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1
Douglas, Cullen William. The Public Inquiry into the shootings at Dunblane Primary School on 13 March 1996. [Edinburgh?]: Stationery Office, 1996.
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2
Office, General Accounting. Medicare: Employer insurance primary payer for 11 percent of disabled beneficiaries : report to congressional committees. Washington, D.C: The Office, 1990.
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3
Office, General Accounting. VA health care: Changes in medical residency slots reflect shift to primary care : report to the Ranking Minority Member, Committee on Veterans' Affairs, U.S. Senate. Washington, D.C. (P.O. Box 37050, Washington 20548-0001): The Office, 2000.
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4
Kirchman, David L. Microbial growth, biomass production, and controls. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198789406.003.0008.
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Soon after the discovery that bacteria are abundant in natural environments, the question arose as to whether or not they were active. Although the plate count method suggested that they were dormant if not dead, other methods indicated that a large fraction of bacteria and fungi are active, as discussed in this chapter. It goes on to discuss fundamental equations for exponential growth and logistic growth, and it describes phases of growth in batch cultures, continuous cultures, and chemostats. In contrast with measuring growth in laboratory cultures, it is difficult to measure in natural environments for complex communities with co-occurring mortality. Among many methods that have been suggested over the years, the most common one for bacteria is the leucine approach, while for fungi it is the acetate-in ergosterol method. These methods indicate that the growth rate of the bulk community is on the order of days for bacteria in their natural environment. It is faster in aquatic habitats than in soils, and bacteria grow faster than fungi in soils. But bulk rates for bacteria appear to be slower than those for phytoplankton. All of these rates for natural communities are much slower than rates measured for most microbes in the laboratory. Rates in subsurface environments hundreds of meters from light-driven primary production and high organic carbon conditions are even lower. Rates vary greatly among microbial taxa, according to data on 16S rRNA. Copiotrophic bacteria grow much faster than oligotrophic bacteria, but may have low growth rates when conditions turn unfavorable. Some of the factors limiting heterotrophic bacteria and fungi include temperature and inorganic nutrients, but the supply of organic compounds is perhaps most important in most environments.
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Blisard, Deanna, and Ali Al-Khafaji. Diagnosis and management of variceal bleeding in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0178.
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Cirrhosis is the most common cause of portal hypertension, which subsequently leads to development of gastroesophageal varices (GEV). Generally, presence of GEV correlates with the severity of cirrhosis and variceal haemorrhage can develop when hepatic venous pressure gradient exceeds 10–12 mmHg. The gold standard for diagnosis and often treatment of GEV is oesophagogastroduodenoscopy (OGD). Management of GEV is divided into primary prophylaxis, acute haemorrhage control, and secondary prophylaxis. Primary prophylaxis includes surveillance OGD and endoscopic intervention based on the size of the varices. Management of acute variceal haemorrhage includes resuscitation and endoscopic interventions. Basic resuscitative measures to maintain haemodynamic stability, vasoconstricting agents to decrease portal pressure, and the use of prophylactic antibiotics. Endoscopic intervention includes any of variceal band ligation, variceal sclerotherapy, and variceal obturation. Radiological or surgical portosystemic shunting markedly reduces portal pressure and are clinically effective therapy for patients who fail endoscopic or pharmacological therapy. Balloon tamponade is effective in temporarily controlling oesophageal variceal haemorrhage in over 80% of patients. Its use should be restricted to patients with uncontrollable bleeding, where more definitive therapy is planned within 24 hours. Secondary prophylaxis includes endoscopy plus pharmacological therapy of non-selective β−blockers.
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Health Sector Reform in the Kurdistan Region - Iraq: Financing Reform, Primary Care, and Patient Safety. Rand, 2014.
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Ray, Sumantra (Shumone), Sue Fitzpatrick, Rajna Golubic, Susan Fisher, and Sarah Gibbings, eds. Clinical trial design. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199608478.003.0014.
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This chapter outlines the various study designs and their uses. The phases of drug development are described and the appropriate study design employed at each phase of development is identified Elimination of bias is critical to the study design and methods of eliminating bias are discussed, defining the population, randomisation and blinding. A summary of the elements to be considered when designing a study are presented including the types of control, placebo or active, and their uses, Non comparative and comparative designs are presented. In the comparative design both within and between patient designs are discussed including crossover, parallel, sequential, factorial and left right comparisons. Patient outcomes measures as well as efficacy measurement are required for new treatments. There is a brief review of pharmaeconomic study designs. Other types of study design, dose escalation and dose response studies are also discussed. As well as reducing bias in studies another critical element is the recording of the primary assessment methods. The choice of methods will affect other aspects of the study such as the statistical considerations. The methodology must be standardised and validated.
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Sabri, Omar, and Martin Bircher. Management of limb and pelvic injuries. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0336.
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Pelvic ring injuries can be life and limb threatening. The mechanism of injury can often be a good indicator of the type of injury; the Young & Burgess classification deploys that concept to full effect. Early identification based on mechanism of injury and improved prehospital care can play a major role in the outcome following such injuries. Pelvic ring injuries can lead to significant haemorrhage. Mechanical measures to stabilize the pelvis, in addition to modern concepts of damage control resuscitation (DCR), have been shown to be effective in early management of potentially life-threatening haemorrhage. Emphasis is now entirely on protecting the primary clot following a pelvic ring injury. Mechanical disturbance by log rolling the patient or springing of the pelvis are strongly discouraged. Early radiological clearance of the pelvis is encouraged. The lethal triad of coagulopathy, acidosis, and hypothermia should be corrected simultaneously to improve outcome. A traffic light system for monitoring venous lactate as an indicator of the patients’ physiological state can help the intensive care practitioner and the surgeon identify optimum timing for surgery. Pelvic ring injuries are associated with significant concomitant injuries. Limb trauma can also be life or limb threatening. Early identification, splinting, and resuscitation follow the same guidelines as pelvic ring injuries. Open long bone fractures should be managed by senior orthopaedic and plastic surgeons.
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Sue, Bogner Marilyn, ed. Misadventures in health care: Inside stories. Mahwah, N.J: Lawrence Erlbaum, 2004.
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Thun, Michael J., Martha S. Linet, James R. Cerhan, Christopher Haiman, and David Schottenfeld. Primary Prevention of Cancer. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780190238667.003.0062.
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Primary prevention has enormous potential to reduce the human, social, and economic costs of cancer worldwide. The following sections discuss the development and application of preventive interventions in six broad areas of public health: tobacco control, the prevention of obesity and physical inactivity, prevention of infection-related cancers, protection against excessive exposure to ultraviolet light, preventive drug therapies (chemoprevention), and the regulation of carcinogenic exposures. All of these areas affect multiple types of cancer and massive numbers of people. Different interventions are at varying stages of development. For example, effective, evidence-based approaches have been developed over several decades to reduce tobacco use, prevent chronic infection with hepatitis B virus, protect children from excessive sun exposure, regulate exposures in high-income countries, and reduce breast cancer incidence and recurrence in high-risk women. More recent efforts are seeking to identify upstream measures to prevent excessive weight gain, reduce caloric intake, and increase physical activity.
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Schofield, C. J. American trypanosomosis (Chagas disease). Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198570028.003.0050.
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American trypanosomosis is due to infection with Trypanosoma cruzi (Protozoa, Kinetoplastidae). This is a widespread parasite of small mammals and marsupials throughout most of the Americas, roughly from the Great Lakes of North America (approx. 42 ° N) to southern Argentina (approx. 46 ° S). It is mainly transmitted by blood-sucking bugs of the subfamily Triatominae (Hemiptera, Reduviidae) which are widespread in the Americas, but rare in the Old World. Except in some research laboratories, and infected immigrants from Latin America, T.cruzi has not been reported from the Old World, although closely-related trypanosome species are commonly found in Old and New World bats.Human infection with T.cruzi is generally known as Chagas disease, taking the name of Brasilian clinician Carlos Justiniano das Chagas who first described it from patients in central Brasil (Chagas 1909). Chagas isolated and described the parasite, correctly deduced most of its life-cycle and clinical symptoms associated with the infection, identified the insect vectors and some of the reservoir hosts, and also trialed initial attempts to control it. He was nominated at least twice for the Nobel prize in medicine (Coutinho and Dias 2000; Lewinsohn 2003).Although difficult to treat, Chagas disease can be controlled by measures to halt transmission, primarily by eliminating domestic populations of the insect vectors, together with serological screening to avoid transmission by blood donation from infected donors. Since 1991, a series of multinational initiatives have used this approach to halt transmission over vast regions of the areas previously endemic for the human infection. Estimated prevalence of the human infection has declined from the 1990 estimate of 16–18 million people infected, to the current estimate of just over 7 million infected (OPS 2006; Schofield & Kabayo 2008). Prevalence is expected to decline further, and control strategies are now being adjusted to develop a sustainable system of disease surveillance, focal vector control, and specific treatment for any new cases (Schofield et al. 2006; WHO 2007). Guidance for diagnosis and treatment is also required for non-endemic countries, where recent years have seen increasing migration from Latin America such that cases of chronic Chagas disease have now been reported from amongst Latin American migrants in Europe, USA and Canada, and Japan, together with some congenital cases and transmission from infected blood donors and by organ transplant.
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Bogner, Marilyn Sue. Misadventures in Health Care : Inside Stories (Human Error and Safety Series). Lawrence Erlbaum, 2003.
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13
Bogner, Marilyn Sue. Misadventures in Health Care: Inside Stories (Human Error and Safety Series). Lawrence Erlbaum, 2003.
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14
Nates, Joseph L., and Sharla K. Tajchman. Indirect calorimetry in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0205.
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Critically-ill patients have unpredictable and dynamic metabolic demands that are difficult to predict and quantify. Combined with the high incidence of pre-existing or development of malnutrition in the ICU, these metabolic demands have deleterious effects on outcomes when patients are provided with inadequate or inappropriate nutrition support. Providing adequate nutritional support that meets these varying metabolic demands is a long-standing challenge in the intensive care unit (ICU). Indirect calorimetry (ICal) is a tool that allows ICU practitioners to accurately assess energy expenditure (EE) in critically-ill patients with unpredictable metabolic demands to optimize nutrition support. ICal provides clinicians with a patient’s measured EE (MEE), a quantification of cellular metabolism, and respiratory quotient (RQ), a reflection of which substrates are primarily being utilized for fuel. Study results help clinicians target optimal nutritional goals and prevent adverse effects associated with both under- and overfeeding patients. Recent studies have suggested avoiding caloric deficits and providing tight caloric control may improve morbidity and mortality outcomes in critically-ill patients, though more studies are needed to verify this potential benefit. Currently, there are no specific guideline recommendations to help clinicians utilize ICal in the ICU. Although ICal is considered to be the gold standard for determining EE in critically-ill patients, its use remains limited by availability, cost, and the need for trained personnel for correct use.
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Alexander, D. J., N. Phin, and M. Zuckerman. Influenza. Edited by I. H. Brown. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198570028.003.0037.
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Influenza is a highly infectious, acute illness which has affected humans and animals since ancient times. Influenza viruses form the Orthomyxoviridae family and are grouped into types A, B, and C on the basis of the antigenic nature of the internal nucleocapsid or the matrix protein. Infl uenza A viruses infect a large variety of animal species, including humans, pigs, horses, sea mammals, and birds, occasionally producing devastating pandemics in humans, such as in 1918 when it has been estimated that between 50–100 million deaths occurred worldwide.There are two important viral surface glycoproteins, the haemagglutinin (HA) and neuraminidase (NA). The HA binds to sialic acid receptors on the membrane of host cells and is the primary antigen against which a host’s antibody response is targeted. The NA cleaves the sialic acid bond attaching new viral particles to the cell membrane of host cells allowing their release. The NA is also the target of the neuraminidase inhibitor class of antiviral agents that include oseltamivir and zanamivir and newer agents such as peramivir. Both these glycoproteins are important antigens for inducing protective immunity in the host and therefore show the greatest variation.Influenza A viruses are classified into 16 antigenically distinct HA (H1–16) and 9 NA subtypes (N1–9). Although viruses of relatively few subtype combinations have been isolated from mammalian species, all subtypes, in most combinations, have been isolated from birds. Each virus possesses one HA and one NA subtype.Last century, the sudden emergence of antigenically different strains in humans, termed antigenic shift, occurred on three occasions, 1918 (H1N1), 1957 (H2N2) and 1968 (H3N2), resulting in pandemics. The frequent epidemics that occur between the pandemics are as a result of gradual antigenic change in the prevalent virus, termed antigenic drift. Epidemics throughout the world occur in the human population due to infection with influenza A viruses, such as H1N1 and H3N2 subtypes, or with influenza B virus. Phylogenetic studies have led to the suggestion that aquatic birds that show no signs of disease could be the source of many influenza A viruses in other species. The 1918 H1N1 pandemic strain is thought to have arisen as a result of spontaneous mutations within an avian H1N1 virus. However, most pandemic strains, such as the 1957 H2N2, 1968 H3N2 and 2009 pandemic H1N1, are considered to have emerged by genetic re-assortment of the segmented RNA genome of the virus, with the avian and human influenza A viruses infecting the same host.Influenza viruses do not pass readily between humans and birds but transmission between humans and other animals has been demonstrated. This has led to the suggestion that the proposed reassortment of human and avian influenza viruses takes place in an intermediate animal with subsequent infection of the human population. Pigs have been considered the leading contender for the role of intermediary because they may serve as hosts for productive infections of both avian and human viruses, and there is good evidence that they have been involved in interspecies transmission of influenza viruses; particularly the spread of H1N1 viruses to humans. Apart from public health measures related to the rapid identification of cases and isolation. The main control measures for influenza virus infections in human populations involves immunization and antiviral prophylaxis or treatment.
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Ronen, Boaz, Joseph S. Pliskin, and Shimeon Pass. Creating Value for Healthcare Organizations (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190843458.003.0018.
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Creating value for healthcare organizations is the primary goal for their managers, both in for-profit and nonprofit organizations. In this chapter, we present the value-focused management methodology, a practical approach for increasing the value of a healthcare organization. The methodology is a multistep approach, including determining the goal, determining the performance measures, identifying the value drivers, deciding how to improve the value drivers, and implementation and control. The value-focused management methodology enables managers to examine systematically where they should devote their time and energy and in which areas the contribution will be marginally small.
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Mody, Rajal K., Angela Ahlquist Cleveland, Shawn R. Lockhart, and Mary E. Brandt. Epidemiology of fungal disease. Edited by Christopher C. Kibbler, Richard Barton, Neil A. R. Gow, Susan Howell, Donna M. MacCallum, and Rohini J. Manuel. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198755388.003.0007.
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Surveillance and outbreak investigations are important epidemiological tools for assessing the frequency, distribution, and determinants of infections. The primary goal of these activities is to identify measures to reduce the burden of disease. This chapter describes examples of surveillance and approaches to outbreak investigations that have formed the basis of fungal infection control measures. However, considerable knowledge gaps exist, new threats are emerging (including antifungal resistance), and healthcare advances are making more people susceptible to severe fungal infections. Expanded surveillance efforts, timely outbreak detection, and effective outbreak investigations are needed to further reduce the burden of fungal infections. This will require confronting challenges that have held back fungal disease epidemiology, including limited clinical suspicion of fungal infections by clinical providers, difficulties in diagnosing fungal infections due to suboptimal diagnostic methods, limited availability of antifungal susceptibility testing and molecular subtyping, and a lack of mandated fungal disease surveillance in most countries.
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Kotseva, Kornelia, Neil Oldridge, and Massimo F. Piepoli. Evaluation of preventive cardiology. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656653.003.0026.
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The Joint European Societies guidelines on cardiovascular disease (CVD) prevention define lifestyle and risk factor targets for patients with coronary or other atherosclerotic disease and people at high risk of developing CVD. However, several surveys in Europe and the United States showed inadequate lifestyle and risk factor management and under-use of prophylactic drug therapies in primary and secondary CVD prevention. Various professional associations have developed core components, standards, and outcome measures to evaluate quality of care and provide guidelines for identifying opportunities for improvements. Optimal control of cardiovascular risk factors is one of the most effective methods for reducing vascular events in patients with atherosclerotic disease or high cardiovascular risk. Improving treatment adherence is also very important. Health-related quality of life (HRQL) is considered as an outcome measure in research studies and in clinical practice. HRQL measures can help in improving patient-clinician communication, screening, monitoring, and continuous assessment of quality of care.
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Kotseva, Kornelia, Neil Oldridge, and Massimo F. Piepoli. Evaluation of preventive cardiology. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199656653.003.0026_update_001.
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The Joint European Societies guidelines on cardiovascular disease (CVD) prevention define lifestyle and risk factor targets for patients with coronary or other atherosclerotic disease and people at high risk of developing CVD. However, several surveys in Europe and the United States showed inadequate lifestyle and risk factor management and under-use of prophylactic drug therapies in primary and secondary CVD prevention. Various professional associations have developed core components, standards, and outcome measures to evaluate quality of care and provide guidelines for identifying opportunities for improvements. Optimal control of cardiovascular risk factors is one of the most effective methods for reducing vascular events in patients with atherosclerotic disease or high cardiovascular risk. Improving treatment adherence is also very important. Health-related quality of life (HRQL) is considered as an outcome measure in research studies and in clinical practice. HRQL measures can help in improving patient-clinician communication, screening, monitoring, and continuous assessment of quality of care.
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Cassidy, Jim, Donald Bissett, Roy A. J. Spence OBE, Miranda Payne, and Gareth Morris-Stiff. Targeted and biological therapies. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199689842.003.0009.
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Hormone therapy describes the role of hormones in the growth of a variety of cancers, and the therapeutic effects of manipulation of hormone levels in these diseases. Sex hormones stimulate the growth of breast and prostate cancers, many of which respond to surgical removal of the hormone-secreting gonad. Pharmacological measures to deliver hormone therapy in these diseases include luteinising hormone releasing hormone (LHRH) agonists and antagonists, inhibitors of sex hormone synthesis, and inhibitors of hormone-receptor binding. These treatments have established benefits in both in the control of advanced disease and the adjuvant therapy of early-stage disease. The pros and cons of combination hormone therapy are discussed. Resistance to hormone therapy may be primary or acquired, and the likely mechanisms are described.
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Johnson, Peter W., and Martin G. Cherniack. Vibration. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780190662677.003.0013.
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This chapter describes vibration exposure in the workplace and its adverse health consequences. Both whole-body vibration and hand-arm vibration are described. The deleterious effects from hand-arm vibration induced by power tools on peripheral nerves and small blood vessels have been documented for more than a century. Whole-body vibration increases spinal load and can contribute to muscle fatigue and deterioration of intervertebral lumbar discs. Neck pain and low back pain are also associated with whole-body vibration from various types of equipment and vehicles. The pathophysiology of various vibration-associated disorders are discussed. Prevention and control measures are described in detail. Control of whole-body vibration rests mainly on primary prevention and selection of appropriate equipment (primarily vehicle and equipment seating) to reduce whole-body vibration exposure.
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Farrar, John T. Understanding clinical trials in palliative care research. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0193.
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Advances in basic science, translational, and clinical research have led to rapid improvements in our understanding of many disease processes. The randomized clinical trial (RCT) has played an important role in validating the benefits and harms of therapies thought to be potentially useful based on scientific theory or clinical observation, and has become the ‘gold standard’ for the demonstration of efficacy. As in all clinical study designs, the RCT has strengths and weaknesses that must be understood to appropriately interpret the study results. While randomization of the intended study population is the primary strength of such trials, choice of the study population, control condition, outcome measures, analysis procedure, and procedures for blinding the study participants can all affect the results. Understanding the requirements of a valid RCT and what can potentially go wrong will improve the conduct of palliative care research and the usefulness of published information in the care of patients.
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Conner, Mark T. Experiential Attitude and Anticipated Affect. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190499037.003.0003.
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Recent research has explored the effects of two affective influences within models such as the theory of planned behavior and reasoned action approach: experiential attitude and anticipated affect. Both refer to perceptions of future affect, that is, cognitively mediated affect. Primary studies and meta-analytic reviews supporting the role of these two affective variables on health behavior are presented. The correlational data use prospective designs and control for other health cognitions and past behavior. The experimental data also explore whether the affective variables mediate the impact of the “affective intervention” on behavior. Strong support is found across studies for both experiential attitude and anticipated affect as important determinants of health behaviors even when controlling for other health cognitions and past behavior. The need for further experimental studies with objective measures of health behavior is noted. Further the testing of the combined effects of manipulating both affective variables is highlighted for further attention.