There is ample opportunity and scope for gynaecology in prim ary care in general practice. Many conditions and problems can be managed successfully in this context without referral to hos pital and specialist care. The first aim of this book is to deal with common problems that are referred for consultant opinion and specialist management to the average District General Hospital by analysing problems of presentation and diagnosis on a symptom-orientated basis. Selection for primary care management as opposed to hospital referral is then considered, following which the wide range of available treatment is evaluated with particular emphasis on the maximum use of up-to-date but proven regimes. The full use of the expertise of the practitioner is highlighted throughout. The second aim is to encourage the practice of primary care gynaecology and to help those doctors who have a special in terest in the subject, while hopefully stimulating others to de velop a similar one. With this in mind, the approach to the problems is realistic and often dogmatic while opportunities for individual management and for practical procedures are kept to the forefront.

DDDDDDDDDDDD Effective management logically follows accurate diagnosis. Such logic often is difficult to apply in practice. Absolute diagnostic accuracy may not be possible, particularly in the field of primary care, when management has to be on analysis of symptoms and on knowledge of the individual patient and family. This series follows that on Problems in Practice which was con cerned more with diagnosis in the widest sense and this series deals more definitively with general care and specific treatment of symp toms and diseases. Good management must include knowledge of the nature, course and outcome of the conditions, as well as prominent clinical features and assessment and investigations, but the emphasis is on what to do best for the patient. Family medical practitioners have particular difficulties and advantages in their work. Because they often work in professional isolation in the community and deal with relatively small numbers of near-normal patients their experience with the more serious and more rare conditions is restricted. They find it difficult to remain up-to-date with medical advances and even more difficult to decide on the suitability and application of new and relatively untried methods compared with those that are 'old' and well proven. IX Their advantages are that because of long-term continuous care for their patients they have come to know them and their families well and are able to become familiar with the more common and less serious diseases of their communities.

This is a book about primary care clinicians and the "clinical uncertainty" endemic to their work. Even when seemingly straightforward, each patient raises unique questions regarding how best to listen to their complaints, empathize with their suffering, or respond to their silences.

This book is also about "addressing" uncertainty in primary care practice and "engaging" it. Engagement requires knowledge, explicit and tacit, placed in the service of a single patient s problem. It also requires carefully managed communication, facilitating dialogue with the patient and encouraging shared problem-solving.

Most importantly, this book is about "collaborative engagement with case-based uncertainty in the setting of small groups of clinicians. "Sommers and Launer contend that the medical profession s tradition of working independently should be augmented with an explicitly shared, collegial one of jointly creating wisdom through practice-based learning.

An international panel of expert clinicians and educators provides: Perspectives on clinical uncertainty in the medical literatureA taxonomy of clinical uncertainty with patient examplesAnalysis of the educator role to support clinicians in engaginguncertainty A compendium of small group methods for collaborative engagement with clinical scenariosAnalysis of the special challenges ofcollaborative engagement

A mind-opening manifesto, "Clinical Uncertainty in Primary Care" will equip primary care clinicians, educators, public health and behavioral health professionals with resources for infusing practice with meaning through collegial collaboration.

From the Foreword: Lucia Sommers and John Launer, with the accompanying input of their contributing authors, have done a deeply insightful and close-to-exhaustive job of defining clinical uncertainty. They identify its origins, components and subtypes; demonstrate the ways in which, and the extent to which it is intrinsic to medicine and they present a cogent case for itsspecial relationship to primary care practice Clinical Uncertainty in Primary Care not only presents amodel of collegialcollaboration and support, it also implicitly legitimatesit. Renee Fox. "

Orthostatische Hypotonie.- Orthostatic hypotension in the elderly: the Honolulu Heart Program.- Campher, ein festes atherisches OEl.- Klinische Pharmakologie von D-Campher.- Toxikologie von D-Campher.- Leichte bis mittelschwere Depressionen.- Haufigkeit und klinische Relevanz der Interaktionen und Nebenwirkungen von Hypericumpraparaten.- Arzneimittelinteraktionen mit Johanniskrautextrakt.- Untersuchung zur Alltagssicherheit des Johanniskrautextraktes Ze 117.- Mechanismen der Interaktionen mit Johanniskrautextrakten.- Johanniskrautextrakt Ze 117 - Klinische Wirksamkeit und Vertraglichkeit.- Chronische Schmerzleiden.- Wirksamkeit eines Harpagophytum-Extrakts bei Patienten mit Ruckenschmerzen.- Wirkmechanismen von Harpagophytum-procumbens-Extrakt LI 174 bei der Behandlung von unspezifischen Ruckenschmerzen.- Placebokontrollierte, randomisierte und doppelblinde Studien zur Analyse der Wirksamkeit und Vertraglichkeit von Oleum-menthae-piperitae-Loesung LI 170 bei Kopfschmerz vom Spannungstyp und Migrane.- Zur Pharmakokinetik und zum Einfluss von Harpagophytumextrakten auf den Arachidonsaurestoffwechsel.- Immunmodulation zur Infektvorbeugung und bei malignen Tumoren.- Pflanzliche Immunstimulanzien aus padiatrischer Sicht.- Sport und Infekte der oberen Atemwege - Epidemiologie, Immunologie und Einflussfaktoren unter besonderer Berucksichtigung der Infektvorbeugung durch Echinacin.- Pharmakodynamik der Arzneimittelkombination aus Echinaceae (purp. et pall.) radix, Baptisiae tinctoriae radix und Thujae occidentalis herba (Esberitox(R) N). Wirksamkeit und Arzneimittelsicherheit bei akuten viralen Infekten.- Misteltherapie - ihr aktueller Stellenwert bei der Behandlung von Tumorerkrankungen.- Reizmagen- und Reizdarmsyndrom.- Symptomatologie, klinische Pathophysiologie und therapeutische Aspekte des Reizdarm-Syndroms.- Therapie von Reizmagen- und Reizdarmsyndrom aus klinischer Sicht.- Stellenwert von Iberogast(R) beim Reizmagen- und Reizdarmsyndrom.- Fixe Kombination aus Pfefferminzoel und Kummeloel - UEbersicht zur Pharmakologie und Klinik.- Pharmazeutische Qualitat und Vorschlage zu Transparenzkriterien ausgewahlter Phytopharmaka beim Reizmagen- und Reizdarmsyndrom.- Phytotherapie des Colon irritabile. Ein systematischer Review.- Weitere Indikationen.- Der Pestwurz-Extrakt Ze 339 - Wirkungsprinzipien und klinische Pharmakologie.- Therapie klimakterischer Beschwerden mit Cimicifuga racemosa - Daten zur Wirkung und Wirksamkeit aus einer randomisierten kontrollierten Doppelblindstudie.- Tradition reicht nicht mehr aus.- Phytopharmaka aus Sicht der gesetzlichen Krankenversicherung (GKV).- Japanische Phytotherapie (Kampo) - Klinische Relevanz und Qualitatssicherung in der modernen Medizin.

Over the past decade, significant advances in research methodology have stimulated dramatic progress in the field of child psychiatry in general, and in pediatric anxiety disorders, more specifically. Pediatric Anxiety Disorders: A Clinical Guide is a comprehensive and vital addition to the literature at an exciting time in the field of psychiatry. This state-of-the-art reference aims to bridge the most up-to-date research findings with relevant clinical perspectives, making it a unique and essential resource for established clinicians and researchers, as well as for students and trainees. The book is organized into four sections, each of which includes chapters on a specific area of interest. The first section reviews the current research regarding etiological mechanisms of pediatric anxiety. The second section provides in-depth descriptions of the anxiety disorders that affect children and adolescents. The third section summarizes the literature on empirically supported assessment tools and evidence based cognitive-behavioral and pharmacological interventions. Of special practical note, the authors of these chapters have included comprehensive summary tables that can serve as quick reference tools. The final section of the text is dedicated to understanding how anxiety manifests in two special populations, children with chronic medical illnesses and those with autism spectrum disorders. Pediatric Anxiety Disorders: A Clinical Guide is an authoritative new volume developed by a renowned collection of clinicians and researchers in the field of childhood anxiety disorders.

Primary Liver Cancer: Surveillance, Diagnosis and Treatment focuses on the many therapies rapidly evolving to assist with controlling hepatocellular carcinoma as well as emerging technologies to assist in early diagnosis as well as prevention. All chapters are written by experts in their fields and include the most up to date information for diagnosis, treatment, surveillance, epidemiology, staging, recurrence and prevention. This volume will serve as a useful resource for clinical gastroenterologists, hepatologists, oncologists, pathologists, and physicians who treat patients with chronic liver disease and hepatocellular carcinoma.

This volume covers the myriad of functional and motility gastrointestinal disorders in a comprehensive manner. The book is divided into seven major sections, with each section beginning with a brief case presentation highlighting the specific disorder to be reviewed. Appropriate criteria is highlighted, followed by a brief review on the epidemiology, etiology, pathophysiology, diagnosis and treatment of each specific disorder. 2-3 key teaching "pearls", test questions and key references are also provided for each chapter. The book is organized so that each chapter can stand on its own and be used as a quick reference source in the clinic. Alternatively, it can be read cover to cover as an authoritative textbook on gastrointestinal functional and motility disorders. Written by international experts in the field of motility disorders, Functional and Motility Disorders of the Gastrointestinal Tract: A Case Study Approach is an invaluable resource for experienced physicians, students, residents, fellows, nurse practitioners and physician assistants.

Whereas during the past decade endoscopy has become established as the leading means of diagnosis and management of diseases affecting the esophagus, starnach and large bowel, radiology has retained its pre-eminence for the clinical study and evaluation of the small bowel. This book provides unique coverage of all current radiological techniques used to study the small bowel, including not only barium studies and angiography but also cross-sectional methods such as uhrasound and computer tomography as well as nuclear medicine. Ernerging techniques such as magnetic resonance imaging are given close consideration, and interventional procedures are dealt with fully. Following an introduction on anatomy, physiology, and pathology pertinent to radiol ogy, the book describes in great detail common and less common congenital and development anomalies, trauma, infectious and infl.ammatory conditions, and tumors. The radiological accounts are illustrated by unique color photographs of pathological specimens. It is important for all professionals involved in the management of patients with small-bowel disease tobe critically informed about the specific advantages as well as the limitations of the various modern imaging techniques now employed for the in vivo morphological evaluation of the small bowel. This comprehensive book provides a timely update of our knowledge in this field and is a welcome addition to our series "Medical Radiology;' which aims to provide exhaustive coverage of modern diagnostic radiology. It will be of great interest for general and abdominal radiologists, gastroen terologists, and abdominal surgeons.

This book is about a new surgical procedure, surgical hysteroscopy, for out-patients. It is both a diagnostic approach and a surgical procedure. As a simple and non-aggresive technique, it is a "patient-friendly" procedure with a little surgical trauma as it avoids hysterectomy or laparotomy procedures thus preserving the genital tract. It is the leading procedure in the treatment of uterine bleeding. It has also proved to be an essential investigation technique of in the assessment of infertility. This book is the result of surgical practice and teaching experience in the field of hysteroscopic procedures.

Primary care physicians are increasingly called upon to identify and manage complex musculoskeletal issues in their patients. This second edition of Common Musculoskeletal Problems in Primary Care: A Handbook is an excellent point of care resource for health care providers to better diagnose and treat patients presenting with common musculoskeletal complaints. Each chapter in this book focuses on a specific joint or region and discusses anatomy, red flags, approach to the patient, common clinical presentations and management, and includes a flow diagram to help direct management and follow-up of a patient's problem. A number of important updates in the field have been addressed in this revised version, most notably the inclusion of information on meaningful use. Meaningful Use legislation requires that healthcare providers give documentation on diagnosis and treatment to every patient at the time of their evaluation and as such, each chapter of this revised edition includes patient instructions and education sections for clinicians. Updated algorithms and physical examination sheets are provided and are formatted to easily fit into an electronic medical record. Featuring a user-friendly approach and step-by-step guidelines for managing a number of common musculoskeletal conditions, this handbook is an ideal reference for medical students, primary care residents and practicing primary care providers alike.

Nocturia: Causes, Consequences and Clinical Approaches is the first volume exclusively on the topic of nocturia and is designed to be a comprehensive treatise on the subject. The volume is organized into 11 chapters first introducing and defining nocturia and its impact to patients and society, followed by chapters dealing with predictors and risk factors; relationship to sleep disorders; overactive bladder; and water homeostasis. Therapeutic areas addressing nocturia are covered in specific chapters and include pharmacotherapy affecting the bladder, prostate and kidneys as well as behavioral therapy and surgical intervention. Separate chapters are devoted to alternative therapies as well as the impact of nocturia in the elderly. The volume closes with a chapter presenting avenues for future investigation into the etiology and management of nocturia. Clinical case scenarios inclusive of figures and tables illuminate the evaluation and management of patients with nocturia. Nocturia: Causes, Consequences and Clinical Approaches will give physicians and related healthcare providers the background to understand the conditions causing nocturia, how nocturia affects society and the basis for its rational treatment. It will be used as a state of the art reference by urologists, urogynecologists, internists, nephrologists, pulmonologists, endocrinologists and sleep medicine specialists.

This book and CD-ROM package integrates the use of STELLA software into the teaching of health, nutrition and physiology, and may be used on its own in nutrition and physiology courses, or can serve as a supplement to introduce the role that simulation modelling can play. The author presents key subjects ranging from the theory of metabolic control, through weight regulation to bone metabolism, and gives readers the tools to simulate these using the STELLA software. Topics include methods for simulation of gene expression, a multi-stage model of tumour development, theories of ageing, circadian rhythms and physiological time, as well as a model for managing weight loss and preventing obesity.

This Pocket Reference offer a multifaceted guide on various aspects of Alzheimer's disease. This thorough review discusses the challenges of diagnosis, different stages of the disease, testing, and current treatment methods, including pharmacological and nonpharmacological management of cognitive decline and symptoms due to Alzheimer's disease. The book also has specific chapters on care issues for patients with Alzheimer's disease, which describes what clinician's and caregivers should expect and how to manage the disease at its various stages. Additionally, the book provides helpful guides, tables, and tips for clinicians and caregivers to help care for the patient and the caregiver themselves.

Gastroparesis is an increasingly recognized disorder. Treatment can be difficult due to the several mechanisms for symptom production. Gastroparesis: Pathophysiology, Presentation and Treatment serves as a concise reference on this disorder that allows clinicians to quickly access and evaluate the necessary information for treating and managing patients with gastroparesis. Each chapter is written byexperts in their respective area. The volume will enable the reader to better understand all aspects of this disorder. The book presents current concepts in a variety of areas opening with the epidemiology, clinical presentation and pathophysiology of gastroparesis. The natural history of patients is explored as well as evaluation of patients with suspected gastroparesis. This section includes chapters on Wireless Capsule Motility, Electrogastrography and Antroduodenal Manometry. This important resource concludes with a full section on treatment including dietary, prokinetic, antiemetic, sensory, electric stimulation, and surgical methods. New developments include the use of gastric electric stimulation for treatment, the use of SmartPill for diagnosis, and a number of new agents in development for this disorder. Gastroparesis: Pathophysiology, Presentation and Treatment is the ideal reference for gastroenterologists, and also for surgeons, endocrinologists, primary care physicians and nutritionists looking to keep pace with the latest information treatment options for their patients. "

In the last decade there has been no major clinical mono- graph on this increasingly common and difficult malignancy which is a killer of young people. The gap in the literature is now filled by this authoritative volumewhich will be essential reading for any body involved in the study or management of melanoma.

This timely guide to communication in patient-centered medicine argues for greater clarity in explaining health risks versus benefits of an array of screening tests, procedures, and drug regimens. It reviews the growing trend toward patients' involvement in their own care, particularly in terms of chronic conditions, and details approaches physicians can use to prepare patients (and themselves) for collaborative decision-making based on informed choices and clear, meaningful knowledge. Chapters apply this lens to a wide range of common interventions as contentious as estrogen replacement therapy and antibiotics, and as widely prescribed as the daily aspirin and the annual physical. With this goal in mind, the authors also introduce an innovative decision-making tool that translates risks and benefits into a clear graphic format for fewer chances of miscommunication or misunderstanding. Among the topics covered: Involving the patient in decision making. Towards a universal decision aid. BRCT: the Benefit/Risk Characterization Theater. Breast Cancer Screening-Mammograms. Prostate Cancer Screening. Colon cancer screening with colonoscopy. Screening for and treating dementia. Statins, cholesterol, and coronary heart disease. Physicians in family and internal medicine will find Interpreting Health Benefits and Risks: A Practical Guide to Facilitate Doctor- Patient Communication a valuable resource for communicating with patients and new possibilities for working toward their better health and health education. This book considers several common and important situations where faulty decision-making makes overtreatment a serious risk. Clear, fair, referenced, and useful information is provided. And a powerful intuitive technique is introduced which allows patient and doctor to talk as equals as they work together in the exam room. The authors emphasize that some patients who have been fully educated will still accept high risks of harm for a small chance of avoiding premature death. But as this book is accepted and its ideas and technique are extended, I feel sure that net harm to patients will be curtailed. And what is more, the integrity of the decision-making process will be improved. -Thomas Finucane, MD, Professor of Medicine, Division of Gerontology and Geriatric Medicine, The Johns Hopkins University School of Medicine

Here, Erich H. Loewy expands on his earlier book Textbook of Medical Ethics (1989) offering healthcare workers and students a new perspective on ethical practice. Textbook of Healthcare Ethics focuses on the social conditions in which medical practice occurs and how ethical healthcare decisions involves nurses, social workers, psychologists, technicians, and patients as well as physicians. This thoroughly revised and expanded edition addresses historical and theoretical underpinnings and practical concerns. A series of case studies serve as a guideline for further discussion. The text examines provocative issues such as organ donation, care of the terminally ill, abortion, HIV-positive healthcare professionals, physician-assisted suicide, and experimentation with fetal tissue. This is an ideal book for all members of the healthcare team as well as students and residents in any discipline of medicine.

This book is based on the proceedings of the fourth Medical Microcomputer Workshop held at the Middlesex Hospital Medical School on 3-5 September 1986. The workshop was attended by clinicians and computer scientists with an interest in applying computer technology to current medical practice. The problems ranged from audit and patient management through to the more complex applications of data analysis obtained from current diagnos tic techniques. The choice of microcomputers has never been greater with low cost making them readily available. A single microcomputer has limita tions in clinical practice and the use of networks for multi-user tasks has expanded its capability but increased the complexity both in terms of hardware and the software needed to run it. Although comprehensive commercial packages are available, none of these are entirely suitable for medical applications without modification. Many of the chapters presented in this book describe the problems encountered and the solutions achieved by configuring and modifying applications software.

This volume provides a history of Eosinophilic Esophagitis (EoE), a basic understanding of the physiology of the eosinophil, and a current understanding of the pathophysiology and genetics of EoE. The emphasis is on clinical applications including presenting symptoms, diagnosis and treatment options for patients with EoE. Written by both pediatric and adult experts in the fields of gastroenterology, allergy and pathology, this volume includes the most up to date information. Providing practical information useful in the treatment of patients, this book will be of great value to gastroenterologists, allergists, pathologists, medical residents, fellows, internists, and general practitioners who treat patients with eosinophilic esophagitis.

Bipolar disorder is one of the most common and disabling conditions affecting humankind. It is a leading cause of disability and mortality worldwide, affecting millions of people. The illness is complex and dynamic, so that many individuals are misdiagnosed for years and clinicians struggle with identifying the most appropriate and successful treatment. Because it is complex and common, people suffering from bipolar disorder seek help from clinicians of all types - from psychiatrists, family doctors, gynecologists, and internists to psychologists, social workers and other therapists. For clinicians without significant experience with bipolar disorder, how to manage the condition can be mystifying. Even experienced psychiatrists will frequently find themselves uncertain of the best approach to a given individual with bipolar illness. This pocket-sized guide was specifically written with this diverse group of clinicians in mind. It provides a concise, practical and current overview of bipolar disorder, including making a correct diagnosis, identifying important medical and psychiatric comorbidities, and describing our current understanding of the epidemiology, genetics and neurobiology of the condition. In addition to these topics to provide context, the majority of the book is focused on a programmatic approach toward managing bipolar disorder, including discussions of specific subpopulations, such as children or women who are pregnant. The book may also be of interest for people with bipolar disorder and their families, to help guide treatment seeking and provide education about this sometimes mystifying condition. The author is an internationally recognized and trusted expert in the study and treatment of bipolar disorder, annually named a Best Doctor (R) and recognized by US News and World Report (R) as a Top 1% Psychiatrist, whose own extensive clinical experience working with people with bipolar disorder guides this book.

Healthcare Changes Reach Main Street: A Call to Action for Physicians provides guidance, examples, and information on processes and time lines for physicians based on the implementation of The Affordable Care Act (ACA) that was established in 2010. This volume focuses on how geriatricians and other healthcare professionals can be engaged in responding to the roll-out of the ACA in their communities, and through this engagement assume leadership roles in local hospitals, healthcare organizations, and medical societies to advance quality improvement and new models of care for older adults. In-depth chapters provide an update on quality improvement efforts at the state level, as well as changes in Medicaid financing and the significant impact this will have for older adults, particularly dual-eligibles. Many elements of the ACA are yet to be rolled out and many healthcare decisions are yet to be made. Healthcare Changes Reach Main Street: A Call to Action for Physicians will guide healthcare decision makers and help them to play a leadership role in advancing quality care for older adults in our changing healthcare environment.

Developed by renowned experts, this comprehensive and easy to read title offers a state-of-the-art description of the management of endocrine, diabetic, and metabolic emergencies and brings the field fully up to date, setting a high standard for diagnosis and treatment in each category. All chapters begin with a summary that presents, in concentrated form, what the physician needs to know to begin the evaluation and emergency treatment of the known endocrine emergencies. This is followed by an extended discussion of the pathophysiology that can be read after initial treatment has begun. Covering such areas as hypoglycemia, acute adrenal insufficiency, ovarian hyperstimulation syndrome, thyroid storm, and pituitary apoplexy, just to name several, Endocrine Emergencies: Recognition and Treatment is an invaluable, practical resource that will be of great interest to endocrinologists, internal medicine and emergency room physicians, fellows and residents.

One of the major advances in the understanding of the mechanism of action of hormones, neurotransmitters and drugs had arisen from the hypothesis that the physiological or pharmacological responses are trig gered by their interaction with specific cell compo nents, termed receptors. However, the presence of receptors has been inferred from indirect data, and only recently has it been possible to study the kinetics of the interaction between drug and receptors directly, through the so called "binding technique. " This NATO-ASI on "Principles and Methods in Receptor Binding" was devoted mainly to the following aspects of the study of receptors: the principles underlying the use of the binding technique; the mathematical models necessary to interpret binding data; the application of binding methods to specific receptors; and, finally, a few selected examples of coupling between receptors and physiological re sponses. In the chapters of this book, special interest is devoted to the analysis of the simplest models for the interaction of receptors with their ligands (either hormones or neurotransmitters or drugs). The graphical techniques used to analyze the data from binding exper iments are extensively discussed, together with the statistics that have to be used in binding analysis. Moreover, the basic concepts to analyze binding data using a personal computer are presented. v vi PREFACE The factors which should be considered when setting up a binding assay (such as choice of ligand and incubation conditions, preparation of tissue, termina tion of incubation) are discussed."