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Poor sexual health is now a major public health issue in the UK, with all four countries having a sexual health strategy, strategic framework or action plan in place. The Government in England wishes to improve sexual health services, with a focus on improving access. All over the country nurses are working in new and innovative ways in sexual and reproductive health. Many are working in advanced and specialist clinical roles as independent practitioners and more creative posts are being developed in the National Health Service to maximise optimum use of nurses’ skills. Several Nurse Consultant posts have now been developed in the speciality of Genito Urinary Medicine (GUM). With this important public health agenda in mind, this book provides a valuable resource for nurses working towards, and at, advanced level in GUM, but the content is also transferable and relevant to nurses working in non-acute settings. This book also provides a skill base for more junior nurses in...

This book is centrally concerned with the formal management of preoperative anxiety. The vast majority of patients experience varying degrees of anxiety when entering hospital for surgery and yet little formal intervention is commonly provided. This is the first book of its kind to be written for nurses exclusively concerning the complete formal pre- and postoperative management of anxiety in relation to modern, elective, adult day surgery. During the early 1970s classic nursing studies suggested information provision to be crucial for effective inpatient preoperative anxiety management. However, following such early recommendations no other formal aspects of psychoeducational care have impacted on mainstream surgical nursing intervention. Physical aspects of care have dominated proceedings for the last three decades or more, whereas psychoeducational aspects have largely remained informal, marginal issues. Both surgery and anaesthesia have changed dramatically during thi...

As in the first edition, we have included relevant information about Gender and Life Span Considerations, and have enhanced this section with information about racial and ethnic differences in health and disease. As our society has an ever-increasing diversity, we have developed this section so that practitioners have a basis from which to develop culturally competent care. Each entry begins with the Diagnosis Related Group (DRG) category. DRGs were initiated by the Health Care Financing Administration to serve as an organizing framework to grouprelated conditions and to stabilize reimbursements. Because they provide a convenient standard to evaluate hospital care, DRGs are used by institutions and disciplines to measure utilization and to allocate resources. We have included DRGs to indicate the expected norms in average length of stay for each entry. Each entry follows the nursing process, with assessment information incorporated in the History and Physical Assessment sections, the...

Unit I, Nursing’s Perspective: Past, Present and Future, explores many aspects that are essential to nursing. A historical overview of early leaders and social forces that have influenced the development of nursing practice is provided. The theoretical frameworks for guiding professional practice and the significance of incorporating research into nursing practice are emphasized. The evolution of our current health care delivery system is discussed with attention given to proposals for change. Unit II, Nursing Process, The Standard of Care, explains each component of the nursing process. The nursing process is the framework for delivering holistic care in an organized scientific manner. A chapter on critical thinking leads the unit discussion of the five phases of the nursing process. Unit III, The Therapeutic Nature of Nursing, discusses the caring nature of nursing as demonstrated through therapeutic communication and actions. Nursing, by definition and purpose, is a therapeutic pr...

Vascular disease is a pathological state of large and medium sized muscular arteries and is triggered by endothelial cell dysfunction. Because of factors like pathogens, oxidized LDL particles and other inflammatory stimuli endothelial cells become activated. This leads to change in their characteristics: endothelial cells start to excrete cytokines and chemokinesand express adhesion molecules on their surface. This in turn results in recruitment of white blood cells (monocytes and lymphocytes), which can infiltrate the blood vessel wall. Stimulation of smooth muscle cell layer with cytokines produced by endothelial cells and recruited white blood cells causes smooth muscle cells to proliferate and migrate towards the blood vessel lumen. The process causes thickening of the vessel wall, forming a plaque consisting of proliferating smooth muscle cells, macrophages and various types oflymphocytes. This plaque result in obstructed blood flow leading to diminished amounts of oxygen and nu...

It is important to appreciate that assessment is fundamental to all procedures that a patient may undergo. It does not happen just once but is an ongoing process repeated at regular intervals depending on the patient’s condition. The most usual time for a thorough assessment to occur is when a patient is admitted to acute or continuing care, but there may be other times when further detailed assessment is necessary. Assessing a patient involves both formal and informal assessment. Formal assessment includes the gathering of objective information about the patient’s condition by interviewing him or her and obtaining answers to questions. Informal assessment includes the things that you notice about a patient while you are talking to them, and may include physical signs and subjective information such as their mood or behaviour. The structure of these assessments will be discussed in more detail in this chapter. Assessment of physical vital signs is also undertaken and these are desc...

The purpose of this book remains what it was in the first seven editions: to present the fundamental principles and facts of human physiology in a format that is suitable for undergraduate students, regardless of academic backgrounds or fields of study: liberal arts,biology, nursing, pharmacy, or other allied health professions. The book is also suitable for dental students,and many medical students have also used previous editions to lay the foundation for the more detailed coverage they receive in their courses. The most significant feature of this book is its clear,up-to-date, accurate explanations of mechanisms,rather than the mere description of facts and events. Because there are no limits to what can be covered in an introductory text, it is essential to reinforce over and over, through clear explanations, that physiology can be understood in terms of basic themes and principles. As evidenced by the very large number of flow diagrams employed, the book emphasizes underst...

The area of treatment of sexual disorders has undergone an enormous expansion during the last few decades. The introduction of pharmacological treatment of these disorders (e.g., sildenafil for erectile dysfunction or antidepressants for paraphilias) rekindled the interest of physicians from different disciplines (psychiatrists, urologists, gynecologists) in sexual dysfunctions. Physicians are finding these disorders amenable to pharmacotherapy. However, the new developments in the area of “sexual pharmacology” have unfortunately also led to a biological reductionism in the field. In the past, most physicians viewed the etiology of sexual dysfunctions/disorders as mainly psychological, rooted in internal conflicts, deep-seated anxiety, and so on. In the present time, physicians in many disciplines view sexual dysfunctions as mostly, if not purely, of biological origin and discard any notion of psychological factors in the etiology of sexual problems. The initial hype about the su...

This book was written to introduce “the world of the soybean” with respect to its myriad health benefits. A number of excellent review articles and books are available that cover the nutritional and physiological functions of soybean and its products. The editor is, however, not aware of a book in English devoted to the study of soybean, written fully or mostly by Japanese. As many varieties of soybean products have been consumed for many years in East Asia, much knowledge has accumulated there documenting the health benefits of these products. Japan may be the most experienced country in the use of soybean for fermented foods. Advances in analytical methodologies have disclosed the full details of the chemical composition of soybean, and most soybean ingredients exert diverse physiological functions. Numerous Japanese researchers have been working for many years in every aspect of soybeans, and the Fuji Foundation for Protein Research has been established to support these studies. As...

Diabetes mellitus is a disease that was recognized in antiquity. Polyuric states resembling diabetes mellitus were described as early as 1550 BC in the ancient Egyptian papyrus discovered by George Ebers (1). The term ‘diabetes’, which is from the Ionian Greek meaning ‘to pass through‘, was first used by Aretaeus of Cappadocia in the second century AD as a generic description of conditions causing increased urine output (2). The association of polyuria with a sweet-tasting substance in the urine was noted in the fifth to sixth century AD by two Indian physicians, Susruta and Charuka (1,2). The urine of certain polyuric patients was described as tasting like honey, sticky to the touch and attracting ants. Two forms of diabetes could be distinguished in the Indians’ descriptions: one affected older, fatter people and the other thin people who did not survive long; this strongly reminds us the present clinical description of Type 2 and Type 1 diabetes. The term diabetes mellitus, an all...

Dengue fever (DF) is an old disease; the fi rst record of a clinically compatible disease being recorded in a Chinese medical encyclopaedia in 992. As the global ship- ping industry expanded in the 18th and 19th centuries, port cities grew and became more urbanized, creating ideal conditions for the principal mosquito vector, Aedes aeg ypti. Both the mosquitoes and the viruses were thus spread to new geographic areas causing major epidemics. Because dispersal was by sailing ship, however, there were long intervals (10–40 years) between epidemics. In the aftermath of World War II, rapid urbanization in Southeast Asia led to increased transmission and hyperendemicity. The fi rst major epidemics of the severe and fatal form of disease, dengue haemorrhagic fever (DHF), occurred in Southeast Asia as a direct result of this changing ecology. In the last 25 years of the 20th century, a dramatic global geographic expansion of epidemic DF/DHF occurred, facilitated by unplanned urbani...

The term “metabolic syndrome” denotes a clustering of traditional and emerging risk factors for atherothrombotic cardiovascular disease. Moreover, individuals who satisfy the current diagnostic criteria that define the syndrome are also at substantially increased risk of developing Type 2 diabetes—itself a coronary heart disease risk equivalent. Central obesity and insulin resistance are core features of the syndrome, which has come to be recognized as a major global threat to vascular health in the 21st century. The time is optimal for a textbook dedicated to this important issue. The metabolic syndrome has adverse implications for many aspects of vascular function ranging from endothelial function, the microvascular tree, medium-sized arteries, and large conduit vessels. Furthermore, gathering evidence suggests that interactions between small and large vessel disease may be more important than perhaps has previously been appreciated. There are fears that the successes in reducing...

The first edition of Brunner & Suddarth’s Textbook of Medical-Surgical Nursing was published in 1964 under the leadership of Lillian Sholtis Brunner and Doris Smith Suddarth. Lillian and Doris pioneered a medical-surgical nursing textbook that has become a classic. Medical-surgical nursing has come a long way since 1964 but continues to be strongly influenced by the expansion of science, medicine, surgery, and technology, as well as a myriad of social, cultural, economic, and environmental changes throughout the world. Nurses must be particularly skilled in critical thinking and clinical decision-making as well as in consulting and collaborating with other members of the multidisciplinary health care team. Along with the challenges that today’s nurses confront, there are many opportunities to provide skilled, compassionate nursing care in a variety of health care settings, for patients in the various stages of illness, and for patients across the age continuum. At the same time, ...

Infectious diseases, also known as transmissible diseases or communicable diseases comprise clinically evident illness (i.e., characteristic medical signs and/or symptoms of disease) resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism. In certain cases, infectious diseases may be asymptomatic for much or even all of their course in a given host. In the latter case, the disease may only be defined as a "disease" (which by definition means an illness) in hosts who secondarily become ill after contact with an asymptomatic carrier. An infection is not synonymous with an infectious disease, as some infections do not cause illness in a host. Infectious pathogens include some viruses, bacteria, fungi, protozoa, multicellular parasites, and aberrant proteins known as prions. These pathogens are the cause of disease epidemics, in the sense that without the pathogen, no infectious epidemic occurs. The term infectivity describ...

An ECG is a way to measure and diagnose abnormal rhythms of the heart, particularly abnormal rhythms caused by damage to the conductive tissue that carries electrical signals, or abnormal rhythms caused by electrolyte imbalances. In a myocardial infarction (MI), the ECG can identify if the heart muscle has been damaged in specific areas, though not all areas of the heart are covered. The ECG cannot reliably measure the pumping ability of the heart, for which ultrasound-based (echocardiography) or nuclear medicine tests are used. It is possible for a human or other animal to be in cardiac arrest, but still have a normal ECG signal (a condition known as pulseless electrical activity). The ECG device detects and amplifies the tiny electrical changes on the skin that are caused when the heart muscle depolarizes during each heartbeat. At rest, each heart muscle cell has a negative charge, called the membrane potential, across its cell membrane. Decreasing this negative charge towards zero, ...

Asthma (from the Greek ἅσθμα, ásthma, "panting") is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Common symptoms include wheezing, coughing, chest tightness, and shortness of breath.Asthma is thought to be caused by a combination of genetic and environmental factors. Its diagnosis is usually based on the pattern of symptoms, response to therapy over time, and spirometry. It is clinically classified according to the frequency of symptoms, forced expiratory volume in one second (FEV1), and peak expiratory flow rate. Asthma may also be classified as atopic (extrinsic) or non-atopic (intrinsic) where atopy refers to a predisposition toward developing type 1 hypersensitivity reactions. Treatment of acute symptoms is usually with an inhaled short-acting beta-2 agonist (such as salbutamol) and oral corticosteroids. In very severe cases intravenous corticosteroids, magnesium su...

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems.People are considered obese when their body mass index (BMI), a measurement obtained by dividing a person's weight in kilograms by the square of the person's height in metres, exceeds 30 kg/m2.Obesity increases the likelihood of various diseases, particularly heart disease, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis.Obesity is most commonly caused by a combination of excessive food energy intake, lack of physical activity, and genetic susceptibility, although a few cases are caused primarily by genes, endocrine disorders, medications or psychiatric illness. Evidence to support the view that some obese people eat little yet gain weight due to a slow metabolism is limited; on average obese people have a greater energy expenditure than their ...

The aim of the third edition of the ABC of Breast Diseases is to provide an up to date, concise, well illustrated, and evidence based text that will meet the dual challenges of mana ging the increasing numbers of women who attend breast clinics and the increasing numbers of women who are diagnosed with breast cancer. This edition contains many new illustrations and diagrams. The chapters on screening, adjuvant therapy, clinical trials, and prognostic factors have been completely rewritten, and all other chapters have been extensively revised. The topics of adjuvant therapy and metastatic breast cancer have been extended to cover the explosion of results gained from the many multinational breast cancer trials which have reported since the last edition of this ABC was published. New authors have added their work to that of those who have already contributed to the success of the book. Thanks to Jan Mauritzen my PA who has coordinated the many revisions, to Eleanor Lines. Commissioning...

Patient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events. The frequency and magnitude of avoidable adverse patient events was not well known until the 1990s, when multiple countries reported staggering numbers of patients harmed and killed by medical errors. Recognizing that healthcare errors impact 1 in every 10 patients around the world, the World Health Organization calls patient safety an endemic concern.Indeed, patient safety has emerged as a distinct healthcare discipline supported by an immature yet developing scientific framework. There is a significant transdisciplinary body of theoretical and research literature that informs the science of patient safety.The resulting patient safety knowledge continually informs improvement efforts such as: applying lessons learned from business and industry, adopting innovative technologies, educating providers and consumers, enhancing...

This is an exciting and challenging time for wound care clinicians as a new understanding of the biology of  healing wounds has given rise to many new wound care treatments and therapies. Although we are gaining new knowledge as to the biology of wound healing, “we can no longer care only for the wound itself; we must step back and look at the entire human being who happens to have a wound that needs healing. ”1 Being able to differentiate among the various treatment options, when and how to apply them, in what combinations, and when to change them has indeed become both an art and a science. “With the emergence of more complex products, we will be increasingly required to use these products ppropriately to maximize their impact. As a better understanding of the wound environment becomes available, our ability to tailor our approach and better treat the patient as a whole increases.” Providing quality care for your wound patients starts with an analysis of the patient’s indivi...