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1
Scott, Naomi. The epidemiology of complex regional pain syndrome. Editado por Paul Farquhar-Smith, Pierre Beaulieu y Sian Jagger. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198834359.003.0062.
Resumen
The landmark paper discussed in this chapter describes a retrospective study examining the epidemiology of complex regional pain syndrome in the Dutch general population. The researchers accessed patient data by means of the Integrated Primary Care Information project, which provided a large representative sample of the general population inclusive of all ages. They found an incidence of 26.2 per 100,000 person-years from a source population of 190,902 people. In those patients diagnosed by a specialist, three contemporaneous diagnostic criteria were applied, one of which was that of the International Association for the Study of Pain (IASP). The authors demonstrated that there were marked differences in the proportions of cases fulfilling different criteria and thus highlighted problems with case diagnosis. When the 1994 IASP criteria were strictly applied, the incidence was found to be 16.8 per 100,000 person-years.
2
Diagnostic Placement and Mastery Tests: Ratio Proportion and Percent. Contemporary Books, 1990.
3
Liu, Timothy C. Phenomenology and Epidemiology of Problematic Internet Use. Editado por Jon E. Grant y Marc N. Potenza. Oxford University Press, 2012. http://dx.doi.org/10.1093/oxfordhb/9780195389715.013.0065.
Resumen
This chapter discusses the phenomenology and epidemiology of problematic Internet se (PIU). Interest in the addictive potential of Internet activities has grown in the past two decades. Problematic Internet use can be broadly defined as uncontrolled use of the Internet that leads to significant psychosocial and functional impairments. It is currently conceptualized as an impulse control disorder that may share features with substance dependence disorders. Reliable studies have estimated the prevalence in the general population to be about 1%, but higher proportions of individuals might be at risk. Comorbidities with other psychiatric disorders are common. Concerns exist regarding the appropriateness and implications of formally recognizing PIU as a distinct disorder in current diagnostic systems. Given the ever-growing exposure to the Internet, especially in younger generations, PIU might become an emerging public health problem. Further studies are greatly needed, especially those using valid measures and longitudinal designs. Neuroimaging and genetic studies should also be explored.
4
Casey, Patricia. The course and prognosis of adjustment disorders (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198786214.003.0008.
Resumen
The diagnostic stability of AD is questionable since there are no specific diagnostic criteria and many clinicians are not familiar with AD, mistaking it for some overlapping disorder. Case-register and inpatient records all identify poor stability, although this was not unique to AD and includes other non-psychotic disorders. The duration of hospitalization is shorter for those with AD than for those with other diagnoses, and a similar pattern has been observed for outpatient follow up. The prognosis for AD is described as good. Long-term follow-up studies show that a large proportion of patients are well and do not require readmission. Among adolescents, a diagnosis of AD may augur more serious underlying psychopathology, and they have higher readmission rates than adults with the diagnosis. AD is the most common diagnosis in those dying by suicide in some countries and it occurs earlier in the course of AD than in other diagnostic groups.
5
Riley, Bobbie y Navil Sethna. Pediatric Complex Regional Pain Syndrome Type 1. Editado por Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi y Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0054.
Resumen
Complex regional pain syndrome type 1 (CRPS-1) is a condition that affects adolescents and children under the age of 7. It usually follows minor injury and rarely occurs spontaneously. The pain is usually out of proportion to the inciting injury. Pain, allodynia, and/or hyperalgesia are severe enough to inhibit use of the affected limb. Delay in diagnosis and self and/or iatrogenic immobilization of the affected limb may lead to worsening pain, skin hypersensitivity and discoloration, swelling, and vasomotor and dystrophic abnormalities. The diagnosis of CRPS-1 and 2 is based on symptoms. There are no diagnostic tests that can confirm the presence or absence of CRPS-1. CRPS-2 diagnosis is established by nerve conduction test and electromyography. Clinical practice neuropathic guidelines are most effective for CRPS-2 treatment. Pharmacological and interventional treatment options for CRPS-1 are limited and usually ineffective because the underlying mechanism(s) are yet to be determined.
6
Clark, Terrell A. Assessment and Development of Deaf Children with Multiple Challenges. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190880545.003.0002.
Resumen
The proportion of children who are deaf or hard of hearing and also have other medical, neurodevelopmental, behavioral, or psychosocial conditions is increasing. Prevalence estimates run as high as 50% to 70%. The shifting complexity challenges not only the learners but also the teachers, administrators, and policymakers responsible for the education of deaf students. Documentation of diagnostic profiles contributes to understanding the learning profile of deaf students with concomitant conditions. This may also inform policy decisions, programmatic design, calibration of parental expectations, and implementation of effective teaching strategies. Through illustrative case examples, this chapter explores the principles of differential diagnosis and the implications of various conditions. Topics covered include genetic syndromes, vestibular dysfunction, intrauterine viral infection with associated congenital hearing loss, autism spectrum disorder, reactive attachment disorder, complex medical histories resulting in severe neurologic compromise, intellectual disabilities, cerebral palsy, and nonsyndromic genetic conditions.
7
Tanislav, Christian y Manfred Kaps. Classification. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198722366.003.0003.
Resumen
The classification of a cerebrovascular event distils information obtained in the workup and other related case history to a category indicating a specific pathophysiology, with direct implications for the subsequent secondary prevention management. A minimum standard of diagnostics is required for a precise classification. In young stroke victims, the conventional Trial of Org 10172 in Acute Stroke Treatment (TOAST) stroke subtype classification may only address the aetiopathogenesis in 30–60% of the individuals who are affected by vascular risk factors. Applying the criteria defined by TOAST for large-artery atherosclerosis, cardioembolism, and small artery disease is reliable for young stroke victims as verified in many clinical investigations. However, in a considerable proportion of stroke patients, the stroke aetiology remains unclear. For this group, some patients need to be treated in a particular manner, such as those with two or more possible aetiologies or those with suspected paradoxical embolism. In patients remaining purely cryptogenic despite an extensive diagnostic workup, imaging findings may help to identify potential triggers, particularly when an embolic infarction pattern in the acute brain imaging is obvious. Despite its shortcomings, the TOAST classification is the most universally used classification in ischaemic stroke patients. New developments in the field are addressed in this chapter and aspects are incorporated for the nominated classification adapted for the specific group of young stroke patients.
8
Archer, Nick y Nicky Manning. Management of fetal structural cardiac disease in pregnancy. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199230709.003.0023.
Resumen
Introduction 304Diagnosis 306Counselling 308Management of pregnancy 310Fetal intervention 312Management of delivery 314Place of delivery 316Future pregnancies 318Cardiac abnormalities account for approximately 20% of neonatal deaths and in some the cardiac cause is only identified at post-mortem; a significant proportion of CHD remains undetected during pregnancy and thus does not influence management of the pregnancy or delivery. However, there are some lesions whose early postnatal management may be altered in the light of prior knowledge and thus prenatal diagnosis may improve postnatal outcome both in terms of mortality and morbidity....
9
Armstrong, Richard. Dementia. Editado por Patrick Davey y David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0228.
Resumen
Dementia is a syndrome defined by a persistent, progressive decline in multiple cognitive functions to a degree sufficient to detrimentally impact activities of daily living and social function. The syndromic diagnosis of dementia is useful, since the general management and economic burden of these patients remains similar, irrespective of etiology. However, a more precise etiological diagnosis must be sought, since disease-specific treatment is increasingly likely to be appropriate. The term ‘mild cognitive impairment’ (MCI) refers to an objective impairment in a cognitive function (usually memory) which does not impair activities of daily living. The aim underlying the use of this term is to identify those with the early pathophysiological changes of neurodegenerative disease. Nonetheless, ‘MCI’ is not synonymous with ‘early dementia’, as a significant proportion of those with MCI will not worsen. The term should therefore be used cautiously.
10
Ducrocq, Gregory, Franck Thuny, Bernard Iung y Alec Vahanian. Acute valve disease and endocarditis. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0059.
Resumen
The management of patients with acute valve disease is now a rare, but challenging, event, as valvular patients are often elderly with severe comorbidities. Furthermore, a proportion of previously operated patients present with acute valve dysfunction. The aim, in this situation, is to establish a rapid diagnosis, based on clinical examination and echocardiography, followed by early intervention. The primary treatment remains surgical valve replacement. However, a more conservative surgical approach is under development, and, more recently, percutaneous interventional techniques have been introduced. In the future, every effort should be made to avoid performing interventions in an acute situation, as it is always at high risk.
11
Ducrocq, Gregory, Franck Thuny, Bernard Iung y Alec Vahanian. Acute valve disease and endocarditis. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0059_update_001.
Resumen
The management of patients with acute valve disease is now a rare, but challenging, event, as valvular patients are often elderly with severe comorbidities. Furthermore, a proportion of previously operated patients present with acute valve dysfunction. The aim, in this situation, is to establish a rapid diagnosis, based on clinical examination and echocardiography, followed by early intervention. The primary treatment remains surgical valve replacement. However, a more conservative surgical approach is under development, and, more recently, percutaneous interventional techniques have been introduced. In the future, every effort should be made to avoid performing interventions in an acute situation, as it is always at high risk.
12
Goossens, Maria E., Frank Buntinx y Maurice P. Zeegers. Bladder and upper urinary tract cancer. Editado por James W. F. Catto. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0070.
Resumen
Urinary bladder cancer (UBC) ranks ninth in worldwide cancer incidence. The most common histological type in Western countries is transitional cell carcinoma (TCC), while in Africa, a substantial proportion of squamous cell carcinomas (SCC) are observed related to the prevalence of infection with Schistosoma haematobium (bilharziasis). UBC has the highest per-patient lifetime cost for cancer in terms of healthcare expenditure compared to all other types of cancer. It is more frequent in men than in women and age is now widely accepted as the greatest single risk factor for developing UBC. The median age at diagnosis is 70 years. Cigarette smoking and specific occupational exposures, such as carcinogenic dyes for painters, are the main known causes of UBC.
13
Thomas, David F. M. Undescended testis and inguinoscrotal conditions in children. Editado por David F. M. Thomas. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0123.
Resumen
The testis descends in response to androgen stimulation in the third trimester of pregnancy. Germ cell maturation which normally occurs in early childhood is impaired or absent in undescended testes. The well-documented phenomenon of secondary ascent is now thought to account for a sizeable proportion of boys undergoing orchidopexy in later childhood. Inguinal hernias and communicating hydroceles are caused by persistence of a patent processus vaginalis. Surgery is always indicated for inguinal hernias but the majority of communicating hydroceles resolve spontaneously. Testicular torsion accounts for 90% acute scrotal symptoms in adolescents, in whom urgent surgical exploration is mandatory unless there is compelling evidence of an alternative diagnosis. Treatment is rarely justified for asymptomatic varicoceles in this age group.
14
Cross, Helen. Seizures and related disorders in children. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569381.003.0693.
Resumen
Epilepsy is most prevalent at each end of the age spectrum—the very young and the very old. Up to 1 per cent of the childhood population will have active epilepsy at any time. Of these 60–70 per cent will be controlled on medication or enter into spontaneous remission, however the remainder will continue to have seizures despite the range of treatment available. There will be associated comorbidity of learning and behaviour difficulties in a significant proportion, and these may take precedence in management over the seizures themselves. Careful evaluation of each individual child with regard to the possible diagnosis and associated comorbidities is required in all children presenting with recurrent paroxysmal episodes in order to optimize management.
15
Cherny, Nathan I. Cancer pain syndromes: overview. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0131.
Resumen
Cancer pain syndromes are defined by the association of particular pain characteristics and physical signs with specific consequences of the underlying disease or its treatment. The recognition of cancer pain syndromes and the ability to distinguish between them is a critical skill for palliative care clinicians since syndromes are associated with distinct aetiologies and pathophysiologies, and they often have important prognostic and therapeutic implications. Pain syndromes associated with cancer can be either acute or chronic. Whereas acute pains experienced by cancer patients are usually related to diagnostic and therapeutic interventions, chronic pains are most commonly caused by direct tumour infiltration. Adverse consequences of cancer therapy, including surgery, chemotherapy, and radiation therapy, account for 15-25% of chronic cancer pain problems, and a small proportion of the chronic pains experienced by cancer patients are caused by pathology unrelated to either the cancer or the cancer therapy.
16
Wilson, Kathryn M. y Lorelei Mucci. Prostate Cancer. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190676827.003.0020.
Resumen
Prostate cancer is among the most commonly diagnosed cancers among men, ranking second in cancer globally and first in Western countries. There are marked variations in incidence globally, and its incidence must be interpreted in the context of diagnostic intensity and screening. The uptake of prostate-specific antigen screening since the 1990s has led to dramatic increases in incidence in many countries, resulting in an increased proportion of indolent cancers that would never have come to light clinically in the absence of screening. Risk factors differ when studying prostate cancer overall versus advanced disease. Older age, African ancestry, and family history are established risk factors for prostate cancer. Obesity and smoking are not associated with risk overall, but are associated with increased risk of advanced prostate cancer. Several additional lifestyle factors, medications, and dietary factors are now emerging as risk factors for advanced disease.
17
Bauzá, Graciela y Ayodeji Nubi. Pathophysiology and management of thoracic injury. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0333.
Resumen
Mechanism, patient presentation, and physical exam are key elements to accurate and prompt diagnosis of thoracic injury. A high proportion of poly-trauma victims suffer thoracic injury which is associated with mortality of with 25-50%. Initial management is guided by ATLS principles of Airway, Breathing, and Circulation. The FAST (focused assessment with sonography for trauma) exam plays a key role in the initial evaluation of thoracic trauma. Most injuries to the thoracic cavity may be managed non-operatively or with bedside procedures with the caveat that patients with thoracic injury require close attention and monitoring in the ICU for potential deterioration. A high index of suspicion is paramount to successful patient care. When operative intervention is required it is often emergent.
18
Monico, Caro. Complex Regional Pain Syndrome for Ambulatory Surgery. Editado por Erin S. Williams, Olutoyin A. Olutoye, Catherine P. Seipel y Titilopemi A. O. Aina. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190678333.003.0055.
Resumen
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.
19
Eckert, J., P. Deplazes y P. Kern. Alveolar echinococcosis (Echinococcus multilocularis). Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198570028.003.0061.
Resumen
In this chapter three forms of echinococcosis in humans are described that are caused by a larval stage (metacestode) of Echinococcus multilocularis Leuckart, 1863, Echinococcus oligarthrus (Diesing, 1863) or Echinococcus vogeli Rausch and Bernstein, 1972. E. multilocularis is the causative agent of alveolar echinococcosis (AE). In the human host the metacestode of E. multilocularis behaves like a malignant tumour, characterized by infiltrative proliferation and the potential to induce serious disease. The liver is nearly exclusively the primary site of metacestode development, but metastases may by formed in adjacent and distant organs. Typically AE exhibits a chronic progressive clinical course, which finally leads to death in up to 90% of untreated patients within 10 years after diagnosis. An undefined proportion of cases are abortive with inactivation of the parasite. Evidence has accumulated in recent years that anti-parasitic therapy with benzimidazoles (albendazole or mebendazole) over many years or lifelong, if necessary combined with interventional procedures, can inhibit disease progression and improve or stabilse the patient’s clinical condition. Radical surgery in an early stage of the infection combined with anti-parasitic therapy for two years may lead to cure. The introduction of benzimidazole therapy of AE (1977), combined with improved diagnostic and surgical procedures, has resulted in significantly increased life-expectancies of adequately treated AE patients. In highly endemic areas ultrasound population screening (partially combinated with antibody detection) has been successfully used for early detection of AE cases. Countrywide annual AE incidence rates are mostly low at approximately < 0.1 to 2.0 per 100,000 inhabitants, but they can be much higher locally. Furthermore, there are indications of emerging case numbers in some areas of Europe and Asia. In spite of relatively low case numbers, AE is a significant disease due to its severity and high costs of treatment (median costs of approximately 145,800 per case).
20
Ong, Albert C. M. y Richard Sandford. Autosomal dominant polycystic kidney disease. Editado por Neil Turner. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0306_update_001.
Resumen
Based on an estimated population prevalence of between 1 in 400 and 1 in 1000, there are over 60,000 individuals with or at risk of developing complications associated with autosomal dominant polycystic kidney disease (ADPKD) in the United Kingdom. This equates to over 300,000 people in the United States and 7 million worldwide. Once diagnosed, an individual with ADPKD will require long-term medical follow-up and treatment with an unknown cost to national health care systems. A major proportion, probably two-thirds, will develop end-stage renal disease (ESRD) requiring renal replacement therapy—dialysis or transplantation. ADPKD is therefore the commonest genetic cause of ESRD. Most centres worldwide report that approximately one in ten patients receiving dialysis therapy have a diagnosis of ADPKD. Improvements in healthcare for individuals with ADPKD will therefore impact directly on patients, their families, and healthcare resources.
21
Kraft, Tim y Alex Wiegmann. Folk Epistemology and Epistemic Closure. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198815259.003.0004.
Resumen
According to epistemic closure, if someone knows some proposition P and also knows that P entails Q, she knows Q as well. This is often defended by appealing to its intuitiveness. Only recently, however, was epistemic closure put to the empirical test: Turri ran experiments in which closure is violated in folk knowledge ascriptions surprisingly often. The chapter authors disagree with this diagnosis. It is by no means obvious which experimentally testable hypothesis proponents of epistemic closure should accept. The chapter formulates a different hypothesis and argues that it is more apt for empirically testing epistemic closure. In a series of experiments the chapter authors manipulated the strength of entailment between two propositions and found that the stronger the entailment, the lower the proportion of participants who violated closure, indicating folk knowledge ascriptions are sensitive to entailment. The chapter concludes that closure is a principle of folk epistemology after all.
22
Russell, Georgina y Onn Min Kon. Tuberculosis. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199657742.003.0022.
Resumen
Tuberculosis is an important infection globally, with 1.45 million deaths attributed to tuberculosis in 2010 by the World Health Organization. Respiratory physicians need to be familiar with the varied presentations and management of this disease. In addition, the proportion of cases now presenting with extrapulmonary disease are approximately half of all cases, and of particular relevance is mediastinal node tuberculosis which represents about 10% of all cases of tuberculosis in the United Kingdom. This chapter presents the case of a patient with miliary tuberculosis who developed significant drug toxicities with antituberculous therapy. The chapter reviews the role of different investigations in making a diagnosis, including the role of the Mantoux test and interferon-gamma release assays, and discusses the often challenging job of contact tracing. Finally, the chapter reviews the management of both sensitive and drug-resistant disease, along with how to manage adverse drug reactions.
23
Kidd, Edwina y Ole Fejerskov. Essentials of Dental Caries. Oxford University Press, 2016. http://dx.doi.org/10.1093/oso/9780198738268.001.0001.
Resumen
Dental caries (tooth decay) is one of the most highly prevalent disease around the world affecting a significant proportion of the population. Dental caries may take place on any tooth surface in the oral cavity where dental plaque is allowed to develop over a period of time. Understanding its causes and progression allows the dental team to prevent and manage it so that patients can maintain healthy teeth for life. The fourth edition of Essentials of Dental Caries provides readers with an up-to-date, clinically relevant guide to dental caries. Written in an accessible style, the authors explain the biological and socioeconomic background of lesion development and progress. Current methods of clinical diagnosis and evidence based management are outlined in clearly laid out and highly illustrated chapters. This book is essential reading for students and practitioners of dentistry, dental therapy, dental hygiene, and oral health educators.
24
Woodberry, Kristen A., Emily Kline y Anthony J. Giuliano. Schizophrenia Spectrum Disorders. Editado por Thomas H. Ollendick, Susan W. White y Bradley A. White. Oxford University Press, 2018. http://dx.doi.org/10.1093/oxfordhb/9780190634841.013.17.
Resumen
Schizophrenia spectrum disorders (SSDs) are among the most serious and complicated psychiatric disorders, particularly in children and adolescents. They have a major impact on all aspects of functioning, including family and social relationships, school, work, and self-care. While schizophrenia tends to develop in late adolescence and early adulthood, nonspecific abnormalities, prodromal symptoms, and a significant proportion of its incidence unfold before age 18. It behooves child and adolescent clinicians to be knowledgeable about and alert to the range of SSD clinical presentations. The chapter reviews the current state of the literature regarding the phenomenology, epidemiology, assessment, diagnosis, and treatment of SSD within a developmental and systems framework. Although both evidence-based and promising practices are presented, these are all too often drawn from the adult literature, underscoring the pressing need for progress in developmentally sensitive assessment and treatment research with this population. Practice implications and future directions are briefly discussed.
25
McLean, Anthony S. y Stephen J. Huang. Cardiac injury biomarkers in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0301.
Resumen
To be clinically relevant, a good cardiac biomarker should have four main characteristics. It should be organ-, disease- and stage-specific to be useful in diagnosis. Its release should be timely and its half-life should be long enough to make measurement possible and meaningful. Its serum or blood concentration should be proportional to disease severity; hence, can be used as a monitoring tool. Finally, their concentrations have implications on long-term outcomes. To date, only a handful of cardiac biomarkers have clinical relevance in the intensive care setting—cardiac troponins (as a marker of cardiac injury) and B-type natriuretic peptide (as a marker of cardiac stress) being probably the most useful. However, cautious interpretations of these biomarkers are needed in intensive care patients as several confounding factors can affect their concentrations.
26
Burgard, Michael y Robert Kohn. Substance Use Disorders in the Elderly. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199374656.003.0030.
Resumen
Substance use disorders in older adults remains lower than in younger adults; however, the prevalence is rising in the elderly population. In the United States, the lifetime prevalence of an alcohol use disorder among persons age 65 and older is 16.1%. Studies of Veteran’s Administration nursing home residents have found that 29% to 49% of those admitted have a lifetime diagnosis of alcohol use disorder. A sizable proportion of the elderly acknowledge driving under the influence. In 2013, 1.5% of the elderly had used illicit drugs. The number requiring treatment for substance abuse is expected to double by 2020. The populations with the fastest increase in opiate mortality are those age 55 and older, including those 65 and older. This chapter presents the epidemiology of substance use among older adults and discusses issues related to elders’ substance use, including use in nursing homes, impaired driving and arrests, use of non-prescription medications, screening for substance use, and treatment.
27
Huber, Judith. Talking about MOTION in Old English. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780190657802.003.0005.
Resumen
The analysis of the 189 Old English motion verbs shows that Old English has a large manner vocabulary and various non-motion verbs attested in motion readings, which are discussed in this chapter. It is argued that although there are Old English path verbs, hardly any of them can be considered as pure path verbs (except nēahlǣcan, genēahian ‘to approach’), a diagnosis which is supported by an investigation of how Latin path verbs are translated in the Old English version of the gospels. The analysis of motion expression in different texts reveals that Old English can be seen as strongly satellite-framing, with the proportion of manner verbs as opposed to neutral verbs depending on text type. The chapter also addresses the changing realization of satellites in the history of English: In the Old English texts analysed, satellites are typically realized by prepositional phrases and adverbs, while true prefixes only play a minor role.
28
Stanley, Barbara y Antonia New, eds. Borderline Personality Disorder. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199997510.001.0001.
Resumen
Until recently, borderline personality disorder (BPD) has been the stepchild of psychiatric disorders. Many researchers even questioned its existence. Clinicians have been reluctant to reveal the diagnosis to patients because of the stigma attached to it. But individuals with BPD suffer terribly and a significant proportion die by suicide and engage in nonsuicidal self-injury. The aim of this primer on BPD is to fill this void and provide clinicians with an accessible, easy-to-use, clinically oriented, evidenced-based guide for early-stage BPD. We present the most up to date data about BPD by leading experts in the field in a format accessible to trainees and professionals working with individuals with BPD and their family members. The volume is comprehensive and covers the etiology of BPD, its clinical presentation and comorbid disorders, genetics and neurobiology of BPD, effective treatment approaches to BPD, the role of advocacy, and the treatment of special subpopulations (e.g., forensic) in the clinical management of BPD.
29
Watson, Louise y Michael W. Beresford. Paediatric-onset systemic lupus erythematosus. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0119.
Resumen
Paediatric or juvenile-onset systemic lupus erythematosus (JSLE) is a rare autoimmune condition, differing from the adult form in terms of severity, organ manifestations, and a less striking female predominance. The diagnosis relies on the adult-derived American College of Rheumatology SLE classification criteria. Genetic, autoantibody, and host immune responses, characteristic of this disease, result in a clinically heterogeneous phenotype. A proportion of paediatric SLE patients will have evidence of a genetic deficiency known to be associated with SLE, such as C1q deficiency, and screening for these is required. A challenging diagnosis to make in the younger age group, the management of JSLE compared to adult-onset SLE requires special consideration towards the significant long-term consequences of the disease and treatment toxicity, combined with an onset during a fundamental time with regards to growth and development. A comprehensive, multidisciplinary team approach to the management of JSLE is essential. With a more severe phenotype and limited comorbidities, patients with JSLE represent an invaluable opportunity for investigating the pathogenesis. To date, clinical trials informing interventions in JSLE are very limited and treatment choices rely on the outcome of adult trials. Patient and family involvement in research to improve outcomes and understanding is essential. New treatments, including biological therapies, are becoming available for clinical use and new treatment combinations have been used to induce and maintain clinical remission.
30
Hide, Geoff y Jennifer Humphries. Computed tomography. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0069.
Resumen
Computed tomography (CT), along with its cross-sectional partner MRI, continues to evolve apace. Although MRI retains the larger role in the musculoskeletal system due to its unparalleled soft tissue contrast and, not least, its lack of ionizing radiation, CT offers significant advantages in many areas. Imaging acute trauma is more rapid with CT, allowing 'whole body' assessment of patients following polytrauma, and CT is more useful than MRI in demonstrating the configuration of fractures, aiding surgical planning. CT can clearly identify cortical bone and areas of calcification, making the diagnosis of tarsal coalitions straightforward and facilitating the diagnosis and characterization of bone tumours such as osteoid osteoma and chondroid lesions. CT arthrography supplements standard imaging with intra-articular contrast to allow the detection of subtle joint abnormalities, and CT can demonstrate needles precisely within bone and soft tissue to enable the performance of complex image-guided procedures. Developments in CT have been especially rapid in the past decade and although this has particularly impacted on cardiac imaging, other areas of medicine, including rheumatology, have benefited. High multislice scanners can obtain data for a volume of tissue allowing reconstruction of slices with exceptional detail in any plane, and can rapidly image large areas of the body such as the spine. CT is responsible for a large proportion of the population's medical radiation exposure. Although techniques allowing reduction in dose continue to advance, radiologists and referrers retain responsibility to ensure that requests for CT examinations are necessary and justifiable.
31
Heidet, Laurence, Bertrand Knebelmann y Marie Claire Gubler. Alport syndrome. Editado por Neil Turner. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0323.
Resumen
The diagnosis of Alport syndrome is suspected from the clinical features and confirmed by identifying the almost pathognomonic ultrastructural changes to the basement membrane in a family member with early disease (so that glomeruli are not too sclerosed), or in modern times by identifying a causative mutation in one or more of the three implicated COL4 genes. Genetic testing is becoming simpler and cheaper, but is still out of the reach of many. Eighty-five per cent of cases are caused by COL4A5 mutations and 10–15% by autosomal recessive disease. A significant proportion of morbidity in X-linked disease occurs in female ‘carriers’ heterozygous for the disease. Changes by light microscopy are non-specific, and can be misleading unless accompanied by electron microscopy. Immunohistology can be helpful but may not be definitive as some causative mutations are not associated with absence of protein product. As COL4A5 is expressed in skin, skin studies are theoretically useful, but they are technically challenging and only a definite negative result is helpful. It is important to distinguish other disorders causing renal disease with deafness, and other causes of glomerular haematuria. Two rare syndromes are caused by extended deletions beyond the COL4A5 gene: X-linked Alport syndrome with diffuse oesophageal leiomyomatosis in which smooth muscle leoimyomas is transmitted in a dominant fashion, and X-linked Alport syndrome with mental retardation.