Книги: "Drift diagnosis"

1

American Psychiatric Association. Task Force on DSM-IV., ed. DSM-IV draft criteria. Washington, D.C: The Association, 1993.

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2

1922-, Leuchtenburg William Edward, ed. Drift and mastery: An attempt to diagnose the current unrest. Madison, Wis: University of Wisconsin Press, 1985.

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3

World Health Organization. Division of Mental Health., ed. I.C.D. - 10: 1990 draft of chapter 5 : categories F00-F99 : mental and behavioural disorders (including disorders of psychological development) : diagnostic criteria and diagnostic guidelines. Geneva: Division of Mental Health, World Health Organization, 1990.

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4

Casey, Patricia. The course and prognosis of adjustment disorders (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198786214.003.0008.

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The diagnostic stability of AD is questionable since there are no specific diagnostic criteria and many clinicians are not familiar with AD, mistaking it for some overlapping disorder. Case-register and inpatient records all identify poor stability, although this was not unique to AD and includes other non-psychotic disorders. The duration of hospitalization is shorter for those with AD than for those with other diagnoses, and a similar pattern has been observed for outpatient follow up. The prognosis for AD is described as good. Long-term follow-up studies show that a large proportion of patients are well and do not require readmission. Among adolescents, a diagnosis of AD may augur more serious underlying psychopathology, and they have higher readmission rates than adults with the diagnosis. AD is the most common diagnosis in those dying by suicide in some countries and it occurs earlier in the course of AD than in other diagnostic groups.

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5

Doherty, Anne. The biological basis of adjustment disorders (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198786214.003.0005.

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The biological basis of adjustment disorders examines the evidence for the biological factors associated with this common diagnosis. Although adjustment disorder is usually characterized as a disorder of psychological adjustment to life stressors, and while it shares overlapping psychopathology with both normal stress response and with major depression, there is evidence that the diagnosis may have pathophysiological characteristics that distinguish it from both. This chapter explores the evidence supporting underlying theories derived from diverse fields including genetics, neuroimaging, and neuroendocrine and neurotransmitter functioning, and considers how the pharmacological management of adjustment disorder is linked to said theories. It discusses the gaps in our knowledge and considers the causes for the relative lack of interest in this diagnosis compared with other diagnoses.

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6

Casey, Patricia. Making the diagnosis in clinical practice (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198786214.003.0006.

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Neither ICD-10 nor DSM-5 has clinical criteria for making the diagnosis of AD. The only requirement is a stressor, either psychosocial or traumatic. The onset of symptoms within 1 month (ICD) and 3 months (DSM) is not evidence based. The symptoms may be depressive, anxious, behavioural, or a mixture of these. A useful clinical indicator that the event was the trigger is that the intensity of the symptoms increases when it is being recalled or recounted and diminishes when the person is removed from it. A number of differentials should also be considered. ICD-11 proposes specific criteria for ICD-11 that include preoccupation with the stressor and difficulty adapting, as evidenced by impaired concentration, sleep disturbance, and so on, causing impairment in functioning. It is unclear whether those diagnosed with AD using the new criteria will be the same clinically as those currently so diagnosed.

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7

American Psychiatric Association. Dsm-IV Draft Criteria. Amer Psychiatric Pub, 1993.

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8

Javed, Jeffrey K., and Jason E. Moore. Respiratory Failure and Hypoxemia (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0006.

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Respiratory failure and hypoxemia are among the most common problems encountered by the rapid response team (RRT) and can lead to rapid patient deterioration and arrest. A brief, systematic approach focusing on treatment priorities such as airway patency, correcting hypoxemia, and supporting work of breathing, allows RRT responders to quickly provide the appropriate level of supportive care and narrow the complex differential diagnosis of acute respiratory failure. This chapter reviews a logical and efficient clinical diagnostic evaluation, therapeutic modalities including rescue treatments and mechanical ventilation, and transport considerations for this patient group. The pragmatic, problem-based clinical approach discussed in this chapter will help RRTs provide effective care for this group of patients.

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9

Casey, Patricia. How common is adjustment disorder? (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198786214.003.0002.

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Most of the large-scale epidemiological studies have neglected AD, although there are some recent smaller studies that have included it. The diagnostic tools in common use, such as SCAN or SCID, either omit AD or only allow the diagnosis to be made when all other disorders have been considered. Studies using these have found a prevalence of less than 2% in the general population or among those attending primary care. Two instruments specific for AD have been published in recent years. The ADNM is a screening instrument based on the proposed ICD-11 criteria, while the DIAD is a diagnostic tool. With these instruments, the prevalence has been shown to be much higher than earlier studies indicated, and in some settings such as liaison psychiatry its frequency eclipsed that of major depression. It is likely that the enhanced status of AD will result in more epidemiological studies that incorporate AD as well as other common disorders.

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10

Casey, Patricia. The diagnostic quagmire: Philosophical issues (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198786214.003.0003.

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As currently defined, adjustment disorder (AD) lies in the hinterland between non-pathological behaviour/distress on one side and full-blown common mental disorders (CMDs) on the other. However, considerable symptom overlap exists, such that AD is frequently misdiagnosed as one of the other CMDs, and vice versa. Given the universality of life events which are stressful, clearly delineating AD from normal adaptive responses is particularly prescient if all human experience is not to be medicalized. DSM-III attempted to deal with this by requiring that the symptoms be ‘clinically significant’, yet this construct is a subjective one. It is not used in ICD-10 but it requires both symptoms and dysfunction, unlike DSM. The heterogeneity of symptoms that constitute a specific diagnosis where no one symptom is essential and all are given equal weight (the polythetic approach) can add to diagnostic uncertainty. The National Institute of Mental Health has made a suggestion for approaching this diagnostic maelstrom.

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11

Malhi, Gin S., and Yulisha Byrow. The current classification of bipolar disorders. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198748625.003.0001.

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The current chapter describes and critically appraises the diagnosis of bipolar disorders in relation to widely used classification systems; namely, the Diagnostic and Statistical Manual of Mental Disorders (5th edition) (DSM-5) and the International Classification of Diseases (10th revision) (ICD-10). In addition, it overviews the diagnostic criteria in relation to the draft version of ICD-11. Patients with bipolar disorder experience extreme fluctuations in mood ranging from depression to mania and, because of the complex nature of the illness, diagnosis remains a clinical challenge. Recent iterations of DSM and ICD have attempted to harmonize taxonomy; however, notable differences remain. These differences are likely to impact the assessment and diagnosis of bipolar disorder and could potentially result in disparate epidemiological findings. Thus, practitioners and researchers alike need to apply careful clinical consideration when assessing those with bipolar disorder.

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12

Parran, Theodore V., John A. Hopper, and Bonnie B. Wilford. Diagnosing Patients and Initiating Treatment (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190265366.003.0011.

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Chapter 11 provides an organized approach to diagnosis and to the initial treatment plan, focusing on substance use disorders. The elements of pharmacological and behavioral approaches to treatment, including the management of withdrawal, are addressed separately (Sections III and IV). It begins with directions on initiation of the patient relationship, with the object of eliciting cooperation. The sources of information that should be interrogated are listed, including the history, screening tools, physical examination, laboratory studies, and collateral information (e.g., the prescription drug monitoring program or PDMP). A discussion of diagnosis includes the principles underlying the ICD-10 and the DSM-5. The process of enlisting the patient in a treatment agreement and in the formulation of a collaborative treatment plan is described; the practical elements of patient education in medication accountability and dosing are included. The chapter concludes with a treatment planning checklist to facilitate orderly transition to the treatment itself.

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13

D’Auria, Stephen, and Ravi Ramani. Chest Pain and Acute Coronary Syndrome (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0011.

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Chest pain is a common presenting complaint faced by the rapid response team (RRT), and can herald a serious process such as acute coronary syndrome or aortic dissection, or be secondary to a minor muscle strain. A methodical approach to chest pain is necessary to avoid premature diagnostic closure. One of the most feared diagnoses is a myocardial infarction. Fortunately, there are well-established guidelines describing the necessary steps for treatment of both ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). This chapter will address the differential for chest pain as well as established guidelines for treatment of acute coronary syndrome.

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14

Lapsia, Munish H., and David T. Huang. Sepsis (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0013.

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Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. This chapter focuses on the first 30 minutes of care for those patients with sepsis in the context of the rapid response team (RRT) activation. The definitions, etiology, incidence, and risk factors for sepsis are reviewed. Recognition of infection, sepsis, and septic shock is also reviewed while highlighting the use of sequential sepsis related organ failure assessment (SOFA) and quick SOFA (qSOFA) scores for diagnosis of sepsis. This chapter also discusses the initial fluid resuscitation, antibiotics, vasopressors, and investigations including lactate levels as a part of management of the patient in sepsis.

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15

Lippmann, Walter. Drift and Mastery: An Attempt to Diagnose the Current Unrest. Franklin Classics Trade Press, 2018.

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16

Lippmann, Walter. Drift and Mastery: An Attempt to Diagnose the Current Unrest. Creative Media Partners, LLC, 2018.

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17

Lippmann, Walter. Drift and Mastery: An Attempt to Diagnose the Current Unrest. Creative Media Partners, LLC, 2018.

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18

Drift and Mastery: An Attempt to Diagnose the Current Unrest. Creative Media Partners, LLC, 2022.

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19

Drift and Mastery: An Attempt to Diagnose the Current Unrest. Creative Media Partners, LLC, 2022.

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20

Drift and Mastery; an Attempt to Diagnose the Current Unrest. Creative Media Partners, LLC, 2018.

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21

Lippmann, Walter. Drift and Mastery; An Attempt to Diagnose the Current Unrest. Franklin Classics Trade Press, 2018.

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22

Lippmann, Walter. Drift and Mastery: An Attempt to Diagnose the Current Unrest. Cosimo, Inc., 2020.

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23

Lippmann, Walter. Drift and Mastery: An Attempt to Diagnose the Current Unrest. Creative Media Partners, LLC, 2017.

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24

Lippmann, Walter. Drift and Mastery; An Attempt to Diagnose the Current Unrest. Franklin Classics Trade Press, 2018.

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25

Sitaraman, Ganesh, William E. Leuchtenburg, and Walter Lippmann. Drift and Mastery: An Attempt to Diagnose the Current Unrest. University of Wisconsin Press, 2015.

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26

Drift and Mastery; an Attempt to Diagnose the Current Unrest. Franklin Classics, 2018.

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27

Catalytic converters: The theory and operation and functional diagnosis manual ; Draft. Colorado State University, 1991.

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28

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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29

Morgan, Jenna, and Saba Balasubramanian. Endocrine surgery (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198749813.003.0006.

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This chapter presents common cases that are clinically relevant to endocrine surgery. These include common surgical presentations often encountered at outpatient clinic, such as thyroid nodules/goitres and hypercalcaemia due to primary hyperparathyroidism, as well as important emergency surgical complications.Although most endocrine surgical conditions are managed by few surgeons with a special interest in these diseases, knowledge of the initial management and immediate treatment of complications is essential for all surgical trainees, particularly as some of these are life-threatening. These cases have been written to incorporate relevant pathophysiology, clinical information, diagnosis, and surgical management of thyroid, parathyroid, and adrenal disease.

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30

Casey, Patricia. History of the concept of adjustment disorders (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198786214.003.0001.

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Adjustment disorder (AD) was introduced by ICD-9 in 1978 and by DSM-III in 1980. Until recently it was neglected in research and in clinical practice. It has withstood the early controversies suggesting that it was a manufactured condition to facilitate the reimbursement of clinicians for treating mild conditions which otherwise would not be covered by insurance. Others argue that it medicalized problems of living. More recent controversies concern its status as a subthreshold disorder, disbarring it from being diagnosed when the threshold for other disorders is reached. Its status has been enhanced by its new positioning in DSM-5 in the Trauma and Stressor-Related Disorders category, similar to ICD-10. However, ICD-11 is proposing making AD a full-threshold disorder with specific criteria for diagnosis, unlike DSM-5. This radical proposal will put ICD-11 and DSM-5 at variance with each other and will require a reappraisal of the research, to date, on AD.

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31

Owers, Corinne, and Roger Ackroyd. UGI surgery (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198749813.003.0001.

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The upper gastrointestinal (UGI) tract comprises of the oesophagus, stomach, and duodenum. Although some emergency management of UGI pathology may fall to the remit of the gastroenterologists, this chapter focuses specifically on surgical management of both benign and malignant pathology of these organs. UGI pathology contributes a significant amount to the on-call emergency workload for the general surgeon, as well as the UGI specialist. Subjects covered include the diagnosis and management of common pathologies in the upper gastrointestinal tract that are clinically relevant to those working in general surgery, including: gastro-oesophageal reflux (GORD) and ulcer disease, UGI bleeding, oesophagogastric cancer and bariatric surgery.

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32

Mori, Masanori. Clinical Signs of Impending Death in Cancer Patients (DRAFT). Edited by Nathan A. Gray and Thomas W. LeBlanc. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190658618.003.0039.

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In this prospective, longitudinal, cohort study, the authors systematically characterized the frequency, onset, and diagnostic performance of 62 clinical signs for impending death in 357 advanced cancer patients admitted to two acute palliative care units. “Early signs” (e.g., Palliative Performance Scale <20%, Richmond Agitation Sedation Scale ≤–2) had a high frequency over the last 3 days but low positive predictive ratios (LRs) for impending death within 3 days. In contract, “late signs” (e.g., death rattle, respiration with mandibular movement, peripheral cyanosis) had a low frequency but high specificity and high positive LR. In addition, seven neurological signs (e.g., decreased response to verbal stimuli, drooping of nasolabial fold, grunting of vocal cords) and upper gastrointestinal bleeding had high positive LRs for impending death within 3 days. Upon further validation, these signs may assist clinicians in formulating the diagnosis of impending death and patients and families in preparing ahead.

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33

Koczo, Agnes, Reshad Mahmud, and Belinda Rivera-Lebron. Pulmonary Embolism (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0020.

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This chapter examines the diagnosis, risk stratification, and breadth of treatment options for pulmonary embolism (PE). It reviews the decision pathways based on degree of clinical suspicion of PE and assessing pre-test probability using the Geneva and Wells’ Score. It also reviews the Pulmonary Embolism Rule-out Criteria (PERC) and D-dimer with high negative predictive values. Imaging and cardiac biomarkers, which allow classification and risk stratification of PE, are discussed in how they guide management. Options for parenteral anticoagulation including bridging to novel oral anticoagulants or vitamin K antagonists for long term therapy are discussed, as well as clinical situations where systemic or catheter based thrombolysis should be considered. Hemodynamic support involving vasopressors are reviewed. The options for surgical embolectomy, as well as special cases including clot in transit, are discussed.

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34

Bradley, Elspeth, Sheila Hollins, Marika Korossy, and Andrew Levitas. Adjustment disorder in disorders of intellectual development (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198786214.003.0010.

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People with disorders of intellectual development (DID) have a diversity of abilities and consequent support needs. Adjustment difficulties give rise to mental distress and behavioural concerns when expectations are more than can be managed in the absence of needed supports. People with DID also experience a disturbing range of negative life events, trauma, and adversity, all of which can trigger adjustment disorder. Unless such stressors are identified, the individual with DID may be diagnosed with more serious psychiatric disorder, and the opportunity to remove the stressor and offer psychological treatment that both minimizes the emotional impact of the stressor and enhances coping (best practice) is lost. Chronic adjustment disorder, other serious psychiatric disorders, and challenging behaviours may develop and be perceived as treatment resistant (as long as the stressor remains). These diagnostic and treatment issues, in the context of the lives of people with DID, are explored in this chapter.

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35

Schott, Christopher K. Critical Care Ultrasound (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0026.

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Point of care ultrasonography (POCUS) is a tool that can be used at the bedside to aid in the diagnosis and treatment of critically ill patients. The ability to directly visualize physiology, pathology, and response to treatment can add valuable information in patient management particularly in time sensitive situations with acutely decompensated patients as may occur in the context of rapid response team (RRT) events. Although most of the data on POCUS to guide resuscitations has been published through emergency medicine (EM) and pre-hospital studies, the same approach can be easily adapted for in-hospital RRT events. This chapter reviews validated POCUS protocols for the assessment of hypotensive, hypoxic, or arresting patients and the ways it can be incorporated into in-hospital RRTs.

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36

Schott, Christopher K., and Jessica A. Fozard. Hypotension and Shock (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0008.

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Hypotension is a common cause of rapid response team (RRT) activation. It is critical to be able to rapidly identify the etiology of hypotension. In the setting of a rapid response team call, there is often limited time and information available when first encountering a hypotensive patient. With attention to key elements in the patient’s history of present illness, physical exam, and findings of predominant changes in systolic, diastolic, and pulse pressures, RRTs can rapidly narrow their differential diagnosis. We will discuss the initial evaluation and treatment recommendations based on the etiology of hypotension and shock. Resuscitation should continue until circulatory homeostasis occurs, as guided by a patient’s exam, vital signs, and trends in laboratory values. This chapter provides a framework on how to quickly differentiate between the causes of hypotension or shock when evaluating patients during a rapid response scenario to most accurately guide therapy.

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37

Nguyen, Linh. Prevalence of Mood Disorders in Patients with Cancer (DRAFT). Edited by Nathan A. Gray and Thomas W. LeBlanc. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190658618.003.0027.

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The prevalence of mood disorders in patients with cancer is uncertain in oncological, hematological, and palliative care settings because most studies have relied on depression symptom-screen methods rather than diagnostic instruments. Mitchell et al aimed to quantify the prevalence of mood disorders in studies where mood disorders were diagnosed by interview. Twenty-four palliative studies (n = 4,007) and 70 oncological and hematological studies (n = 10,071) were included in this meta-analysis of interview-based studies. The prevalence of depression was 24.6% and 20.7%, depression or adjustment disorder 24.7 and 31.6%, and all types of mood disorders 29% and 38%, respectively. There were no correlates of depression including age, gender, or palliative versus nonpalliative settings. Interview-defined mood disorders is less common in patients with cancer than reported previously (30%–40% prevalence) without a difference between palliative and nonpalliative care settings. Clinicians should remain attentive for all mood complications, not just depression.

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38

Hagedoorn, Mariët, and Tracey A. Revenson. Men Caring for Women in the Cancer Context (DRAFT). Edited by Youngmee Kim and Matthew J. Loscalzo. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190462253.003.0004.

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This chapter provides an overview of the consequences of a cancer diagnosis for female patients and their male caregivers, mostly partners or spouses. The majority of the couples adjust well; only a minority shows elevated levels of psychological distress a year or more after diagnosis. Nevertheless, the literature shows that cancer and its treatment may have a considerable impact on sexual functioning, fertility, and other aspects of the relationship. Communication between patients and partners and between couples and health care professionals plays a key role in solutions to these problems. Psychosocial interventions that may ameliorate the stresses these couples face are presented throughout the chapter. The authors also address issues of gender and caregiving.

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39

Wild, Jonathan, Emma Nofal, Imeshi Wijetunga, and Antonia Durham Hall. Emergency surgery (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198749813.003.0007.

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Emergency general surgery comprises patients with surgical problems requiring surgical intervention or post-operative surgical patients who require further surgical intervention or symptom palliation at any time of the day or night. Beyond the cases discussed below, this will include also emergency presentations from all of the sub-specialty chapters covered so far. Over 600,000 emergency hospital admissions are made to general surgery. Of these patients, they comprise the sickest patient cohort relative to the majority of elective patients, which results from sepsis, shock, or organ dysfunction from the underlying causative pathology, as well as the impact of any pre-existant comorbid states. This often has a significant impact on patient outcome, with high rates of morbidity and mortality relative to elective surgery. With this in mind, a lot of work has been channelled into improving outcomes for these patients. Furthermore, emergency and trauma surgery is beginning to establish itself as a subspecialty in itself. This chapter starts by making applied discussion of the assessment and initial investigation of acute abdominal pain, a complaint that comprises half of the annual 600,000 emergency general surgical admissions. It covers the pertinent features of diagnosis, investigation, and management of a range of common or serious emergency surgical and trauma cases that will be encountered on the acute surgical take. Kidney transplantation is not in itself an emergency operation when you consider the degree of pre-operative preparation of recipient donors, but is included in this chapter as it is commonly encountered by junior trainees on the emergency theatre list when donors are found at short notice.

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40

Rix, Keith. Adjustment disorders in legal settings (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198786214.003.0012.

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Sitting uncomfortably at the end or, as some might assert, off the end of the spectrum of mental disorder and in that grey area between normality and abnormality, adjustment disorders are already a challenge when they arise in legal settings. The challenge will be all the greater when reliance is placed on ICD-11 and DSM-5. This chapter analyzes cases from the civil and criminal jurisdictions to show the often pragmatic approaches taken by the courts in cases of adjustment disorder. These cases are used to suggest an approach as to how medical experts should report in cases where the diagnosis of adjustment disorder is an issue.

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41

Macauley, Robert C. Ethics of Prenatal Palliative Care (DRAFT). Edited by Robert C. Macauley. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199313945.003.0011.

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Palliative care can begin before birth, as parents wrestle with a prenatal diagnosis of a serious condition. The options are not limited to terminating the pregnancy or providing maximal treatment upon delivery. Prenatal interventions and focusing on comfort following delivery are also options. This also impacts the method of delivery, for if a pregnant woman’s values demand respect, so also should a request for caesarean section for fetal distress, even in the context of a serious fetal condition. The language one uses also impacts management and outlook, with terms such as “incompatible with life” both inaccurate and misleading. This chapter discusses these issues in the context of palliative care.

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42

Padmanabhan, Rajagopala, and Penny Sappington. Ventricular Assist Devices (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0021.

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Ventricular assist devices (VADs) have become a cornerstone of therapy in the management of end-stage heart failure, both as a means of bridging to cardiac transplantation and as destination therapy for long-term quality of life improvement. Responding to medical emergencies in patients with VADs poses numerous challenges to rapid response team (RRT) providers. Managing these patients requires basic understanding of VAD function and physiology and the multitude of complications that follow their implantation. Most healthcare professionals lack exposure to VADs, and although it may seem daunting, this chapter will provide a systematic approach of how to identify, troubleshoot, diagnose, and manage VAD-associated complications and provide emergency care for the VAD patient.

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43

Schneider, Antoine, and Rinaldo Bellomo. Atrial Fibrillation and Other Cardiac Arrhythmias (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0005.

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Cardiac arrhythmias are common in hospitalized patients, with their incidence increasing in older patients and those with comorbidities. Cardiac arrhythmias represent a trigger for approximately 10% of rapid response team (RRT) activations. Of those, atrial fibrillation (AF) is the most commonly observed. Other common cardiac arrhythmias in the in-hospital setting include supraventricular tachycardia, atrial flutter, ventricular tachycardia, and bradycardias. Members of the RRT should be skilled in the diagnosis and management of these common arrhythmias. This chapter presents an overview of cardiac arrhythmias that RRT members are likely to encounter, discussing their incidence and significance, as well as their immediate management.

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Macauley, Robert C. Clinical Practice of Palliative Care (DRAFT). Edited by Robert C. Macauley. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199313945.003.0018.

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Communication, cultural sensitivity, and respect for spirituality undergird the practice of palliative care. Clinicians must appreciate the nuance of communicating complex diagnoses and often grim prognoses and know how to respond when patients express a desire to not be fully informed (or their family demands that they not be). Across cultures there is significant variation in how prognosis is communicated, who makes decisions for a patient, and attitudes toward end-of-life care. Many patients and families also rely on their religious or spiritual beliefs in making medical decisions, and expectation of a “miracle” and perceived religious “mandates” for continued treatment demand spiritually-nuanced responses.

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45

Buckalew, Nelly A. Pain and Addiction in Older Adults (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190265366.003.0031.

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Addressing unique effects of both addiction and analgesia on older adults, this chapter defines the geriatric population and proceeds to discuss the recognition of addiction or substance misuse in it. There is little argument that the elderly have special diagnostic concerns and management needs that are imposed upon those of younger adults. The concept of the pain signature is introduced as a measure of the functions with which the individual’s pain interferes. Four instruments serving as diagnostic aids are included in tabular format: the pain signature elements; a list of recommended patient history queries; suggested components of the review of systems; and special components of the physical examination. The tables are geared specifically toward geriatric patients. The two central themes of the chapter are treatment of pain, and the treatment of opioid misuse and addiction.

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Terplan, Mishka. Pain and Addiction in Women (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190265366.003.0032.

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Women experience pain differently than men and suffer unique pain conditions. Pain syndromes frequently overlap in women and can be associated with co-occurring mental health disorders, addiction, and intimate partner violence as well as childhood sexual abuse. A discussion of extant concepts for understanding pain in women includes gender-role theory, exposure theory, and vulnerability theory. The chapter focuses predominantly on women of child-bearing age, and their unique risks and management requirements; consequently, contraceptive needs and fulfillment are reviewed for their place in the clinical management of pain and addiction. Unique to women, dysmenorrhea, chronic pelvic pain, endometriosis, fibromyalgia, interstitial cystitis, vulvodynia, and pregnancy may all be undervalued or overlooked in a non-gynecological setting. The higher susceptibility of women to osteoporotic disease and associated pain in older age constitutes another risk zone for pain mismanagement. A text box (30.1) describes the opioid neonatal abstinence syndrome, its diagnosis, and its management.

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Badger, Terry, and Chris Segrin. Female Caregivers of Male Cancer Patients (DRAFT). Edited by Youngmee Kim and Matthew J. Loscalzo. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190462253.003.0007.

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The diagnosis and treatment of cancer is a relationship, rather than an individual problem, because there is a patient and often an informal caregiver. In terms of male cancer patients and their female caregivers, this is most often studied in the context of prostate cancer patients and their female caregivers. Concepts from the stress process model are used to organize research findings on the women caring for their male partners with cancer. This review illustrates how different contexts of care, primary objective stressors, and resources can all contribute to the primary subjective stressors (e.g., quality of life, relationship problems, role demands) experienced by dyads in this context. Interventions to help caregivers as well as directions for clinical practice and future research are discussed.

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Morgan, Douglas E. Point-of-Care Testing (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0030.

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Point-of-care testing (POCT) is defined as medical diagnostic testing performed outside the clinical laboratory in close proximity to where the patient is receiving care. POCT is typically performed by non-laboratory personnel and the results are used for clinical decision making. When used appropriately, point-of-care testing (POCT) is a valuable resource during the rapid response system (RRS) activation. Advantages include shortened time between acquiring a sample from the patient and analysis of that sample and a subsequent decrease in time to clinical decision making. Disadvantages revolve largely around the cost of POCT. Driving forces behind the movement towards POCT include care process optimization, improvement of patient outcomes, changing regulatory requirements, and changes in the face of the workforce.

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Kaplan, Tamara, and Tracey Milligan. Dementia 2: CJD, NPH, and Summary (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190650261.003.0010.

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The video in this chapter explores dementia, and focuses on Creutzfeldt Jakob Disease (CJD), and Normal Pressure Hydrocephalus (NPH). It outlines the causes and symptoms of CJD, as well as diagnostic tests (MRI, CSF presence of protein 14-3-3, EEG, and biopsy). It also discusses NPH, including its characteristics and treatment.

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Kaplan, Tamara, and Tracey Milligan. Demyelinating Diseases 2: NMO, ADEM, GBS, CIDP (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190650261.003.0014.

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The video in this chapter explores demyelinating diseases, and focuses on neuromyelitis optica (NMO), acute disseminated encephalomyelitis (ADEM), Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP), including their symptoms, causes, and diagnostic tests.

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