{"title":"Median Neuropathy—Carpal Tunnel Syndrome","authors":"M. Lark, N. Fujihara, K. Chung","doi":"10.1093/med/9780190617127.003.0001","DOIUrl":"https://doi.org/10.1093/med/9780190617127.003.0001","url":null,"abstract":"This chapter presents general treatment strategies for carpal tunnel syndrome using a clinical case example. It discusses assessment and planning, diagnostic pearls, decision-making, surgical procedures (open and endoscopic carpal tunnel release), management pearls, aftercare, complications and their management, and evidence and outcomes. Physical exams, such as Phalen’s test or a Tinel sign over the median nerve, are introduced, whereas steps in the surgical procedure are shown with intraoperative photographs. The chapter provides information on modern practices for comprehensive management of carpal tunnel syndrome from start to finish.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77072990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Psychosis and the family: the role of family interventions","authors":"J. Onwumere, E. Kuipers","doi":"10.1093/MED/9780198828761.003.0010","DOIUrl":"https://doi.org/10.1093/MED/9780198828761.003.0010","url":null,"abstract":"The development of psychotic illness exerts a significant impact on the affected individual but will also affect, in a variety of ways, their family and social networks. Although psychotic conditions are severe mental health problems, they are treatable, and family care and support play an important role in helping to achieve better recovery outcomes. In its first half, this chapter provides an overview of the impact of psychosis on family carers and the close relationship that exists between family wellbeing and patient outcomes, including the relevance of expressed emotion. The second half of the chapter offers an outline of family interventions—the psychological talking therapies designed to help individuals living with psychosis and their families to improve their understanding of the illness, develop skills in positive communication, problem-solving and coping, and identify appropriate support pathways. The evidence base underpinning the interventions and future developments in working with families is also discussed.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87051053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Charge Syndrome","authors":"Pilar Mercado, J. E. Eklund, Jennifer L. Anderson","doi":"10.1093/med/9780190685157.003.0003","DOIUrl":"https://doi.org/10.1093/med/9780190685157.003.0003","url":null,"abstract":"The major diagnostic features of CHARGE syndrome include coloboma of the eyes, choanal atresia or stenosis, distinctive external ears, cranial nerve abnormalities, and absent or small semicircular canals. The mnemonic refers to coloboma of the eye, heart defects, atresia of choanae, retardation of growth and development, cenitalia hypoplasia, and ear abnormalities and deafness. There is no defined etiology, though a de novo mutation on the CHD 7 gene located on Chromosome 8 is responsible for more than 50% of CHARGE cases. The incidence of CHARGE is about 1:10,000 live births with an equal distribution between males and females. The anesthetic implications of this syndrome are many and vary with the patient’s phenotype. A potential difficult airway, congenital heart defects, choanal atresia, and cranial nerve abnormalities present the most significant issues for the anesthesiologist. A multidisciplinary team must be established early to properly care for these complex patients.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88028216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anesthetic Management of Scoliosis Surgery in Children","authors":"A. Patil, S. Pestieau","doi":"10.1093/med/9780190685157.003.0029","DOIUrl":"https://doi.org/10.1093/med/9780190685157.003.0029","url":null,"abstract":"Scoliosis is defined as an abnormal curvature of the spine, which, if severe enough, can affect pulmonary or cardiac function and ultimately require surgical repair. There are 3 well-defined types of scoliosis: idiopathic, neuromuscular, and congenital scoliosis. Anesthetic management of children undergoing posterior spinal fusion can be challenging due to patient comorbidities, the need for neuromonitoring, the potential for significant blood loss, and various perioperative complications. In addition, postoperative pain after spinal fusion is known to be severe and often exceeds those reported in other major surgical procedures. To properly care for these patients, it is vital to be knowledgeable about the anesthetic and pain management considerations of patients undergoing posterior spinal fusion.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83931546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The glutamate system and addiction","authors":"D. Nutt, L. Nestor","doi":"10.1093/med/9780198797746.003.0009","DOIUrl":"https://doi.org/10.1093/med/9780198797746.003.0009","url":null,"abstract":"Glutamate is the primary excitatory neurotransmitter in the brain. Glutamate is involved in synaptic plasticity, particularly within dopamine systems of the brain that are involved in reward. Glutamate-dependent plasticity is involved in the development of substance addiction through its actions at NMDA receptors during long-term potentiation (LTP) related learning and memory processes. This plasticity within brain circuitry involved in learning and memory is sustained during substance abstinence and may provide a neural substrate for a vulnerability to addiction relapse. Medications that possess the efficacy to reduce glutamate tone in certain brain circuits may reduce craving, and ultimately, relapse in substance dependence. Further research is required, however, to show that the modulation of glutamate transmission in the brain confers clinical benefits in substance addiction.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82605827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ependymomas","authors":"P. Klimo, N. Shimony","doi":"10.1093/med/9780190696696.003.0026","DOIUrl":"https://doi.org/10.1093/med/9780190696696.003.0026","url":null,"abstract":"Pediatric posterior fossa tumors are usually ependymoma, pilocytic astrocytoma, or medulloblastoma. Ependymoma appears well-demarcated with heterogeneous enhancement on magnetic resonance imaging (MRI). Full neural axis MRI is indicated to assess for metastatic disease. Management is typically surgical resection of the tumor, with consideration for cerebrospinal fluid diversion if patients present with severe hydrocephalus. Extent of resection of the tumor is the most important factor in predicting recurrence and overall survival, and gross total resection is ideal. Infratentorial ependymomas have 2 molecular subtypes, which has implications for responsiveness to adjuvant therapy and prognosis. Infratentorial ependymomas are biologically different from supratentorial ependymomas. Postoperative radiation improves local control.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91459899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Suicide and Nonsuicidal Self-Injury","authors":"P. Soloff, C. Schmahl","doi":"10.1093/MED/9780199362318.003.0011","DOIUrl":"https://doi.org/10.1093/MED/9780199362318.003.0011","url":null,"abstract":"This chapter reviews current data on the prevalence of suicidal behavior and non-suicidal self-injury (NSSI) in patients with PDs; the characteristics of attempters versus completers; and the epidemiology of NSSI in borderline personality disorder (BPD). In addition, it presents explanatory models for suicide and NSSI. Also, there are comprehensive discussions of the neurobiological mechanisms involved in both suicidality and NSSI focusing on the structural and functional neuroimaging of emotion dysregulation, impulsivity, executive cognitive deficits, affective interference and cognitive function, and the Endogenous Opioid System. The chapter concludes with a detailed description of pain processing as it interacts with NSSI.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83052210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"An Orientation to Implementation Science in Cancer","authors":"David A. Chambers, W. Norton, Cynthia A. Vinson","doi":"10.1093/med/9780190647421.003.0001","DOIUrl":"https://doi.org/10.1093/med/9780190647421.003.0001","url":null,"abstract":"THE ROOTS of implementation science (IS) in cancer in some sense date back to the earliest days of uncovering cancer’s etiology, diagnosis, prevention, and treatment, although it was not called that. Indeed, unlocking the mysteries of cancer and determining effective ways to intervene began not in the lab but, rather, the clinic. As Mukherjee recounted in the seminal work, The Emperor of All Maladies, 1 cancer had been the subject of clinical examination for centuries, and the drive to optimize care began in those early days. As opposed to the largely separate worlds of research discovery and care delivery that exist today, scientific research and cancer treatment coexisted. In addition, epidemiologic observations of risk factors affecting oncogenesis developed targets for what types of prevention programs needed to be implemented. Naturally, the challenges of what exactly to implement and how best to implement have been with us throughout time.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83498519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cleft Palate, Cleft Lip, and Pierre Robin Sequence","authors":"M. Harvey, I. Ayad","doi":"10.1093/MED/9780190685157.003.0020","DOIUrl":"https://doi.org/10.1093/MED/9780190685157.003.0020","url":null,"abstract":"Pierre Robin sequence (PRS) is characterized by micrognathia, glossoptosis, and airway obstruction. Often associated with cleft palate, PRS is usually an isolated finding but is associated with a syndrome one-third of the time. The micrognathia and glossoptosis lead to airway obstruction, respiratory compromise, and feeding difficulties. Severe cases and prolonged and repeated airway obstruction and respiratory distress can lead to failure to thrive, hypoxemia, pulmonary hypertension, cardiac arrest, and death. Treatment options for the management of airway obstruction in PRS depends on the degree of obstruction and any associated comorbidities and range from noninvasive respiratory support to surgical correction of the physical defect. Patients with PRS should be considered as challenging to ventilate and intubate, and the practitioner should be well prepared for the possibility of difficulty with airway management. Anesthetic management is tailored to minimize postoperative upper airway obstruction and avoid disruption of the integrity of the surgical repair.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80662206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Theories, Frameworks, and Models in Implementation Science in Cancer","authors":"T. Skolarus, R. Tabak, A. Sales","doi":"10.1093/med/9780190647421.003.0004","DOIUrl":"https://doi.org/10.1093/med/9780190647421.003.0004","url":null,"abstract":"This chapter describes implementation theories, models, and frameworks and justifies their systematic use to build understanding of implementation science across the cancer care continuum and, ultimately, facilitate stewardship of effective cancer care and spending across complex clinical and public health contexts. The chapter discusses several previously developed taxonomy and categorization schemes as well as resources to aid implementation researchers and practitioners in their cancer-related implementation science efforts. The importance of precision implementation using systematic theoretical approaches to coincide with precision oncology efforts and funding is also discussed. After providing concrete examples of theory, model, and framework use across the continuum from prevention to palliative care, relevant implementation science opportunities for collaboration, patient-reported outcomes research, de-implementation, and measurement are highlighted as future directions. A case is constructed for the systematic use of theories, models, and frameworks in implementation science and practice.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85323766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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