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Pulmonary Hypertension in Adult Congenital Heart Disease

Pulmonary hypertension (PH) is a haemodynamic and pathophysiological disorder associated with a variety of cardiovascular and respiratory conditions, including congenital heart disease (CHD) . PH is defned by international guidelines as an increase in mean pulmonary arterial pressure (meanPAP) ≥25 mmHg at rest, assessed by cardiac catheterization. The normal values of resting mean PAP are 14 ± 3 mmHg, with an upper limit of 20 mmHg. The signifcance of values in the “grey zone” of 21–24 mmHg is unclear, and currently, due to lack of data, there is no reliable defnition of PH occurring with exercise. A comprehensive international clinical classifcation for PH categorizes the multiple conditions in which PH may be present according to similarities in clinical presentation, pathology, haemodynamics and treatment (Table 1.1). Haemodynamically, PH can be distinguished into precapillary and post-capillary based on the absence or presence of a rise in mean left atrial/mean pulmonary wedge/left ventricular end-diastolic pressure (≤15 mmHg). Patients in group 1, pulmonary arterial hypertension (PAH), have precapillary PH with a pulmonary vascular resistance (PVR) >3 Wood units (WU) in the absence of other causes of precapillary PH such as lung disease (belonging to group 3), chronic thromboembolic PH (CTEPH group 4) or other rare diseases (group 5).

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Reproductive Ethics

When we frst envisioned organizing a conference solely on issues in reproductive ethics we were met by some skepticism by friends and colleagues. Were there really enough compelling topics and scholarship in this area to sustain interest for a 2-day conference? Our view, and the perspective confrmed by this book, is that reproductive ethics is a feld that has many questions, which we have only started to explore to the extent that they deserve. There are two reasons this is true. One is that some “hot button” issues have received all the attention—abortion, in particular, comes to mind here. The other is that unlike many well-litigated areas of bioethics, such as end-of-life care, emerging technologies in reproductive ethics are changing the ethical playing feld faster than the bioethics literature can keep pace. As for whether reproductive ethics can sustain interest we can only note that it is hard to imagine a subject that humans spend more time and energy upon than sex and reproduction. It is the only area of bioethics that can be called sexy without invoking an implausible metaphor.

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Rehabilitation Medicine for Elderly Patients

The World Health Organization has estimated that by the year 2050, the world’s population over 60 years will double from about 11% in 2015 to 22% . This means that there will be approximately two billion people aged 60 or older living on the planet. Of these, approximately 20% or 400 million will be 80 years or older. In the year 2015, Japan was the only country in the world with 30% or more of the population in the 60 years or older group. The WHO is projecting that by the year 2050, more than 25 countries, including most countries in Europe, will have a population distribution very similar to that of Japan. For example, the percentage of Italians older than 60 years will increase from approximately 20% in 2010 to approximately 33% in the year 2050. This increase in the number of people in older age groups is associated with an increase in life expectancy. For example, in Japan, life expectancy at age 60 is 86 years and in at least 13 other countries life expectancy at age 60 is now 85 years (Table 1.1). Further, the number of centenarians is also increasing, and in several regions of the world, including Sardinia, Italy and Icaria, Greece, there are a disproportionately large number of people in this age group.

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Psychiatry and Neuroscience Update – Vol. II

The general crisis of individualism is reflected in the conflicts generated by human beings themselves in different parts of the planet: fundamentalism, xenophobia, gender violence, wars, genocide, and exploitation of human beings. Politically, individualism is presented under the form of extreme Manichean positions: left or right, capitalism or socialism, liberalism or communism. However, human society is much more complex; these simplifcations are no longer possible. Neither the left nor the right will provide paradise, even less if their exponents think themselves to be possessors of absolute truth. On the other hand, respect for the diversity of the other view is not exhausted in the development of critical thinking. The purpose of this review is to schematically describe the viewpoint of Tischner, based on the notion of encounter to refer to the original experience with another human being where the other takes the highest level of persuasion. The encounter with another is the agathologic horizon of the interpersonal experience, and opens up the possibility of meeting with oneself in a new way. By impotence or ignorance many tragedies are possible, and in fact they have taken place in the darkest periods of mankind when evil apparently killed good, resulting in the most sadistic forms of selfshness. Finally, the present review tends to demonstrate that on the agathologic horizon, the manifestations of the other and oneself are developed in a true sense of the good and the bad, the different logos that ft the drama or tragedy in interpersonal relationships.

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The Resilient Physician A Pocket Guide to Stress Management

Burnout is a stress-induced syndrome defned by the three distinct manifestations: emotional exhaustion, depersonalization, and diminished sense of personal accomplishment . It is no surprise that burnout among physicians is on the rise. A 2015 Mayo Clinic survey compared burnout between 2011 and 2014 and reported an increase in the percentage of physicians reporting at least one symptom of burnout, from 45.5% to 54.4%. Loss of autonomy, increasing demands of time and energy, insurance hassles, and the ever-present “electronization” of medicine have intruded into the once sacred bond between doctor and patient. In fact, a recent physician survey noted that the top three causes of burnout were too many bureaucratic tasks, followed by too many work hours and increasing computerization. Most physicians were drawn to the medical vocation in an effort to help others and mitigate suffering. To most, the call to medicine was indeed a vocation, not a profession. The word vocation is derived from the Latin word vocatio, “a call.” When one answers a “calling,” fulfllment and satisfaction follow—that is, when one is empowered to actualize the “calling” through enactment of one’s passion and enthusiasm.

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Person-Centred Practice in Nursing and Health Care

Since publishing Person-Centred Nursing: Theory and Practice (McCormack & McCance 2010) the field of person-centredness in health care has grown significantly. In that short 5-year period, we have seen a burgeoning of interest in the topic, the development of a range of initiatives to promote person-centredness,
and an increased volume of research exploring, understanding and evaluating person-centred practices. Person-centred care has a long association with nursing, with a focus on treating people as individuals; respecting their rights as a person; building mutual trust and understanding; and developing therapeutic relationships. However, this has now become a more inclusive health-care philosophy and strategic focus. It is for this reason that we have adopted a more broad-based health-care perspective in this book. The promotion of ‘person-centredness’ is consistent with health-care policy direction internationally. There have been a number of challenges to the focus on person-centredness in nursing and health care and a view that other approaches such as relationship-centred care, compassionate care and even dignified care are more appropriate frameworks for expressing an inclusive family and community approach to what can generally be understood as holistic care practices. However, none of these have stood the test of time as ‘alternatives’ but instead are increasingly seen as components of person-centred nursing and health care, or as constructs that explain different dimensions of person-centredness. This goes some way to affirming the importance of person-centred approaches, not just as care practices in particular professional groups, but as a philosophical underpinning of health-care systems that places people at the centre.

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Gastrointestinal Pharmacology

The gastrointestinal (GI) system is responsible for the digestion and absorption of ingested food and liquids. Due to the complexity of the GI tract and the substantial volume of material that could be covered under the scope of GI physiology, this chapter briefly reviews the overall function of the GI tract, and discusses the major factors affecting GI physiology and function, including the intestinal microbiota, chronic stress, inflammation, and aging with a focus on the neural regulation of the GI tract and an emphasis on basic braingut interactions that serve to modulate the GI tract. GI diseases refer to diseases of the esophagus, stomach, small intestine, colon, and rectum. The major symptoms of common GI disorders include recurrent abdominal pain and bloating, heartburn, indigestion/dyspepsia, nausea and vomiting, diarrhea, and constipation. GI disorders rank among the most prevalent disorders, with the most common including esophageal and swallowing disorders, gastric and peptic ulcer disease, gastroparesis or delayed gastric emptying, irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD). Many GI disorders are difficult to diagnose and their symptoms are not effectively managed. Thus, basic research is required to drive the development of novel therapeutics which are urgently needed. One approach is to enhance our understanding of gut physiology and pathophysiology especially as it relates to gut-brain communications since they have clinical relevance to a number of GI complaints and represent a therapeutic target for the treatment of conditions including inflammatory diseases of the GI tract such as IBD and functional gut disorders such as IBS.

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Neuroblastoma: The Clinical Aspects

Neuroblastoma is a predominantly pediatric cancer, arising from the primordial neural crest cells that form the sympathetic nervous system. The prognosis for patients with neuroblastoma can vary from uniform survival in low risk patients to fatality in patients with high risk disease. This chapter gives a brief overview of the epidemiology, genetics, clinical presentation, diagnosis, and discussion of the various staging systems and risk classifcations of neuroblastoma. We also briefly describe our understanding of the conventional and novel treatment modalities available and their effects on the current prognosis of patients with neuroblastoma. The purpose of this chapter is to serve as a brief overview of the clinical aspects of neuroblastoma, to serve as a foundation of knowledge for scientists aspiring to develop new therapeutic modalities for this dreadful pediatric disease.

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Trauma, Resilience, and Health Promotion in LGBT Patients

In the last four decades, lesbian, gay, bisexual, and transgender (LGBT) people have made significant progress in gaining social acceptance and securing legal rights in many parts of the world. Same-sex sexual and gender-nonconforming behavior used to be considered morally, pathologically, and legally aberrant throughout the world, but LGBT identities are now increasingly affirmed and celebrated in many countries. However, the trauma that LGBT people have experienced throughout history remains part of their shared identity. Moreover, even in relatively accepting parts of the world (e.g., North America, Western Europe), LGBT people continue to encounter verbal abuse, physical and sexual victimization, and structural oppression . The increased risk of experiencing such events results in a “fundamental ecological threat,” forcing sexual and gender minorities to choose between expressing their authentic selves or the identities validated by society [2, p246]. Constant exposure to marginalization and the frequent fear of victimization contribute to unrelenting vigilance that may ultimately become integrally linked to identity. The primary aim of this chapter is to describe the intersection of trauma and identity among LGBT people. First, we will review diagnostic criteria for posttraumatic stress disorder (PTSD) and then discuss how current conceptualizations of trauma overlook associations between non-traumatic events and PTSD-like disorder.

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Translational Informatics in Smart Healthcare

The past decade has witnessed great advances in biomedical informatics. Biomedical informatics is an emerging field of healthcare that aims to translate the laboratory observation into clinical practice. Smart healthcare has also developed rapidly with ubiquitous sensor and communication technologies. It is able to capture the online patient-centric phenotypic variables, thus providing a rich information base for translational biomedical informatics. Biomedical informatics and smart healthcare represent two interrelated disciplines. On one hand, biomedical informatics translates the bench discoveries into bedside, and, on the other hand, it is reciprocally informed by clinical data generated from smart healthcare. In this chapter, we will introduce the major strategies and challenges in the application of biomedical informatics technology in precision medicine and healthcare. We highlight how the informatics technology will promote the precision medicine and therefore promise the improvement of healthcare.

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