is greater due to age-related pathophysiological changes and concomitant chronic conditions. Available data indicate an increasing number of injuries among older people, which is associated with there being more older people and an increasing number of these people are participating in sports and physical exercise. An appropriate identification of risk factors for injury and education of older people can reduce the incidence of injuries. Methods of preventing injuries include protective equipment such as helmets, warming up, and properly designed training programmes. Health benefits of participation in regular physical activity adjusted to health status and physical functioning outweigh hazards of sport-related injuries, even in advanced age.
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Dobb, Geoffrey J. Diarrhoea and constipation in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0183.
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The diagnosis of intra-abdominal hypertension (IAH)/abdominal compartment syndrome (ACS ) relies on accurate IAP measurement. The current gold standard for measurement is intermittently every 4–6 hours via the bladder. IAP monitoring should be performed in all critically-ill or injured patients exhibiting ≥1 risk factors for the development of IAH, and continued until risk factors are resolved and intra-abdominal pressure (IAP) has remained normal for 24–48 hours. IAH and ACS cause organ dysfunction through direct compression of the heart, compression of both arterial and venous perfusion of the abdominal organs, and abdomino-thoracic pressure transmission. All organ systems are affected by IAH-induced injury. Standard surgical treatment of established ACS not responding to non-invasive management consists of decompressive laparotomy via midline or transverse incision. Promising alternative surgical strategies are being developed to avoid the complications of the open abdomen.
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Lee, Lorri A. Postoperative Visual Loss. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0064.
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Postoperative visual loss (POVL) has multiple diagnoses and contributory causes including emboli, direct globe compression, prolonged elevation of venous pressure in the head with associated large fluid shifts, prolonged hypotension, periorbital trauma, preexisting ophthalmologic anatomic risk factors, and many other associated factors. It frequently results in permanent injury and severe disability. Though any loss of vision postoperatively should prompt an emergent or urgent ophthalmologic consultation, some of the rarer causes of POVL are considered true medical or surgical emergencies. This chapter briefly discusses these rarer causes and primarily focuses on the more common POVL diagnoses, including the mechanism of injury, appropriate assessment, and initial management.
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Hesdorffer, Dale C. Epidemiology of Epilepsy. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0042.
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Epilepsy affects 1 out of every 26 people during their lifetime. Worldwide, the incidence of epilepsy ranges from 28.0/100,000 to 235.5/100,000, with the large variation attributable to differences in methodology across studies. The prevalence of active epilepsy provides important information about the burden of epilepsy in the population and spurs public health planner to assess the needs of the epilepsy population. The active prevalence of epilepsy ranges from 2.4/1,000 to 22.8/1,000 worldwide and more than 65 million people have active epilepsy. Risk factors for childhood-onset and adult-onset epilepsy are discussed, considering epilepsy etiologies (e.g., severe traumatic brain injury), newer risk factors without bidirectional relationships with epilepsy (e.g., low socioeconomic status), risk factors with bidirectional relationships (e.g., psychiatric disorders), and different types of acute symptomatic seizures (e.g., febrile seizures).
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Brallier, Jess W., and Jonathan S. Gal. Neuroprotection for Spine Surgery. Edited by David L. Reich, Stephan Mayer, and Suzan Uysal. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190280253.003.0020.
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Perioperative neurologic injury related to spine surgery, albeit rare, can result in devastating functional loss. As the number of spine operations has increased, so has the need for strategies designed to avoid and protect against such injury. This chapter reviews the common etiologies of neurologic deficits secondary to spine surgery and the factors that place patients at increased risk for developing these complications. The use of intraoperative neuromonitoring, including somatosensory evoked potentials (SSEPs), electromyography (EMG), and transcranial motor evoked potentials (TcMEPs), to detect surgical trespass of neuronal elements is also reviewed. The authors also summarize the role of physiologic parameter optimization, including mean arterial blood pressure and body temperature, and pharmacologic interventions, should an injury occur. Current practice guidelines for preventing and managing perioperative neurologic injury are described.
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Vasilevskis, Eduard E., and E. Wesley Ely. Causes and epidemiology of agitation, confusion, and delirium in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0226.
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Confusion is a non-specific, non-diagnostic term to describe a patient with disorientation, impaired memory, or abnormal thought process. Agitation describes an increased level of psychomotor activity, and anxious or aggressive behaviour. Many agitated patients may also be delirious, yet they only represent a minority of all delirious patients. ICU delirium is an acute cognitive disorder of both consciousness and content of thought. The hallmark of ICU delirium is a fluctuating mental status, inattention, and an altered level of consciousness. Delirium is the end product of a sequence of insults and injury that lead to a common measurable manifestation of end-organ brain injury. It does not have a single aetiology, but often has multiple different and potentially interacting aetiologies. Both non-modifiable and modifiable risk factors play important roles in the development of delirium. Importantly, the new onset of delirium should prompt the physician to investigate the underlying cause. Cognitive impairment and age are among the most important non-modifiable risk factors, whereas administration of benzodiazepines is the greatest. The alpha-2 adrenoceptor agonist dexmedetomidine shows promise as a sedative reducing the risk for delirium when compared with benzodiazepines.
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Ware, Lorraine B. Pathophysiology of acute respiratory distress syndrome. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0108.
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The acute respiratory distress syndrome (ARDS) is a syndrome of acute respiratory failure characterized by the acute onset of non-cardiogenic pulmonary oedema due to increased lung endothelial and alveolar epithelial permeability. Common predisposing clinical conditions include sepsis, pneumonia, severe traumatic injury, and aspiration of gastric contents. Environmental factors, such as alcohol abuse and cigarette smoke exposure may increase the risk of developing ARDS in those at risk. Pathologically, ARDS is characterized by diffuse alveolar damage with neutrophilic alveolitis, haemorrhage, hyaline membrane formation, and pulmonary oedema. A variety of cellular and molecular mechanisms contribute to the pathophysiology of ARDS, including exuberant inflammation, neutrophil recruitment and activation, oxidant injury, endothelial activation and injury, lung epithelial injury and/or necrosis, and activation of coagulation in the airspace. Mechanical ventilation can exacerbate lung inflammation and injury, particularly if delivered with high tidal volumes and/or pressures. Resolution of ARDS is complex and requires coordinated activation of multiple resolution pathways that include alveolar epithelial repair, clearance of pulmonary oedema through active ion transport, apoptosis, and clearance of intra-alveolar neutrophils, resolution of inflammation and fibrinolysis of fibrin-rich hyaline membranes. In some patients, activation of profibrotic pathways leads to significant lung fibrosis with resultant prolonged respiratory failure and failure of resolution.
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Kaplan, Tamara, and Tracey Milligan. Seizures and Epilepsy (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190650261.003.0008.
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The video in this chapter explores seizures and epilepsy, including definitions or focal or generalized seizures and epilepsy, as well as the differences between the two. It discusses risk factors for epilepsy (family history, history of febrile seizures, brain injury) and its diagnosis (by history and EEG), as well as comorbidities of epilepsy (mood and cognitive disorders, accidents, and sudden unexpected death).
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Saxon, Leanne. Bone. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199533909.003.0006.
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Sports participation has numerous positive health benefits; however, it is also associated with an increased risk of injury. While bone injuries in sport are less frequent than ligament tears, contusions, or surface wounds, they can be debilitating for an athlete because of the time needed for recovery. In this chapter I describe the incidence and cost of bone injuries in sport, fundamentals of bone biology and repair, risk factors associated with fractures, stress fractures, and periostitis, and review both current and possible future recommendations for the treatment of bone-related injuries....
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Pruthi, Rajiv K. Coagulation (Hemostasis and Thrombosis). Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199755691.003.0295.
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The coagulation system has 2 essential functions: to maintain hemostasis and to prevent and limit thrombosis. The procoagulant component of the hemostatic system prevents and controls hemorrhage. Vascular injury results in activation of hemostasis, which consists of vasospasm, platelet plug formation (platelet activation, adhesion, and aggregation), and fibrin clot formation (by activation of coagulation factors in the procoagulant system). The anticoagulant system prevents excessive formation of blood clots, and the fibrinolytic system breaks down and remodels blood clots. Quantitative abnormalities (deficiencies) and qualitative abnormalities of platelets and coagulation factors lead to bleeding disorders, whereas deficiencies of the anticoagulant system are risk factors for thrombosis. Common disorders of hemostasis and thrombosis are reviewed.
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Gray, Andrew C. Orthopaedic approach to the multiply injured patient. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.012003.
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♦ Major trauma results in a systemic stress response proportional to both the degree of initial injury (1st hit) and the subsequent surgical treatment (2nd hit).♦ The key physiological processes of hypoxia, hypovolaemia, metabolic acidosis, fat embolism, coagulation and inflammation operate in synergy during the days after injury/surgery and their effective management determines prognosis.♦ The optimal timing and method of long bone fracture fixation after major trauma remains controversial. Two divergent views exist between definitive early intramedullary fixation and initial external fixation with delayed conversion to an intramedullary nail once the patient’s condition has been better stabilised.♦ There is agreement that the initial skeletal stabilisation should not be delayed and that the degree of initial injury has a more direct correlation with outcome and the development of subsequent systemic complications rather than the method of long bone fracture stabilisation.♦ Trauma patients can be screened to identify those more ‘at risk’ of developing systemic complications such as respiratory insufficiency. Specific risk factors include: A high injury severity score; the presence of a femoral fracture; the combination of blunt abdominal or thoracic injury combined with an extremity fracture; physiological compromise on admission and uncorrected metabolic acidosis prior to surgery.♦ The serum concentration of pro-inflammatory cytokine interleukin (IL) 6 may offer an accurate method of quantifying the degree of initial injury and the response to surgery.♦ The effective management of the polytraumatised patient involves a team approach and effective communication with allied specialties and theatre staff. A proper hierarchy of the injuries sustained can then be compiled and an effective surgical strategy made.
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Bafadhel, Mona. Prevention of respiratory disease. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0344.
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The prevention of disease at a population health level rather than an individual health level is aimed at reducing causes of ‘preventable’ death and, under the auspices of public health and epidemiology, is an integral part of primary, secondary, and tertiary care. Classification of death is usually according to the type of primary disease or injury. However, there are a number of recognized risk factors for death, and modifications in behaviour or risk factors can substantially reduce preventable causes of death and the associated healthcare and economic burden of chronic disease management. According to the WHO, hundreds of millions of people from infancy to old age suffer from preventable chronic respiratory diseases, there are over four million deaths annually from preventable respiratory diseases, and common respiratory disorders (e.g. lower respiratory tract infections, chronic obstructive pulmonary disease, lung cancer, and tuberculosis) account for approximately 20% of all deaths worldwide. This chapter discusses the prevention of respiratory disease, covering diseases associated with smoking (one of the biggest risk factors associated with preventable deaths), air pollution, and other lifestyle factors associated with respiratory disease; changes in legislation concerning smoking and work-related respiratory disease; and, finally, the prevention of respiratory diseases through the use of immunization and screening tools.
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Barnard, Matthew, and Nicola Jones. Intensive care management after cardiothoracic surgery. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0368.
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Management of the post-cardiothoracic surgical patient follows general principles of intensive care, but incorporates certain unique considerations. In cardiac surgical patients peri-operative ischaemia, arrhythmias and ventricular dysfunction mandate specific monitoring requirements, and individual pharmacological and mechanical support. Suspicion of myocardial ischaemia should not only lead to pharmacological treatment, but also consideration of urgent angiography to exclude coronary graft occlusion. Ventricular dysfunction may be pre-existing or attributable to intra-operative myocardial ‘stunning’. Catecholamines and phosphodiesterase inhibitors are the mainstay of therapy. Rarely, intra-aortic balloon pumping or ventricular assist devices are required. Significant bleeding (with potential cardiac tamponade), respiratory compromise, acute kidney injury, neurological injury, and deep sternal wound infection each occur in ~2–3% of cardiac surgical patients. Each of these has individual risk factors and specific management considerations. General guidelines for patients who have undergone thoracic surgery include early extubation, fluid restriction, effective analgesia, and protective lung ventilation. Thoracic patients are at risk of atelectasis, respiratory infection, bronchial air leak, and right ventricular failure. Positive pressure ventilation is avoided whenever possible particularly after pneumonectomy, but is sometimes necessary in compromised patients. Air leaks are common. Alveolopleural fistulae usually improve with conservative management,whereas bronchopleural fistulae are more likely to require surgical intervention. Lung surgery is high risk for patients with ischaemic heart disease. Patients with pre-existing elevated pulmonary vascular resistance may exhibit right ventricular dysfunction and may fail to cope with a further increase in pulmonary vascular resistance consequent to lung resection. Lung collapse and infection are constant risks throughout the entire post-operative period.
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Adam, Sheila, Sue Osborne, and John Welch. Renal problems. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199696260.003.0007.
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The kidneys normally excrete metabolic waste products in urine while maintaining fluid, electrolyte, and acid–base balance. However, critical illness frequently leads to renal impairment, loss of these functions, and potentially life-threatening complications. This chapter describes the functional anatomy and physiology of the renal system, important risk factors for acute kidney injury, and how renal function can be monitored and maintained. The methods, advantages, disadvantages, and practical management of different types of renal replacement therapy are discussed, together with essential aspects of holistic patient care.
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Cukrowicz, Kelly C., and Erin K. Poindexter. Suicide. Edited by C. Steven Richards and Michael W. O'Hara. Oxford University Press, 2014. http://dx.doi.org/10.1093/oxfordhb/9780199797004.013.033.
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Suicide is a significant concern for clinicians working with clients experiencing major depressive disorder (MDD). Previous research has indicated that MDD is the diagnosis more frequently associated with suicide, with approximately two-thirds of those who die by suicide suffering from depression at the time of death by suicide. This chapter reviews data regarding the prevalence of suicidal behavior among those with depressive disorders. It then reviews risk factors for suicide ideation, self-injury, and death by suicide. Finally, the chapter provides an empirical overview of treatment studies aimed at decreasing risk for suicide, as well as an overview of several recent treatment approaches showing promise in the reduction of suicidal behavior.
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Swanson, Karen L. Neoplastic and Vascular Diseases. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199755691.003.0618.
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Neoplastic and vascular disorders are reviewed. Lung cancer is the most common malignancy and cause of cancer death in both men and women worldwide. The incidence of new lung cancers has continued to decrease in men and increase in women. The risk factors include cigarette smoking, other carcinogens, cocarcinogens, radon exposure, arsenic, asbestos, coal dust, chromium, vinyl chloride, chloromethyl ether, and chronic lung injury. Genetic and nutritional factors have been implicated. Among vascular disorders, pulmonary embolism is most common. Pulmonary embolism (PE) is the cause of death in 5% to 15% of hospitalized patients who die in the United States. In a multicenter study of PE, the mortality rate at 3 months was 15% and important prognostic factors included age older than 70 years, cancer, congestive heart failure, COPD, systolic arterial hypotension, tachypnea, and right ventricular hypokinesis.
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Dinescu, Anca, and Mikhail Kogan. Falls. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190466268.003.0023.
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Falls in the elderly are very common, and their frequency increases with aging. At a personal level, falls are associated with a subsequent fear of falling, a decline in function, increased nursing home placement, and increased use of medical services, and complications resulting from falls represent the leading cause of death from injury in geriatric population. At the more global level, falls in the elderly are associated with increased use of medical services and increased cost directly to the patient and also indirectly, if we add the number of hours of work lost by caregivers who will assume care of that elderly person after the fall. This chapter covers the definition and relevance of falls in the elderly population; etiology and risk factors for falls; evaluation and management; and assessment for and correction of risk factors. Integrative management approaches discussed in this chapter are movement and exercise, nutrition and supplements, and hormone replacement.
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Subhas, Kamalakkannan, and Martin Smith. Intensive care management after neurosurgery. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0369.
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The post-operative management of neurosurgical patients is directed towards the prevention, prompt detection, and management of surgical complications, and other factors that put the brain or spinal cord at risk. Close monitoring is required in the first 6–12 post-operative hours as deterioration in clinical status is usually the first sign of a potentially fatal complication. The majority of patients do not require complex monitoring or management beyond the first 12 hours after elective surgery, although prolonged intensive care unit management may be required for those who develop complications, or after acute brain injury. Cardiovascular and respiratory disturbances adversely affect the injured or ‘at risk’ brain, and meticulous blood pressure control and prevention of hypoxia are key aspects of management. Hypertension is particularly common after intracranial neurosurgery and may cause complications, such as intracranial bleeding and cerebral oedema, or be a consequence of them. A moderate target for glycaemic control (7.0–10 mmol/L) is recommended, avoiding hypoglycaemia and large swings in blood glucose concentration. Pain, nausea, and vomiting occur frequently after neurosurgery, and a multimodal approach to pain management and anti-emesis is recommended. Adequate analgesia not only ensures patient comfort, but also avoids pain-related hypertension. Disturbances of sodium and water homeostasis can lead to serious complications, and a structured approach to diagnosis and management minimizes adverse outcomes. Post-operative seizures must be brought rapidly under control because of the risks of secondary cerebral damage and/or progression to status epilepticus.
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Bo Mahler, Per. Aetiology and prevention of injuries in youth competitive non-contact sports. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199232482.003.0045.
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Unfortunately, most studies quoted in the following sections are based on case reports and case series rather than randomized prospective or intervention studies and therefore give limited significant information about risk factors and the influence of prevention on injury.6–9 It is also noteworthy that little information is available on children in certain sports10,11 and that adult data have therefore been used to extrapolate when appropriate. Taking this in to consideration, the present chapter underlines certain trends that can be drawn from the literature and that give a reasonable basis on which to develop and promote prevention strategies.
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Ladner, Travis R., Nishant Ganesh Kumar, Lucy He, and J. Mocco. Neuroprotection for Vascular and Endovascular Neurosurgery. Edited by David L. Reich, Stephan Mayer, and Suzan Uysal. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190280253.003.0019.
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The complexity of neurovascular disease presents a challenge to the surgical and anesthesia teams managing patients with such conditions. With open or endovascular techniques, abrupt changes in hemodynamic status and intracranial pressure are an ever-present concern throughout the perioperative period. Monitoring of neurological status, hemodynamic parameters, and intracranial pressure are important adjuncts. Targeted physiologic and pharmacological interventions are critical to ensuring safe completion of complex procedures and the prevention secondary injury. This chapter reviews common complications of cerebrovascular and endovascular operations and their risk factors and summarize clinical principles, strategies, and considerations for maximizing neuroprotection in the treatment of neurovascular disease.