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1
Koczo, Agnes, Reshad Mahmud, and Belinda Rivera-Lebron. Pulmonary Embolism (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0020.
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This chapter examines the diagnosis, risk stratification, and breadth of treatment options for pulmonary embolism (PE). It reviews the decision pathways based on degree of clinical suspicion of PE and assessing pre-test probability using the Geneva and Wells’ Score. It also reviews the Pulmonary Embolism Rule-out Criteria (PERC) and D-dimer with high negative predictive values. Imaging and cardiac biomarkers, which allow classification and risk stratification of PE, are discussed in how they guide management. Options for parenteral anticoagulation including bridging to novel oral anticoagulants or vitamin K antagonists for long term therapy are discussed, as well as clinical situations where systemic or catheter based thrombolysis should be considered. Hemodynamic support involving vasopressors are reviewed. The options for surgical embolectomy, as well as special cases including clot in transit, are discussed.
2
Appelbaum, Kenneth L., and Kevin R. Murphy. Attention deficit disorders. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199360574.003.0037.
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The diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) in correctional settings is in itself problematic and quite contentious; treating the disorder more so. Community prevalence studies estimate that 2.5% to 4% of adults in the United States and worldwide meet diagnostic criteria for ADHD. Some research findings suggest that ADHD occurs at far greater prevalence rates among criminal justice populations than in the population at large. The nature of the condition, its assessment, and its management combine to create a perfect storm of potentially vexing challenges for the prison psychiatrist. This chapter reviews those diagnostic and treatment challenges, including the risk of diversion and misuse of controlled substances among inmates. An assessment and treatment model is presented that takes into account and minimizes risk while helping ensure access to care in appropriately selected cases. Some inmates have a compelling need for treatment, potentially including stimulant medications. Neither unbridled use nor complete elimination of stimulants makes good clinical or administrative sense for correctional systems. An approach that relies on current impairment in significant functional areas, meaningful involvement in treatment, and absence of active misuse of substances will allow access to medication for those with verifiable need while lessening the risks associated with prescription of controlled substances in jails and prisons. The issues of differential diagnosis in a population with epidemic substance abuse, the challenges of appropriate management, and an evidence-based treatment model are discussed in this chapter.
3
Raines, James C., ed. Evidence-Based Practice in School Mental Health. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780190886578.001.0001.
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Schools have become the default mental health providers for children and adolescents, but they are often poorly equipped to meet the mental health needs of their students. The introduction tackles how to make students eligible for school-based services using the Individuals with Disabilities Education Act or Section 504 of the Rehabilitation Act. Using the new DSM-5 as an organizing principle, this book then addresses the 12 most common mental disorders of childhood and adolescence, ages 3–18. While there are many books that address child and adolescent psychopathology, this book focuses on how to help students with mental disorders in pre-K–12 schools. Each chapter addresses the prevalence of a disorder in school-age populations, appropriate diagnostic criteria, differential diagnosis, comorbid disorders, rapid assessment instruments available, school-based interventions using multitiered systems of support, and easy-to-follow suggestions for progress monitoring. Unique to this book, each chapter has detailed suggestions for how school-based clinicians can collaborate with teachers, parents, and community providers to address the needs of youth with mental health problems so that school, home, and community work together. Each chapter ends with a list of extensive web resources and a real-life case example drawn from the clinical practice of the authors. The final chapter addresses two newly proposed diagnoses for self-harm in the DSM-5 and brings a cautious and sensible approach to assessing and helping students who may be at risk for serious self-injury or suicide.
4
Rihmer, Zoltán, Xénia Gonda, and Péter Döme. The assessment and management of suicide risk in bipolar disorder. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198748625.003.0016.
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Bipolar spectrum disorders are among the most frequent psychiatric ailments associated with a considerable risk of suicidal behaviour. Approximately 4–19% of (mostly untreated) patients with bipolar disorders ultimately commit suicide, and about 20–60% of them make at least one suicide attempt in their lifetime. Compared with the general population, the risk of committing suicide is about 10–30 times higher in patients with bipolar disorder. However, the majority of bipolar patients never attempt or commit suicide. Therefore, the routine assessment of several risk factors for suicide in clinical practice may aid in the recognition of those patients who are at the highest risk. This chapter summarizes the clinically most relevant suicide risk and protective factors in bipolar disorders. In addition, we review evidence-based strategies for suicide prevention in bipolar disorder.
5
De Braganca, Kevin C., and Roger J. Packer. Medulloblastoma. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0139.
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Medulloblastoma is the most common malignant brain tumor in pediatric patients. Patients are presently stratified to either standard or high-risk groups based on clinical and pathologic criteria. Approximately 80% of patients with standard risk disease are cured of their primary disease. High-risk and recurrent disease groups have a poorer outcome; 5-year progression-free survival is only 65% with high-risk disease. Disease control after recurrence is very poor. Treatment is multimodal and also aims to limit short- and long-term toxicities. Recent identification of four molecular subtypes of medulloblastoma may change risk assignment and therapy. Addressing the medical and psychosocial issues of survivors continues to improve the quality of life for these patients beyond the disease’s treatment.
6
Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0049.
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Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
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Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0049_update_001.
Full textAbstract:
Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
8
Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0049_update_002.
Full textAbstract:
Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
9
Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0049_update_003.
Full textAbstract:
Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
10
Manski, Charles F. Patient Care under Uncertainty. Princeton University Press, 2019. http://dx.doi.org/10.23943/princeton/9780691194738.001.0001.
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Although uncertainty is a common element of patient care, it has largely been overlooked in research on evidence-based medicine. This book strives to correct this glaring omission. Applying the tools of economics to medical decision making, the book shows how uncertainty influences every stage, from risk analysis to treatment, and how this can be reasonably confronted. In the language of econometrics, uncertainty refers to the inadequacy of available evidence and knowledge to yield accurate information on outcomes. In the context of health care, a common example is a choice between periodic surveillance or aggressive treatment of patients at risk for a potential disease, such as women prone to breast cancer. While these choices make use of data analysis, the book demonstrates how statistical imprecision and identification problems often undermine clinical research and practice. Reviewing prevailing practices in contemporary medicine, the book discusses the controversy regarding whether clinicians should adhere to evidence-based guidelines or exercise their own judgment. It also critiques the wishful extrapolation of research findings from randomized trials to clinical practice. Exploring ways to make more sensible judgments with available data, to credibly use evidence, and to better train clinicians, the book helps practitioners and patients face uncertainties honestly. It concludes by examining patient care from a public health perspective and the management of uncertainty in drug approvals. The book explains why predictability in the field has been limited and furnishes criteria for more cogent steps forward.
11
Condon, Marie, Philippa Dodd, and Liz Lightstone. The patient with systemic lupus erythematosus. Edited by Giuseppe Remuzzi. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0162.
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AbstractSystemic lupus erythematosus (SLE) is a chronic, relapsing, inflammatory, often febrile multisystemic disorder, characterized by involvement of the skin, joints, visceral organs, and serosal membranes. Symptoms and manifestations vary widely over an unpredictable relapsing and remitting course.The presentation of SLE can range from mild forms to severe disease requiring hospitalization. Most commonly it manifests as a combination of constitutional symptoms, particularly fatigue and fever, with cutaneous, musculoskeletal, mild haematological, and serological involvement; however, when renal, haematological or central nervous system disease predominate it can be more severe, even life-threatening. There is a tendency for the disease pattern present at the time of onset to prevail during subsequent exacerbations.Investigating SLE depends to an extent on the presentation of the individual. However a number of haematological, biochemical and immunological investigations provide useful diagnostic information, either for the disease itself or in context of organ system involvement, and should be performed routinely.The presence of lupus nephritis should be considered in any lupus patient with impaired kidney function, proteinuria, hypertension, or an active urine sediment; the gold standard investigation in this context is a kidney biopsy. Glomerular immune complex deposition is the hallmark of lupus nephritis and underpins the International society of Nephrology/Renal Pathology Society classification of lupus nephritis.The diagnosis of SLE is based upon the presence of clinical and/or laboratory features and immunological markers that meet the various published diagnostic criteria. In 2012, lupus nephritis identified on kidney biopsy became an independent diagnostic criterion.This chapter goes through the clinical manifestations, investigations (including a detailed look at the kidney biopsy) and a review of the latest published diagnostic criteria.
12
Gordon, Kathryn H., Jill M. Holm-Denoma, Valerie J. Douglas, Ross Crosby, and Stephen A. Wonderlich. The Classification of Eating Disorders. Edited by W. Stewart Agras and Athena Robinson. Oxford University Press, 2017. http://dx.doi.org/10.1093/oxfordhb/9780190620998.013.1.
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The purpose of this chapter is to elucidate the key issues regarding the classification of eating disorders. To this end, a review of nosological research in the area of eating disorders is presented, with a particular focus on empirically based techniques such as taxometric analysis, latent class analysis, and factor mixture modeling. This is followed by a section outlining areas of overlap between the current Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5) eating disorder categories and their symptoms. Next, eating disorder classification models that are alternatives to the DSM-5 are described and critically examined in light of available empirical data. Finally, areas of controversy and considerations for change in next version of the DSM (i.e., the applicability of DSM criteria to minority groups, children, and males; the question of whether clinical categories should be differentiated from research categories) are discussed.
13
Balas, Michele C., and E. Wesley Ely. Assessment and therapeutic strategy for agitation, confusion, and delirium in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0227.
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Agitation and delirium are conditions that are highly prevalent in the intensive care unit (ICU). Both are believed to be caused by a number of modifiable and non-modifiable risk factors, and present with a variety of signs and symptoms. Consequently, these conditions are notoriously difficult to detect and treat. Variations in sedative practices, misperceptions regarding delirium and its association with outcomes, and lack of knowledge regarding screening tools, may all impede effective assessment, and management of agitation and delirium. A further complication is that many of the medications used to treat critically-ill patients are now known to increase the risk of delirium. While studies conducted over the last decade have significantly contributed to our understanding of how best to diagnose, prevent, and manage these common conditions, this knowledge is not always successfully adopted into everyday clinical practice. This chapter provides readers with an evidence-based review of agitation and delirium assessment and therapeutic strategies applicable for use in the ICU setting.
14
O'Hagan, Anthony, and Mike West, eds. The Oxford Handbook of Applied Bayesian Analysis. Oxford University Press, 2018. http://dx.doi.org/10.1093/oxfordhb/9780198703174.001.0001.
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This handbook discusses various applications of modern Bayesian analysis in important and challenging problems. With contributions from leading researchers and practitioners in interdisciplinary Bayesian analysis, the book highlights current frontiers of research in each application. Each chapter involves a concise review of the application area, describes the problem contexts and goals, discusses aspects of the data and overall statistical issues, and offers detailed analysis with relevant Bayesian models and methods. The book is organised into five sections based on the field of application, namely: Biomedical and Health Sciences; Industry, Economics and Finance; Environment and Ecology; Policy, Political and Social Sciences; and Natural and Engineering Sciences. Topics range from an epidemiological study involving pregnancy outcomes, to matching and alignment of biomolecules; pharmaceutical testing from multiple clinical trials concerned with side-effects and adverse events; malaria mapping in the Amazon rain forest; risk assessment of contamination of farm-pasteurized milk with the bacterium Vero-cytotoxigenic E. coli (VTEC) O157; Bayesian analysis and decision making in the maintenance and reliability of nuclear power plants; risk modelling regarding speculative trading strategies in financial futures markets; the use of hierarchical models to characterize the uncertainty of climate change projections; and the use of multistate models for mental fatigue.
15
Burman, Deepa, Daniel J. Buysse, and Charles F. Reynolds. Treatment of Sleep Disorders. Oxford University Press, 2015. http://dx.doi.org/10.1093/med:psych/9780199342211.003.0021.
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This chapter provides an evidence-based review of the seven categories of DSM-5 sleep-wake disorders. Specific sleep-wake disorders vary widely in their clinical manifestations, etiologies, treatment, and the level of evidence supporting those treatments. Sleep-wake disorders are prevalent, increase the risk of many common mental and substance use disorders, and exacerbate these disorders, with which they typically co-occur. Unless properly treated in their own right, sleep-wake disorders can impair treatment response and worsen the long-term course of mental disorders. Thus, it is important for psychiatrists and other mental health practitioners to understand the diagnosis and treatment of sleep-wake disorders and when to refer patients to a sleep medicine specialist.
16
Douglas, Kevin S., Tonia L. Nicholls, and Johann Brink. Interventions for the Reduction of Violence by Persons with Serious Mental Illnesses. Edited by Phillip M. Kleespies. Oxford University Press, 2016. http://dx.doi.org/10.1093/oxfordhb/9780199352722.013.34.
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Violence perpetrated by persons with serious mental illness (SMI), although certainly not the norm among this group, is of clinical and legal import in numerous legal settings. Among these are civil commitment, forensic psychiatry (insanity acquittees), and the criminal justice system. In this chapter, we provide a critical review of interventions and their empirical support that are used to reduce violence among persons with SMI. Promising findings support the use of cognitive behavioral, social learning, and cognitive skills approaches that are consistent with the Risk-Need-Responsivity (RNR) approach to crime and violence prevention. Anger management remains a promising, focused intervention with reasonable support in the literature. Dialectical behavioral therapy (DBT) has substantial general support. Community-based mandatory service programs such as outpatient commitment and mental health courts appear effective. Finally, the evidence base for the violence-reducing effect of certain psychotropic medication, particularly clozapine, is promising yet inconsistent.
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Kumpfer, Karol L., and Cátia Magalhães. Prevention as Treatment. Edited by Sara Maltzman. Oxford University Press, 2016. http://dx.doi.org/10.1093/oxfordhb/9780199739134.013.22.
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This chapter reviews the application of treatment methods in prevention, with an emphasis on family-based substance abuse, delinquency, and child maltreatment. The goal of prevention is to increase resilience in high-risk children. Considerable overlap exists between evidence-based prevention and treatment interventions, including their etiological and intervention theories, cognitive behavioral change methods and outcome objectives. Also included is the Institute of Medicinespectrum of treatment disorders, a review of prevention and treatment intervention theories, and methods used to design effective family interventions, with an emphasis on family systems, social ecology and resilience theories including the author’s Transactional Framework of Resilience model and the Strengthening Families Program. Lastly, this chapter covers the applications of clinical techniques to improve resilience characteristics and processes and places evidence-based prevention programs methods within this framework and details their similarity to treatment. Digital technology (e.g., DVDs, Web, smart phones, television, etc.) is recommended to reduce intervention costs and “go-to-scale” to have a greater public health impact in promoting resilience in children.
18
Ray, Sumantra (Shumone), Sue Fitzpatrick, Rajna Golubic, Susan Fisher, and Sarah Gibbings, eds. Monitoring. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199608478.003.0013.
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This chapter discusses the role and responsibilities of monitors/CRAs seeking to improve awareness of their role in a global industry becoming more and more technologically focused. How the role is changing through the introduction of risk based monitoring. Often the only liaison between the Sponsor and each study site, CRAs are crucial to the successful completion of a clinical trial and need to be armed with appropriate knowledge and training to conduct their visits. Successful monitoring requires experience, people skills, management ability and knowledge – of the protocol, CRFs, study drug/device, therapeutic area, regulations and SOPs. In this chapter this spectrum of roles and responsibilities is presented in a concise and understandable format. Questions such as: What type of person makes a good monitor? EDC and/or paper? How – and how often – to monitor? are addressed. There are helpful tips and strategies on a variety of topics, notably preparing a monitoring plan; how to identify and assess potential investigators; preparing for a Study Initiation Visit; eCRFs and remote monitoring; thorough Source Data Verification; how to report monitoring visits plus example checklists associated with site visits and review of the Investigator Site File. The guidance provided in this chapter should help CRAs perform their essential role in encouraging good, high quality research - and provide an insight into the CRA role to those whose work is being monitored.
19
Frerk, Christopher, and Takashi Asai. The airway in anaesthetic practice. Edited by Michel M. R. F. Struys. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0048.
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This chapter provides a comprehensive review of current airway management set against its historical context and likely future developments in the field. Developments in equipment design are discussed against the background of a short review of the anatomy and physiology relevant to clinical airway management. An exploration of airway devices examines progress in design from the first facemasks and early hands-free delivery systems, through to current second-generation supraglottic airways and the future of providing improved protection against aspiration. Continuing advances in tracheal tube and cuff design are set alongside developments in techniques and equipment for laryngoscopy and possibilities for supplementing capnography in confirmation of correct tube placement within the trachea. The use of newer drugs to facilitate control of airway reflexes is also discussed. The importance of using optimal evidence-based techniques in airway management is highlighted in the reduction of complications. This covers preoperative evaluation of the airway, planning a strategy, induction of anaesthesia, and establishing a clear airway through to safe termination of anaesthesia, emergence, tracheal extubation, and recovery. Techniques for dealing with complications if they arise are described. Drawing on lessons from the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society ‘Major complications of airway management in the United Kingdom’ (NAP4) and the general literature, emphasis is placed on high-risk areas of airway management and areas where the existing knowledge base is not covered in depth in other texts.
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Guidelines for Diagnosing and Managing Disseminated Histoplasmosis among People Living with HIV. Organización Panamericana de la Salud, 2020. http://dx.doi.org/10.37774/9789275122488.
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Histoplasmosis is a disease caused by the fungus Histoplasma capsulatum. This disease is highly endemic in some regions of North America, Central America, and South America and is also reported in certain countries of Asia and Africa. It often affects people with impaired immunity, including people living with HIV, among whom the most frequent clinical presentation is disseminated histoplasmosis. The symptoms of disseminated histoplasmosis are non-specific and may be indistinguishable from those of other infectious diseases, especially disseminated tuberculosis (TB), thus complicating diagnosis and treatment. Histoplasmosis is one of the most frequent opportunistic infections caused by fungal pathogens among people living with HIV in the Americas and may be responsible for 5–15% of AIDS-related deaths every year in this Region. These guidelines aim to provide recommendations for the diagnosis, treatment, and management of disseminated histoplasmosis in persons living with HIV. Although the burden of disease is concentrated in the Americas, the recommendations presented within these guidelines are applicable globally. These guidelines were produced in accordance with the World Health Organization (WHO) handbook for guideline development. The Guideline Development Group elaborated the final recommendations based on a systematic review of scientific literature and critical evaluation of the evidence available using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. These guidelines are intended for health-care providers, HIV program managers, policy-makers, national treatment advisory boards, researchers, and other professionals involved in caring for people who either have or may be at risk of developing disseminated histoplasmosis.