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1
Rivers, Lynn C. Curricular validity of the New York State physical therapy student performance evaluation instrument: A thesis in Multidisciplinary Study. 1995.
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2
Holden, Melanie A., Martin J. Thomas, and Krysia S. Dziedzic. Miscellaneous physical therapies. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0026.
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Miscellaneous physical therapies, such as assistive devices, thermotherapy, manual therapy, and electrotherapy are commonly used to treat patients with osteoarthritis (OA) in addition to written information and exercise. However, the evidence underpinning specific miscellaneous physical therapies is often limited, with small study sizes, heterogeneous populations, and differing study designs making it difficult to draw firm conclusions about their effectiveness. One or more miscellaneous physical therapies feature within 15 current clinical guidelines for OA. The specific types of physical therapies addressed are variable, as are their recommendations. There is most agreement for miscellaneous physical therapies in hand OA, with multiple guidelines addressing and consistently recommending joint protection, splinting, and thermotherapy in addition to core treatment. However these recommendations are predominantly based on a small number of randomized controlled trials (RCTs). Use of walking aids and footwear is commonly addressed and recommended for patients with hip and knee OA, although recommendations are predominantly based on expert opinion. Other physical therapies recommended for hip and knee OA range from orthoses to less conventional leech therapy. When a recommendation for a miscellaneous physical therapy is not made, it is commonly due to limited clinical evidence, rather than evidence of harm. Due to limited evidence and lack of consensus between clinical guidelines, for some therapies, use of specific miscellaneous physical therapies in clinical practice should be based upon the best available evidence, a holistic, individualized clinical assessment and shared decision-making with the patient. Further large-scale, high-quality RCTs would be useful to inform future guideline recommendations and clinical practice.
3
Gale, William G. Fiscal Therapy. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780190645410.001.0001.
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America faces two distinct but related economic challenges. Steadily rising federal debt—largely fueled by rising healthcare costs and an aging population that will boost spending on Social Security, Medicare, and Medicaid—will make it harder to grow the nation’s economy, boost living standards, respond to wars or recessions, address social needs, and maintain the US role as a global leader. At the same time, an increasingly fractured society has left many people behind and let critical investments lag, even as overall prosperity has grown. How and when US citizens address these challenges will help determine the future they build for themselves and their children. This book proposes a remedy with three core elements: controlling entitlement spending in ways that preserve and enhance the programs’ anti-poverty and social insurance roles; betting on the future by stipulating major new public investments in human and physical capital; and raising and reforming taxes to pay for government services fairly and efficiently. Together, these changes would control federal borrowing, strengthen the economy, increase opportunity, reduce inequality, and build better lives for current and future generations. There is no need to kill popular programs or starve government. Indeed, a primary goal of fiscal reform is to maintain and enhance the vital functions that government provides. The country needs to act responsibly, pay for the government it wants, and shape that government in ways that serve it best.
4
Scarlet, Janina, Ariel J. Lang, and Robyn D. Walser. Acceptance and Commitment Therapy for Posttraumatic Stress Disorder. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190205959.003.0003.
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This chapter examines evidence for the effectiveness of complementary and alternative medicine (CAM) for posttraumatic stress disorder (PTSD). There is high demand for CAM among both military and civilian consumers and thus CAM for PTSD warrants thorough analysis. The CAM interventions reviewed herein include mindfulness and other meditative practices, acupuncture, yoga, relaxation, breathing training, and physical exercise. Although there are few rigorous studies of CAM for PTSD, available evidence suggests that these approaches are moderately effective. They would generally not be considered a first line intervention for PTSD at this point, but rather would be recommended as an adjunct to established approaches. The limited number of studies available, however, precludes drawing firm conclusions. Thus, future work should focus on better understanding the optimal uses of CAM for PTSD.
5
Tennankore, Karthik K., and Christopher T. Chan. Choices and considerations for in-centre versus home-based renal replacement therapy. Edited by David J. Goldsmith. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0144.
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There has been a renewed global interest in expanding home dialysis (both peritoneal dialysis (PD) and home haemodialysis (HHD)), but the majority of patients are maintained on in-centre haemodialysis (HD). While the importance of in-centre haemodialysis cannot be overlooked, home dialysis has many advantages. If so, why are so few patients maintained on home dialysis therapies? From the perspective of the patient, both inadequate modality education and self-perceived barriers limit selection of home dialysis. Physicians are less likely to consider elderly frail patients as candidates for home therapies. In addition, inadequate training and poor reimbursement for home dialysis are important physician barriers. From the facility perspective, the limited availability of personnel and physical resources to maintain a home unit are important barriers. However, while there are many obstacles to home dialysis, they can be overcome. Improved patient education, home support for elderly dialysis patients, and financial incentives may be effective measures. In addition, at the facility level, an emphasis needs to be placed on infrastructure development. Overall, while the appropriate balance of in-centre versus home-based renal replacement therapy has not been determined, maximizing the number of patients on home therapies is a reasonable target.
6
Wang, Roger, and Sarah Choxi. Cervical Myofascial Pain. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190271787.003.0007.
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Cervical myofascial pain (CMP) is caused by trauma, spine pathology, repetitive strain, postural dysfunction, and physical deconditioning of the muscles that support the shoulders and neck. These include the trapezius, levator scapulae, splenius capitis, and rhomboid muscles. Treating the underlying etiology is the most effective therapy, however, it may be challenging to diagnose CMP, adding to the difficulty of definitive therapy. Management of CMP often requires a multidisciplinary approach incorporating physical therapy, pharmacotherapy, injection therapy, and behavioral modification. Neck pain is a common condition affecting two-thirds or more of the global population during their lifetime. The etiology of neck pain includes cervical disk disease, cervical facet-mediated pain, and CMP. In particular, CMP is often a cause of disability in the population with chronic neck pain.
7
Schneider, Antoine G., Neil J. Glassford, and Rinaldo Bellomo. Choice of Renal Replacement Therapy and Renal Recovery. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0038.
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Acute kidney injury (AKI) is a major complication of critical illness, associated with increased mortality and morbidity. Among survivors of AKI, a subset will develop the need for chronic dialysis. Chronic dialysis imposes a major physical, emotional, economic, and social burden on ICU survivors and their caregivers. Evidence suggests that the type of renal replacement therapy used in the acute setting may affect renal recovery differently. For example, intermittent haemodialysis (IHD) increases the risk of hypotension and acute volume and solute fluctuations, and such physiological events have been associated with fresh renal injury. In contrast, continuous renal replacement therapy (CRRT) does not carry such risks. Consistent with such physiological and experimental observations and differences, several observational studies and some randomized controlled trials suggest that using IHD, instead of CRRT, as the preferred form of RRT increases the risk of patients entering a chronic dialysis programme. A recent meta-analysis confirmed these findings. Clinicians making decisions about the choice of RRT modality in ICU patients should carefully consider these observations.
8
Maani, Christopher V., and LT Col Edward M. Lopez. Pain Management Procedures. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190495756.003.0030.
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Patients referred to pain clinics are often those with the most severe pain, who have failed more conservative approaches or strictly medical modalities. In other instances, the patients are referred for concerns of comorbidities or lack of pain management resources such as a clinic and procedure room with fluoroscopic capabilities. While the goal for these percutaneous interventions is improved pain control, they should be considered adjuncts and not replacements for a comprehensive pain management strategy. Most patients benefit from multimodal pain medication strategies, physical therapy, stress management and relaxation training, occupational therapy, acupuncture, or other treatment therapies. This chapter provides an overview and discussion of several of the most common pain procedures encountered in clinical pain management practices today. Each procedure is discussed with an initial description of the strategy, including technical aspects, medical indications, and relevant complications important for the pain management physician to understand. This will be followed by a section on considerations for anesthetic management.
9
Schmidt, Gregory A., and Kevin Doerschug. Promoting physical recovery in critical illness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0378.
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Survivors of critical illnesses are often faced with persistent neuromuscular weakness that interferes with daily activities. Advancements in survival from critical illness have led to a rise in the number of patients afflicted with post-intensive care unit (ICU) incapacity. It is clear that the pathology leading to ICU-acquired weakness is present within 24 hours of the start of ICU care. Care-givers must consider interventions to limit or reverse these processes from the onset of critical illness. We suggest strategies both for avoiding harms and for actively promoting recovery of skeletal and respiratory muscles. Muscular silence contributes to, while muscular activity alleviates, myopathy. Thus, limiting sedation and neuromuscular blockade will facilitate spontaneous muscle activity, and allow for active participation in physical therapy. Protocols that aggressively assess for the potential for extubation shorten the duration of ventilation and thus decrease exposure to sedation. Mobility teams should safely guide patients in their progress from a passive range of motion through more active therapies despite ongoing critical illness. Early ICU mobility is not only safe, but reduces the incidence of delirium and duration of mechanical ventilation. Importantly, early ICU mobility increases the likelihood of a return to independent function among ICU survivors. A change in culture from one that practices deep sedation and protective support is suggested, to one that demonstrates an urgency to liberate patients from the confines and perils of critical illness.
10
Thakur, Anand C. Pain Management Assessment Beyond the Physician Encounter. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199981830.003.0011.
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The long-term use of opioids in the treatment of chronic pain patients has increased dramatically over the last two decades. With this increase has come abuse, misuse, diversion, and overdose deaths, resulting in tremendous media attention. Further, there has been an increase in regulatory scrutiny of the prescribing practices of healthcare professionals. Monitoring patient compliance with chronic opioid therapy has become very important. Urine drug monitoring and patient agreements are part of this monitoring effort. However, interpreting test results can be challenging and applying these results to patient care can be complex. Metabolites, interfering substances, and false-positives and false-negative results all need to be considered when interpreting test results. Test results should not be considered sacrosanct and should always be an opportunity for discussion with a patient.
11
McCarron, Robert M., Amir Ramezani, Ian Koebner, Samir J. Sheth, and Jessica Palka. Integrated Chronic Pain and Psychiatric Management. Edited by Robert E. Feinstein, Joseph V. Connelly, and Marilyn S. Feinstein. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190276201.003.0023.
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Both physical pain and psychiatric disorders are widely prevalent, and collectively they account for the most frequently presenting complaints in the primary care setting. These conditions are a complex challenge for both the patient and provider, with frequent high use of medical services and increased morbidity. The Integrated Behavioral Pain Medicine (IBPM) treatment model incorporates a multidisciplinary, biopsychosocial, team-based approach for patients who have chronic and largely treatment-refractory pain. IBPM uses an integrated care team of providers and coordinators, who collectively work with the chronic pain patient to individualize a pain management plan, which may include pharmacologic management, cognitive-behavioral therapy, trauma-focused therapy, biofeedback, mindfulness, acupuncture, nutrition, behavioral weight and sleep management, and physical therapy. Ideally, primary care providers will refer patients to an IBPM model of care, but if the treatment model is not available in a specific area, a piecemeal approach with partial use of services is recommended.
12
Ravindran, Arun V., and Tricia L. da Silva. The role of complementary and alternative therapies for the management of bipolar disorder. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198748625.003.0029.
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Complementary and alternative medicine (CAM) therapies are a group of diverse medical and health systems, practices, and products not currently considered to be part of conventional medicine. These therapies have growing popularity and it is suggested that more than a third of patients with bipolar disorder (BD) use some form of CAM therapy. Although there are several forms of CAM therapies, including physical therapies, nutraceuticals, herbal remedies, and mindfulness-based interventions, reports in BD are few in number and often of poor quality. Sleep deprivation has the strongest evidence for benefit as an augmentation therapy in bipolar depression. There is promising evidence for other CAM therapies, including exercise, bright light therapy, omega-3 fatty acids, N-acetylcysteine, and the traditional Chinese medicine formulation, Free and Easy Wanderer Plus. However, limitations such as small number of studies, small sample sizes, few randomized investigations, and contradictory findings currently preclude definitive recommendations.
13
Wein, Simon, and Limor Amit. Adjustment disorders and anxiety. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0174.
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Adjustment disorders and anxiety are two of the more common responses to stressors in palliative care. At one end of the spectrum, adjustment and anxiety are normal defences. However, when coping mechanisms fail these responses can become pathological. Judging when a response is pathological is based on two principles: the severity of symptoms and the extent of disruption of normal functioning or homeostatic adaptation. The intimate two-way relationship between physical and psychological symptoms in palliative care means that physical symptoms have to be well controlled and that psychological symptoms can be masked by physical complaints. Management principles include talking therapies, psychopharmacology, and complementary treatments. Examples of innovative psychological treatments are dignity therapy and meaning-centred therapy. Every palliative care intervention requires consideration of the family and it is also important to monitor anxiety and adjustment of the staff who are also prone to burn-out, compassion fatigue, and difficulties in adjusting to stressors.
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Marcu, Loredana, Eva Bezak, and Barry Allen. Biomedical Physics in Radiotherapy for Cancer. CSIRO Publishing, 2012. http://dx.doi.org/10.1071/9780643103306.
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The scientific and clinical foundations of Radiation Therapy are cross-disciplinary. This book endeavours to bring together the physics, the radiobiology, the main clinical aspects as well as available clinical evidence behind Radiation Therapy, presenting mutual relationships between these disciplines and their role in the advancements of radiation oncology.
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Daniel, Rene, and Catriona M. Harrop, eds. Medical Management of Neurosurgical Patients. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780190913779.001.0001.
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Modern management of neurosurgical patients requires close cooperation between neurosurgeons and other specialists. The latter include internists, nurse practitioners, and physician assistants. This textbook aims to provide for these professionals a guide to the challenges associated with the medical management of these patients. It gives an overview of neurosurgical operations and procedures, seizure management, and preoperative risk stratification. It further discusses the intricacies of the management of fever, infection, electrolytes, bleeding disorders, and endocrine problems in the context of central nervous system injury. A particular emphasis is placed on the management of pressure injuries, pain management, and physical and occupational therapy, which are critical areas in the care of the neurosurgical patient. Finally, it reviews the types of contributions that palliative care can make to the care of the neurosurgical patient. The book’s objective is to provide a practical tool, and, where appropriate, its chapters include algorithms and tables to increase the efficiency of medical decision-making when caring for these patients.
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Grassi, Luigi, Maria Giulia Nanni, and Rosangela Caruso. Psychotherapeutic interventions. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198806677.003.0010.
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Psychotherapy is an integrative and integrated part of modern patient/relation-centered care in the advanced and terminal phases of physical illness. Psychiatric disorders (e.g. depressive spectrum, stress-related, and anxiety disorders), other clinically significant psychosocial conditions (e.g. demoralization, existential pain) and interpersonal, psychological, and spiritual needs have to be addressed by psychological intervention. Supportive-Expressive Group Psychotherapy (SEGT), Meaning-Centered Psychotherapy (MCT), Managing Cancer and Living Meaningfully Therapy (CALM), cognitive-existential therapy, dignity therapy (DT) and other psychotherapeutic interventions have been developed over the last 40 years. These treatments have proved to be effective in increasing the patients’ sense of dignity, purpose, and meaning, and to reduce demoralization, anxiety, and existential distress at the end of life. Also Family Focused Grief Therapy (FFGT) and grief therapy have shown to be effective in overcoming anxiety, depression, and complicated grief symptoms both before and after loss. Psychotherapy should thus be considered a mandatory ingredient of palliative care.
17
Arulkumaran, Nishkantha, and Maurizio Cecconi. Cardiac output assessment in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0136.
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Haemodynamic monitoring facilitates effective resuscitation and the rapid assessment of the response to time-dependent vasoactive and fluid therapyin different shock states. Since the introduction of the pulmonary artery catheter, several minimally and non-invasive CO monitoring devices have been introduced to provide continuous monitoring and a dynamic profile of fluid responsiveness. Several of these monitors provide additional haemodynamic parameters including dynamic indices of preload and volumetric indices. Patient outcome is dependent accurate acquisition and interpretation of data and subsequent management. Whilst data from CO monitors offer valuable information on global hamodynamics, they do not preclude tissue hypoperfusion. Furthermore, there is no ‘ideal’ CO value for an individual patient, and the trend in haemodynamic parameters in response to therapy may be more informative than the absolute values. CO monitoring should be based upon the patient’s needs, the clinical scenario, and the experience of the treating physician.
18
Dworkin, Ian, Daniel A. Fung, and Timothy T. Davis. Biologic and Regenerative Therapies. Edited by Mehul J. Desai. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199350940.003.0027.
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Low back pain is one of the most debilitating conditions worldwide, and a major cause is degenerative disc disease. Current therapies range from conservative treatments, such as medications, physical therapy, and other modalities, to more invasive treatments such as injections and surgery; however, these therapies neither stop the progression of degeneration nor restore function to the degenerating disc; they focus on symptom management, not on etiology. A novel approach to treating degenerative disc disease involves using regenerative therapies such as stem cells, growth factors, and gene therapy. The goal of these therapies is not just to decrease symptoms, but to reverse disc degeneration, while simultaneously enhancing current treatment modalities. Though clinical translation of regenerative therapies is in its infancy, in vitro and in vivo investigations have revealed these therapies’ potential in treating degenerative disc disease as well as a multitude of other musculoskeletal conditions.
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Byrne, Gerard. Anxiety disorders in older people. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199644957.003.0045.
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Anxiety symptoms and anxiety disorders are highly prevalent among older people, including among those with physical frailty and cognitive impairment. Clinicians are advised to consider the effects of prescribed medication and other substances, and the influence of general medical conditions, in the older person presenting with anxiety. Psychological treatments are recommended for older people with anxiety disorders of mild to moderate severity. These include relaxation training, exposure-based interventions, and cognitive behaviour therapy. Pharmacological interventions are in widespread use, although there is little evidence in support of the long-term use of either benzodiazepines or antipsychotics in older people with anxiety disorders. Instead, treatment with antidepressant medication is recommended.
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Link, Bruce G., Jo C. Phelan, and Greer Sullivan. Mental and Physical Health Consequences of the Stigma Associated with Mental Illnesses. Edited by Brenda Major, John F. Dovidio, and Bruce G. Link. Oxford University Press, 2017. http://dx.doi.org/10.1093/oxfordhb/9780190243470.013.26.
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People with mental illnesses experience physical illness and premature mortality at much higher rates compared to people without such illnesses. This chapter proposes that the stigma of mental illness comprises an important set of causes of this physical health disparity. It draws on classical and modified labeling theory from sociology for insights and propositions as to why mental illness stigma might affect physical health. The chapter proposes that the stigma of mental illness might affect not only the future experience of mental illness but also a broad range of physical illnesses, thereby contributing to the substantial physical health disparity that people with mental illnesses experience. The chapter develops a conceptual model that places at its center stigma processes including structural, interpersonal, social psychological, and internalized processes. Stigma processes at these levels induce stress and reduce resources, which in turn compromise physical health to produce large physical health disparities.
21
Forman, Evan M., and Meghan L. Butryn. Effective Weight Loss. Oxford University Press, 2016. http://dx.doi.org/10.1093/med:psych/9780190232009.001.0001.
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Millions of people attempt to lose weight every year, but most will not succeed. Simply learning about a new diet and exercise plan is not enough. This book presents 25 detailed sessions of an empirically supported, cognitive-behavioral treatment package called acceptance-based behavioral treatment (ABT) that has now been utilized successfully in five large National Institute of Health–sponsored clinical trials. The foundation of this approach is comprised of the nutritional, physical activity, and behavioral components of the most successful, gold-standard behavioral weight loss packages, such as Look Ahead and the Diabetes Prevention Project. These components are synthesized with acceptance, willingness, behavioral commitment, motivation, and relapse prevention strategies drawn from Acceptance and Commitment Therapy, Dialectical Behavior Therapy and Relapse Prevention Therapy. ABT is premised on the idea that specialized self-control skills are necessary for weight control, given our innate desire to consume delicious foods and to conserve energy. These self-control skills revolve around a willingness to choose behaviors that may be perceived as uncomfortable for the sake of a more valuable objective. The treatment focuses on both weight loss and weight loss maintenance and aims to confer lifelong skills that facilitate long-term weight control. The companion Client Workbook contains summaries of session content, worksheets, handouts, and assignments.
22
Forman, Evan M., and Meghan L. Butryn. Effective Weight Loss. Oxford University Press, 2016. http://dx.doi.org/10.1093/med:psych/9780190232023.001.0001.
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Millions of people attempt to lose weight every year, but most will not succeed. Simply learning about a new diet and exercise plan is not enough. This book presents 25 detailed sessions of an empirically supported, cognitive-behavioral treatment package called acceptance-based behavioral treatment (ABT) that has now been utilized successfully in five large National Institute of Health–sponsored clinical trials. The foundation of this approach is comprised of the nutritional, physical activity, and behavioral components of the most successful, gold-standard behavioral weight loss packages, such as Look Ahead and the Diabetes Prevention Project. These components are synthesized with acceptance, willingness, behavioral commitment, motivation, and relapse prevention strategies drawn from acceptance and commitment therapy, dialectical behavior therapy and relapse prevention therapy. ABT is premised on the idea that specialized self-control skills are necessary for weight control, given our innate desire to consume delicious foods and to conserve energy. These self-control skills revolve around a willingness to choose behaviors that may be perceived as uncomfortable for the sake of a more valuable objective. The treatment focuses on both weight loss and weight loss maintenance and aims to confer lifelong skills that facilitate long-term weight control. This companion Client Workbook contains summaries of session content, worksheets, handouts, and assignments.
23
Garner, Jane. Psychodynamic psychotherapy. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199644957.003.0019.
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Psychodynamic therapy is based on a psychoanalytic approach drawing on concepts of human development, relationships and experience. Psychoanalysis is both a technique of investigation and a theory of treatment, and it can help us understand aspects of clinical practice, for example the sometimes apparently irrational responses of patients, families or staff. This chapter explores how psychoanalysis has been relatively slow to encompass older people’s issues, but how it now contributes important insights about maturity and later life. Older people are less likely to be offered psychotherapy even though there is good evidence that they benefit from treatment as much as younger adults. In undertaking therapy with older people, there are particular issues to bear in mind, for example the physical reality of the patient and the setting, as well as the transference and counter transference issues that may arise around this stage of life.
24
Kohan, Lynn, and James Liadis. Cervicogenic Pain. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190271787.003.0006.
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Cervicogenic pain is a common source of pain in many patients who present with neck and head pain. It is a secondary headache believed to be caused by referral of pain from a variety of upper cervical pain generators. The typical pain generators of cervicogenic headache are structures that are innervated by the upper three cervical nerves and that relay these signals through the trigeminocervical nucleus, resulting in head pain. Imaging studies may help to rule out other pathologies but cannot be used to make a diagnosis of cervicogenic headache. Treatment options include a multidisciplinary approach using physical therapy, medications, and interventional treatments.
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Dekker, Joost, Daniel Bossen, Jasmijn Holla, Mariëtte de Rooij, Cindy Veenhof, and Marike van der Leeden. Psychological strategies in osteoarthritis of the knee or hip. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0025.
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Characteristic clinical presentations of osteoarthritis (OA) include pain and activity limitations. These presentations are dependent on psychological processes. The literature reviewed in this chapter leads to the following conclusions: (1) symptoms of depression, anxiety, and fatigue are more prevalent among patients with OA than among the general population. Recently, a depressive mood phenotype has been identified in knee OA. (2) Symptoms of depression, anxiety, and fatigue, as well as other psychological variables are established risk factors for future worsening of pain and activity limitations. (3) Psychological interventions such as depression care and pain coping skills training have been demonstrated to improve pain and activity limitations, as well as psychological outcomes. Self-management may have beneficial effects, although there is clearly room for improvement. Interventions combining psychological interventions with exercise therapy have been shown to be effective; improved outcome over exercise therapy alone stills needs to be demonstrated. (4) Psychological interventions are effective in improving exercise adherence and promoting physical activity. Overall, it can be concluded that the psychological approach towards OA is fruitful: the psychological approach has resulted in substantial contributions to the understanding and management of clinical presentations of OA, including pain and activity limitations.
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Scott, Jan. Psychological interventions for early stage bipolar disorder. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198748625.003.0011.
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Clinical staging and early intervention models used in psychosis and depression have only recently been applied to individuals ‘at risk’ of bipolar disorder (BD), or experiencing a first episode of BD. This chapter briefly discusses the concept of staging and then reviews ongoing research into the adaptation and use of psychological interventions in ‘at risk’ and ‘first BD episode’ populations. Evidence indicates that the current interventions may not sufficiently target specific developmentally normal changes in cognitive–emotional and sleep–circadian regulation systems that may act as triggers for mood episodes. So the chapter discusses how to tackle these ‘dysregulations’ and how to ensure any ‘early stage’ therapy is sufficiently flexible to tackle the range of problems experienced, including mood symptoms, harmful alcohol or substance use, and/or co-morbid physical ill-health and that the therapy models must take into account that not all individuals in high-risk populations actually develop BD.
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Kainth, Daraspreet Singh, Karanpal Singh Dhaliwal, and David W. Polly. Sacroiliac Joint Fusion: Percutaneous and Open. Edited by Mehul J. Desai. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199350940.003.0020.
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Sacroiliac joint (SIJ) pain is the source of back pain in up to 25% of patients presenting with back pain. There is significant individual variation in the anatomy of the sacrum and the lumbosacral junction. SIJ pain is diagnosed with the history and physical examination. SIJ injection of a local anesthetic along with steroids is often used to confirm the diagnosis. Nonoperative treatment includes nonsteroidal anti-inflammatories, physical therapy, joint manipulation therapies, and SIJ injections. SIJ pain can also be successfully treated with radiofrequency ablation in some patients. Surgical treatment includes the open anterior sacroiliac joint fusion technique and minimally invasive techniques. The benefits of minimally invasive SIJ fusion versus open surgery include less blood loss, decreased surgical time, and shorter hospital stay. Further studies are needed to determine the long-term durability of the minimally invasive surgical techniques.
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Carter, Bryan D., William G. Kronenberger, Eric L. Scott, and Christine E. Brady. Children's Health and Illness Recovery Program (CHIRP). Oxford University Press, 2020. http://dx.doi.org/10.1093/med-psych/9780190070267.001.0001.
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Adolescents with chronic illness, particularly when accompanied by debilitating, painful, and/or fatiguing symptoms, face challenges that are disruptive to their normal physical, psychological, and social development. The Children’s Health and Illness Recovery Program (CHIRP) is an evidence-based program specifically designed to address the skills needed by adolescents with chronic illnesses to become more confident and independent in coping and managing their illness and lifestyle. The flexible 12-session format of CHIRP can be administered with individual teens and their families or conducted in teen groups with a parallel parent group component. CHIRP integrates and adapts effective treatment components from behavioral family systems therapy, cognitive behavioral therapy, coping strategies intervention, interpersonal psychotherapy, assertiveness training, among others, into therapeutic activities in the companion CHIRP Teen and Family Workbook. This CHIRP Clinician Guide provides detailed instructions for implementing the manualized treatment protocol in the workbook. CHIRP was developed from both a careful review of the evidence-based literature on treatments for adolescents with chronic physical illness and the authors’ more than six decades of combined experience in helping children and families improve their quality of life and independence while coping with a chronic illness. Clinical outcome data on teens who have completed CHIRP demonstrate significant improvement in independent functioning and reduction in symptoms of fatigue and chronic pain; longitudinal data suggest these improvements not only persist but that teens continue to make gains on these factors beyond the completion of treatment, allowing them to pursue meaningful life goals as they transition to young adulthood.
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Jones, Christina, Peter Gibb, and Ramona O. Hopkins. Testimonies in Understanding the Psychological and Cognitive Problems Faced by Survivors of Critical Illness. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199398690.003.0001.
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Millions of patients are treated in intensive care units (ICUs) each year, and the number of survivors is growing as a result of advances in critical care medicine. Unfortunately, many survivors of critical illness have substantial morbidity. Physical, psychological, and cognitive impairments are particularly common—so much so that a group of clinicians coined the term “post-intensive care syndrome” (PICS) to help raise awareness. Patients surviving critical illnesses are often quite weak, and physical therapy, hopefully starting in the ICU, is vital. But weakness is only one of the problems critical-illness survivors and their loved ones face. Unfortunately, many survivors are left with cognitive impairment (e.g., impaired memory, attention, and executive functioning), as well as distress-related psychiatric phenomena such as posttraumatic stress and depression. Importantly, these problems are not limited to adult patients, and loved ones also suffer. In this chapter the authors describe their personal journeys in coming to understand the suffering and issues that critical-illness survivors and their families face.
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Casaer, Michael P., and Greet Van den Berghe. Nutrition support in acute cardiac care. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0032.
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Malnutrition in cardiac and critical illness is associated with a compromised clinical outcome. The aim of nutrition therapy is to prevent these complications and particularly to attenuate lean tissue wasting and the loss of muscle force and of physical function. During the last decade, several well-powered randomized controlled nutrition trials have been performed. Their results challenge the existing nutrition practices in critically ill patients. Enhancing the nutritional intake and the administration of specialized formulations failed to evoke clinical benefit. Some interventions even provoked an increased mortality or a delayed recovery. These unexpected new findings might be, in part, caused by an important leap forward in the methodological quality in the recent trials. Perhaps reversing early catabolism in the critically ill patient by nutrition or anabolic interventions is impossible or even inappropriate. Nutrients effectively suppress the catabolic intracellular autophagy pathway. But autophagy is crucial for cellular integrity and function during metabolic stress, and consequently its inhibition early in critical illness might be deleterious. Evidence from large nutrition trials, particularly in acute cardiac illness, is scarce. Nutrition therapy is therefore focused on avoiding iatrogenic harm. Some enteral nutrition is administered if possible and eventually temporary hypocaloric feeding is tolerated. Above all, the refeeding syndrome and other nutrition-related complications should be prevented. There is no indication for early parenteral nutrition, increased protein doses, specific amino acids, or modified lipids in critical illness.
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Casaer, Michael P., and Greet Van den Berghe. Nutrition support in acute cardiac care. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0032_update_001.
Full textAbstract:
Malnutrition in cardiac and critical illness is associated with a compromised clinical outcome. The aim of nutrition therapy is to prevent these complications and particularly to attenuate lean tissue wasting and the loss of muscle force and of physical function. During the last decade, several well-powered randomized controlled nutrition trials have been performed. Their results challenge the existing nutrition practices in critically ill patients. Enhancing the nutritional intake and the administration of specialized formulations failed to evoke clinical benefit. Some interventions even provoked an increased mortality or a delayed recovery. These unexpected new findings might be, in part, caused by an important leap forward in the methodological quality in the recent trials. Perhaps reversing early catabolism in the critically ill patient by nutrition or anabolic interventions is impossible or even inappropriate. Nutrients effectively suppress the catabolic intracellular autophagy pathway. But autophagy is crucial for cellular integrity and function during metabolic stress, and consequently its inhibition early in critical illness might be deleterious. Evidence from large nutrition trials, particularly in acute cardiac illness, is scarce. Nutrition therapy is therefore focused on avoiding iatrogenic harm. Some enteral nutrition is administered if possible and eventually temporary hypocaloric feeding is tolerated. Above all, the refeeding syndrome and other nutrition-related complications should be prevented. There is no indication for early parenteral nutrition, increased protein doses, specific amino acids, or modified lipids in critical illness.
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Casaer, Michael P., and Greet Van den Berghe. Nutrition support in acute cardiac care. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0032_update_002.
Full textAbstract:
Malnutrition in cardiac and critical illness is associated with a compromised clinical outcome. The aim of nutrition therapy is to prevent these complications and particularly to attenuate lean tissue wasting and the loss of muscle force and of physical function. During the last decade, several well-powered randomized controlled nutrition trials have been performed. Their results challenge the existing nutrition practices in critically ill patients. Enhancing the nutritional intake and the administration of specialized formulations failed to evoke clinical benefit. Some interventions even provoked an increased mortality or a delayed recovery. These unexpected new findings might be, in part, caused by an important leap forward in the methodological quality in the recent trials. Perhaps reversing early catabolism in the critically ill patient by nutrition or anabolic interventions is impossible or even inappropriate. Nutrients effectively suppress the catabolic intracellular autophagy pathway. But autophagy is crucial for cellular integrity and function during metabolic stress, and consequently its inhibition early in critical illness might be deleterious. Evidence from large nutrition trials, particularly in acute cardiac illness, is scarce. Nutrition therapy is therefore focused on avoiding iatrogenic harm. Some enteral nutrition is administered if possible and eventually temporary hypocaloric feeding is tolerated. Above all, the refeeding syndrome and other nutrition-related complications should be prevented. There is no indication for early parenteral nutrition, increased protein doses, specific amino acids, or modified lipids in critical illness.
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Hodges, Donald A. Bodily responses to music. Edited by Susan Hallam, Ian Cross, and Michael Thaut. Oxford University Press, 2012. http://dx.doi.org/10.1093/oxfordhb/9780199298457.013.0011.
Full textAbstract:
This article explores bodily responses to music, i.e., physiological and physical responses. Bodily responses to music are among the core experiences of music. They are hugely complex, with a myriad of response types interwoven into the fabric of thoughts, feelings, and social context. Bodily responses are highly idiosyncratic, as each person brings a unique self to a music-listening situation. Researchers have made significant strides in ferreting out the details of these responses, and, in collaboration with practitioners, have made progress in utilizing this knowledge, particularly in music therapy and music-medicine applications. With all this, however, the richness and complexity of the human experience leaves much yet to be discovered.
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Wein, Simon, and Lea Baider. Coping in palliative medicine. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0172.
Full textAbstract:
Coping is a universal experience. Anxiety, existential distress, physical discomfort, depression, anger, and the wish to die are some of the stressors that patients have to cope with in palliative medicine. Coping strategies can be beneficial or detrimental. Earlier concepts emphasized coping as a way to control and manage the stressors. Recent literature has raised the idea that ‘just coping’ might not be good enough, but aiming to grow psychologically as a response to the stress could be preferable. There are several theories about the nature of coping and therapies include narrative life review, meaning therapy, dignity therapy, hope, courage, positive psychology, fighting spirit, and mobilizing social supports and personal relationships. Spiritual care and chaplaincy have also emerged as important resources for some patients. Most people use life-long coping styles that they bring to the illness and support is best directed to embellishing the good coping traits and dis-encouraging the bad ones.
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Venables, Karen. Basic physics. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199696567.003.0002.
Full textAbstract:
Chapter 2 discusses the basic physics of external beam therapy, and addresses that distribution of radiation within the patient will be affected by many factors. These include the energy and modality of the beam, the density of the tissue, the use of beam modifiers such as wedges and compensators, and the distance of the patient from the machine. The apparent distribution will also be affected by the accuracy of the algorithm used in the planning system.
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Monico, Caro. Complex Regional Pain Syndrome for Ambulatory Surgery. 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/9780190678333.003.0055.
Full textAbstract:
Complex regional pain syndrome (CRPS) is a disease of the nervous system characterized by pain localized in an extremity. This pain is typically out of proportion to the inciting event and is accompanied by sensory disturbances, as well as motor, vasomotor, and sudomotor signs and symptoms. CRPS is a challenging clinical presentation and diagnosis. The etiology of this previously rare condition in children, is typically post-traumatic. It’s management requires a biopsychosocial approach. The principal modality that will improve pain and function in children with CRPS is physical therapy together with an interdisciplinary approach to management. The key to successful treatment involves early appropriate intervention, education for the child and family, and excellent communication between team members. This chapter uses a case study of a 12-year-old girl with CRPS to illustrate these concepts.
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Metzger, Eran D., Jacob C. Holzer, and Rebecca W. Brendel. Forensic Issues in the Geriatric Psychiatry Consult Liaison Service and the Right to Accept and Refuse Treatment. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199374656.003.0014.
Full textAbstract:
The consultation liaison psychiatrist frequently encounters questions of decision-making capacity for hospitalized geriatric patients. This trend will only continue as the population ages and questions about the ability of aging patients to make medical decisions and broader life decisions arise more and more frequently. Consultation liaison psychiatrists tasked with determining these capacities may be faced with a duality of roles: responsibility to the patient but also protective obligations imposed by laws and regulations. Consultation liaison psychiatrists should engage these evaluations carefully and be forthright with patients. An approach focusing on the nature and cause of incapacity, the potential for reversibility of incapacity, adequately informing the patient, relying on colleagues in occupational and physical therapy as well as speech and language pathology for functional assessment, and understanding the patient’s life history and story can lead to results respectful of both the patient’s well-being and dignity. This chapter presents forensic issues relevant to the geriatric psychiatry consultation-liaison service through an illustrative clinical vignette.
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Rosenquist, Ellen W. K., and Natalie Strickland. Pediatric Pain and Development of Pain Systems. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190217518.003.0026.
Full textAbstract:
The diagnosis and treatment of pain in the pediatric population is challenging because there is still much that is not understood about the development of pain systems in the human body. Many common pain syndromes manifest unique characteristics in the pediatric population that vary greatly from those in adults. In addition, pediatric treatments vary greatly from those used for adults and typically rely to a far greater degree on physical therapy or other nonpharmacologic treatments before resorting to pharmacologic or interventional therapies. Furthermore, there are many factors that must be taken into consideration when treating children, such as the child’s stage of development, pharmacokinetic and pharmacodynamic variables, caregiver concerns, psychosocial considerations, ethical considerations, and the ability of the child to describe his or her pain. This chapter highlights important topics to be considered when managing pain in pediatrics.
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Camden, Vera J. Bunyan Unbound. Edited by Michael Davies and W. R. Owens. Oxford University Press, 2018. http://dx.doi.org/10.1093/oxfordhb/9780199581306.013.28.
Full textAbstract:
In a 1945 letter to the British Medical Journal, D. W. Winnicott protests unethical impositions upon mental patients in which surgeons are ‘cutting brains about’. He remarks, ‘what happens if these physical therapy methods spread to the treatment of criminals? What guarantee have we that a Bunyan in prison will be allowed to keep his brain intact and his imagination free?’ Bunyan, whose resistance to the repressive authorities of his day fostered his genius, in fact flourished in prison, keeping his brain intact, his imagination free. During his long confinement, the prison walls become the scene of his dream of The Pilgrim’s Progress (1678). Drawing upon psychoanalytic theories of guilt, punishment, and creativity, this chapter offers the case of Bunyan as a Nietzschean ‘pale criminal’ whose lonely confinement quells his conscience and consolidates his identity as pastor, poet, and pilgrim.
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Alshaikh, Jumana T., Shaan Sudhakaran, and Helene Rubeiz. Trigeminal Neuralgia. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190271787.003.0002.
Full textAbstract:
Trigeminal neuralgia is characterized by severe, unilateral, paroxysmal stabbing pain affecting the face in the distribution of one of the divisions of the trigeminal nerve. The episodes of pain are brief and are triggered by innocuous physical stimuli. Typical age of onset is the sixth decade, with a female predominance. The most common cause is neurovascular compression. Other causes include multiple sclerosis and structural abnormalities in the cerebellopontine angle. The diagnosis is made clinically, but MRI can be useful in evaluation of the underlying etiology. First-line pharmacotherapy is carbamazepine or oxcarbazepine. If medical therapy fails, procedural interventions should be considered. From ablations to craniotomy, there is an array of procedural treatments available for trigeminal neuralgia. Patients should be educated on the risks and benefits of each procedure prior to pursuing treatment.
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Inglehart, Ronald F. Modernization, Existential Security, and Cultural Change. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190879228.003.0001.
Full textAbstract:
Survey data from countries containing over 90% of the world’s population demonstrate that in recent decades, rising levels of economic and physical security have been reshaping human values and motivations, thereby transforming societies. Economic and physical insecurity are conducive to xenophobia, strong in-group solidarity, authoritarian politics, and rigid adherence to traditional cultural norms; conversely, secure conditions lead to greater tolerance of outgroups, openness to new ideas, and more egalitarian social norms. Existential security shapes societies and cultures in two ways. Modernization increases prevailing security levels, producing pervasive cultural changes in developed countries. But long before, substantial cross-sectional cultural difference existed, reflecting historical differences in vulnerability to disease and other factors. Analysts from different perspectives have described these cultural differences as Collectivism versus Individualism, Materialism versus Postmaterialism, Survival versus Self-expression values, or Autonomy versus Embeddedness, but all tap a common dimension of cross-cultural variation that reflects different levels of existential security.
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Dimitrov, Nadya, and Kathy Kemle, eds. Palliative and Serious Illness Patient Management for Physician Assistants. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780190059996.001.0001.
Full textAbstract:
There are still medical providers who believe palliative care medicine is limited to care of the dying. It is actually devoted to relief of suffering at every stage of life. Comprehensive management of patients with serious illness, including the relief of their symptoms, impacts their lives and those of their families, significant others, and caregivers, including healthcare providers. The knowledge and skills inherent in this medical specialty enables them all to grow and fosters resilience in their lives. Patient centered care is the best model that incorporates team practice with physicians and other healthcare professionals, and this is a cornerstone of palliative care medicine. Furthermore, PAs are compassionate listeners who provide comprehensive diagnosis and treatment of vulnerable patient populations across the life span and in all healthcare settings. Among medical providers involved in palliative care medicine, PAs are the only group whose accreditation requirements incorporate this knowledge and training. This text represents a new resource for PAs, clinicians, researchers, and educators of the profession to further facilitate its expansion into palliative and serious illness care. PAs are thereby poised to reduce the workforce shortage of healthcare professionals in palliative care medicine.
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Austin, Diane. Vocal Psychotherapy. Edited by Jane Edwards. Oxford University Press, 2015. http://dx.doi.org/10.1093/oxfordhb/9780199639755.013.4.
Full textAbstract:
Vocal psychotherapy is the first model of music psychotherapy that focuses primarily on the voice. Vocal psychotherapy can be defined as the use of the breath, sounds, vocal improvisation, songs, and dialogue within a client-therapist relationship to promote intrapsychic and interpersonal growth and change. Since 2000 the Vocal psychotherapy training program in New York has been training postgraduate music therapists. This training provides the opportunity to learn the theoretical underpinnings that integrate the physical, psychological and spiritual benefits of singing, along with in-depth understanding of the theories from the fields of psychology, traumatology, addiction treatment, and psychodrama. There are now training programs in Vancouver, BC and in Seoul, Korea. An overview of Vocal psychotherapy is provided here and details of the main tenets of the approach are described, as well as techniques used in therapy sessions.
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Helmchen, Hanfried. Fuzzy boundaries and tough decisions in psychiatry. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198722373.003.0007.
Full textAbstract:
In the field of mental disorders the boundaries between mental normality and disease are often blurred. Psychiatrists, being aware of the instrumental nature of psychiatric diagnoses, try to deal with these blurred boundaries by stipulating strict definitions of clinical categories, by operationalizing diagnoses, and by using evidence-based methods of production and algorithmic application of medical knowledge. However, the clinical uncertainties can only partially be reduced by these means, because the physician always has to consider the individuality of the patient as well as to find a helpful solution to the dilemma of not treating a treatable but only probable or even only possible disease condition versus treating a variation of normal behavior against the risk of obtaining unwanted side effects of drug therapy or stigmatization. As is shown in the chapter, subthreshold mental disorders provide illuminating illustrations of these limits of medical standardization.
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Dickerman, Anna L., Yesne Alici, William Breitbart, and Harvey Max Chochinov. Palliative Care and Spiritual Care of Persons with HIV and AIDS. 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/9780199392742.003.0041.
Full textAbstract:
The meaning and role of palliative and spiritual care have evolved over the last decades, along with the dramatically changing clinical picture of AIDS. Although advances in antiretroviral therapy and medical interventions have allowed persons with HIV/AIDS and access to care to live longer and healthier lives, many persons in the United States and throughout the world continue to die of AIDS. There is an increased need for a comprehensive, multidisciplinary approach to care including psychosocial and family support. Curative, palliative, and spiritual care should be integrated, without dichotomizing curative and palliative approaches, in order to meet the challenges of AIDS throughout the course of illness. This chapter reviews basic concepts of palliative and spiritual care, as well as specific challenges facing clinicians involved in HIV palliative care. Finally, issues such as bereavement, demoralization, dignity, meaning, cultural sensitivity, doctor–patient communication, and psychiatric contributions to physical symptom control are reviewed.
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Schott, Christopher K., and Jessica A. Fozard. Hypotension and Shock (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0008.
Full textAbstract:
Hypotension is a common cause of rapid response team (RRT) activation. It is critical to be able to rapidly identify the etiology of hypotension. In the setting of a rapid response team call, there is often limited time and information available when first encountering a hypotensive patient. With attention to key elements in the patient’s history of present illness, physical exam, and findings of predominant changes in systolic, diastolic, and pulse pressures, RRTs can rapidly narrow their differential diagnosis. We will discuss the initial evaluation and treatment recommendations based on the etiology of hypotension and shock. Resuscitation should continue until circulatory homeostasis occurs, as guided by a patient’s exam, vital signs, and trends in laboratory values. This chapter provides a framework on how to quickly differentiate between the causes of hypotension or shock when evaluating patients during a rapid response scenario to most accurately guide therapy.
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Lameire, Norbert, Raymond Vanholder, and Wim Van Biesen. Clinical approach to the patient with acute kidney injury. Edited by Norbert Lameire. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0222_update_001.
Full textAbstract:
The prognosis of acute kidney injury (AKI) depends on early diagnosis and therapy. A multitude of causes are classified according to their origin as prerenal, intrinsic (intrarenal), and post-renal.Prerenal AKI means a loss of renal function despite intact nephrons, for example, because of volume depletion and/or hypotension.There is a broad spectrum of intrinsic causes of AKI including acute tubular necrosis (ATN), interstitial nephritis, glomerulonephritis, and vasculitis. Evaluation includes careful review of the patient’s history, physical examination, urinalysis, selected urine chemistries, imaging of the urinary tree, and eventual kidney biopsy. The history should focus on the tempo of loss of function (if known), associated systemic diseases, and symptoms related to the urinary tract (especially those that suggest obstruction). In addition, a review of the medications looking for potentially nephrotoxic drugs is essential. The physical examination is directed towards the identification of findings of a systemic disease and a detailed assessment of the patient’s haemodynamic status. This latter goal may require invasive monitoring, especially in the oliguric patient with conflicting clinical findings, where the physical examination has limited accuracy.Excluding urinary tract obstruction is necessary in all cases and may be established easily by renal ultrasound.Distinction between the two most common causes of AKI (prerenal AKI and ATN) is sometimes difficult, especially because the clinical examination is often misleading in the setting of mild volume depletion or overload. Urinary chemistries, like calculation of the fractional excretion of sodium (FENa), may be used to help in this distinction. In contrast to FENa, the fractional excretion of urea has the advantage of being rather independent of diuretic therapy. Response to fluid repletion is still regarded as the gold standard in the differentiation between prerenal and intrinsic AKI. Return of renal function to baseline or resuming of diuresis within 24 to 72 hours is considered to indicate ‘transient, mostly prerenal AKI’, whereas persistent renal failure usually indicates intrinsic disease. Transient AKI may, however, also occur in short-lived ATN. Furthermore, rapid fluid application is contraindicated in a substantial number of patients, such as those with congestive heart failure.‘Muddy brown’ casts and/or tubular epithelial cell casts in the urine sediment are typically seen in patients with ATN. Their presence is an important tool in the distinction between ATN and prerenal AKI, which is characterized by a normal sediment, or by occasional hyaline casts. There is a possible role for new serum and/or urinary biomarkers in the diagnosis and prognosis of the patient with AKI, including the differential diagnosis between pre-renal AKI and ATN. Further studies are needed before their routine determination can be recommended.When a diagnosis cannot be made with reasonable certainty through this evaluation, renal biopsy should be considered; when intrarenal causes such as crescentic glomerulonephritis or vasculitis are suspected, immediate biopsy to avoid delay in the initiation of therapy is mandatory.
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Fagard, Robert, Giuseppe Mancia, and Renata Cifkova. Blood pressure. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656653.003.0014.
Full textAbstract:
Prevention of hypertension can help prevent cardiovascular disease and renal complications. Obesity, a high sodium and low potassium intake, physical inactivity, and high alcohol consumption all contribute to the development of hypertension, and randomized controlled trials have shown that appropriate lifestyle modifications are able to reduce blood pressure and/or prevent the development of hypertension. The major complications of hypertension are stroke, coronary heart disease, heart failure, peripheral artery disease, and chronic kidney disease. Multiple randomized controlled trials and their meta-analyses have shown that treatment with antihypertensive drugs reduces the incidence of fatal and non-fatal cardiovascular events. In addition, meta-analyses have shown that there are no clinically relevant differences in the effects of the five major drug classes on outcome, so all of them are considered suitable for the initiation and maintenance of antihypertensive therapy. Nevertheless, the therapeutic approach in the elderly, women, and patients with diabetes, cerebrovascular, cardiac, or renal disease deserves special attention.
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Latronico, Nicola, Simone Piva, and Victoria McCredie. Long-Term Implications of ICU-Acquired Muscle Weakness. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0024.
Full textAbstract:
Intensive care unit-acquired weakness (ICUAW) is a significant and common complication with major implications for survivors of critical illness. ICUAW is a clinical diagnosis made in the presence of generalized muscle weakness that occurs in the setting of critical illness when other causes of muscle weakness have been excluded. Critical illness polyneuropathy and myopathy are the most common causes of ICUAW. Short-term implications of ICUAW include alveolar hypoventilation and an increased risk of pulmonary aspiration, atelectasis, and pneumonia—factors which may contribute to acute respiratory failure and ICU re-admission. In the long term, ICUAW has been associated with physical disturbances, including unsteady gait, sensory loss, foot drop, and, in more severe cases, persistent quadriparesis and ventilator dependency. ICUAW appears to heavily influence the failure of ICU patients to return to baseline health status post-discharge. There is a paucity of evidenced-based therapeutic strategies to reduce the incidence of ICUAW; however, early rehabilitative therapy might represent an effective measure in improving functional status.
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Bhaumik, Sabyasachi, and Regi Alexander, eds. Oxford Textbook of the Psychiatry of Intellectual Disability. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198794585.001.0001.
Full textAbstract:
Intellectual Disability (ID), a lifelong condition characterized by an impairment of intellectual functioning and deficits in adaptive skills is part of a spectrum of developmental disorders which also includes other conditions like autism and ADHD. While psychiatric problems are three to four times more common in those with ID, diagnosing it can be fraught with difficulties due to associated communication problems, atypical presentations, overlap with physical conditions, and experience of marginalization and abuse. In addition, treatment approaches may be different and the potential for treatment-related side effects greater. With a range of international experts authoring its chapters and providing the up-to-date evidence base in assessment, diagnosis, and treatment of mental health problems in people with ID, this book will be useful not just for the trainee doctor in psychiatry, but also for those in allied professions like general practice, nursing, psychology, speech and language therapy, social work, and occupational therapy as well as family members and carers and all those involved in any way with organizing or delivering care and treatment for people with intellectual disability and mental health problems. Throughout, the book addresses issues that are of relevance to those on the frontline and hence most chapters offer examples of clinical issues that come up in day to day practice. There are also a number of single response multiple choice questions that will serve as an aid to learning.