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1
Consultants, GEI. Immediate response action completion report, method 3 risk characterization, and class B-1 response action outcome statement: MBTA storm drain Washington Street, Somerville, Massachusetts. Woburn, MA: GEI Consultants, 2009.
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2
United States. Congress. House. Committee on Government Reform. Subcommittee on National Security, Emerging Threats, and International Relations. Defense health care: Improvements needed in occupational and environmental health surveillance during deployment to address immediate and long-term health issues : report to the Chairman, Subcommittee on National Security, Emerging Threats, and International Relations, Committee on Government Reform, House of Representatives. Washington, D.C.]: United States Government Accountability Office, 2005.
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3
Phillips, Tudor. Risk factors for post-amputation pain. Edited by Paul Farquhar-Smith, Pierre Beaulieu, and Sian Jagger. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198834359.003.0066.
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The landmark paper discussed in this chapter is ‘Immediate and long-term phantom limb pain in amputees: Incidence, clinical characteristics and relationship to pre-amputation limb pain’, published by Jensen et al. in 1985. This study examined a cohort of older patients undergoing limb amputation, and carefully related pre-amputation pain to the development and nature of phantom limb pain. The authors demonstrated that a third of patients experienced pain similar to the pre-amputated limb pain immediately after amputation; patients who had experienced pre-amputation pain were more likely to experience phantom limb pain in the first 6 months after the amputation; and persistent phantom limb pain was more likely in patients who experienced stump pain after amputation. The study had clear implications for pain management but, importantly, it also demonstrated that peripheral pain, in the form of pre-amputation and stump pain, was important in determining the development and maintenance of phantom limb pain.
4
Fleurke, Floor M. Catastrophic Climate Change, Precaution, and the Risk/Risk Dilemma. Oxford University Press, 2017. http://dx.doi.org/10.1093/acprof:oso/9780198795896.003.0011.
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Whilst the seriousness of a given problem may call for immediate and targeted intervention, the ensuing uncertain impacts on other elements of inter-connected systems may be equally deleterious. Climate change is a prime example of such a risk/risk dilemma. The risk of inaction must be weighed against the risk of resorting to increasingly tempting responses to mitigate or adapt to the effects of climate change. The precautionary principle might offer some guidance in this risk/risk arena. Precaution is a tool to deal with uncertain risks without dictating outcomes. Although it is commonly associated with a negative regulatory tilt, it can also serve to warrant and mandate the use of, for example, a new technology or substance in order to reduce risks. This chapter explores the dilemma of risk/risk trade-offs in the face of potentially catastrophic climate change, and examines the contours of a precautionary regulatory response to such impasses.
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Corrà, Ugo, and Bernhard Rauch. Acute care, immediate secondary prevention, and referral. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656653.003.0021.
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Preventive cardiology (PC), as performed in various cardiac rehabilitation (CR) settings, is effective in reducing recurrent cardiovascular events after both acute coronary syndromes or myocardial revascularization. However, the need for newly structured PC programmes and processes to provide a continuum of care and surveillance from the acute to post-acute phases is evident. Phase I CR serves as a bridge between acute therapeutic interventions and phase II CR. After clinical stabilization, phase I CR ideally provides a multifaceted and multidisciplinary intervention, including post-acute clinical evaluation and risk assessment, general counselling, supportive counselling, early mobilization, discharge planning, and referral to phase II CR. All these are important and contribute to achieving the preventive target. All the interventions within phase I CR should be supervised and provided in a comprehensive manner involving several healthcare professionals. For explanatory purposes this chapter analyses and describes these components separately.
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Roger, Mccormick, and Stears Chris. Part VII Characteristics of Legal Risk, 25 Causation. Oxford University Press, 2018. http://dx.doi.org/10.1093/law/9780198749271.003.0026.
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This chapter first considers the relationship between the sources of legal risk considered in Chapter 24 and the causes of loss attributable to legal risk identified in the International Bar Association definition. Whereas the sources describe the social circumstances that cause legal risk to arise, the definition is concerned with how an institution, when faced with a legal risk-originated problem, should answer the question: how did this happen (or how can we prevent this happening)? Consideration of the sources helps us to understand why legal risks arise in the broader social context but it is the definition that provides the pointer to the more immediate causes of risk and loss in any specific context. The remainder of the chapter turns to relevant case law.
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Mitchem, Laura, Henrietta Harrison, and Alex G. Stewart. Fire and fear: Immediate and long-term health aspects. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198745471.003.0014.
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Fires can cause significant health concerns within local communities impacted by any associated smoke plume. This chapter discusses the potential public health concerns associated with fires, in particular fires at waste-processing installations. Using an example scenario, actions to be undertaken throughout the incident response, from initial acute phase to recovery, are considered, along with health concerns and fears, real or perceived, involvement of asbestos-contaminant material, multi-agency communication mechanisms, and potential issues associated with long-running fires. The multi-agency mechanisms for response are detailed, including the various coordinating groups (strategic, tactical, recovery coordinating groups (SCG, TCG, RCG, respectively), and expert cells (scientific and technical advisor cell, air quality cell (AQC)). Key points to note in the incident response include concerns raised by the local population, typical health effects associated with exposure to a smoke plume, and tools that support the response to the incident and the public health risk assessment.
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Puttler, Leon I., Robert A. Zucker, and Hiram E. Fitzgerald. Developmental Science, Alcohol Use Disorders, and the Risk–Resilience Continuum. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190676001.003.0001.
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The origins and expression of addiction are best understood within the context of developmental processes and dynamic systems organization and change. For some individuals, these dynamic processes lead to risk cumulative or cascade effects that embody adverse childhood experiences that exacerbate risk; predict early onset of drinking, smoking, or other substance use; and often lead to a substance use disorder (SUD) during the transitions to adolescence and emergent adulthood. In other cases, protective factors within or outside of the individual’s immediate family enable embodiment of normative stress regulatory systems and neural networks that support resilience and prevention of SUDs. A case study is provided to illustrate these processes and principles of the organization of addictive behavior. Finally, a model of risk to resilience captures the flow of development and the extent to which individual-experience relationships contribute to risk and resilience.
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Stephen J, Lubben. Part I United States, 3 Lehman’s Derivative Portfolio: A Chapter 11 Perspective. Oxford University Press, 2017. http://dx.doi.org/10.1093/law/9780198755371.003.0003.
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This chapter looks at the immediate cause of Lehman’s failure, which it argues was the repo market and the company’s inability to access funding for its operations at that time. Lehman’s derivatives were not the direct cause of its failure, but its derivatives, and the growth of the derivatives markets in general, led to the assumption of outsized risks and systemic weaknesses that facilitated the crisis. This chapter suggests that the continuation of the safe harbours ‘as is’ renders chapter 11 nonviable for larger financial institutions, and recent contractual attempts to work around the safe harbors are insufficient to solve the problem, while the increased role of clearinghouses in financial institution failures will force regulators to confront difficult choices. In short, the regulators will have to balance two competing systemic risks: the risk of an unruly resolution of the financial institution, balanced against increased risk to the clearinghouse.
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Cullen, Christian, Shyamkumar Bhatt, Suhel Abo-Hatab, and Jonathan Lautier. National Security Risks: Immediate Challenges Before Summer 2012. University of Buckingham Press, The, 2011.
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11
Beed, Martin, Richard Sherman, and Ravi Mahajan. Airway. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199696277.003.0002.
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Airway obstructionComplications at intubationAirway/facial traumaAirway/facial burnsAirway infectionsAirway foreign bodiesAirway haemorrhageEndotracheal tube complicationsTracheostomy complicationsAn obstructed airway is a medical emergency requiring immediate treatment. Where possible, patients at risk should be identified early so that airway obstruction can be prevented. Although upper airway obstruction may be gradual in onset it more commonly progresses very rapidly. Continuous assessment is required to identify signs of impending airway obstruction....
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Stoddard, Frederick J., and Robert L. Sheridan. Wound Healing and Depression. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190603342.003.0009.
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Depression and wound healing are bidirectional processes for adults and children consistent with the conception of depression as systemic. This systemic interaction is similar to the “bidirectional impact of mood disorder on risk for development, progression, treatment, and outcomes of medical illness” generally. And, evidence is growing that the bidirectional impact of mood disorder may be true for injuries and for trauma surgery. Animal models have provided some support that treatment of depression may improve wound healing. An established biological model for a mechanism delaying wound healing is increased cortisol secretion secondary to depression and/or stress, and impaired immune response, in addition or together with the other factors such as genetic or epigenetic risk for depression. Cellular models relate both to wound healing and to depression include cytokines, the inflammatory response (Miller et al, 2008), and cellular aging (Telgenhoff and Shroot, 2005) reflected in shorter leukocyte telomere length (LTL) (Verhoeven et al, 2016). Another model of stress impacting wound healing investigated genetic correlates—immediate early gene expression or IEG from the medial prefrontal cortex, and locomotion, in isolation-reared juvenile rats. Levine et al (2008) compared isolation reared to group reared samples, and found that, immediate gene expression in the medial prefrontal cortex (mPFC) was reduced, and behavioral hyperactivity increased, in juvenile rats with 20% burn injuries. Wound healing in the isolation reared rats was significantly impaired. They concluded that these results provide candidates for behavioral biomarkers of isolation rearing during physical injury, i.e. reduced immediate mPFC gene expression and hyperactivity. They suggested that a biomarker such as IEGs might aid in demarcating patients with resilient and adaptive responses to physical illness from those with maladaptive responses
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Resolution Trust Corporation: Immediate action is needed to control insurance costs : report to the Chairman, Resolution Trust Corporation Oversight Board. Washington, D.C: The Office, 1991.
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14
Resolution Trust Corporation: Immediate action is needed to control insurance costs : report to the Chairman, Resolution Trust Corporation Oversight Board. Washington, D.C: The Office, 1991.
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15
Valgimigli, Marco, and Marco Angelillis. Treatment of non-ST elevation acute coronary syndromes. Edited by Stefan James. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0311.
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Treatment of patients presenting with a non-ST elevation acute coronary syndrome (NSTE-ACS) aims at immediate relief of ischaemia and the prevention of serious adverse events, including death, myocardial (re)infarction, and life-threatening arrhythmias. In NSTE-ACS, patient management is guided by risk stratification (troponin, electrocardiogram, risk scores, etc.). Treatment options include anti-ischaemic and antithrombotic drugs and coronary revascularization including percutaneous coronary interventions, or coronary artery bypass grafting. While long-term secondary prevention with aspirin monotherapy is currently the gold standard approach for all NSTE-ACS patients who tolerate the drug, additional medications on top of aspirin such as oral P2Y12 inhibitors or oral anticoagulation have been investigated across clinical trials and their long-term use should be guided by the ischaemic versus bleeding risk status of each single individual patient.
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Perkins, Claire. Post-operative complications. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199642663.003.0015.
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Surgical patients are at risk of post-operative complications. A thorough pre-operative assessment and the implementation of appropriate care/treatment plans will reduce the likelihood of complications occurring. The surgical nurse should have a good knowledge and understanding of recognizing, preventing, and treating post-operative complications. The ABCDE approach should be used in the immediate post-operative period and if the patient becomes acutely unwell. This chapter uses body systems and the ABCDE approach to review post-operative complications.
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Chakera, Aron, William G. Herrington, and Christopher A. O’Callaghan. Screening for kidney disease. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0353.
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Renal disease is common and, with routine reporting of estimated glomerular filtration rates, impairment of renal function is increasingly being recognized. As renal impairment is usually asymptomatic until very advanced, chronic kidney disease (CKD) guidelines have been developed to improve the identification and screening of at-risk populations. Target groups include patients with vascular risk factors (e.g. diabetes mellitus and hypertension); patients with certain multisystem diseases which can cause renal impairment; patients with urological conditions; patients on nephrotoxic medication; and immediate relatives of patients with established renal disease. Kidney function should also be checked during intercurrent illness and perioperatively in all patients with CKD or suspected CKD. The frequency of screening is dictated by the CKD stage.
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Ng, Ju-Mei. Airway Fire. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0023.
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Airway fires during tracheotomy are rare but potentially fatal events, which are preventable. There are many surgical procedures that place the patient at a higher risk for airway fires, identification of those procedures and the associated risk is the first step towards avoiding this deadly complication. In this chapter the fire triad, of which each of the three components is independently necessary for fire to occur is described. Operating room fire safety measures are reviewed, with emphasis on the management of airway fires. The immediate interventions during an airway fire are discussed, together with the dilemma of which method should be used to secure the airway after the endotracheal tube catches fire.
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Smedley, Julia, Finlay Dick, and Steven Sadhra. Principles of risk assessment and risk management. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199651627.003.0021.
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Introduction and terminology 416Conceptual model 417General principles 418Sources of scientific evidence and uncertainty 420Risk communication and perception 421Decisions in OH often entail a choice between two or more options, the comparative merits of which are not immediately obvious. The decision may be for an individual (e.g. whether to ground a pilot because of a health problem), for the whole of a workforce (e.g. whether to immunize HCWs against smallpox), or at a societal level (e.g. whether to permit the use of a pesticide). Risk management is the process by which decisions of this sort are made, following an assessment of the risks and benefits associated with each option. Depending on the nature of the decision, the process of risk assessment and management may be more or less formalized....
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Feinstein, Robert E., and Brian Rothberg. Violence. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199326075.003.0013.
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Potentially violent patients need immediate attention and evaluation to determine their risk of imminent violence. A past history of violence is the best predictor of future violent behavior, and individuals who have committed violent acts in the past and have been arrested for assaultive behavior represent the highest risk; people who carry weapons or have access to weapons are of relatively high risk. Individuals with violent impulses who are either intoxicated or are in withdrawal have the most extreme risk for imminent violence. The treatment of acute aggression or agitation involves the judicious use of sedative-anxiolytics or low doses of second-generation antipsychotics. SSRIs have been used to treat aggressive, impulsive, and violent symptoms, particularly in individuals with head injuries, and lithium carbonate can reduce impulsive aggression to extremely low levels in some aggressive patients. Two Tarasoff decisions have become national standards for clinical practice regarding “duty to warn” and “duty to protect” all potential victims of life-threatening danger from a homicidal patient.
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Harris-Short, Sonia, Joanna Miles, and Rob George. 12. Child Protection. Oxford University Press, 2015. http://dx.doi.org/10.1093/he/9780199664184.003.0012.
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All books in this flagship series contain carefully selected substantial extracts from key cases, legislation, and academic debate, providing able students with a stand-alone resource. This chapter examines the law on state intervention into family life where a child is considered to be ‘in need’ or at risk of significant harm. It discusses the competing approaches to state intervention and the principles underpinning the Children Act (CA) 1989; the legal framework governing local authority support for children in need under Part III of the CA 1989; the law and procedure regulating compulsory intervention into family life by means of care proceedings under Part IV; and the various emergency and interim measures available to protect a child thought to be at risk of immediate harm.
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Rovner, Michelle Sher. Post-Tonsillectomy Bleeding. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0080.
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Post-tonsillectomy bleeding is a well-described complication that can rapidly evolve into one of the most challenging clinical situations in anesthesia. Tonsillectomy and adenoidectomy is one of the most common pediatric surgical procedures. A frequent indication for this procedure is adenotonsillar hyperplasia associated with obstructive sleep apnea. These children may be very challenging to care for and may have significant respiratory and fluid management issues postoperatively. This situation requires immediate attention and action with regard to resuscitation in a hypovolemic patient in combination with the challenges of a potentially difficult airway. This chapter discusses obstructive sleep apnea and its associated increased risk of postoperative complications with regard to tonsillectomy and adenoidectomy. It also reviews risk factors for postoperative tonsillar bleeding and the considerations in treating these children.
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Richardson, Michael G. STAT Caesarean Delivery. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0043.
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During emergency cesarean delivery (CD), indicated by immediate threat to fetal or maternal life, the anesthesiologist must quickly provide anesthesia that is rapid in onset and safe for both patients. Neuraxial anesthesia using well-functioning in-dwelling epidural catheters is achievable with early enough notification. Still, general anesthesia is often the most expedient method. Advanced airway devices and evolving difficult airway management algorithms have likely contributed to observed reductions maternal morbidity and mortality associated with general anesthesia. Long before the crisis arises, other measures can mitigate against risk, including early assessment and identification of at-risk patients, establishment of effective neuraxial labor analgesia in high-risk patients, and effective teamwork and communication. Establishing interprofessional labor and delivery unit goals and strategies, conducting team debrief sessions after each STAT CD, and identifying obstacles and generating case-specific strategies to overcome them constitute a resource-effective way to substantially reduce decision-to-delivery intervals and improve neonatal outcomes.
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Frye, Mark A., Paul E. Croarkin, Marin Veldic, Malik M. Nassan, Katherine M. Moore, Simon Kung, Susannah J. Tye, William V. Bobo, and Jennifer L. Vande Voort. Evidence-based treatment of bipolar depression. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198748625.003.0007.
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Despite the predominant illness burden, evidence-based treatment, and by extension regulatory approved, for acute bipolar depression is significantly less than evidence bases in acute mania and maintenance treatment. Complicating this deficit has been persistent use of unimodal antidepressant therapy without clear and convincing benefit. Successful regulatory-approved drug development has focused on atypical antipsychotic therapy. Evidence-based treatments also include lamotrigine and divalproex by meta-analyses and a number of manual-based psychotherapies. In contrast, unimodal antidepressants as a class for bipolar depressed patients as a group appear to provide substantial benefit and may pose risk for mood destabilization. Promising novel and neuromodulatory treatments while encouraging require further systematic investigation. Understanding unimodal antidepressant response and risk patterns in bipolar disorder has immediate clinical implications. Moreover, evidence-based guidelines will need to bridge more individualized or precision-based treatment interventions.
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Williams, Andy, and Ali Narvani. Combined ligament injuries around the knee. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.008012.
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♦ Any knee with major disruption of two ligaments is likely to have been dislocated at the time of injury♦ Knee dislocations are associated with high risk of neurovascular injury. Angiography or vascular ultrasound is mandatory♦ In knee dislocations, following immediate reduction and stabilization usually with a brace, acute repair of the ruptured soft tissue structure within 2–3 weeks of injury is likely to provide superior results compared to later reconstruction♦ Management of most multiligament injuries is complex and requires surgical intervention therefore specialist centres are best to be involved early♦ In cases with associated malalignment, osteotomy can improve the results of ligament reconstruction.
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Dodds, Jodi, Aaron I. Loochtan, and Cheryl D. Bushnell. Ischemic Stroke Management in Pregnancy. Edited by Emma Ciafaloni, Cheryl Bushnell, and Loralei L. Thornburg. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190667351.003.0014.
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Ischemic stroke during pregnancy is relatively rare, but when it occurs, the risk is highest in the postpartum period. This is a condition that requires immediate recognition and evaluation for acute management to potentially prevent devastating neurological consequences. Determining an etiology while considering physiological changes during and after pregnancy is also important. Post-stroke care including implementing secondary stroke prevention via pharmacological and non-pharmacological methods is regular practice. Consideration of physical, occupational, and speech therapy strategies as well as lifestyle modification and evaluation and treatment of co-morbid psychiatric conditions is also paramount. Postpartum care and consideration of future pregnancies and hormonal changes that may occur is also important.
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Sinkin, Robert A., and Christian A. Chisholm, eds. PCEP Neonatal Care (Book III). 3rd ed. American Academy of Pediatrics, 2016. http://dx.doi.org/10.1542/9781610020572.
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Developed by a distinguished editorial board, the Perinatal Continuing Education Program (PCEP) is a comprehensive, self-paced education program in four volumes. This popular resource features step-by-step skill instruction, and practice-focused exercises covering maternal and fetal evaluaton and immediate newborn care. The PCEP workbooks feature leading-edge procedures and techniques, and are filled with clear explanations, step-by-step skill instruction, and practice-focused exercises. Book III includes 10 units covering information and skills assessment and initial management of frequently encountered neonatal illnesses, plus the comprehensive unit review Is the Baby Sick?, which ties all neonatal therapies and skills together for management of sick and at-risk newborns.
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Galynker, Igor. The Suicidal Crisis. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190260859.001.0001.
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One of the most difficult determinations a psychiatrist makes is whether the chronically suicidal patient is at risk for suicide in the immediate future. The Suicidal Narrative is the first book to help clinicians evaluate the risk of imminent suicidal behavior. The book describes a theoretical framework for a systematic and comprehensive assessment of short-term suicide risk and also describes practical ways of conducting risk assessment interviews in different settings. The book is based on the narrative crisis model of suicide, which posits that individuals with trait vulnerability for suicide attempt suicide after they develop the suicide crisis syndrome when they feel that their life narrative has no acceptable future. This book first reviews current models of suicidal behavior and introduces the narrative crisis model of suicide. Next, it provides a comprehensive description of trait vulnerabilities followed by a discussion of stressful life events that may increase short-term suicide risk. The book’s core introduces the key concepts of the narrative crisis model of suicide—the suicidal narrative and suicide crisis syndrome—and addresses the clinical value of clinicians’ emotional responses to suicidal patients. Finally, the book provides practical guidance for conducting short-term suicide risk assessment and introduces current approaches to suicide risk reduction. The Suicidal Narrative is designed as a textbook and reference guide. The book contains more than 50 clinical case vignettes, detailed examples of risk assessment interviews, as well as test cases for self-assessment.
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Evans, Charlotte, Anne Creaton, Marcus Kennedy, and Terry Martin, eds. Specialized retrieval systems. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198722168.003.0020.
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Civilian and military retrieval services commonly respond to mass casualty events and international disasters. It is necessary to adapt usual practices to achieve the most for many. The structures, systems, language, and discipline take on a military flavour in civilian disaster response. This brings some order to the chaos and facilitates multiagency cooperation. Triage, treatment, and transport must occur in unfavourable environments. This is exemplified in military scenarios where there is ongoing risk to casualties and retrieval teams. Medical care provided by retrieval teams will depend on risk and resources. Staged retrieval may be required. This is also the case with civilian international retrieval where the patient may be transferred to an intermediate destination facility for immediate care, before being repatriated to their country of origin. Also included, is a section on medical emergency response teams which provide a critical care response to deteriorating patients in a hospital ward setting.
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Verslype, Chris, David Cassiman, and Johan Verhaeghe. Liver disorders. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0043.
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Liver disease can complicate 5% of pregnancies, putting mother and child at risk for increased morbidity and mortality. Cholestasis, portal hypertension, and liver failure represent three major clinical entities that should be recognized early because of the prognostic implications. Liver disease in pregnancy is generally separated into disorders that are unique to pregnancy and those that coincide with pregnancy. This chapter recommends a systematic approach that focuses on the major differential diagnostic characteristics of pregnancy-related liver diseases and a limited set of tests for pregnancy-unrelated liver diseases. Management of these conditions should be performed by a multidisciplinary team and ranges from simple medical therapies to immediate termination of the pregnancy.
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Visser, Frans, and Maarten Simoons. Percutaneous Coronary Intervention and Thrombolysis in AMI & other ACS. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199544769.003.0003.
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• Acute coronary syndromes (ACS) comprise an evolving acute myocardial infarction (AMI) presenting with or without ST-elevation and unstable angina• Patients presenting with an ST-elevation MI require immediate reperfusion therapy by primary percutaneous coronary intervention (PCI) or, if such is not available, thrombolysis• Cardiologists, emergency care physicians, general practictioners and ambulance services should collaborate to develop a national or regional system to optimise AMI therapy, given the national or local facilities and available resources• A subgroup of high-risk patients presenting with ACS without ST-elevation benefit from PCI or coronary artery bypass graft surgery• In all patients with ACS intensive anti-platelet and anti-thrombotic therapy is warranted, as well as B-blockers, ACE-inhibitors and statins.
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O'Shea, Janet. Risk, Failure, Play. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190871536.001.0001.
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Decried as mere brutality on display and celebrated as viscerally real, combat sport has escaped nuanced reflection. Risk, Failure, Play addresses this gap, signaling the many ways in which competitive martial arts differentiate themselves from violence through risk-based play. Despite its association with frivolity and ease, play is not the opposite of danger, rigor, or failure. Indeed, Risk, Failure, Play demonstrates the ways in which physical recreation allows us to manage the complexities of our current social reality. This book suggests that play gives us the ability to manage difficult conditions with intelligence and that physical play, with its immediacy and its heightened risk, is particularly effective at accomplishing this task. Presented from the perspective of a dancer and writer, this book takes readers through considerations of the politics of everyday life exemplified in martial arts practices such as jeet kune do, Brazilian jiu jitsu, kickboxing, Filipino martial arts, and empowerment self-defense. Risk, Failure, Play intertwines personal experience with phenomenology, social psychology, dance studies, performance studies, and theories of play and competition in order to produce insights on pleasure, mastery, vulnerability, pain, agency, individual identity, and society. Ultimately, this book suggests that play allows us to rehearse other ways to live than the ones we see before us, challenging us to reimagine our social reality.
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Bone, Angie, Alan Wilton, and Alex G. Stewart. Flooding and health: Immediate and long-term implications. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198745471.003.0015.
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Flooding can happen at any time of year and anywhere in the UK, not just in communities living near rivers or the coast. As our climate warms, flooding is expected to occur more frequently, through a combination of sea-level rise and increasing rainfall. As floods are highly dependent on location and context, and the impacts are often complex, sustained, and diverse, a well-coordinated multi-agency plan and response is required. Flooding has extensive and significant impacts on health and wellbeing, including immediate effects (e.g. drowning, injuries, carbon monoxide poisoning) and delayed effects (e.g. mental health issues). The role of Health Protection is to provide scientific and technical advice to responders, public health communications, health surveillance, and to maintain its own business continuity. This chapter sets out the basic facts around flooding and health, illustrating the issues, actions, misconceptions and challenges during the acute response and longer-term clean-up and recovery phases.
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Sinkin, Robert A., and Christian A. Chisholm, eds. PCEP Specialized Newborn Care (Book IV). 3rd ed. American Academy of Pediatrics, 2016. http://dx.doi.org/10.1542/9781610020596.
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Developed by a distinguished editorial board, the Perinatal Continuing Education Program (PCEP) is a comprehensive, self-paced education program in four volumes. This popular resource features step-by-step skill instruction, and practice-focused exercises covering maternal and fetal evaluaton and immediate newborn care. The PCEP workbooks feature leading-edge procedures and techniques, and are filled with clear explanations, step-by-step skill instruction, and practice-focused exercises. Book IV includes 6 units dealing with complex neonatal therapies, such as assisted ventilation, as well as a unit on continuing care for at-risk babies and those with special problems following intensive care. Contents include: Unit 1: Direct Blood Pressure Measurement Skills Units: Transducer Blood Pressure Monitoring Unit 2: Exchange, Reduction, and Direct Transfusions Part 1: Respiratory Distress Skills Unit: Exchange Transfusions Unit 3: Continuous Positive Airway Pressure Skills Unit: Delivery of Continuous Positive Airway Pressure Unit 4: Assisted Ventilation With Mechanical Ventilators Skills Unit: Endotracheal Tubes Unit 5: Surfactant Therapy Skills Unit: Surfactant Administration Unit 6: Continuing Care for At-Risk Babies
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Kočka, Viktor, Steen Dalby Kristensen, William Wijns, Petr Toušek, and Petr Widimský. Percutaneous coronary interventions in acute coronary syndromes. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0047.
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Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following:All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hoursPatients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groupsOther patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentationLow-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testingStents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settingsTriple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk
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Kočka, Viktor, Steen Dalby Kristensen, William Wijns, Petr Toušek, and Petr Widimský. Percutaneous coronary interventions in acute coronary syndromes. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0047_update_001.
Full textAbstract:
Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following:All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hoursPatients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groupsOther patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentationLow-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testingStents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settingsTriple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk
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Kočka, Viktor, Steen Dalby Kristensen, William Wijns, Petr Toušek, and Petr Widimský. Percutaneous coronary interventions in acute coronary syndromes. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0047_update_002.
Full textAbstract:
Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following: All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hours. Patients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groups. Other patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentation. Low-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testing. Stents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settings. Triple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk.
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Kočka, Viktor, Steen Dalby Kristensen, William Wijns, Petr Toušek, and Petr Widimský. Percutaneous coronary interventions in acute coronary syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0047_update_003.
Full textAbstract:
Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following: All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hours. Patients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groups. Other patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentation. Low-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testing. Stents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settings. Triple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk.
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Sturgess, Jane, Derek Duane, and Rebekah Ley, eds. A Medic's Guide to Essential Legal Matters. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198749851.001.0001.
Full textAbstract:
Patient expectations for immediate, risk-free healthcare have never been greater; the scrutiny that the medical profession face to deliver this perfect care has also never been greater; the complexity of the law under which we work and practise is ever-increasing, yet clinicians are meant to have an up-to-date understanding of all these matters. Many legal texts are written in ‘legalese’ language, which may be off-putting or confusing to the medical professional, especially in times of urgency and stress. This book has been written in an attempt to overcome these concerns while specifically aimed at the non-legally trained healthcare practitioner. It offers pragmatic easy-to-access information and guidance for the busy clinician needing to check the legal landscape before, during, or after treatments and consultations. This book is designed to be your number one reference for all medicolegal matters that demand an immediate answer. Each chapter details pertinent case law, statutes and legislation, and professional guidance, before considering specific aspects of medicolegal importance. Sections of text are complimented with a ‘key points’ summary box to act as a reminder or revision aid. Further reading is suggested at the end of each chapter, including links to websites that can provide up-to-date advice as the law changes and evolves. An alphabetical glossary of legal terms at the end of the book offers a rapid and easy reference that supports every chapter.
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Chandrasekhar, Shobana, and C. LaToya Mason. Valvular Disease. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0050.
Full textAbstract:
Cardiovascular disease is a leading cause of maternal morbidity and mortality worldwide. Complex valvular heart disease accounts for approximately 30% to 50% of all cardiac diseases of pregnancy and presents significant challenges to the management of the parturient affected by it. Determination of disease severity and maternal risk assessment are especially important to development of appropriate plans of care for the labor, delivery, and immediate postpartum periods, when adverse events for both mother and fetus may occur. An understanding of the pathophysiology of the causative lesions and hemodynamic goals, thorough evaluation, and a multidisciplinary approach are key components to the successful management of these patients, allowing for appropriate selection of an anesthetic technique that balances the benefits and consequences to both mother and infant, thereby leading to optimal patient outcomes.
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Scordino, David. Appendicitis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0036.
Full textAbstract:
Appendicitis is caused by acute inflammation of the appendix (usually secondary to obstruction) and can result in perforation, leading to peritonitis, sepsis, and/or abscess formation. Symptomatology includes anorexia, nausea, vomiting, and periumbilical pain (later localizing to the right lower quadrant). Patients at the extremes of age and pregnant women may have atypical presentations and higher rates of perforation and complications. Most patients suspected of having appendicitis receive prompt surgical intervention (usually laparoscopic). Antibiotic therapy, initiated preoperatively, varies for perforated vs nonperforated appendicitis. In patients with evidence of a contained abscess, nonoperative therapy is considered, as abscess is evidence of a prolonged disease course (more than 5 days) prior to presentation. On imaging, patients may have a well-circumscribed abscess or phlegmon; if immediate surgical intervention is attempted, there is significant risk of morbidity due to adhesions to adjacent tissues.
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Simon, Grieser, and Mecklenburg Christian. 6 The Revision of the Credit Derivative Definitions in the Context of the Bank Recovery and Resolution Directive. Oxford University Press, 2016. http://dx.doi.org/10.1093/law/9780198754411.003.0006.
Full textAbstract:
This chapter examines the adaptation of the International Swaps and Derivatives Association (ISDA) framework by means of the 2014 ISDA Credit Derivatives Definitions (2014 Definitions) in addressing how the EU Bank Recovery and Resolution Directive (BRRD) affects credit derivatives. Particularly, it analyses how the institution or obligation to which the credit derivative is referenced becomes subject to the measures. Financial derivatives are financial instruments which provide for an immediate or future exchange of a reference value. Its price inter alia derives from the underlying reference value. Credit Derivatives help transferring the risk of a referenced third party defaulting on its obligation from the buyer to the seller of the Credit Derivative. The chapter explores the documentation of Credit Derivatives and the adjustments made during the financial crisis. It concludes with an analysis of the BRRD from a Credit Derivatives’ perspective and illustrates experiences made during the financial crisis.
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Pisinger, Charlotta, and Serena Tonstad. Smoking. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656653.003.0010.
Full textAbstract:
Smoking causes all forms of cardiovascular disease (CVD): there is no safe level of smoking. The health benefits of quitting smoking are immediate. In patients with coronary heart disease smoking cessation results in a dramatic decline in future cardiovascular events and reduces cardiovascular death; it is the most effective and cheapest treatment for preventing new or recurrent CVD. Tobacco dependence should be regarded as a chronic disease with a lifelong risk of relapse. Making treatment readily available and reducing barriers to treatment increase the likelihood that smokers will accept treatment. Medication and follow-up should be arranged for all smokers upon hospital discharge and in outpatient settings. High priority should be given to identification and documentation of the smoking status of all patients, and systematic provision of cessation support. Clinicians should also ask about exposure to second-hand smoke and should play an active role in advocating for stronger tobacco controls.
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Pisinger, Charlotta, and Serena Tonstad. Smoking. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199656653.003.0010_update_001.
Full textAbstract:
Smoking causes all forms of cardiovascular disease (CVD): there is no safe level of smoking. The health benefits of quitting smoking are immediate. In patients with coronary heart disease smoking cessation results in a dramatic decline in future cardiovascular events and reduces cardiovascular death; it is the most effective and cheapest treatment for preventing new or recurrent CVD. Tobacco dependence should be regarded as a chronic disease with a lifelong risk of relapse. Making treatment readily available and reducing barriers to treatment increase the likelihood that smokers will accept treatment. Medication and follow-up should be arranged for all smokers upon hospital discharge and in outpatient settings. High priority should be given to identification and documentation of the smoking status of all patients, and systematic provision of cessation support. Clinicians should also ask about exposure to second-hand smoke and should play an active role in advocating for stronger tobacco controls.
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Shvarts, Shifra, and Siegal Sadetzki. Ringworm and Irradiation. Oxford University Press, 2022. http://dx.doi.org/10.1093/med/9780197568965.001.0001.
Full textAbstract:
The practice of using x-rays for the medical treatment of benign diseases began in the 1920s and peaked in the 1940s and 1950s. Radiation therapy was considered good medical practice during the first decades of the 20th century and was very effective at controlling and eliminating ringworm (tinea capitis), an epidemic that was spread mainly among children. Results were often immediate. In the United States, Canada, Europe, Australia, the Middle East, and North Africa, hundreds of thousands of children were treated with radiation therapy for ringworm of the scalp. X-ray treatment gradually came to an end in the 1960s when other effective oral treatments were developed (e.g., griseofulvin for ringworm). In parallel, studies started to suggest that radiation exposure, especially in childhood, might increase the risk for developing blood malignancies, benign and malignant tumors of the thyroid gland, and leukemia. This volume discusses the use of irradiation for the treatment of ringworm in different countries in the first half of the 20th century; the latent risk for the development of tumors, malignancies, thyroid cancer, brain tumors, and other health effects among the exposed population; media coverage; and the initiatives of the National Cancer Institute to launch a nationwide campaign warning the medical community and public about the late health effects of ionizing radiation
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Rao, Chethan P. Venkatasubba, and Jose Ignacio Suarez. Management of non-traumatic subarachnoid haemorrhage in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0239.
Full textAbstract:
Non-traumatic subarachnoid haemorrhage (ntSAH) is a complex disease affecting multiple systems and the hospital course of affected patients can be variable. ntSAH is associated with high morbidity and mortality, with the causes of early deaths being either rebleeding or hydrocephalus. The risk of rebleeding is reduced by immediate control of arterial blood pressure and early securing of ruptured aneurysms by either endovascular coiling or surgical clipping. Ongoing management focuses on prevention, detection, and management of delayed neurological deficits. Current recommendations include prophylactic use of nimodipine, maintenance of hypertension and euvolaemia or hypervolaemia, and endovascular treatment of vasospasm that fails to respond to medical therapy. Systemic complications following ntSAH include myocardial injury, acute lung injury, venous and pulmonary thromboembolism, fluid and electrolyte abnormalities, and severe sepsis. Each of these complications should be treated on its merits. Due to the complexity of management patients with ntSAH should be treated in a critical care environment by a collaborative team of neurosurgeons, neuroradiologists, neurologists and intensivists.
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Lavalle, Carlo, Renato Pietro Ricci, and Massimo Santini. Conduction disturbances and pacemaker. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0055.
Full textAbstract:
The most frequent clinical conditions complicated by bradyarrhythmias or atrioventricular blocks seen in an emergency setting are the degeneration of the conduction system, acute myocardial infarction, drug toxicity, and hyperkalaemia. Pacemaker malfunction is another cause of potentially life-threatening bradyarrhythmias. The presence of signs/symptoms of hypoperfusion and the localization of the block condition the therapeutic approach. Treatment of bradyarrhythmias and atrioventricular block in a critical care setting may be preventative or therapeutic. A preventative approach is necessary when the risk of a sudden block with an inadequate ventricular escape rhythm is present, but the patient is asymptomatic. Symptomatic patients require immediate treatment. If the block is located at His bundle level or at bundle branch level, atropine may be ineffective and may even worsen the degree of the block. If drug administration is ineffective, transvenous temporary pacing is indicated. Transcutaneous cardiac pacing is another temporary method of pacing indicated in various critical clinical settings.
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Grant, Warrent. Quick and Pratical Guide to Start Investing in the Stock Market: Start Earning Immediately Without Risk. Independently Published, 2019.
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Dewhurst, Alexander Timothy, and Brigitta Brandner. Intensive care management after vascular surgery. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0370.
Full textAbstract:
Vascular patients require admission to an intensive care unit at a number of stages during their hospital stay. They often have multiple co-morbidities and are at risk of major complications. Their management strategy requires a multidisciplinary approach with locally agreed pathways taking national frameworks into account. Vascular emergencies require immediate resuscitation and transfer to a tertiary cardiovascular centre. Vascular disease occurs throughout the arterial vascular tree, affecting both large and small vessels. The major cause is atherosclerosis. The management of vascular conditions is complex, and includes both medical and surgical interventions. Disease can be classified as non-occlusive where there is restricted blood flow or occlusive where the vessels are completely obstructed. Aneurysmal disease occurs when vessels walls weaken. The surgical treatment of these lesions is to either replace the diseased segment of artery with a vascular graft or to exclude it with an endovascular stent. Occlusive vascular disease can occur because of atherosclerotic emboli or thrombosis, and can be treated by embolectomy, bypass, or endovascular procedures. Medical therapy with β-blockade, lipid-lowering agents, anti-hypertensives agents, and control of diabetes reduces cardiovascular risk. Recent advances in medical technology have shifted treatment options from open surgical to endovascular procedures. The long-term outcome and cost benefit of endovascular procedures is yet to be established.
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Craig, Anne, and Anthea Hatfield. The Complete Recovery Room Book. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198846840.001.0001.
Full textAbstract:
New technologies are increasingly available for patient care but simple ‘tried and true’ old fashioned methods are still essential. The care that a patient receives in the first hours after surgery is crucial to minimizing the risk of complications such as heart attacks, pneumonia, and blood clots. As the patient awakes from their drug-induced coma, it takes time for them to metabolize and excrete drugs. They remain unable to care for themselves, and are at increased risk of harm. The recovery room staff must manage both comatose and physiologically unstable patients and deal with the immediate postoperative care of surgical patients. The sixth edition of this popular book, introducing a new author Dr Anne Craig, will provide nurses, surgeons and anaesthetists guidance on how to manage day-to-day problems and make difficult decisions. Previous editions of this book have established it as the definitive guide to setting-up, equipping, staffing, and administering an acute care unit. Basic science, physiology and pharmacology are fully explained. There are chapters on specific symptoms including pain and vomiting, and chapters devoted to the unique postoperative needs of individual types of surgery. This new edition brings this important text up to date and new drugs and techniques for monitoring are described. A new section looks ahead to the future development and design of recovery rooms and how they can contribute to patient well-being.