This comprehensive text on the pharmacological, medical, and legal aspects of drug abuse has been thoroughly updated for the Fourth Edition, and a new chapter on club drugs added. The chapter on medical effects was completely rewritten to focus on infections that develop in i.v. drug abusers, and information on the international regulation of drug use was added to the chapter on drug abuse and the law. The book is written at a level appropriate for upper level undergraduate students, graduate or medical students, and drug counselors. All major drugs of abuse are covered: tobacco, opioids, central stimulants (including cocaine, amphetamine, and caffeine), alcohol and other sedatives, marijuana, club drugs (MDMA, GHB, and ketamine), hallucinogens, and volatile solvents. For each type the authors discuss history and culture, the characteristic patterns of use, subjective and physiological effects, mechanisms of pharmacological action, and toxic effects. Epidemiological aspects are discussed as well as pharmacological treatment possibilities where applicable.

Like its predecessors, this edition of FUNDAMENTALS OF FAMILY MEDICINE will present the medical student and practitioner with common clinical problems of family practice, placing special emphasis on those problems most common in the office setting. Topics such as pregnancy, labor and delivery, common problems of the elderly, headache, hypertension, urinary tract infections, osteoarthritis, HIV, anxiety disorders and athletic injuries are thoroughly reviewed and updated and include new information on drugs, as well as new case studies. The third edition will also include new discussion questions, new information on problems of the infant and child and tables describing the Folstein Minimental Status Exam and assessment of the elderly. New chapters include: The Family Physician's Role in Responding to Biological and Chemical Terrorism and Information Mastery: Evidence-Based Medicine. A unique, continuing feature of the third edition will be The Index Family paradigm, a three-generation extended family with selected illnesses. A genogram will introduce this family model and specific family members will form the basis of case presentations for discussions that follow each chapter. Useful material on clinical prevention consultations and referrals will also be updated and featured. This book -- clinical, portable and easy-to-use -- is a "must have" for all students in Family Medicine.

Violence within the family, whether directed against children, partners or elders, profoundly disturbs our notions of what the relationship between the family and the discipline of general practice should be. GPs are doctors to whole families and yet their relationships with patients are individual ones, drawing their strength from the principles of confidentiality, mutual trust and positive regard. Violence and abuse within families necessarily challenges all of these, creating a profusion of ethical, interpersonal and practical difficulties and dilemmas. At the same time the nature of general practice confers unique opportunities to deal effectively with family violence.

GPs and GP registrars will find this book an invaluable and empowering resource. It brings together a broad range of expertise and opinion from relevant specialities and disciplines and sets family violence in its historical, epidemiological and societal context. It describes in separate sections, child abuse, domestic violence and elder abuse, its presentations, diagnosis and treatment; and suggests ways forward for its prevention and early detection. It draws throughout on the experience of GPs, health visitors and social workers, providing practical safe and workable guidelines.

Family violence can present to any member of the primary care team and there is much here that will be of relevance and interest to them all.

This text is designed to enhance patient care by providing the primary care practitioner with contemporary up-to-date information on the wide variety of topics they will confront in their practice. With the rapid and wide-spread technological advances of recent years, no single aspect of medicine has become as daunting as informatics. Physicians are now confronted with a broad and enormous range and volume of information. Accessing, managing and implementing this information is a serious task.This text has a practical, reader-friendly approach that provides access to key issues. It will provide the primary care physician with the fundamentals of informatics, including electronic medical record (EMR), electronic scheduling, billing and using scientific databases.As information continues to make the rapid leap from paper to bytes, this book is essential for staying current. It shows how to most effectively implement the changes to the advantage of both the physician and patient.

This forward-looking resource shines needed light on-and offers realistic solutions for eliminating-health disparities affecting one of the most vulnerable populations: children. Its multilevel framework identifies sources of pediatric health inequities in developmental, societal, familial, financial, and service delivery contexts and sets out innovations for breaking down and addressing longstanding concerns. Plentiful opportunities are described for reducing gaps and promoting equity at various service platforms, from locally-based improvements to systemwide tech upgrades, that can be used as models for revamping larger health policy. And the authors' long-term perspective emphasizes screening, wellness care, early intervention, and prevention strategies to support young patients in the transitions between childhood, adolescence, and young adulthood. Included in this compact idea book: Disparities in child health: a review Quality of care in pediatrics and health disparities: the increasing role of quality improvement science Community health worker interventions Technology-based interventions to address pediatric health disparities Place-based strategies in promoting health equity Future directions for a solutions-based approach With its clear delineation of issues and priorities, and its workable recommendations for addressing them, Disparities in Child Health is a ready source of ideas and advocacy for practitioners and researchers in pediatrics, maternal and child health, and general practice/family medicine.

With up to 60 per cent of women experiencing both physical and emotional symptoms during the menopause, including hot flushes, mood swings and loss of libido, managing these symptoms can be a complex task. Managing the Menopause is a highly practical, evidence-based reference, covering all forms of management in detail. Providing guidance on prescribing, as well as the advantages and disadvantages of various products and therapies, particular emphasis is given to addressing concerns over the long-term complications of Menopausal Hormone Therapy (MHT) use. The book contains new chapters on nutrition, ovarian tissue cryopreservation and migraine in the menopause and previous chapters have been fully updated to inform readers of the latest research. Treatment plans are included in the text, helping clinicians to support their patients quickly and effectively. A comprehensive review of the menopause that is easily understood at all levels, this is an essential guide for clinicians.

This title focuses on the work, well-being and lives of doctors during a period of constant change and crisis in the National Health Service and of growing anxiety about levels of clinical competence and accountability. The alarming number of well-publicized 'failures' by medics - at the Royal Bristol Children's Hospital, the Kent and Canterbury Hospital, for instance, and the appalling breach of trust by Dr Harold Shipman -the Manchester General Practitioner found guilty of murdering 15 patients - has led to a Government enquiry into the accountability of the profession. All, it seems, is far from well among medics.;The text shows how GPs are responding to their changing roles in a changing society; and how such responses may be understood in a context of whole life histories as well as within the norms of medical culture. Doctors, as a profession, have tended, for many reasons, to hide behind a professional curtain in what can be a very 'male' world. Some matters - surrounding the emotional well-being of doctors - are hard for doctors to talk about in this world where, too often, they have been taught to cope, like 'good men should'. The book reveals the emotional problems doctor

Women and Exercise is an invaluable resource for all physicians, from general practitioners to specialists seeking information outside their specialty, who need up-to-date information and expert advice about women and exercise.

This volume provides innovative methods to evaluate the attainment and contributions of primary systems and practitioners. It extends the previous edition by highlighting two additional areas: equity in health services and health, and overlap between clinical medicine and public health. It provides an important basis for future directions in health policy.

Professional medicine has often been seen as a field that discriminates against women as doctors and patients. Yet women are entering medicine in increasing numbers. This 1998 book explores the position of women in the medical profession in Australia and the UK, asking the key question 'Do women doctors make a difference?' Based on an extensive survey of general practitioners and specialists, the book evokes the culture of contemporary medicine by describing the experiences of doctors themselves, often in their own words. Pringle employs a distinctive theoretical approach, but writes accessibly and with insight about a profession that is slowly being transformed. She notes the success of women in entering medicine and describes the ways in which they have challenged medical authority and practice. This is an original and important work that contains new visions for medical practice.

Nancy Ainsworth-Vaughn studied stories, topic control, "true" questions, and rhetorical questions in 101 medical encounters in US private-practice settings. In exceptionally lucid and accessible style, Ainsworth-Vaughn explains how power was claimed by and co-constructed for both patients and doctors (previous studies have focused upon doctors' power). The discourse varied along a continuum from interview-like talk to conversational talk. Six chapters are organized around data and include extended examples of actual talk in detailed transcription; four of these data-oriented chapters focus upon dynamic, moment-to-moment use of speech activities in emerging discourse, such as doctors' and patients' stories that co-constructed selves, and a patient's sexual rhetorical questions. Two more chapters offer non-statistical quantitative data on the frequency of questioning and sudden topic changes in relation to gender, diagnosis, and other factors. Contributing to discourse theory, Ainsworth-Vaughn significantly modifies previous definitions for topic transitions and rhetorical questions and discovers the role of storytelling in diagnosis. The final chapter provides implications for physicians and medical educators.

Significantly revised and updated, the fourth edition of this popular AAP policy manual helps you identify, prevent, and treat pediatric environmental health problems. This comprehensive guide puts critical children's health information and answers to parents' questions at your fingertips. From asbestos to radiation, ultraviolet rays, pesticides, asthma, lead, tobacco, and child care and school environments-current information on an exhaustive range of environmental health issues is included. Most chapters on chemical and physical hazards are organized in sections that describe the pollutant, routes of exposure, systems affected, clinical effects, diagnostic methods, treatment, and prevention of exposure and include suggested responses to questions that parents may ask. Topics include Addressing Environmental Health in Primary Care Food and Water Chemical and Physical Exposures Public Health Aspects of Environmental Health Emerging Technologies And more

Dieser UEbungsatlas fur Neuropadiater und Neurologen beinhaltet eine didaktisch aufgearbeitete Sammlung von EEG-Beispielen mit wissenschaftlichen Definitionen und knappen Fallbeschreibungen. Das breite Spektrum an Kurvenmaterial reicht vom Neugeborenen bis zum jungen Erwachsenenalter und hilft dem EEG-Lernenden, eigene Befunde zu erheben und zu bewerten.

Safe and effective prescribing is one of the pillars of medical practice but is much more complicated than it seems. Many new prescribers find prescribing extremely challenging, and a plethora of independent, multidisciplinary prescribers are also seeking guidance. However, pharmacology textbooks are rarely practical. They warn to 'take care when prescribing erythromycin to a patient on warfarin, as the INR may rise'. But what should the prescriber actually do? Surviving Prescribing fulfils an important need by offering practical advice for real-world prescribing problems. The book complements existing educational resources but adds a new perspective. Written by experienced contributors from a variety of professional backgrounds, the content speaks directly to the problems routinely seen in hospital prescribing. And all in one, pocket-sized volume. Whether revising for the national Prescribing Safety Assessment, preparing for starting on the wards, or looking for a quick reference guide, this book is an essential companion.

Coronary heart disease remains the leading cause of death in both men and women in most industrialized countries. Yet it is largely preventable, and health care providers can acquire the skills to help their patients reduce their risks substantially. Traditional risk factors such as cigarette smoking, hypercholesterolimia, hypertension, sedentary lifestyle, obesity and glucose intolerance explain a major proportion of coronary events. Recent evidence also suggests important adjunctive roles for hormone replacement therapy in postmenopausal women, and aspirin prophlaxis in individuals at high risk of a first myocardial infarction. Emerging evidence indicates an important role for diet in the prevention of heart disease. Although the importance of lifestyle and behavioral modifications may well be known among physicians and other health-care providers, the implementation of this knowledge has been limited. One reason is that the information supporting the value, feasibility and cost-effectiveness of risk-reduction strategies has not been previously synthesized and made widely available to health-care providers in office and community settings.
Prevention of Myocardial Infarction fills these critical gaps by providing a state-of-the-art compendium of the scientific evidence on the efficacy of coronary disease prevention, while focusing on helping clinicians develop intervention skills to utilize available knowledge. Chapters by leading authorities in cardiovascular epidemiology, clinical cardiology, cost-effectiveness analysis, and public health translate the theory of preventive cardiology into feasible implementation. The counseling and other intervention strategies described in thistextbook have documented clinical efficacy and cost-effectiveness, and they require little time to learn or implement. The book is written mainly for primary care providers, including general internists and family physicians, but will also be of interest to medical subspecialties such as cardiologists and endocrinologists, as well as medical students, dietitians, psychologists, epidemiologists, and students, practitioners, and researchers in public health.

When patient meets doctor, as well as engaging in a transaction with a clinical purpose, they react to one another as people. Their personalities and ability to make relationships in general also affect the professional interaction. As with other relationships, things can go wrong. The outcome of a consultation may not then be what was hoped for or intended on either side. What may be lost, or not even achieved, is a sense of working with one another - hence the 'problem patient' or 'quack doctor'. This book describes the factors that may complicate the clinical transaction between patient and doctor, emphasising and explaining the influence of often unconscious personal aspects. This is encompassed within a readily applied and concise model, which yields a fresh analysis and understanding. The insight gained can help doctors, within their own consultational styles, to better manage their interaction with patients. Plentiful clinical case vignettes illustrate this approach to understanding and managing clinical transactions and will be welcomed by clinical students and doctors in training, as well as by their trainers.

Effective communication with patients suffering from cancer and their relatives is essential for providing the best possible standards of care. This practical guide will help you to improve your ability to recognize and respond to the physical, psychological, and spiritual problems which cancer patients experience. For the first time in one volume, practical guidelines which have proven efficiency over years in clinical practice are presented. Real dialogues illustrate a clear model of eliciting, assessing, and responding to patients' needs and concerns with an emphasis primarily on the skills and strategies needed for effective communication between health professionals and patients trying to adapt to a fear-provoking diagnosis and an uncertain future. The book also provides invaluable guidance on how to deal with your own emotional responses to the challenges faced in working with seriously ill people. Everyone who cares for cancer patients will benefit from the sympathetic yet practical advice offered in this book.

Which developments can be expected to take place in the dental health of the Dutch population in the decades to come, and what are the influential factors? What effects might the changing supply of dental professionals, the additional substitution of responsibilities from dentists to dental hygienists and the possible reforms in health care insurance have on the nation's oral status? These are some of the central questions discussed in this report by the Scenario Committee and the research group. For this purpose, the Committee developed a computer simulation model of dental health care which was used to analyze future scenarios. The future scenarios described in this report clearly show that a number of crucial decisions must be taken if dental health care is to remain accessible and available for all sections of the population in the future.

The first STG report to embody scenarios on population aging, health and care appeared in 1985. This report describes developments since 1985, reviewing the current position and setting out updated scenarios. The 1985 report set out three scenarios, in which the central focus was on the developing future pattern of demand for care by the elderly. The present report too sets out three scenarios, centring on the demand for care, in which account is taken of a variety of factors; it also details four strategic scenarios whose central focus is on the developing supply of care and which set supply and demand one against the other. Three of the strategic scenarios -- emphasizing respectively intramural, extramural and informal care -- suppose the demand for care to be met in full; the fourth scenario, which rolls current policies on the care of the elderly forward into the future, pinpoints discrepancies between the need for care and the extent to which that need is likely to be met, making clear in so doing that a review of long-term policy for the elderly is urgently needed.

How did doctors make a living? Making a Medical Living explores the neglected socio-economic history of medical practice, beginning with the first voluntary hospital in 1720 and ending with national health insurance in 1911. It looks at private practice and how this was supplemented by public appointments. In this innovative study, Anne Digby makes use of new archival sources of information to produce a compelling picture of ordinary rather than elite doctors, and of the dynamics of provincial rather than metropolitan practice. From the mid-eighteenth century doctors travelled to see ordinary patients, developed specialisms and expanded institutions. Despite limitations in treatment, doctors raised demand for their services as illuminating case studies of women, children, the poor and the affluent show. But doctors did not limit their own numbers, and were largely unsuccessful in restricting competition from other practitioners, with the significant exception of women. Consequently, many GPs struggled to make a living by seeing numerous patients at low fees. Doctors' entrepreneurial activity thus helped shape English medicine into a distinctive pattern of general and specialist practice, and of public and private health care.

When patient meets doctor, as well as engaging in a transaction with a clinical purpose, they react to one another as people. Their personalities and ability to make relationships in general also affect the professional interaction. As with other relationships, things can go wrong. The outcome of the consultation may not then be what was hoped for or intended on either side. This 1994 book considers the factors which may cause problems in the doctor-patient relationship, emphasising and explaining the often unconscious personal aspects of doctor and patient within a model studied from various perspectives. Through this insight doctors can be helped to manage their interactions with patients within their own consultational style, thereby avoiding many unnecessary professional relationship problems. This analysis, which is well-illustrated by clinical case vignettes, is sure to be welcomed by clinicians, trainees and course organisers in all areas where communication between individuals plays an important role.

The number of individuals who are obese or overweight has dramatically increased over recent years and is now becoming epidemic. These individuals are more likely to suffer cardiovascular diseases and therfore physicians, specialists, and trainees increasingly need to deal with these issues on the ward and in clinic. As a result, the need for appropriate knowledge of up-to-date clinical management of obesity and its associated cardiovascular problems is essential for any practicing physician.
Obesity and Cardiovascular Disease is a readily assimilated pocket guide to obesity and cardiovascular disease. It is intended to be used "on-the-go" and is compact enough to be on hand while in consultation with patients. It provides a clear and succinct overview of contemporary clinical management of cardiovascular risk stratification, and fully covers the diagnosis and treatment of cardiovascular in obese patients and individuals with increased visceral adiposity, translating up-to-date clinical research findings into clinical practice. Particular emphasis is placed on recent updates in practical care in obesity and cardiovascular disease, such as new diagnostic techniques and novel pharmacological and surgical approaches, as well as cardiac visceral fact, ethnic differences in adiposity-related cardiovascular risk, and metabolically healthy, but obese subjects. Topics are presented in an easily accessible format with numerous illustrations, photographs, tables, diagnostic and therapeutic algorithms while highlight boxes summarize the main concepts discussed in each chapter.

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."