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1
Boa, E. R. An illustrated guide to the state of health of trees: Recognition and interpretation of symptoms and damage. Rome: Food and Agriculture Organization of the United Nations, 2003.
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2
Stanghellini, Giovanni. Symptom as cypher. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198792062.003.0023.
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This chapter argues that the symptom-as-aletheia concept can be better explained in the light of Jaspers’ concept of ‘cypher’. Cyphers show what without them would remain implicit for us. Symptoms are a special category of cyphers: through them alterity, that is, the hidden yet operative (and perplexing) dimension of our existence, is made manifest. Like symptoms, cyphers are the contingent opportunity of recognition, of a possible encounter between the person and the encompassing dimension of her existence. The cypher must keep on an inexhaustible signification with which no definite interpretation is commensurate. Symptoms in the phenomenological–hermeneutic paradigm are anomalies, but not abnormal phenomena in a strict sense. Rather, they are what awakens one’s care for oneself. The symptom reflects and reveals alterity in oneself—in it, alterity becomes conspicuous. From the vantage offered by the symptom one can see oneself from another, often radically different and new, perspective.
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Fine, Perry G., and Matthew Kestenbaum. Clinical Processes and Symptom Management. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190456900.003.0003.
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This chapter describes what to do when a patient experiences severe anxiety and uncontrolled agitation that negatively affect care and the caregiving environment. Agitation and severe anxiety (panic) represent some of the few true emergency conditions in a hospice setting, so early recognition and prevention are critical. The discussion covers causes in depth, including psychosocial/spiritual and biomedical causes. The chapter details a tactical approach to evaluating and managing severe anxiety and agitation. An example of this is assessing if the patient has an organic brain syndrome due to advancing disease with either local or systemic manifestations and reviewing medications for adverse drug reactions. It then details appropriate processes of care, such as providing pharmacotherapy for acute and recurrent agitation.
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Waldmann, Carl, Neil Soni, and Andrew Rhodes. Neurological disorders. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199229581.003.0022.
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Agitation and confusion 360Status epilepticus 362Meningitis 364Intracerebral haemorrhage 366Subarachnoid haemorrhage 368Ischaemic stroke 370Guillain–Barre syndrome 372Myasthenia gravis 374ICU neuromuscular disorders 376Tetanus 378Botulism 380Neurorehabilitation 382Hyperthermias 384Agitation and confusion are common features in critical illness. Agitation is a symptom or sign of numerous acute and chronic disease states that include pain, anxiety and delirium. Agitation is present in around half of ICU patients, with 15% experiencing severe agitation. Confusion may also be chronic or acute and arise from an overlapping set of pathological processes that includes hypoxia, hypotension, hypoglycaemia and dementia. It is possible to be agitated and not confused, and vice versa. Recognition and treatment of the underlying condition is of utmost importance, rather than treating the symptoms alone....
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Kendell, Mary, and Margie Wentzel. Women’s Health. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190466268.003.0011.
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Although the hormonal changes that occur during menopause are the same for all women, the experience of menopause will be as unique as the woman herself. It will be modulated as much by the physiological changes that occur in her body as it will be by her cultural upbringing, thoughts and attitudes about this time in her life, and her current life stressors. Recognition of menopause as a unique experience for every woman is an essential component of an integrative approach to health care for this phase of life. Management and treatment options should include proactive anticipatory education, symptom screening, diet and lifestyle recommendations and, when necessary, pharmacotherapeutics. This chapter covers vasomotor symptoms, skin changes, breast health and breast cancer, genitourinary complaints, sexuality, and hormone replacement therapy.
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Lyons, Kelly E., and Rajesh Pahwa. Recognition and Treatment of Non-Motor Symptoms of Parkinson's Disease. Oxford University Press, 2011.
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7
Forsyth, Rob, and Richard Newton. Signs and symptoms. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198784449.003.0003.
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This chapter addresses the diagnostic approach to the patterns of symptoms and signs commonly seen in the paediatric neurology clinic. It encourages pattern recognition. The presentations considered are: altered mental state (agitation/confusion); motor disorders (exercise limitation and muscle pain; eye or facial movement abnormalities; the floppy infant; a funny gait; weakness; unsteadiness or falls; toe-walking; disordered sensation, numbness, pain, dysaesthesia; deafness, loss or disturbance of hearing or vision; paroxysmal disorders (funny turns, loss of awareness, epilepsy, headache, movement disorders); developmental delay, impairment or regression, school failure; speech disturbance; behaviour disorder; symptoms that might suggest a spinal disorder such as back pain, incontinence, or scoliosis; other skeletal abnormality including abnormal skull size or shape, foot deformity; sleep disturbance.
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Bissonnette, Bruno, and Bernard Dalens. Syndromes: Rapid Recognition and Perioperative Implications. McGraw-Hill Professional, 2006.
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9
Bruno, Bissonnette, ed. Syndromes: Rapid recognition and perioperative management. New York: McGraw-Hill, 2005.
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10
Bissonnette, Bruno, and Bernard Dalens. Syndromes: Rapid Recognition and Perioperative Implications. McGraw-Hill Professional, 2006.
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11
Bruno, Bissonnette, ed. Syndromes: Rapid recognition and perioperative implications. New York: McGraw-Hill Medical Pub. Division, 2006.
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12
Bissonnette, Bruno. Syndromes: Rapid Recognition and Perioperative Implications, 2nd Edition. McGraw-Hill Education, 2019.
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13
Boa, E. R. Illustrated Guide To The State Of Health Of Trees Recognition And Interpretation Of Symptoms And Damage. Food & Agriculture Organization of the UN (FA, 2004.
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14
Oliver, David. End of life: Wishes, values and symptoms, and their impact on quality of life and well-being. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198757726.003.0013.
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The holistic assessment of the patient with ALS and their family will help to maximize the care as the disease progresses and the end of life approaches. This includes consideration of advance care planning, so that the person’s wishes are known if they lose capacity or communication late in the disease course. Discussion of ventilatory support, either by non-invasive ventilation or tracheostomy ventilation, is particularly important so that decisions are not made in a crisis situation. Although ventilatory support may improve quality of life (QoL) and length of survival, there may be increased dependency and continued disease progression. The recognition of the later stages of disease progression can allow further discussion and anticipation and preparation for end of life care—for patient, family, and professions—so that QoL is maximized until death.
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King, Daniel. Aretaios of Kappodokia. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780198810513.003.0003.
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This chapter turns to the neglected author, Aretaios of Kappodokia, and his nosological writings. Aretaios develops an anatomically informed vision of pain perception which employs Aristotelian ideas about perception; he describes these symptoms in a manner which combines specific and formal medical terminology with more quotidian language and metaphors for various pain symptoms. This combination of linguistic registers helps provide a structure for the recognition and diagnosis of different symptoms and their conditions. Aretaios combines these two aspects of his nosology with a vision of the patient and his interaction with them that emphasizes their joint, heroic confrontation of pain and disease. Aretaios stresses, ultimately, the patient’s and doctor’s joint or combined confrontation of pain and disease.
16
Walsh, Richard A. When Less Is More. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190607555.003.0006.
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The natural history of PD produces a predominance of nonmotor complications in the later years that can often be more disabling than the motor complications due to their impact on quality of life. Quality of life is less impaired by motor symptoms than it is by cognitive impairment, hallucinations, autonomic involvement, and sleep disruption. Carer burden can be significant, and a shift of emphasis toward maximizing quality of life for patient and carer over the achievement of continuous dopaminergic stimulation is required. Recognition of the carer burden is an important facet of the palliative neurology consultation, which should target resources to limit carer burnout in recognition of their critical role.
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Medforth, Janet, Linda Ball, Angela Walker, Sue Battersby, and Sarah Stables. Pregnancy complications. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198754787.003.0012.
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The chapter is concerned with recognition and the most recent guidance on the management of commonly seen pregnancy complications. These include early pregnancy bleeding, antepartum haemorrhage, hyperemesis, obstetric cholestasis, multiple pregnancy, breech presentation, intrauterine growth restriction, thromboembolic disorders, and the principles of thromboprophylaxis. Each section describes the condition and factors that may lead to its development. Signs and symptoms are described, along with contraindications and aspects of treatment. Special considerations in the antenatal management plans are included.
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Barton, Joel, and Gavin Martin. Local Anesthesia Systemic Toxicity. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0087.
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Regional anesthesia can deliver multiple benefits to patients undergoing surgery. However, administering even appropriate doses of local anesthetic agents for regional anesthesia can be life threatening, and the risks must be well understood. Local anesthetic systemic toxicity (LAST) is a spectrum or sequence of symptoms and dysfunction that affects the nervous and cardiopulmonary systems. Management of LAST revolves around recognition, supportive care, and, specifically, administration of lipid emulsion. The American Society of Regional Anesthesia practice advisory for management of LAST is an excellent point-of-care reference for anesthesiologists practicing regional anesthesia.
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Torres, Albina R., Leonardo F. Fontenelle, Roseli G. Shavitt, Marcelo Q. Hoexter, Christopher Pittenger, and Euripedes C. Miguel. Epidemiology, Comorbidity, and Burden of OCD. Edited by Christopher Pittenger. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190228163.003.0004.
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This chapter addresses the interrelated topics of OCD epidemiology, comorbidity, and disease burden. Obsessive-compulsive disorder (OCD) is a frequent condition, especially if subthreshold manifestations are considered. Epidemiological surveys describe current and lifetime prevalence rates of full-blown OCD around 1% and 2.5%, respectively. Subthreshold symptoms occur in up to a third of the general population. Comorbidity is the rule in OCD, which increases the complexity, severity, distress, chronicity, and negative impact of the disorder. Comorbidity may influence the search for, adherence with, and response to treatment. OCD entails significant costs to society, both illness related and care/treatment related. Epidemiological surveys show that only a minority of individuals with OCD are receiving treatment. Recognition and treatment of OCD is often delayed for many years, increasing the morbidity and the burden of sufferers, family members, and society. Increasing public awareness, professional recognition, and access to treatment is an urgent clinical and public health need.
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Kuttikat, Anoop, and Nicholas Shenker. Fibromyalgia and chronic widespread pain syndromes—adult onset. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0160.
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Fibromyalgia syndrome (FMS) is characterized by chronic widespread pain, excessive fatigue, unrefreshing sleep, and other associated somatic symptoms. FMS is common in the general population with an estimated prevalence of 2-4% and is about six times more common in females than males. FMS causes significant individual and societal costs. The precise aetiology of FMS remains unclear. Dysfunctional pain processing within the central nervous system is the primary abnormality. FMS is a clinical diagnosis based on pattern recognition and it can coexist with other conditions. A multidisciplinary approach, incorporating patient education, physical therapies, psychological therapies, and pharmacotherapy, is effective in managing these patients.
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Beattie, R. Mark, Anil Dhawan, and John W.L. Puntis. Coeliac disease. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569862.003.0033.
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Who to investigate 234How to investigate 236Diagnosis 238Treatment 240Follow-up and support 242Coeliac disease is an immune-mediated enteropathy caused by a permanent sensitivity to gluten which is present in wheat, barley, and rye. It occurs in genetically susceptible children and adults. The classical presentation is with chronic diarrhoea, abdominal distension, and failure to thrive. The widespread availability of antibody screening has considerably changed the clinical spectrum of cases seen. The testing of children with less classical symptoms and screening of children at high risk has brought increasing recognition of the varied presentation and increased prevalence of this now very common condition....
22
Frost, Randy O., Lucy Graves, and Elizabeth Atkins. Hoarding Disorder. Edited by Christopher Pittenger. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190228163.003.0052.
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Hoarding Disorder (HD), new in DSM-5, is remarkably prevalent, affecting 2% to 5% of the population. Hoarding symptoms were long considered an aspect of OCD, but it has been increasingly recognized that they differ, phenomenologically and epidemiologically; the new DSM-5 diagnosis formalizes this recognition. HD is a complex disorder consisting of problems with attachments to possessions that lead to difficulty discarding and organizing them. Together, these features lead to severely cluttered living spaces that can pose serious health and safety threats. The vast majority of those with HD acquire excessively, mostly through buying or collecting things that others have discarded. Hoarding behaviors appear early in life and typically get progressively worse over the life span. Cognitive behavioral therapy specifically designed to treat hoarding has been shown to be effective, though many still suffer from symptoms after treatment. Several medications have shown promise, but no controlled clinical trials have been conducted.
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Jones, Christina, and Richard D. Griffiths. Post-Traumatic Stress Disorder Following Critical Illness. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0021.
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Post-traumatic stress disorder (PTSD) has been shown to be a significant problem for both patients and relatives after critical illness. For patients the recall of delusional memories from the period in ICU can be a powerful trigger for the development of PTSD. Such memories are described by patients as very vivid and difficult to separate from reality. Early recognition and treatment of PTSD, where needed, can reduce the long term effects. Chronic PTSD, where symptoms have been present for three months after the traumatic event, is associated with a number of long term health problems such as chronic pain. It can also have profound effects on relationships, financial status and overall wellbeing. The provision of an ICU diary has been shown to reduce the incidence of PTSD in patients and reduce the level of PTSD-related symptoms in family members. For the majority of patients this relatively simple intervention helps them to fill in memory gaps and combat any delusional memories they may recall.
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Fall, Magnus. Bladder pain syndrome. Edited by Rob Pickard. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0011.
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Bladder pain syndrome has a profound impact on the patients’ physical, professional, and personal life. Generally, recognition of this clinical syndrome is hampered by insufficient expertise in the medical community. The correct diagnosis is often delayed by several years and may be preceded by multiple medical consultations and treatment attempts. Still, this is one of the most painful, non-malignant conditions to be encountered in urology and it is probably more common than generally believed. Problems as to diagnosis, phenotyping, terminology, and management persist, but during the last few years there has been increasing activity to resolve those issues. In this chapter, symptoms, findings, and treatment options are outlined.
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Schelenz, Silke. Fungal diseases of the gastrointestinal tract. 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/9780198755388.003.0026.
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Fungal diseases of the gastrointestinal (GI) tract can occur because of an overgrowth of yeast in the gut, exposure to contaminated food and water, or as part of disseminated invasive fungal infections from other sites. The extent of the disease depends on the underlying risk factors, such as diabetes or immunosuppression, and ranges from colonization, localized infection, or fungaemia, to aggressive life-threatening GI tract infections. Candida spp. are the commonest cause of mucosal infection, although mould infections are increasingly reported. Serious invasive mould infections are difficult to diagnose as symptoms are often non-specific. Early recognition, prompt antifungal treatment, and surgical intervention can be lifesaving.
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Sjoblom, Matthew D., Diane Gordon, and Lori A. Aronson. Hypopituitarism. Edited by Erin S. Williams, Olutoyin A. Olutoye, Catherine P. Seipel, and Titilopemi A. O. Aina. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190678333.003.0041.
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Hypopituitarism is a decreased secretion of pituitary hormones. It is especially concerning during surgery and anesthesia if it results in adrenal insufficiency, hypothyroidism, or diabetes insipidus. Common causes in children include pituitary tumor and/or treatment, traumatic brain injury, and empty sella syndrome. Perioperative management includes recognition of clinical symptoms, such as hypotension, fatigue, polydipsia, and increased urine output. Unrecognized adrenal insufficiency may result in significant morbidity or mortality. Intraoperative treatment may involve stress-dose corticosteroids, careful fluid management, and desmopressin. This chapter uses the case study of a 9-year-old boy who presents for bilateral removal of tibial orthopedic hardware to illustrate the concepts.
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Dierdorf, Stephen F. Hypocalcemia/Hypercalcemia. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0038.
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Calcium is critical to many vital physiologic functions. These functions include cardiac rhythm and contractility, neuromuscular transmission, and skeletal muscle contractility. 45% of the calcium in the blood is ionized, which is more revalent to the physiologic function of calcium as opposed to the fraction that is bound. Serum ionized calcium levels are closely regulated by the parathyroid gland via calcium-sensing receptors and parathormone secretion. Low or high levels of calcium can result in life-threatening cardiac dysrhythmias and skeletal muscle weakness leading to respiratory failure. The anesthesiologist must be aware of the clinical conditions that place patients at risk for calcium abnormalities. This will allow for early recognition of the signs and symptoms, so that measurements can take place and rapid treatment can be given.
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Greenwald, Margaret L. Wernicke’s Aphasia: Auditory Processing and Comprehension. Edited by Anastasia M. Raymer and Leslie J. Gonzalez Rothi. Oxford University Press, 2015. http://dx.doi.org/10.1093/oxfordhb/9780199772391.013.5.
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This chapter includes a discussion of the symptoms of Wernicke’s aphasia, including impaired auditory comprehension and neologistic verbal expression. Anosognosia, impaired attention, and impaired self-monitoring are discussed as they relate to Wernicke’s aphasia. Current evidence of the neuroanatomical correlates of Wernicke’s aphasia and the role of Wernicke’s area is presented from a variety of experimental perspectives. Theoretical approaches to understanding impaired auditory processing in Wernicke’s aphasia are discussed in relation to perception, recognition, and comprehension of speech. Methods for the assessment and interpretation of receptive and expressive language in Wernicke’s aphasia and jargon aphasia are described within the context of a cognitive model depicting multiple input modalities and output modes of language. Finally, current methods for the treatment and management of Wernicke’s aphasia are reviewed, with an emphasis on evidence-based practice.
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Brugha, Traolach S. Comorbidity assessment. Edited by Traolach S. Brugha. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198796343.003.0010.
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This final chapter in Part II captures the distinctions between autism and other mental disorders (and intellectual disability). Issues and challenges in comorbidity assessment are discussed including development and course of social interaction. Under recognition of autism by psychiatrists and the conditions they tend to diagnose in such cases (depression, BPD, anxiety) are considered. Possible harmful effects of misdiagnosis in clinical contexts and in advice (employers, benefits system, courts, etc.) are discussed. How to differentiate symptoms that might seem to be part of two conditions (e.g. OCD versus RRBs) is discussed as is the possible confusion between autism and other similar clinical presentations. Specific comorbidities covered include ADHD, Intellectual Disability, suicidality, anxiety, depression, and masking issues and any major mental disorder in adulthood. Issues of law are also covered.
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Shorter, Edward, and Max Fink. Introduction. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190881191.003.0001.
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Catatonia is a syndrome that is identifiable, verifiable, and eminently treatable, unlike other disorders in the roster of psychiatric diseases. Catatonia is not a form of “schizophrenia,” and, although it may “piggyback” on other diseases, it is also a disease in its own right. Today, catatonia is often not recognized; clinicians and the public are more familiar with the term as a subtype of “schizophrenia.” Failure to diagnose it is very common. This introduction documents the earliest descriptions of the disorder and its treatment and gives a brief history of the acceptance of the term “catatonia” by the psychiatric discipline. The authors emphasize the importance of recognizing the symptoms of catatonia and appreciating how straightforward its treatment is. Proper recognition is important because catatonia may be life-threatening, so diagnosing and treating it properly are matters of importance.
31
Levesque, Anna, and Edward V. Nunes. Recognizing Addiction in Older Patients. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199392063.003.0002.
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Alcohol and substance-use disorders in older adults can present in primary care practice in subtle or confusing ways. Screening and diagnostic tools validated in younger populations may limit their recognition. The main objective of this chapter is to differentiate signs and symptoms of alcohol or substance use disorder from other medical and psychiatric comorbidities. We review normal metabolic changes associated with aging as well as clinical features of harmful drinking. The risks of combining alcohol with psychoactive prescription medications are also considered. The relevance of DSM-5 diagnostic criteria to older patients is explored, and we review the evidence for the importance of systematic screening using validated instruments in an older population. Therapeutic vs. aberrant uses of psychoactive prescription medications in the geriatric population are discussed. Finally, we review patterns of illicit substance use in older adults.
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Postuma, Ronald B. REM sleep behavior disorder. Edited by Sudhansu Chokroverty, Luigi Ferini-Strambi, and Christopher Kennard. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199682003.003.0038.
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A diagnosis of REM sleep behavior disorder (RBD), a disorder characterized by “acting out” of dreams during REM sleep, has critical implications for a patient’s future. Aside from being a treatable parasomnia, usually managed with melatonin or clonazepam, RBD is the most powerful risk factor for Parkinson disease and dementia with Lewy bodies yet discovered. Over 70% of patients with idiopathic RBD will develop a neurodegenerative synucleinopathy. Moreover, the disease course is more severe in patients with RBD than those without. Numerous screens have been developed to aid detection, and clinical history can help distinguish RBD from NREM parasomnia. However, final diagnosis relies on polysomnographic documentation of REM atonia loss. Given the profound implications of idiopathic RBD, patients need careful counseling and the offer of neurological follow-up to detect and treat prodromal disease symptoms. Recognition of RBD is also a means to discover and test protective therapies against neurodegenerative disease.
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Soni, Neil. Assessment and management of fat embolism. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0337.
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Fat embolism syndrome is a complication of a range of conditions. It is hard to prevent, difficult to diagnose, and there is no specific effective treatment. The syndrome is composed of respiratory, haematological, neurological, and cutaneous symptoms and signs associated with trauma, in particular long bone fractures, and other disparate surgical and medical conditions. It most commonly follows orthopaedic surgery, but can also follow liposuction and medical conditions, as disparate as cardiopulmonary resuscitation and sickle cell disease are possible precipitants. The pathogenesis is still debated. It is clear that while fat emboli occur quite commonly, the clinical syndrome with respiratory, neurological, and other sequelae is rare. Diagnosis is by pattern recognition, but recently characteristic features seen on cerebral magnetic resonance imaging can be used to increase the probability of the diagnosis. Various therapeutic options have been tried and failed and treatment is currently supportive.
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Orellana, Renán A., and Jorge A. Coss-Bu. Nutrition and Gastrointestinal Emergencies. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199918027.003.0014.
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Appropriate nutrition must be tailored to the specific needs of individual patients. Needs depend on the child’s baseline nutritional status, the severity of disease, and specific organ dysfunction. Enteral nutrition is preferable whenever possible. Parenteral nutrition may be necessary when efforts to supply adequate nutrition enterally are contraindicated or unsuccessful. Patients with symptoms of acute abdomen require prompt recognition of surgical and nonsurgical disorders. Upper gastrointestinal hemorrhage may require transfusion of blood products, vasoactive drug infusion to minimize ongoing losses, and endoscopy following stabilization. Pancreatitis typically requires an orogastric/nasogastric tube for decompression, aggressive pain management, and radiological evaluations. Abdominal compartment syndrome needs to be recognized promptly to avoid further injury. Acute liver failure commonly leads to multiorgan system dysfunction and death. Specific therapy is available only in a minority of cases, and outcome depends on excellent supportive care, prompt evaluation by a pediatric gastroenterologist, and referral to a transplant center.
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Alyazidi, Raidan, and Soren Gantt. Herpes simplex Virus. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190604813.003.0007.
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Herpes simplex virus (HSV) types 1 and 2 cause several important syndromes, including congenital and perinatal infections that can cause devastating consequences in newborns (i.e., neonatal HSV). Most neonatal HSV infections are acquired intrapartum in the infected maternal birth canal. Since genital HSV infections are common, neonatal HSV is an important complication in infected women, even if maternal symptoms are absent. As a result of the developmental status of the fetal and newborn immune system, neonatal HSV infection is associated with life-threatening disease. This chapter reviews the clinical presentations of neonatal HSV infection, as well as advances in diagnosis and therapy. Skin vesicles and fever are often absent, which contributes to a delay in initiating effective therapy. Early recognition is key. Despite significant advances in diagnostic testing and antiviral treatment for neonatal HSV, morbidity and mortality remain high and no vaccine is currently available for clinical use.
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Post, Robert M. The Neurochemistry and Epigenetics of PTSD. Edited by Frederick J. Stoddard, David M. Benedek, Mohammed R. Milad, and Robert J. Ursano. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190457136.003.0014.
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This chapter reviews the neurochemistry and epigenetics of posttraumatic stress disorder (PTSD). Traditional views of the neurochemistry of PTSD focus on alterations in classical central nervous system neurotransmitters serotonin and norepinephrine and pathological reactivity in the hypothalamic-pituitary-adrenal axis, and these are only briefly noted here. Instead, the chapter emphasizes a series of new conceptualizations and neurochemical data that have recently been elucidated. One is the recognition of the symptoms and neurobiology of PTSD as a moving target, being very different in different stages of illness evolution. Differences are apparent in the neurochemistry involved in early life stressor-related vulnerabilities to PTSD, the acute stress reaction, compensation and resolution phases, or ongoing chronicity with sleep disturbance, nightmares, flashbacks, hyperarousal, and dulling and depression. The neurochemical abnormalities vary as a function of this temporal unfolding and the common acquisition and progression of comorbid syndromes of alcohol and substance abuse.
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Fraser, Jamie L., Frédéric Sedel, and Charles P. Vendetti. Disorders of Cobalamin and Folate Metabolism. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199972135.003.0027.
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Cobalamin C deficiency (cblC) and related disorders of intracellular cobalamin metabolism may present at any time from the prenatal period through adolescence/adulthood and are due to deficiency of the cobalamin cofactors adenosylcobalamin and methylcobalamin. Chronic complications of cblC depend on the age at presentation and may include poor growth, renal dysfunction, neuropsychiatric manifestations, intellectual disability, strokes, progressive leukoencephalopathy and spinal cord degeneration, psychiatric manifestations and executive function deficits, and optic nerve and retinal anomalies. While less common than in isolated MMA, acute metabolic decompensation may occur in cblC patients due to accumulation of methylmalonic acid and associate metabolites and should be managed as in isolated MMA in conjunction with a metabolic consultant. The most common inborn error of folate (vitamin B9) metabolism relevant for adult patients is methylenetetrahydrofolate reductase (MTHFR) deficiency. Manifestations are primarily neurological, but the disorder may present in a substantial number of adults with psychiatric symptoms. Early recognition with adequate treatment is crucial.
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Carrico, Adam W., and Michael H. Antoni. Psychoneuroimmunology and HIV. Edited by Mary Ann Cohen, Jack M. Gorman, Jeffrey M. Jacobson, Paul Volberding, and Scott Letendre. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199392742.003.0021.
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Psychoneuroimmunology (PNI) examines the biological and behavioral pathways whereby psychosocial factors may influence the course of chronic medical conditions, including HIV/AIDS. This chapter summarizes PNI research conducted examining the possible role of negative life events (including bereavement), stress reactivity, personality factors, cognitive appraisals, and affective states (depression) in HIV illness progression. Because much of this research was conducted in the era prior to the advent of effective antiretroviral therapy, important questions remain regarding whether there the associations of psychosocial factors with HIV illness progression are independent of medication adherence and persistence. There is also increasing recognition that chronic viral infections such as HIV have neuropsychiatric effects, and more recent PNI research has focused on studying the bidirectional communication between the immune system and central nervous system in HIV. Future research should focus on obtaining definitive answers to these questions to inform the development of novel approaches for reducing psychiatric symptoms and optimizing health outcomes among persons with HIV.
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Black, Donald W. Epidemiology and Phenomenology of Compulsive Buying Disorder. Edited by Jon E. Grant and Marc N. Potenza. Oxford University Press, 2012. http://dx.doi.org/10.1093/oxfordhb/9780195389715.013.0072.
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Compulsive buying disorder (CBD) is defined as excessive shopping cognitions and buying behavior that leads to distress or impairment. This chapter presents an overview of its definition and recognition, clinical symptoms, epidemiology, natural history, and both cultural and family factors. Compulsive buying disorder is found worldwide and has a lifetime prevalence of 5.8% in the U.S. general population. The disorder has a female preponderance, has an onset in the late teen years or early 20s, appears to be chronic or recurrent, and occurs mainly in women. Subjects with CBD report a preoccupation with shopping, prepurchase tension or anxiety, and a sense of relief following a purchase. Compulsive buying disorder is associated with significant psychiatric comorbidity, particularly mood and anxiety disorders, substance use disorders, eating disorders, other disorders of impulse control, and Axis II disorders, although there is no special “shopping” personality. The disorder tends to run in families, and these families are filled with mood and substance use disorders.
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Cowen, Philip, Paul Harrison, and Tom Burns. Shorter Oxford Textbook of Psychiatry. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199605613.001.0001.
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Widely recognised as the standard text for trainee psychiatrists, the Shorter Oxford Textbook of Psychiatry stands head and shoulders above the competition. Honed over five editions it displays a rare fluency, authority and insight, and it makes the process of assimilating information as smooth and enjoyable as possible. The resource provides an introduction to all the clinical topics required by the trainee psychiatrist, including all the sub-specialties and major psychiatric conditions. Throughout, the authors emphasize the basic clinical skills required for the full assessment and understanding of the patient. Discussion of treatment includes not only scientific evidence, but also practical problems in the management of patients their family and social context. It emphasizes an evidence-based approach to practice and gives full attention to ethical and legal issues. Introductory chapters focus on recognition of signs and symptoms, classification and diagnosis, psychiatric assessment, and aetiology. Further chapters deal with all the major psychiatric syndromes as well as providing detailed coverage of pharmacological and psychological treatments. It also gives equal prominence to ICD and DSM classification - often with direct comparisons.
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Powell, Jenny. Approach to diagnosing skin disease. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0244.
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Making a diagnosis in dermatology may seem daunting when there are 6 000 or more possibilities, and the terminology seems so complex. This chapter suggests a systematic approach to picking up clues from symptoms and signs, and understanding how to describe skin disease; this approach, together with experience (obtained through seeing patients, asking more experienced colleagues, and reading) will help with pattern recognition and, sometimes, lead to the answer. The skin has such a wide range of structural and functional varieties that disorders of the skin are not only common but also very variable. However, it is important to be able to give a patient a diagnosis. This ‘working label’ means that the patient fits into a known group not only in their typical presentation but also as a guide for response to treatment, prognosis, and, sometimes, for explanation of etiology and whether genetic or infective factors are important; that is, it is helpful in explaining the disease to the patient. Despite the complexity of the skin, making a diagnosis in dermatology is no different from making a diagnosis in other areas; it is based on taking a history, examining the patient, and performing investigations, if indicated.
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Todd, Stacy, and Nick Beeching. Fungal infection. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0315.
Full textAbstract:
Fungi, comprising yeasts, moulds, and higher fungi, have a worldwide distribution and are uncommon causes of disease in healthy individuals. However, over the last 20 years, invasive fungal disease (IFD) has become an increasing cause of morbidity and mortality. This is probably due to the increasing numbers of patients with underlying host conditions, which predispose to opportunistic IFD (e.g. transplant and anti-tumour necrosis factor immunosuppression, HIV, or chronic lung disease), and to increased recognition of endemic IFD (e.g. histoplasmosis), which cause disease in both immunocompetent and immunocompromised hosts in selected geographic locations. Diagnosis of IFD remains a challenge. Symptoms are often non-specific, and a definite diagnosis requires invasive sampling with appropriate laboratory testing of these samples. Non-invasive tests are being developed, but their positive and negative predictive values still need validation. Diagnostic criteria (‘proven, probable, and possible’) established primarily for use in research and clinical trials can also prove useful in clinical environments. However, the most important step in identifying patients with IFD is to consider the diagnosis in those at risk. This chapter will focus on the commonest causes of IFD (Candida spp., Aspergillus spp., Cryptococcus spp., and histoplasmosis).
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Clark, David. To Comfort Always. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199674282.001.0001.
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Palliative medicine was first recognized as a specialist field in the United Kingdom in 1987. One hundred years earlier, the London-based doctor William Munk had published a treatise on ‘easeful death’ that mapped out the principles of practical, spiritual, and medical support at the end of life. In the intervening years a major process of development took place, which led to innovative services, new approaches to the study and relief of pain and other distressing symptoms, a growing interest in ‘holistic’ care for those with advanced disease, and a desire to gain more recognition for end-of-life care. This book traces the history of palliative medicine, from its nineteenth-century origins, to its modern practice around the world today. It takes in the changing meaning of ‘euthanasia’; assesses the role of religious and philanthropic organizations in the creation of homes for the dying; and explores how twentieth-century doctors created a special focus on the care of those for whom cure or recovery is not possible. To Comfort Always traces the rise of clinical studies, academic programmes, and international collaborations to promote palliative care. It examines the continuing need to provide evidence in support of development and assesses the dilemmas of unequal access to services and pain-relieving drugs, as well as the periodic accusations of creeping medicalization within the field. The first history of its kind, it concludes with some reflections on the achievements of palliative medicine to date and the challenges that remain.
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Lal, Mira, and Johannes Bitzer. Disease severity, pain, and patient perception: themes in clinical practice and research. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198749547.003.0006.
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Chapter 6 begins with a discussion of how to assess disease severity. It then moves on to the concepts of physical and emotional pain, which are particularly useful for understanding pelvic floor problems, infertility, pregnancy loss, and chronic pelvic pain. All of these have biological, psychological, and social features associated with their aetiopathogenesis, and presentations. To manage these conditions effectively, it is crucial to understand the patient's perception. First, pelvic/perineal dysfunction is addressed. This includes the loss of urinary and bowel continence, with deleterious effects on biopsychosocial health. The condition is common, and can cause severe morbidity following any delivery mode, including a planned caesarean. This is illustrated by an evaluation of biopsychosocial morbidity, quantified by categorising patient perceptions of severity of incontinence, and related sexual problems. The psychosomatic repercussions of infertility, miscarriage, stillbirth, and chronic pelvic pain are then appraised. Since physical and emotional pain can affect these conditions, timely recognition and biopsychosocial management helps promote positive physical, mental and social health. A special focus is given to endometrial implants outside the uterine cavity (endometriosis). These can cause chronic pelvic pain, infertility, and pregnancy loss, but may be symptomless. Their aetiology remains unclear. Ovulation suppression relieves pain and treatment is tentative, with removal of the affected pelvic organs being an extreme option. Even after this, however, symptoms may persist. A pathway using the tailored psychosomatic approach is advocated to provide patient-centred care where indicated.
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Shaibani, Aziz. Pseudoneurologic Syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190661304.003.0022.
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The term functional has almost replaced psychogenic in the neuromuscular literature for two reasons. It implies a disturbance of function, not structural damage; therefore, it defies laboratory testing such as MRIS, electromyography (EMG), and nerve conduction study (NCS). It is convenient to draw a parallel to the patients between migraine and brain tumors, as both cause headache, but brain MRI is negative in the former without minimizing the suffering of the patient. It is a “software” and not a “hardware” problem. It avoids irritating the patient by misunderstanding the word psychogenic which to many means “madness.”The cause of this functional impairment may fall into one of the following categories:• Conversion reaction: conversion of psychological stress to physical symptoms. This may include paralysis, hemisensory or distal sensory loss, or conversion spasms. It affects younger age groups.• Somatization: chronic multiple physical and cognitive symptoms due to chronic stress. It affects older age groups.• Factions disorder: induced real physical symptoms due to the need to be cared for, such as injecting oneself with insulin to produce hypoglycemia.• Hypochondriasis: overconcern about body functions such as suspicion of ALS due to the presence of rare fasciclutations that are normal during stress and after ingestion of a large amount of coffee. Medical students in particular are targets for this disorder.The following points are to be made on this topic. FNMD should be diagnosed by neuromuscular specialists who are trained to recognize actual syndrome whether typical or atypical. Presentations that fall out of the recognition pattern of a neuromuscular specialist, after the investigations are negative, they should be considered as FNMDs. Sometimes serial examinations are useful to confirm this suspicion. Psychatrists or psychologists are to be consulted to formulate a plan to discover the underlying stress and to treat any associated psychiatric disorder or psychological aberration. Most patients think that they are stressed due to the illness and they fail to connect the neuromuscular manifestations and the underlying stress. They offer shop around due to lack of satisfaction, especially those with somatization disorders. Some patients learn how to imitate certain conditions well, and they can deceive health care professionals. EMG and NCS are invaluable in revealing FNMD. A normal needle EMG of a weak muscles mostly indicates a central etiology (organic or functional). Normal sensory responses of a severely numb limb mean that a lesion is preganglionic (like roots avulsion, CISP, etc.) or the cause is central (a doral column lesion or functional). Management of FNMD is difficult, and many patients end up being chronic cases that wander into clinics and hospitals seeking solutions and exhausting the health care system with unnecessary expenses.It is time for these disorders to be studied in detail and be classified and have criteria set for their diagnosis so that they will not remain diagnosed only by exclusion. This chapter will describe some examples of these disorders. A video clip can tell the story better than many pages of writing. Improvement of digital cameras and electronic media has improved the diagnosis of these conditions, and it is advisable that patients record some of their symptoms when they happen. It is not uncommon for some Neuromuscular disorders (NMDs), such as myasthenia gravis (MG), small fiber neuropathy, and CISP, to be diagnosed as functional due to the lack of solid physical findings during the time of the examination. Therefore, a neuromuscular evaluation is important before these disorders are labeled as such. Some patients have genuine NMDs, but the majority of their symptoms are related to what Joseph Marsden called “sickness behavior.” A patient with carpal tunnel syndrome (CTS) may unconsciously develop numbness of the entire side of the body because he thinks that he may have a stroke.
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Tatlisumak, Turgut, and Lars Thomassen, eds. Ischaemic Stroke in the Young. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198722366.001.0001.
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Stroke in the young is different, complex, and challenging. This book delivers a comprehensive review of the different aspects of young ischaemic stroke. Incidence, risk factors, and aetiology differ notably from those seen in the elderly. There is an increased prevalence of traditional risk factors already at a young age, but the book also focuses on special risk factors in young stroke patients. In many young stroke patients, aetiology remains unclear. The book outlines an extensive diagnostic workup and a stroke subtype classification adapted for young strokes. Gender differences are prevalent in young stroke. The book describes risk factors that are either unique or more prevalent in women and the importance of treating them aggressively. Stroke symptoms in children are comparable to those in adults, but there is a dramatic bystander delay in diagnosing the stroke. The text therefore also deals with rapid stroke recognition and adaption to the special needs in children. Young stroke patients are under-represented in randomized controlled treatment trials. In the emergency setting, unusual clinical findings and off-label situations may be faced and the decision-making process may be challenging. Recommendations for secondary prevention are also mainly extrapolated from studies in older individuals. The authors extrapolate data and draw conclusions on the acute and prophylactic treatment of young stroke. Prognosis after young stroke is poor. Even minor stroke may have devastating life-long consequences for quality of life, education, and working capacity. The book points to the opportunity for lifelong prevention of vascular events.
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Dasgupta, Bhaskar. Polymyalgia rheumatica. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0134.
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This chapter reviews advances in pathogenesis; European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria with clinical, laboratory, and ultrasound criteria for classification as polymyalgia rheumatica (PMR); the heterogeneity and overlap between PMR, inflammatory arthritis, and large-vessel vasculitis as illustrated by representative cases; recent guidelines on early and correct recognition, investigations, and management of PMR; the scope of disease-modifying agents; socio-economic impact, outcomes, and patient experience in PMR. It also discusses areas for future research including clinical trials with biological agents and newer steroid formulations, standardized outcome assessments, and the search for better biomarkers in PMR. PMR is one of the common inflammatory rheumatic diseases of older people and represents a frequent indication for long-term glucocorticoid (GC) therapy. It is characterized by abrupt-onset pain and stiffness of the shoulder and pelvic girdle muscles. Its management is subject to wide variations of clinical practice and it is managed in primary or secondary care by general practitioners (GPs), rheumatologists, and non-rheumatologists. The evaluation of PMR can be challenging, as many clinical and laboratory features may also be present in other conditions, including other rheumatological diseases, infection, and neoplasia. PMR is usually diagnosed in the primary care setting, but standard clinical investigations and referral pathways for suspected PMR are unclear. The response to standardized therapy is heterogeneous, and a significant proportion of patients do not respond completely. There is also an overlap with inflammatory arthritis and large-vessel vasculitis for which adjuvant disease-modifying medications are often used. Prolonged corticosteroid therapy is associated with a variety of side effects, especially when high-dose glucocorticoid therapy is employed. Giant cell arteritis (GCA) is also often linked to PMR. It is a vasculitis of large- and medium-sized vessels causing critical ischaemia. GCA is a medical emergency because of the high incidence of neuro-ophthalmic complications. Both conditions are associated with a systemic inflammatory response and constitutional symptoms. The pathogenesis is unclear. The initiating step may be the recognition of an infectious agent by aberrantly activated dendritic cells. The key cell types involved are CD4+ T cells and macrophages giving rise to key cytokines such as interferon-γ (implicated in granuloma formation), PDGF (intimal hyperplasia), and interleukin (IL)-6 (key to the systemic response). The pathogenesis of PMR may be similar to that of GCA, although PMR exhibits less clinical vascular involvement. The mainstay of therapy is corticosteroids, and disease-modifying therapy is currently indicated in relapsing disease.
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Izzedine, Hassan, and Victor Gueutin. Drug-induced acute tubulointerstitial nephritis. Edited by Adrian Covic. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0084.
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Drug-induced acute tubulointerstitial nephritis (ATIN) is the most common aetiology of ATIN and a potentially correctable cause of acute kidney injury (AKI). An interval of 7–10 days typically exists between drug exposure and development of AKI, but this interval can be considerably shorter following re-challenge or markedly longer with certain drugs. It occurs in an idiosyncratic and non-dose-dependent manner. Antibiotics, NSAIDs, and proton pump inhibitors are the most frequently involved agents, but the list of drugs that can induce ATIN is continuously increasing. The mechanism of renal injury is postulated to involve cell-mediated immunity, supported by the observation that T cells are the predominant cell type comprising the interstitial infiltrate. A humoral response underlies rare cases of ATIN, in which a portion of a drug molecule (i.e. methicillin) may act as a hapten, bind to the tubular basement membrane (TBM), and elicit anti-TBM antibodies. The classic symptoms of fever, rash, and arthralgia may be absent in up to two-thirds of patients. Diagnostic studies, such as urine eosinophils and renal gallium-67 scanning provide only suggestive evidence. Renal biopsy remains the gold standard for diagnosis, but it may not be required in mild cases or when clinical improvement is rapid after removal of an offending medication. Pathologic findings include interstitial inflammation, oedema, and tubulitis. The time until removal of such agents and the severity of renal biopsy findings provide the best prognostic value for the return to baseline renal function. Poor prognostic indicators are the long duration of AKI (> 3 weeks), a patient’s advanced age, and the high degree of interstitial fibrosis. Early recognition and appropriate therapy are essential to the management of drug-induced ATIN, because patients can ultimately develop chronic kidney disease. The mainstay of therapy is timely discontinuation of the causative agent, whereas controversy persists about the role of steroids.