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1
Ozawa, Kazue. Liver surgery approached through the mitochondria: The Redox theory in evolution. Basel: Karger, 1992.
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2
McKitrick, Jennifer. The Failure of Conceptual Analysis. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198717805.003.0002.
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Dispositions are often regarded with suspicion. Consequently, some philosophers try to semantically reduce disposition ascriptions to sentences containing only non-dispositional vocabulary. Typically, reductionists attempt to analyze disposition ascriptions in terms of conditional statements. These conditional statements, like other modal claims, are often interpreted in terms of possible worlds semantics. However, conditional analyses are subject to a number of problems and counterexamples, including random coincidences, void satisfaction, masks, antidotes, mimics, altering, and finks. Some analyses fail to reduce disposition ascriptions to non-modal vocabulary. If reductive analysis of disposition ascriptions fails, then perhaps there can be metaphysical reduction of dispositions without semantic reduction. However, the reductionist still owes us an account of what makes disposition ascriptions true. But to posit a causal power for every unreduced dispositional predicate is an overreaction to the failure of conceptual analysis.
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Beattie, R. Mark, Anil Dhawan, and John W.L. Puntis. Intestinal failure. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569862.003.0013.
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Short-bowel syndrome 98Excessive diarrhoea 100Motility disorders 101Mucosal disorders 102The term intestinal failure (IF) refers to a functionally impaired gastrointestinal tract unable to maintain biochemical homeostasis and support normal growth. Short-bowel syndrome (SBS) is a common cause of IF and usually defined as a severe reduction in functional gut mass below the minimal amount necessary for digestion and absorption adequate to satisfy the nutrient and fluid requirements for growth. Other causes of IF include mucosal abnormalities giving rise to protracted diarrhoea, and neuromuscular disorders resulting in chronic idiopathic intestinal pseudo-obstruction syndrome (CIIPS). See ...
4
Failure Mode and Effects Analysis in Health Care: Proactive Risk Reduction. Joint Commission Resources, 2005.
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5
Todinov, Michael T. Risk-Based Reliability Analysis and Generic Principles for Risk Reduction. Elsevier Science, 2006.
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6
Risk-Based Reliability Analysis and Generic Principles for Risk Reduction. Elsevier Science, 2006.
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7
Trestman, Robert L., and Ashbel T. Wall. Supply Reduction in Prison. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199374847.003.0015.
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Interdiction of addictive substances is a challenge in all settings. Prisons are no exception. Given the high prevalence of addictive disorders among prisoner populations the demand for illicit substances is very high. This chapter reviews the ways in which correctional staff have approached this concern, including a substantial focus on preventing illicit substances from entering the facility in the first place. This effort requires a broad array of interventions, including monitoring phone calls and mail; structuring and overseeing the visitation process; using trained canines; and employing intrusive searches any time a prisoner leaves the facility and returns. These efforts interface with an ongoing process to monitor prison activities for drugs that get past screening efforts. Random drug testing, canine tours of the facility, and an intricate system of informants, are each an element of effective monitoring activities. This chapter reviews the effectiveness and cost-effectiveness of such interventions, and considers the consequences of failure. Given that such consequences may include staff corruption and the development or growth of a prison drug economy, effective interdiction is a priority in every well-run facility.
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Ozawa, Kazue. Liver Surgery Approached Through the Mitochondria: The Redox Theory in Evolution. S Karger Pub, 1993.
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9
Keshav, Satish, and Alexandra Kent. Starvation and malnutrition. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0332.
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Starvation is a state of severe malnutrition due to a reduction in macro- and micronutrient intake. The basis underlying starvation is an imbalance between energy intake and energy expenditure. The commonest cause of starvation is lack of available food, usually due to environmental, social, and economic reasons, although other causes include anorexia nervosa; depression and other psychiatric disorders; coma and disturbance of consciousness; intestinal failure; and mechanical failure of digestion, including poor dentition and intestinal obstruction. Protein energy malnutrition is usually seen in developing countries. This chapter discusses starvation and malnutrition, focusing on their etiology, symptoms, demographics, natural history, complications, diagnosis, treatment, and prognosis.
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Seal, David Wyatt, Sarah Yancey, Manasa Reddy, and Stuart A. Kinner. Alcohol Use Among Incarcerated Individuals. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199374847.003.0004.
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This chapter examines alcohol use among individuals who experience incarceration. It reviews the epidemiology of alcohol use before prison, in prison, and after release from prison, and discusses the role of treatment and policy reform in reducing the health and social harms associated with alcohol use in this population. Finally, it summarizes key conclusions, including the lack of data from resource-poor settings where neither routine surveillance nor epidemiological research is common; the failure of much surveillance to distinguish between alcohol use and drug use; and the wide variability in the measurement of alcohol use, misuse, or dependence across studies. The chapter discusses the difficulties in assessing the effectiveness of alcohol use reduction programs in correctional systems, given that many programs prioritize drug use reduction as a primary goal, and that there are wide differences across correctional settings in the availability and quality of these services.
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Cardinale, Daniela, and Carlo Maria Cipolla. Anthracycline-related cardiotoxicity: epidemiology, surveillance, prophylaxis, management, and prognosis. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0290.
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Anthracycline-induced cardiotoxicity is of considerable concern, as it may compromise the clinical effectiveness of treatment, affecting both quality of life and overall survival in cancer patients, independently of the oncological prognosis. It is probable that anthracycline-induced cardiotoxicity is a unique and continuous phenomenon starting with myocardial cell injury, followed by progressive left ventricular ejection fraction (LVEF) decline that, if disregarded and not treated progressively leads to overt heart failure. The main strategy for minimizing anthracycline-induced cardiotoxicity is early detection of high-risk patients and prompt prophylactic treatment. According to the current standard for monitoring cardiac function, cardiotoxicity is usually detected only when a functional impairment has already occurred, precluding any chance of its prevention. At present, anthracycline-induced cardiotoxicity can be detected at a preclinical phase, very much before the occurrence of heart failure symptoms, and before the LVEF drops by measurement of cardiospecific biochemical markers or by Doppler myocardial and deformation imaging. The role of troponins in identifying subclinical cardiotoxicity and treatment with angiotensin-converting enzyme inhibitors, in order to prevent LVEF reduction is an effective strategy that has emerged in the last 15 years. If cardiac dysfunction has already occurred, partial or complete LVEF recovery may still be achieved if cardiac dysfunction is detected early after the end of chemotherapy and heart failure treatment is promptly initiated.
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Leaver, Susannah, and Timothy Evans. Hypoxaemia in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0085.
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Hypoxaemia is a reduction in the partial pressure of oxygen in the blood below 8 kPa/60 mmHg. Hypoxaemia results from one, or several, or a combination of causes. Calculating the alveolar–arterial gradient can help to delineate the cause. Acute respiratory failure manifests in a number of ways, the most sensitive indicator being an increased respiratory rate. Diagnosis is dependent on a comprehensive history, examination in combination with appropriate blood tests, and imaging. Hypoxaemia is the final common pathway of a number of conditions and the exact cause may not be immediately apparent. Despite this, the same management principles apply. A trial of non-invasive ventilation can be used to support patients during respiratory failure who do not require immediate endotracheal intubation. However, it is recommended that this is instituted for a preset trial period (e.g. 1–2 hours) in an HDU/ICU setting where facilities for definitive airway management are available. Invasive ventilation aims to facilitate treatment of the underlying condition whilst minimizing side effects through lung protective ventilatory strategies.
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Smiseth, Otto A., Maurizio Galderisi, and Jae K. Oh. Left ventricle: diastolic function. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0021.
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Evaluation of diastolic function by echocardiography is useful to diagnose heart failure with preserved ejection fraction by showing signs of diastolic dysfunction, and regardless of ejection fraction, echocardiography can be used to estimate left ventricular (LV) filling pressure. Diastolic dysfunction occurs in a number of cardiac diseases other than heart failure and mild diastolic dysfunction is part of the normal ageing process. The fundamental disturbances in diastolic dysfunction are slowing of myocardial relaxation, loss of restoring forces, and reduced LV chamber compliance. As a compensatory response there is elevated LV filling pressure. Slowing of relaxation and loss of restoring forces are reflected in reduction in LV early diastolic lengthening velocity (e?) by tissue Doppler. The reduced diastolic compliance is reflected in faster deceleration of early diastolic transmitral velocity by pulsed wave Doppler. Elevated LV filling pressure is reflected in a number of Doppler indices and in enlarged left atrium. This chapter reviews the physiology of diastolic function, the clinical methods and indices which are available, and how these should be applied.
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Sarwal, Minnie M., and Ron Shapiro. Paediatric renal transplantation. Edited by Jeremy R. Chapman. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0290.
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Approximately 1 in 65,000 children develops end-stage renal disease (ESRD) each year with almost 1200 children (aged 0–19 years) in the United States developing ESRD annually. Kidney transplantation is the primary method of treating ESRD in the paediatric population. The special issues in children and adolescents with ESRD include achieving normal growth and cognitive development. This chapter discusses the advances in surgical techniques, patient selection, transplant evaluation/preparing for transplantation, postoperative management (including fluid management in infants and small children), and the evolution of immunosuppressive drugs that have resulted in improved quality of life and a reduction in the mortality rate of children with chronic renal failure.
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Vinen, Katie, Fliss E. M. Murtagh, and Irene J. Higginson. Palliative care in end-stage renal disease. Edited by David J. Goldsmith. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0146.
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The changing demographics of the end-stage renal failure population have necessitated a different focus of care for older or highly co-morbid patients. End-of-life care for this population is best provided by combined nephrological and palliative care input. Honest prognostic information, excellent communication, and understanding the patient’s own priorities lie at the heart of this type of care. Excellent symptom control, a reduction in treatment burdens, and an effective network of professional support can be offered by clinicians. Ensuring a renal patient is able to die well and providing support for their family during and after death are important aspects of nephrological care.
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Javaid, Kassim. Paget’s disease of bone. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0274.
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Paget’s disease of bone is an uncommon bone disorder with increased bone resorption and disorganized bone formation of woven bone. Its cause is unclear; there is a clear genetic component but additional environmental factors are important, given the reduction in severity and prevalence in the UK. Paget’s disease is usually asymptomatic and detected by an unexplained raised alkaline phosphatase on routine biochemistry. Symptoms include focal bone pain, including headache. Other symptoms include bone deformity and complications such as fracture and nerve conduction. Paget’s disease can sometimes present with immobilization-associated hypercalcaemia or high-output cardiac failure, and rarely can transform to an osteosarcoma. This chapter addresses the clinical features, diagnosis, and management of Paget’s disease of bone.
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Gidwani, Hitesh, and Chenell Donadee. Hypertensive Emergencies (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0009.
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Hypertensive emergencies may be encountered by rapid response teams (RRTs). Various forms of acute organ dysfunction separate hypertensive urgency from hypertensive emergency. These include acute heart failure, acute coronary syndrome, acute aortic dissection, ischemic stroke, hemorrhagic stroke, hypertensive encephalopathy, sympathetic crisis, postoperative hypertension, and hypertensive emergencies in pregnancy. RRTs must be able to rapidly assess the patient’s condition, initiate treatment, and triage the patient to the appropriate level of care. This chapter summarizes the initial evaluation and triage of the patient as well as the blood pressure reduction goals in the acute period for the various conditions associated with hypertensive emergencies, discussing suggested drugs with the dosages, and looking at common pitfalls.
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Das, Upasak, Amartya Paul, and Mohit Sharma. Can information campaigns reduce last mile payment delays in public works programme? Evidence from a field experiment in India. 21st ed. UNU-WIDER, 2021. http://dx.doi.org/10.35188/unu-wider/2021/955-6.
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Does information dissemination among beneficiaries of welfare programmes mitigate their implementation failures? We present experimental evidence in the context of a rural public works programme in India, where we assess the impact of an intervention that involves dissemination of publicly available micro-level data on last mile delays in payment and programme uptake, along with a set of intermediate outcomes. The findings point to a substantial reduction in last mile payment delays along with improvements in awareness of basic provisions of the programme and process mechanisms while indicating a limited effect on uptake. However, we find a considerable increase in uptake in the subsequent period, which is potentially indicative of an ‘encouragement’ effect through the reduction in last mile delays. A comparatively higher impact on payment delay was found for deprived communities. The findings lay a platform for an innovative information campaign that can be used by government and civil society organizations as part of transparency measures to improve efficiency.
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Orlikowski, David, and Tarek Sharshar. Epidemiology, diagnosis, and assessment of neuromuscular syndromes. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0243.
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Admission to ICU with severe limb weakness, or the occurrence of a respiratory or motor deficit, and failure to wean from mechanical ventilation while in the intensive care unit are common presentations of a neuromuscular disease. Neuromuscular diseases include neuronopathies, neuropathies, myasthenic syndromes, and myopathies. An accurate neurological examination and complementary investigations are necessary for both diagnosis and for evaluating the severity of the disease. Assessment of respiratory muscle function is a key step in deciding the need for mechanical ventilation and subsequently its weaning. Hypercapnia often indicates an impending respiratory arrest, but normocapnia, which can be seen in a patient with severe reduction in vital capacity is not reassuring. Hypoxaemia can be due to hypercapnia, pulmonary injury (atelectasis or pneumonia), or pulmonary embolism. Cardiac evaluation is important as cardiomyopathies are frequent in myopathies.
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Streumer, Bart. The Symmetry Objection. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780198785897.003.0006.
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This chapter argues that non-cognitivists need to explain how their view is compatible with the claim that when two people make conflicting normative judgements, at most one of these judgements is correct. It considers three quasi-realist explanations of how non-cognitivism is compatible with this claim. It argues that to defend these explanations non-cognitivists must take their quasi-realism so far that the book’s arguments against realism also apply to non-cognitivism. The chapter also argues that non-cognitivists cannot explain how their view is compatible with this claim by endorsing a hybrid view or by appealing to a version of the reduction argument. The failure of these explanations constitutes the symmetry objection to non-cognitivism. The chapter ends by comparing non-cognitivism to the error theory.
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Knights, David, and Vedran Omanović. Rethinking Diversity in Organizations and Society. Edited by Regine Bendl, Inge Bleijenbergh, Elina Henttonen, and Albert J. Mills. Oxford University Press, 2016. http://dx.doi.org/10.1093/oxfordhb/9780199679805.013.22.
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The problem addressed in this chapter is whether emphasis on the ‘business case’ has gone too far, for even on its own terms there have been questions concerning the actual commercial benefits of diversity management. The concern is that if practitioner interests in anti-discrimination are reduced to the business case, then any failure to achieve commercial benefits will condemn the whole programme. Consequently, there has to be some return to the social justice arguments for managing diversity. As a way of seeking to stimulate such developments, we have conducted a literature survey of the various methodological and analytical frameworks deployed in diversity in organizations research. This is in order to search for alternatives to the reduction of ideas and interests in diversity to a single managerial preoccupation with making diversity ‘pay’, or limiting diversity practices to their potential to generate commercial benefits.
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Cardim, Nuno, Denis Pellerin, and Filipa Xavier Valente. Hypertrophic cardiomyopathy. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0042.
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Hypertrophic cardiomyopathy is a common inherited heart disease caused by genetic mutations in cardiac sarcomeric proteins. Although most patients are asymptomatic and many remain undiagnosed, the clinical presentation and natural history include sudden cardiac death, heart failure, and atrial fibrillation. Echocardiography plays an essential role in the diagnosis, serial monitoring, prognostic stratification, and family screening. Advances in Doppler myocardial imaging and deformation analysis have improved preclinical diagnosis as well as the differential diagnosis of left ventricular hypertrophy. Finally, echocardiography is closely involved in patient selection and in intraoperative guidance and monitoring of septal reduction procedures. This chapter describes the pathophysiology, clinical presentation, role of echocardiography, morphological features, differential diagnosis, diagnostic criteria in first-degree relatives, echo guidance for the treatment of symptomatic left ventricular outflow tract obstruction, and follow-up and monitoring of patients with hypertrophic cardiomyopathy.
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Humphreys, Paul. Introduction. Edited by Paul Humphreys. Oxford University Press, 2016. http://dx.doi.org/10.1093/oxfordhb/9780199368815.013.44.
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This introduction provides an overview of the current state of philosophy of science and some predictions about its future direction. The contents of the handbook are described using a framework based on the unity of science and approaches to reduction, with the successes and failures of each described. New areas in the discipline, such as the philosophy of astronomy, data, neuroscience, and post-empiricism are discussed, as well as traditional areas such as causation, explanation, and theory structure. A defense of contemporary philosophy of science against external criticisms is given, including examples of progress within the field and technical relevance to particular sciences. The reasons for internal disagreements are provided and compared to disagreements within science.
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Pinto, Mónica, and Martín Sigal. Influence of the ICESCR in Latin America. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198825890.003.0008.
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The influence of the ICESCR in Latin America is significant, since countries in the region have increasingly incorporated ESCR into their legal systems during the last three decades. Several national constitutions contain such rights, and domestic courts have growingly recognized their justiciability. Also, ESCR have entailed new collective procedures and discussions about access to justice and the role of the judiciary. While the great majority of Latin American States have adopted a regional instrument dealing with ESCR, the delay between its adoption and entry into force allowed the ICESCR to decisively influence the regional bodies. Notwithstanding the robust normative incorporation of ESCR into domestic legal systems, the region is marked by poverty, inequality, and basic ESCR deprivation, which shows a failure to translate legal advances into a reduction of social injustice. The huge gap between legal recognition of rights and their implementation is a central challenge to be addressed.
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Sharples, Jack D. The International Political Economy of Eastern European Energy Security. Edited by Debra J. Davidson and Matthias Gross. Oxford University Press, 2018. http://dx.doi.org/10.1093/oxfordhb/9780190633851.013.7.
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This chapter assesses whether the concerns over regional energy security in Eastern Europe that have arisen since 2013 are caused by market failure, or by commercial gas trade falling victim to regional political tensions, with reference to the trilateral gas relationship between Russia, Ukraine, and the European Union (EU). In doing so, it highlights the political economy of the more competitive, flexible gas market in the EU and the traditional, non-competitive bilateral gas trade between Gazprom (Russia) and Naftogaz (Ukraine) in Eastern Europe, with the latter remaining open to political influence. The chapter concludes that the absence of market mechanisms led to energy security concerns that were later exacerbated by the crisis in political relations between Russia and Ukraine. It follows that the integration of Ukraine into the European gas market and reduction of Russian-Ukrainian bilateral over-dependence, will ease concerns over regional energy security in Eastern Europe.
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Rich, Mark M. Critical Illness Neuropathy, Myopathy, and Sodium Channelopathy. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0033.
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Skeletal muscle weakness is a common problem that complicates recovery from critical illness. The primary causes of weakness include neuropathic disorders, myopathic disorders, and mixed disorders. Recent studies have demonstrated that reduced excitability of the nerve and muscle cell membranes might contribute to weakness during the acute stages of the polyneuropathy and myopathy encountered in critically ill patients. In both tissues, an acquired sodium channelopathy can lead to increased inactivation of channels, leading to inexcitability an paralysis. Experimental sepsis models have demonstrated a similar reduction in excitability in myocardial cells as well as in motor neurons within the spinal cord. The presence of a channelopathy in multiple tissues raises the possibility that reduced excitability of neurons within the CNS might contribute to septic encephalopathy. If this is the case, a single therapy to improve excitability might treat failure of a number of electrically active tissues.
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Dhaun, Neeraj, and David J. Webb. Endothelins and their antagonists in chronic kidney disease. Edited by David J. Goldsmith. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0114_update_001.
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The endothelins (ETs) are a family of related peptides of which ET-1 is the most powerful endogenous vasoconstrictor and the predominant isoform in the cardiovascular and renal systems. The ET system has been widely implicated in both cardiovascular disease and chronic kidney disease (CKD). ET-1 contributes to the pathogenesis and maintenance of hypertension and arterial stiffness, as well endothelial dysfunction and atherosclerosis. By reversal of these effects, ET antagonists, particularly those that block ETA receptors, may reduce cardiovascular risk. In CKD patients, antagonism of the ET system may be of benefit in improving renal haemodynamics and reducing proteinuria, effects seen both in animal models and in some human studies. Data suggest a synergistic role for ET receptor antagonists with angiotensin-converting enzyme inhibitors in lowering blood pressure, reducing proteinuria, and in animal models in slowing CKD progression. However, in clinical trials, fluid retention or cardiac failure has caused concern and these agents are not yet ready for general use for risk reduction in CKD.
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Debaveye, Yves, and Greet Van den Berghe. Pathophysiology and management of pituitary disorders in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0262.
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The pituitary gland plays a predominant role in the endocrine system. Consequently, patients with pituitary diseases or after pituitary surgery present unique challenges to the intensivist. Failure of the anterior pituitary gland to secrete one or more pituitary hormones results in a clinical syndrome known as hypopituitarism. While hypopituitarism is mostly encountered in patients in whom the diagnosis has already been made, acute exacerbation of an undiagnosed insufficiency may occasionally occur. Acute decompensated patients with suspected hypopituitarism should be admitted to an intensive care unit for haemodynamic stabilization, replacement of missing hormones, and identification and treatment of the causative stressor. Prompt administration of hydrocortisone is the single most important acute medical intervention in hypopituitaric patients. Failure of the posterior pituitary to secrete antidiuretic hormone results in diabetes insipidus (DI). DI is characterized by excess volumes of severely diluted urine, which can lead to hyperosmolality and hypernatraemia as many critically-ill patients do not have free access to oral fluids due to obtundation or sedation. Management of DI includes the correction of free water deficit and the reduction of polyuria with desmopressin. The post-operative care following pituitary surgery focuses on vigilant observation for neurosurgical complications (visual loss, meningitis, and cerebrospinal fluid leakage) and monitoring of neuroendocrinological perturbations (hypopituitarism and disorders of water balance, such as DI and SIADH). SIADH presents with hyponatremia, hypo-osmolality, and inappropriately concentrated urine in a setting of euvolaemia and can be managed in most cases by fluid restriction. Potential disruption of the pituitary-adrenal function is covered with peri-operative glucocorticoids.
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Assessment of Fetal Alcohol Spectrum Disorders. Organización Panamericana de la Salud, 2020. http://dx.doi.org/10.37774/9789275122242.
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Fetal alcohol spectrum disorders (FASD) represent a range of physical, mental, and behavioral disabilities caused by alcohol use during pregnancy, or prenatal alcohol exposure (PAE). FASDs are considered to be one of the leading preventable causes of developmental disability. Despite its high prevalence, FASD is often misdiagnosed or underdiagnosed, making interventions more challenging or delayed. Earlier diagnosis yields greater benefits for affected children, which include a reduction in secondary disabilities such as substance use disorders and learning and cognitive disabilities leading to school failure, and improved life outcomes. Most importantly, diagnosis provides a context for understanding a child’s behavior. When the environment surrounding a child with an FASD opts to focus on the child’s strengths as a means for intervention, there is a greater likelihood of that child achieving success as an adult. Diagnosis of FASD is further beneficial to the extent that it leads to a reduction of future births of children with FASD. This publication was initially developed for use in Spanish-speaking countries of the Americas and is intended to serve as a training workbook for providers of various disciplines to learn about the fundamentals of diagnosing FASD and to apply them to several case scenarios. It also discusses ethical implications of diagnosing FASD to the mother and child. Target audiences include physicians, psychologists, allied health professionals, social workers, and other providers that may encounter individuals affected by FASD. It is ideally used as a supplement for in-person training by experts in the fields of dysmorphology, epidemiology, and neuropsychology.
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Waldmann, Carl, Neil Soni, and Andrew Rhodes. Obstetric emergencies. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199229581.003.0031.
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Pre-eclampsia 518Eclampsia 520HELLP syndrome 522Postpartum haemorrhage 524Amniotic fluid embolism 526Pre-eclampsia is a common complication of pregnancy, UK incidence is 3–5%, with a complex hereditary, immunological and environmental aetiology.Abnormal placentation is characterized by impaired myometrial spiral artery relaxation, failure of trophoblastic invasion of these arterial walls and blockage of some vessels with fibrin, platelets and lipid-laden macrophages. There is a 30–40%, reduction in placental perfusion by the uterine arcuate arteries as seen by Doppler studies at 18–24 weeks gestation. Ultimately the shrunken, calcified, and microembolized placenta typical of the disease is seen. The placental lesion is responsible for fetal growth retardation and increased risks of premature labour, abruption and fetal demise. Maternal systemic features of this condition are characterized by widespread endothelial damage, affecting the peripheral, renal, hepatic, cerebral, and pulmonary vasculatures. These manifest clinically as hypertension, proteinuria and peripheral oedema, and in severe cases as eclamptic convulsions, cerebral haemorrhage (the most common cause of death due to pre-eclampsia in the UK), pulmonary oedema, hepatic infarcts and haemorrhage, coagulopathy and renal dysfunction....
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Sinagra, Gianfranco, Marco Merlo, and Davide Stolfo. Dilated cardiomyopathy: clinical diagnosis and medical management. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0356.
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Dilated cardiomyopathy (DCM) is a relatively rare primary heart muscle disease with genetic or post-inflammatory aetiology that affects relatively young patients with a low-risk co-morbidity profile. Therefore, DCM represents a particular heart failure model with specific characteristics and long-term evolution. The progressively earlier diagnosis derived from systematic familial screening programmes and the current therapeutic strategies have greatly modified the prognosis of DCM with a dramatic reduction of mortality over recent decades. A significant number of DCM patients present an impressive response to pharmacological and non-pharmacological evidence-based therapy in terms of haemodynamic improvement with subsequent left ventricular reverse remodelling, which confer a favourable long-term prognosis. However, in some DCM patients the outcome is still severe. This prognostic heterogeneity is possibly related to the aetiological variety of this disease. Maximal effort towards an early aetiological diagnosis of DCM, by using all diagnostic available tools (including cardiovascular magnetic resonance imaging, endomyocardial biopsy, and genetic testing when indicated), as well as the individualized long-term follow-up appear crucial in improving the prognostic stratification and the clinical management of these patients.
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Masip, Josep, Kenneth Planas, and Arantxa Mas. Non-invasive ventilation. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0025.
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During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure and bilevel pressure support ventilation. Whereas non-invasive pressure support ventilation requires a ventilator, continuous positive airway pressure is a simpler technique that can be easily used in non-equipped areas such as the pre-hospital setting. The success of non-invasive ventilation is related to the adequate timing and selection of patients, as well as the appropriate use of interfaces, the synchrony of patient-ventilator, and the fine-tuning of the ventilator.
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Masip, Josep, Kenneth Planas, and Arantxa Mas. Non-invasive ventilation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0025_update_001.
Full textAbstract:
During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure and bilevel pressure support ventilation. Whereas non-invasive pressure support ventilation requires a ventilator, continuous positive airway pressure is a simpler technique that can be easily used in non-equipped areas such as the pre-hospital setting. The success of non-invasive ventilation is related to the adequate timing and selection of patients, as well as the appropriate use of interfaces, the synchrony of patient-ventilator, and the fine-tuning of the ventilator.
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Masip, Josep, Kenneth Planas, and Arantxa Mas. Non-invasive ventilation. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0025_update_002.
Full textAbstract:
During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure and bilevel pressure support ventilation. Whereas non-invasive pressure support ventilation requires a ventilator, continuous positive airway pressure is a simpler technique that can be easily used in non-equipped areas such as the pre-hospital setting. The success of non-invasive ventilation is related to the adequate timing and selection of patients, as well as the appropriate use of interfaces, the synchrony of patient-ventilator, and the fine-tuning of the ventilator.
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Masip, Josep, Kenneth Planas, and Arantxa Mas. Non-invasive ventilation. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0025_update_003.
Full textAbstract:
During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, immunocompromised or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure, bilevel pressure support ventilation and more recently, high flow nasal cannula. Whereas non-invasive pressure support ventilation requires a ventilator, the other two techniques are simpler and can be easily used in non-equipped areas by less experienced teams, including the pre-hospital setting. The success of non-invasive ventilation is related to an adequate timing, proper selection of patients and interfaces, close monitoring as well as the achievement of a good adaptation to patients’ demand.
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Blunn, Gordon. Bearing surfaces. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.007006.
Full textAbstract:
♦ Traditionally bearings were made from polyethylene and cobalt chrome. These bearings are still most commonly used for knee replacements. In hip replacements due to osteolysis caused by polyethylene wear alternative material combinations at the bearing surface are used♦ Highly cross linked plastics have been developed and have been shown to reduce wear. There are a number of different types available which differ in their performance♦ Metal on metal bearings first used in the 1960s have also been developed and show very low wear rates. These bearings are more susceptible to edge loading and the resulting metal ion release can result in adverse biological reactions leading to failure♦ Whilst ceramic on plastic surfaces have been used for a considerable amount of time the reduction in wear is not as great as with well functioning metal on metal bearings♦ Ceramic on ceramic bearings have been used for a considerable time and show even lower wear rates than metal on metal bearings. In the past there has been an incidence of catastrophic fracture of these bearings but developments in materials technology have considerably reduced these events.
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Brummer, Julie, Lars Møller, and Stefan Enggist. Preventing Drug-Related Death in Recently Released Prisoners. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199374847.003.0018.
Full textAbstract:
The mortality risk for recently released prisoners is alarmingly high. These individuals, especially in the first 2 weeks following release, are at an increased risk for death compared with an age- and gender-matched general population, with the majority of fatalities attributed to overdoses. Although a number of factors contribute to these incidents, the decreased tolerance resulting from a period of abstinence during incarceration is believed to be especially important. Other important factors are the concurrent use of multiple drugs, the lack of pre-release counseling and post-release follow-up, and the failure to identify those at greatest risk. This chapter describes studies conducted in various countries on post-release drug-related deaths. The literature review supports the finding that there is a significantly heightened risk of overdose death during the initial post-release period and suggests a number of prevention and harm reduction responses that may be applied at various levels of the criminal justice system to reduce drug-related deaths in ex-prisoners. Some identified potential preventive responses are the provision of opioid substitution therapy delivered in combination with psychosocial intervention for opioid-dependent prisoners and a continuity of care and stability of treatment through all stages of the criminal justice system, including during community integration, which can be supported by close linkages between prison-health and public-health systems. Take-home naloxone programs are another promising strategy to prevent overdose deaths among people recently released from prison.
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Keh, Didier. Steroids in critical illness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0054.
Full textAbstract:
The benefit of prolonged application of moderate-dose corticosteroids in systemic inflammatory diseases remains controversial. In critical illness, the endogenous cortisol effect may become insufficient due to adrenal dysfunction and corticosteroid resistance to counterbalance an exaggerated and protracted inflammatory response, which has been termed ‘critical illness-related corticosteroid insufficiency’ (CIRCI). There is evidence that moderate-dose hydrocortisone (200–300 mg/day) significantly fastens shock reversal in patients with septic shock, but may improve survival probably only in patients with high risk of death. Thus, therapy should be considered only in refractory shock with poor response to fluid administration and vasopressor therapy. The indication should be based on clinical judgement and not on cortisol measurement. The application prolonged of moderate-dose methylprednisolone (1 mg/kg/day) was found to be most effective in early acute respiratory distress syndrome, and associated with improved lung function, reduction of mechanical ventilation, and faster discharge from the ICU, but a survival benefit was found only in pooled data, including cohort studies. A continuous infusion and weaning of corticosteroids may be preferable to bolus applications and abrupt withdrawal to avoid side effects such as rebound of inflammation and shock, glucose variability, or respiratory failure. There is currently no evidence that prolonged application of moderate-dose corticosteroids increase the risk of secondary infections or muscle weakness, but infection surveillance should be implemented and combination with muscle relaxants be avoided.
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Jardine, Alan G., and Rajan K. Patel. Lipid disorders of patients with chronic kidney disease. Edited by David J. Goldsmith. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0102.
Full textAbstract:
The risk of developing cardiovascular (CV) disease is increased in patients with chronic kidney disease (CKD) and although dyslipidaemia is a major contributory factor to the development of premature CV disease, the relationship is complex. Changes in lipid fractions are related to glomerular filtration rate and the presence and severity of proteinuria, diabetes, and other confounding factors. The spectrum of CV disease changes from lipid-dependent, atheromatous coronary disease in early CKD to lipid-independent, non-coronary disease, manifesting as heart failure, and sudden cardiac death in advanced and end-stage renal disease. Statin-based lipid-lowering therapy is proven to reduce coronary events across the spectrum of CKD. The relative reduction in overall CV events, however, diminishes as CKD progresses and the proportion of lipid-dependent coronary events declines. There is nevertheless a strong argument for the use of statin-based therapy across the spectrum of CKD. The argument is particularly strong for those patients with progressive renal disease who will eventually require transplantation, in whom preventive therapy should start as early as possible. The SHARP study established the benefits and endorses the use of lipid-lowering therapy in CKD 3-4 but uncertainty about the value of initiation of statin therapy in CKD 5 remains. There is, however, no rationale for stopping agents started earlier in the course of the illness for compelling indications, particularly in those who will ultimately be transplanted. The place of high-density lipoprotein-cholesterol raising and triglyceride lowering therapy needs to be assessed in trials. Modifying dyslipidaemia in CKD has demonstrated that lipid-dependent atheromatous cardiovascular disease is only one component of the burden of CV disease in CKD patients, that this is proportionately less in advanced CKD, and that modification of lipid profiles is only one part of CV risk management.
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Bardin, Thomas, and Tilman Drüeke. Renal osteodystrophy. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0149.
Full textAbstract:
Renal osteodystrophy (ROD) is a term that encompasses the various consequences of chronic kidney disease (CKD) for the bone. It has been divided into several entities based on bone histomorphometry observations. ROD is accompanied by several abnormalities of mineral metabolism: abnormal levels of serum calcium, phosphorus, parathyroid hormone (PTH), vitamin D metabolites, alkaline phosphatases, fibroblast growth factor-23 (FGF-23) and klotho, which all have been identified as cardiovascular risk factors in patients with CKD. ROD can presently be schematically divided into three main types by histology: (1) osteitis fibrosa as the bony expression of secondary hyperparathyroidism (sHP), which is a high bone turnover disease developing early in CKD; (2) adynamic bone disease (ABD), the most frequent type of ROD in dialysis patients, which is at present most often observed in the absence of aluminium intoxication and develops mainly as a result of excessive PTH suppression; and (3) mixed ROD, a combination of osteitis fibrosa and osteomalacia whose prevalence has decreased in the last decade. Laboratory features include increased serum levels of PTH and bone turnover markers such as total and bone alkaline phosphatases, osteocalcin, and several products of type I collagen metabolism products. Serum phosphorus is increased only in CKD stages 4-5. Serum calcium levels are variable. They may be low initially, but hypercalcaemia develops in case of severe sHP. Serum 25-OH-vitamin D (25OHD) levels are generally below 30 ng/mL, indicating vitamin D insufficiency or deficiency. The international KDIGO guideline recommends serum PTH levels to be maintained in the range of approximately 2-9 times the upper normal normal limit of the assay and to intervene only in case of significant changes in PTH levels. It is generally recommended that calcium intake should be up to 2 g per day including intake with food and administration of calcium supplements or calcium-containing phosphate binders. Reduction of serum phosphorus towards the normal range in patients with endstage kidney failure is a major objective. Once sHP has developed, active vitamin D derivatives such as alfacalcidol or calcitriol are indicated in order to halt its progression.