General practitioners and nurses working in a variety of settings have no control over the type of problems that patients present. Whether they want to deal with sexual abuse or not is irrelevant: sooner or later they will be presented with the problem by a patient who will assume that both their physical problems and their distress may be discussed with a practitioner of medicine or nursing.;It is only recently that doctors have become familiar with the concept that sexual abuse may be an important factor in almost any complaint.;Dr Wakley has written sensitively about the problems of those confused and distressed by sexual abuse and of the responses of those who pick up the unspoken and spoken clues. Some patients may need to be referred to ther specialists but others can be successfully treated over a short period of time in their own general practice.;This is not comfortable reading. Dr Wakley discusses problems that evoke an uneasy response. At the same time, the practitioner is helped to acquire knowledge and develop new skills to extend the scope of medical care.

The cost of malpractice insurance to physicians has been increasing in recent years, as has the threat to physicians of being sued. This book describes and analyzes the workings of the market for physicians' liability insurance. The authors use their own data and other sources to study questions such as: Is the market for medical malpractice insurance competitive? Has the profitability of medical malpractice insurance been excessive? Why do malpractice insurers demand reinsurance? What effect has insurance regulation had on premiums? And it explores what experience rating is and how it is done.

General Practice is undergoing the most major series of changes since the introduction of the National Health Service in 1948. They concern both concepts of care and practical details of the way care is delivered. In spite of the hostility generated by the changes most of the broad general concepts have been accepted. The principle of patients having more choice is widely sup ported, the inclusion of preventive medicine and antici patory care in the responsibilities of practice has few opponents, the introduction of audit as a way of im proving performance has been generally welcomed. Even the idea of putting GPs in better financial management of patients and drug budgets has had supporters in prin ciple. The antipathy has generally related to the method of introduction of these changes. One important con cern has been the time requirements of the New Con tract and the feeling that these will erode the real nature of our work: the close personal relationship with pa tients. If we improve the quality of our management this is less likely to happen. We shall be able to work within the New Contract and retain the quality of service we pro vide. If we improve the understanding of our staff of what we are trying to achieve we are more likely to reach the targets that we set whilst keeping people happy. vii This book sets out to explain the New Contract."

Choosing Your Practice is a practical guide for physicians who are making the transition from training to private practice or from one practice to another. The author, a clinician as well as a manager of medical services, offers his colleagues guidance on conducting an intelligent search for the practice, community, and associates that are best for them. Useful strategies also are given for evaluating offers and negotiating agreements with prospective associates.

General Practice is undergoing the most major series of changes since the introduction of the National Health Service in 1948. They concern both concepts of care and practical details of the way care is delivered. In spite of the hostility generated by the changes most of the broad general concepts have been accepted. The principle of patients having more choice is widely sup ported, the inclusion of preventive medicine and antici patory care in the responsibilities of practice has few opponents, the introduction of audit as a way of im proving performance has been generally welcomed. Even the idea of putting GPs in better financial management of patients and drug budgets has had supporters in prin ciple. The antipathy has generally related to the method of introduction of these changes. One important con cern has been the time requirements of the New Con tract and the feeling that these will erode the real nature of our work: the close personal relationship with pa tients. If we improve the quality of our management this is less likely to happen. We shall be able to work within the New Contract and retain the quality of service we pro vide. If we improve the understanding of our staff of what we are trying to achieve we are more likely to reach the targets that we set whilst keeping people happy. vii This book sets out to explain the New Contract."

Neurological Disorders is the latest and fifth monograph in the series on management and treatment in major clinical specialties or patient groups. Each book is complete in'its own right and has been prepared by practising physicians with an interest in treatment and management, together with scientists involved in clinical research. The volumes are intended to fill a gap between standard textbooks of medicine and therapeutics and research reviews, symposia and original articles in superspecialist fields. It is the aim of the series to give authoritative up-to-date advice on treatment and management which will be of use to both specialists and nonspecialists and to allow recent advances in pathophysiol ogy and developments in treatment to be viewed in the context of contemporary clinical practice. The approach is intentionally by the minimum number didactic. Each volume has been written of authors to ensure a degree of continuity and uniformity of style. The first four volumes dealt respectively with gastrointestinal diseases, rheumatic diseases, treatment in the elderly and car diovascular disease. The present volume covers neurological diseases. Chapter 1 is an introduction to drugs and the nervous system. It reviews the chemical basis of neurotransmission and mechanisms of drug action in neurological disease. There follows a series of chapters discussing patient management in general and drug treatment in particular in common neurological problems presen ting in general medical practice. These include headache, cerebral vascular disease, epilepsy and the movement disorders."

Bewahrt als Standardwerk fur Kinder- und Jugendarzte in Klinik und Praxis, prasentiert die 5. Auflage luckenlos das gesamte aktuelle Wissen der Padiatrie in zwei Banden. Der Erfahrungsschatz des erweiterten Herausgeberteams und der uber 300 renommierten Autoren sorgt fur exzellente didaktische und inhaltliche Qualitat des Buches. In dem mehrbandigen Werk sind in uber 350 Kapiteln alle organspezifischen Erkrankungen bis hin zu seltenen Krankheiten nach aktuellen Behandlungsleitlinien ubersichtlich, pragnant und klar beschrieben. Eingangige UEbersichten und instruktive Abbildungen machen das Werk anschaulich. Knappe Literaturangaben geben am Ende jedes Kapitels die wichtigsten UEbersichtsarbeiten zu jedem der padiatrischen Themen und Spezialgebiete an. Die letzte Sektion widmet sich der Arzneimitteltherapie bei Kindern und bietet unter anderem ein Kapitel zur padiatrischen Labordiagnostik und eine UEbersicht uber die Interaktion von Arzneimitteln in der Kinder- und Jugendmedizin.

One of the paradoxes of general practice is that we emphasize on the one hand how important it is that the general practitioner learns to tolerate uncertainty, and then regret on the other hand that so few general practitioners research the uncertainties they find in their every day work. In the first chapter of my first edition of this book I suggested that general practitioners were missing opportunities to take part in a fascinating and rewarding professional activity because of an unnecessary fear of the unknown, and tried to encourage more to try research for themselves. There has been an impressive increase in what has been asked about, researched and written about in the last decade and this second edition tries to bring up to date the advice I think may help others to become involved in research for themselves. The basic principles of good research are of course timeless and apply to enquiry in any discipline. However, detail changes; there are new aids to reviewing literature, the increased emphasis in social science research has been matched by a range of new methods of collecting information, computers have revolutionized how data is handled and statistics is an ever-developing science in its own right. The chapters in this book which describe what can be referred to as the technology of the research process have been revised to reflect the impact of these recent developments rather than re-written.

Backing up the pioneering medical researchers and experi menters are the phalanxes and cohorts of practising clinicians in district general hospitals and in general practice who may have to implement and apply any breakthroughs and advances in practical and realistic terms. This they cannot, and should not, be expected to do without careful consideration and analysis. It is essential, therefore, to have regular reviews of the growing points of medicine which are constructively critical as well as being enthusiastic and which can present the issues and implications clearly and fairly to clinicians. The Practical Clinical Medicine series is designed to provide such regular reviews on selected subjects. Each volume is under the charge of an invited editor who selects his team of 4-6 experts. Each contribution is an authoritative, detailed and referenced examination of his topic, is clearly presented in an understandable manner and is practical, relevant and applic able to everyday clinical practice. The series is intended as a means of communication between researchers and practising clinicians. It is dedicated to gener alists who provide primary health care in general practice and to generalists providing secondary medical care in district vii viii Series Editors' Foreword general hospitals. Both are involved in applying good general practical clinical medicine for their patients, but can only succeed in a climate of constant review and examination."

Schizophrenia is one of the most traumatic psychiatric disorders, both for the affected person and their family. It also carries an unfortunate stigma and suffers from frequent misinterpretation by the popular media. The disorder usually manifests itself through significant periods of hallucinations, bizarre delusions, and disorganized behaviour, but the individuals who suffer from this brain disorder are not generally violent, and do have periods of remission. However it is often difficult for these individuals to maintain a regular lifestyle and relationships at home and at work, and many individuals with schizophrenia end up unable to live independently or, worse, homeless. This new edition in the popular Facts series provides a concise and up-to-date account of the underlying causes and symptoms of schizophrenia, as well as current theories about the disorder. The authors look at all the current treatment options, both medical and psychological, together with likely side-effects and the problem of compliance with treatment. The role of the family and the community in caring for individuals with schizophrenia is also considered. The authors are experienced psychiatrists and psychologists with many years' experience in the treatment and study of schizophrenia. This book will provide a welcome source of information for individuals with schizophrenia, their family members, and those involved in caring for them.

This sixth edition of the Oxford Textbook of Palliative Medicine takes us now into the third decade for this definitive award-winning textbook. It has been rigorously updated to offer a truly global perspective, highlighting the best current evidence-based practices, and collective wisdom from more than 200 experts around the world. This leading textbook covers all the new and emerging topics, updated and restructured to reflect major developments in the increasingly widespread acceptance of palliative medicine as a fundamental public health need. The sixth edition includes new sections devoted to family and caregiver issues, cardio-respiratory symptoms and disorders, and genitourinary symptoms and disorders. In addition, the multi-disciplinary nature of palliative care is emphasized throughout the textbook, covering areas from ethical and communication issues, the treatment of symptoms, and the management of pain. The Oxford Textbook of Palliative Medicine is a truly comprehensive text. No hospital, hospice, palliative care service, or medical library should be without this essential source of information. This sixth edition of the Oxford Textbook of Palliative Medicine is dedicated to the memory of Professor Kenneth Fearon husband of Professor Marie Fallon and a surgeon who became a world leader in the research and management of anorexia and cachexia. He modeled a work-life balance that is so critical in our field, with devotion to both his patients and his family.

'Cardiovascular Disease' is the fourth monograph in the series on management and treatment in major clinical sub specialties or patient groups. Each book is complete in its own right and has been prepared by practising physicians with specialist experience and a particular interest in treatment and management. The series has been prepared to fill a gap between standard textbooks of medicine and therapeutics and research reviews, symposia and original articles in specialist fields. The volumes aim to give authoritative, up-to-date advice on treatment and management which will be of use to both specialists and non-specialists and allow recent advances and developments to be seen in the context of contemporary clinical practice. The first three volumes dealt respectively with gastroin testinal diseases, rheumatic diseases and treatment in the elderly. Cardiovascular disease covers the range of common diseases affect ing the heart and the circulation. In view of the importance of coronary heart disease as a cause of death and morbidity a substan tial part of the book is devoted to description of the factors asso ciated with coronary artery disease (hyperlipidaemia and hypertension) and their management by drug and non-drug means. A further five chapters are devoted to the clinical syndromes asso ciated with coronary heart disease and their management. These not only consider acute 'in hospital' management, including sur gery, but also address epidemiological questions, including approaches to secondary prevention of myocardial infarction."

A patient's job is to tell the physician what hurts, and the physician's job is to fix it. But how does the physician know what is wrong? What becomes of the patient's story when the patient becomes a case? Addressing readers on both sides of the patient-physician encounter, Kathryn Hunter looks at medicine as an art that relies heavily on telling and interpreting a story--the patient's story of illness and its symptoms.

There are many textbooks which give detailed descriptions of the causes, clinical features and treatment of disease. There are a number of books devoted to clinical methodo logy which tell the student the questions which he must ask and describe the physical signs that he should seek. The authors of these books rarely devote more than a page or two to a job description and advice on how to acquire clinical skills. Although a sound knowledge of the facts is essential, a good doctor differs from a bad doctor more by his attitude and craftsmanship than by his knowledge. These important matters receive scant attention in the textbooks because the authors regard them as part of the spoken tradition which is taught at the bedside or in the clinics and is absorbed by watching clinicians while they are dealing with patients. The image of the doctor who greets patients with his pen poised over a prescription pad, and the calls for holistic medicine, imply that a number of students do not pick up the relevant attitudes and skills on the way. That this feeling is shared by the profession itself is suggested by the forma tion of a society to promote the treatment of the whole patient, and another for the promotion of humanism in cardiology. Good doctors have been treating the whole patient humanely since the profession was founded, and I find it shocking that it is thought that such societies are necessary."

This book is about four ways of using the consultation in primary health care. One ofthem is very familiar, the other three a little less so. But they should all be as much a part of the repertoire of doctor or nurse as examining some system of the body or relieving pain and discomfort. If each is not used when appropriate, the full potential of the consultation is not achieved. This is the practical message of the book. Simultaneously it is concerned with the more theoretical problems of clarifying the role of the generalist in contemporary medicine and of relating it to the wider world of people's day-to-day lives and decisions and to their interest in seeking health for their children and themselves. Is primary care too broad and general to be manageable? Is it a pot-pourri derived from other disciplines or is it distinct? If distinct, exactly how does it differ and can its principles be stated in a clear and practical way? How can it respond effectively to people's wants and needs? The same four uses of the consultation, presented in a diagram which can be easily remembered, serve as a simple map for outlining the role of the doctor or nurse in primary care. The details of the map are filled in with clinical anecdotes and copious reference to studies from all over the world.

In the sixth edition of this work John Fry has reverted to the format of the earlier editions published in 1965, 1970 and 1973 and has presented statistical data drawn widely from many sources. General practice in the United Kingdom and elsewhere throughout the world has undergone many changes in the past decade. This new edition brings the available statistical informa tion up to date and indicates the way ahead. General practice, the College and the National Health Service have been closely linked in effecting change. The membership of the College con tinues to grow and its influence in changing the face of general practice in the United Kingdom is significant. John Fry's new book presents that characteristic blend of fact and personal opinion which was so successful in earlier editions and so valuable to general practice and others in primary health care. Once again he has shown what can be achieved by one man based on his own work and those of others in general practice. John Lawson RCGP, 1983 President of the Royal College of General Practitioners vi Preface The Present State and Future Needs series had its roots in the dark days of the early 1960s when morale in general practice was low and when numbers of new entrants were actually going down. They were the days of mass emigration of doctors from Britain and the National Health Service. The fourth and fifth editions were entitled Trends in General Practice (1977 and 1979)."

Designed for quick reference, Algorithmic Diagnosis of Symptoms and Signs: A Cost-Effective Approach equips you to effectively interpret more than 230 of the most common symptoms and signs. The ideal aid for the busy clinician, this handy, portable resource promotes a cost-effective patient workup, explaining which diagnostic tests are most appropriate (and when such tests are not indicated). Comprehensive updates throughout put the very latest diagnostic approaches at your fingertips. Features: Evaluate patients efficiently using clear, step-by-step algorithms that spell out what to look for, what tests to order, what differentials to consider, and when to refer to a specialist. Master essential clinical skills with a new section on "Getting the most out of your history and physical examination." Effectively evaluate more conditions through new algorithms for various symptoms and laboratory tests, including algorithms representing diseases that are symptoms of other diseases. Recognize diagnostic alternatives at a glance thanks to differential diagnostic tables. Your book purchase includes a complimentary download of the enhanced eBook for iOS, Android, PC & Mac. Take advantage of these practical features that will improve your eBook experience: The ability to download the eBook on multiple devices at one time - providing a seamless reading experience online or offline Powerful search tools and smart navigation cross-links that allow you to search within this book, or across your entire library of VitalSource eBooks Multiple viewing options that enable you to scale images and text to any size without losing page clarity as well as responsive design The ability to highlight text and add notes with one click

Psychosomatic Medicine (PM) is a rapidly developing subspecialty of psychiatry focusing on psychiatric care of patients with other medical disorders. PM specialists diagnose and manage psychiatric symptoms in a variety of medical settings, optimize their patients' medical care, and expand understanding regarding the role of psychological factors in health and disease. Dr. Kurt Ackerman and Dr. Andrea DiMartini presernt Psychosomatic Medicine , portable handbook geared to helping psychiatric and other medical practitioners and trainees to stay current in their understanding of the practice of psychosomatic medicine. Drawing practical techniques and wisdom from their team of contributors, Psychosomatic Medicine provides readers with historical background, key clinical information and guidelines, readily accessible charts and tables, exercises to aid in self-assestment, and suggestions for further reading to spark additional learning in this rapidly developing field of psychiatry.

The past few years have witnessed the emergence of steroid hormones as the wonder molecules which generate as much discussion in the scientific literature as they do in a typical living room. This transition has been a result of the tremendous public and scientific interest in the normal functioning of the hor mones as well their suggested involvement in several clinical conditions. In the recent past, notable scientific and technological advances have been made in the areas of contraception and regulation of fertility. Steroid receptors are the indis pensable mediators of hormonal responses and are complex protein molecules which appear to exist in association with other, yet undefined, proteins and/or factors. Receptors for vitamin D, retinoic acid and the thyroid hormones share structural similarities with steroid receptors, and the roster of this superfamily is still expanding. While our knowledge of the diversity and magnitude of steroid effects has advanced, the precise mode of steroid hormone action has alluded investigators. This volume brings together an international team of prominent investigators who discuss their most recent work on the basic and clinical aspects of steroid/nuclear receptors. The contributions represent updated versions of the invited presentations made at The Second Meadow Brook Conference on Steroid Receptors in Health and Disease. I am grateful to my colleagues on the Scientific Committee: Etienne Baulieu, Jack Gorski, Benita Katzenellenbogen, David Toft and James WittJiff, who provided the vision and guidance in formulating an out standing program."

Als Schmerzpatient mussen Sie ggf. regelmassig Schmerzmedikamente einnehmen, um den Alltag bewaltigen zu koennen. Dieser Ratgeber erklart verstandlich die Wirkungsweise und die moeglichen Risiken der verschiedenen Substanzen, wie sie richtig eingesetzt werden und welche Nebenwirkungen auftreten koennen. Der Leser erhalt auf praktische Fragen klare Antworten, z.B.: Welche Tatigkeiten darf ich unter Schmerzmitteln ausuben, darf ich Maschinen bedienen oder Auto fahren? Sind Schmerzmittel in der Schwangerschaft und Stillzeit erlaubt? Wie lange durfen Schmerzmittel eingenommen werden? Die Autoren sind AErzte und Experten auf dem Gebiet der Schmerzmedizin und kennen die Sorgen und Fragen von Patienten. Sie wenden sich an alle, die Schmerzmedikamente verschrieben bekommen haben oder rezeptfrei verkaufliche Schmerzmedikamente einnehmen.

Qualifizierte Diagnostik des Urinsediments! Dieses Lehrbuch vermittelt umfassend in Theorie und Praxis die qualifizierte Diagnostik des Urinsediments. Es erklart die Grundlagen der Urinsedimentdiagnostik und gibt daruber hinaus auch versierten Untersuchern zahlreiche Tipps. Exzellente Digitalfotografien in der Hellfeld- und Phasenkontrast-Mikroskopie zeigen eindeutig alle morphologischen Merkmale und unterstutzen das sichere Erkennen und Differenzieren der Bestandteile des Urinsediments. Fur Nephrologen, Urologen, Gynakologen, Internisten, Allgemeinmediziner, Studierende der Medizin, MTLAs und medizinisches Fachpersonal. Die 3. Auflage wurde umfassend aktualisiert, einige Kapitel ganzlich erneuert und durch zahlreiche neue hochaufloesenden mikroskopischen Aufnahmen als auch durch Kurzvideos als Zusatzmaterial erweitert.