This book covers a wide range of disorders such as atrial fibrillation, artificial heart valves, deep vein thrombosis, pulmonary embolism and stroke. Handbook of Oral Anticoagulation aims to provide an accessible overview of the exciting new developments in this field. Incorporating numerous quick-reference tables and figures and fully referenced throughout to key papers and the latest reviews, it will be a useful resource for all healthcare professionals involved in thromboprophylaxis.

Motility is a fundamental property of living systems, from the cytoplasmic streaming of unicellular organisms to the most highly differentiated and devel oped contractile system of higher organisms, striated muscle. Research on var ious aspects of motile systems in muscle and undifferentiated or non muscle cells has been developing at an ever more rapid pace in the laboratories of investiga tors with a wide variety of backgrounds using methodologies varying from me chanics to the most sophisticated physical measurements. Significant contri butions to our understanding of motility are coming from the disciplines of cell biology, biochemistry, pharmacology, molecular biology, biophysics, and physiology. The findings have relevance not only to basic scientists but to clinicians in such diverse fields as cardiology and neurology and to scientists in the more traditional physical sciences. Cell and Muscle Motility is a new multivolume series of essays by distinguished research workers in various fields whose work has a common thread of dealing with one aspect or another of motility. The essays are meant to focus on topics of current interest, to be critical rather than exhaustive, and to indicate the current trends of research efforts. The series is intended to foster an interchange of concepts among various workers in the field and to serve as a reference for students and workers who wish to familiarize themselves with the most current progress in motility.

One million people in the United States suffer from systemic lupus erythematosus (SLE or lupus), a chronic autoimmune disease that is potentially debilitating and sometimes fatal as the immune system attacks the body's cells and tissue, resulting in inflammation and tissue damage. SLE can affect any part of the body, but most often damages the heart, joints, skin, lungs, blood vessels, liver, kidneys and nervous system. The course of the disease is unpredictable, with periods of illness alternating with remission. It can be treated symptomatically, mainly with corticosteroids and immunosuppressants, though there is currently no cure. The symptoms of lupus vary widely, come and go unpredictably, and often mimic or are mistaken for other illnesses. As a result, patients present with varied symptoms to different practitioners and diagnosis can be elusive, with patients sometimes suffering unexplained symptoms and untreated lupus for years. Hence, a practical guide to the diagnosis and treatment of lupus is a valuable resource to an array of clinicians and may help expedite earlier diagnosis and better patient care. Part of the Oxford American Rheumatology Library, this concise, authoritative pocketbook describes the pathophysiology of lupus, diagnostic strategies and tools, and current and emerging therapeutic options, focusing on direct clinical applications for busy healthcare professionals. With 20 new tables and the most up-to-date information on the diagnosis, treatment and management of the condition, this second edition fulfills a need for a concise, practical guide to Lupus for clinicians that distills the principal features of this complicated, often misunderstood disorder.

A riveting expose of child abuse in America and how the newest breed of pediatricians determines what happened, why, and at whose hands. Although more than one million children are abused each year in the United States, child abuse often remains a secret to family members, professionals, and politicians who neither see nor understand it. Child abuse pediatricians are the newest breed of pediatricians, specialized in exposing abuse. With detective-like acumen, child abuse pediatricians deduce through careful medical analysis who has abused and who has been abused. Describing the most compelling cases among the thousands that they have evaluated, author Lawrence Ricci reveals the trauma, pain, disability, and sometimes death that abused children experience at the hands of trusted adults. This gripping look at the dark side of American families is about good parents and poor ones, perpetrators and victims, and collateral victims such as innocent family members. It is also about the professionals who have made it their career to expose child abuse and to treat children who have suffered from it. The conclusion calls for systematic changes that could help to stem the tide of child abuse. Explains how signs of abuse can be missed by professionals, community members, and even family members Includes interviews and insights from more than two dozen child abuse pediatricians Addresses physical, sexual, and emotional abuse, including abuse by neglect and abuse due to Munchausen syndrome by proxy Details how cases can go wrong in court rooms when confuscation by defense attorneys overpowers evidence brought to court by child abuse pediatricians Offers ideas for stemming the tide of child abuse

A successful seientific career requires constant effort on the part of the seientist. If such a career is to be achieved by seientists in developing countries where the faeilities are not easily available, even more dedication is required. Dr. K. M. Sivanandaiah, having completed a successful career in the field of peptide chemistry, is such a seientist. Being weIl aware of the limited research facilities available in India, we are extraordinarily appreciative of Professor Sivanandaiah's dedication to the advancement of science. As a Professor of Chemistry and, until his retirement in 1992, the Head of the Department of Studies in Chemistry at Bangalore University, India, he not only devoted much of his time to his students, teaching basic organic chemistry, but was also able to contribute to the field of peptide chemistry. After completing 25 years of service at Central College, Bangalore, where he was admired as an outstanding teacher, Professor Sivanandaiah is still active in research. He is now Professor Emeritus and continues to contribute to the field of peptides. As former students of Professor Sivanandaiah, we felt that publishing a book containing articles related to the design, synthesis, conformation, and biological activity of peptides and written by eminent scientists in the field of peptide research would be a fitting tribute to his role in the field of bioorganic chemistry.

One of the fascinations of psychiatry is that it is amenable to many different approaches. In seeking to account for mental disorder, for example, it is pos sible to explore the meaning and significance of symptoms in the psychody namic sense, to examine the social determinants of illness, or to adopt an es sentially biological viewpoint in investigating links between physiological and psychological dysfunction .. As a clinical discipline it may be practiced in the community, in the specialized clinic or hospital, or shoulder-to-shoulder with other medical practitioners in the general hospital. This richness and diversity are at once a strength and a weakness, attracting practitioners with a wide range of talents and interests, yet sometimes leading to polarizations and false an titheses. The so-called "medical model" of psychiatry has come under a good deal of attack, and deservedly so when claiming an exclusive provenance over all types and aspects of mental disorder. What cannot be gainsaid, however, is the central role of medicine in relation to many parts of the field, and the success in terms of understanding and therapy that has resulted from medicine's in volvement. Nor can it be doubted, after the most cursory acquaintance with the physically or mentally ill, that the relationship between these two forms of suffering is often so close and so mutually reinforcing that distinctions are drawn somewhat arbitrarily. This last is perhaps the cardinal reason for the alliance between medicine and psychiatry."

Amenorrhea: A Case-Based Clinical Guide is a comprehensive review of the current knowledge regarding normal female reproductive physiology. Replete with interesting case vignettes and providing diagnostic algorithms and therapeutic strategies for amenorrhea, Amenorrhea: A Case-Based Clinical Guide is divided into three sections. The first section is composed of two chapters that provide a thorough review of basic science and clinical knowledge about the organ systems responsible for normal physiology of the menstrual cycle. The second section includes discussion about menstrual cycle disruption as it relates to hypothalamic-pituitary dysfunction, surgical and natural menopause, genetic defects, premature ovarian failure/insufficiency and the effects of caloric excess and restriction. The third section offers an update on the physiological effects of prolonged amenorrhea induced surgically or by hypothalamic dysfunction and also includes an original chapter that focuses solely on the impact of race and ethnicity on the prevalence and diagnosis of amenorrhea. Amenorrhea: A Case-Based Clinical Guide brings together chapters from renowned experts who offer state-of-the-art, clinically useful information in a case-based, reader-friendly fashion. This title will be a welcome addition to the bookshelves of all clinicians who practice in women's health settings.

The New Contract which came into force on April 1st 1990 includes proposals for the provision of minor surgery services by the General Practitioner. The aim of this book is to assist those doctors undertaking minor surgery in their Practices. It is intended to present a practical, clear and concise text. This is accompanied by easy to follow illustrations. The contents of the book are governed by two considerations. Firstly, it covers only those procedures which are safe for the patient. Secondly, it only includes minor surgery which it is possible for the ordinary General Practitioner in a busy practice to undertake. Vll Chapter One The Advantages of Minor Surgery in General Practice Minor Surgery:- Despite this descriptive term, no surgery can be considered "minor" no matter where it is carried out! It requires a knowledge of anatomy and basic surgical principles. There must be an understanding of the procedures and technical skills required. Careful planning is needed at all stages. Arrangements must also be made to deal with any complications and disasters which may occur. Having stated these provisos, however, surgical procedures can and should be an important part of general practice within the British National Health Service (NHS). There are many advantages to be gained, both for patient and doctor, when minor surgery is undertaken by the general practitioner.

North American Parasitic Zoonoses provides a concise and useful review of essential information about parasitic zoonotic diseases. North American Parasitic Zoonoses, volume six of "World Class Parasites", is written for researchers, students, veterinarians, physicians and scholars who enjoy reading research that has a major impact on human health, or agricultural productivity, and against which we have no satisfactory defense. It is intended to supplement more formal texts that cover taxonomy, life cycles, morphology, vector distribution, symptoms and treatment. It integrates vector, pathogen and host biology and celebrates the diversity of approach that comprises modern parasitological research.

Presenting patient- and problem-oriented review articles, this series is designed to keep the internist, general surgeon, and specialist in gastroenterology and hepatology abreast of the latest advances in the field.

Since its launch in 1998 the European Society for Intravenous Anaesthesia (EuroSIVA) has come a long way in providing educational material and supporting the research and clinical application of intravenous anaesthesia. After the first two annual meetings held in Barcelona and Amsterdam in 1998 and 1999, three other successful meetings took place in Vienna, Gothenburg and Nice in 2000, 2001 and 2002. Next to these main meetings, starting in the year 2000, a smaller winter meeting has been organised every last week of January in Crans Montana, Switzerland. Both the main summer and the winter meetings breathe the same atmosphere of sharing the latest on intravenous anaesthesia research in the presence of a friendly environment and good company. Since the first meetings the educational tools of EuroSIVA have increased in quantity and technical quality allowing digital slide and video presentation along with the use of the computer simulation program TIVAtrainer during the speaker sessions and the workshops. Furthermore, EuroSIVA now exploits a website www. eurosiva. org that allows for continuous exchange of information on intravenous anaesthesia, the TIVAtrainer, the EuroSIVA meetings and online registration for these meetings. The EuroSIVA is currently engaged in friendly contacts with the Asian Oceanic Society for Intravenous Anaesthesia (AOSIVA), the United Kingdom Society for Intravenous Anaesthesia (UKSIVA), the Korean Society for Intravenous Anaesthesia (KSIVA), the European Society of Anaesthesiology (ESA) and the International Society for Applied Pharmacology (ISAP).

MICHAEL S. GAZZANIGA The investigation of the human brain and mind involves a myriad of ap proaches. Cognitive neuroscience has grown out of the appreciation that these approaches have common goals that are separate from other goals in the neural sciences. By identifying cognition as the construct of interest, cognitive neuro science limits the scope of investigation to higher mental functions, while simultaneously tackling the greatest complexity of creation, the human mind. The chapters of this collection have their common thread in cognitive neuroscience. They attack the major cognitive processes using functional stud ies in humans. Indeed, functional measures of human sensation, perception, and cognition are the keystone of much of the neuroscience of cognitive sci ence, and event-related potentials (ERPs) represent a methodological "coming of age" in the study of the intricate temporal characteristics of cognition. Moreover, as the field of cognitive ERPs has matured, the very nature of physiology has undergone a significant revolution. It is no longer sufficient to describe the physiology of non-human primates; one must consider also the detailed knowledge of human brain function and cognition that is now available from functional studies in humans-including the electrophysiological studies in humans described here. Together with functional imaging of the human brain via positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), ERPs fill our quiver with the arrows required to pierce more than the single neuron, but the networks of cognition."

Hypoxia is a constant threat throughout life. International experts from many different fields, including clinicians, clinical researchers, and basic scientists, have contributed to this volume, presenting state-of-the-art information regarding normal and abnormal (pathophysiological) responses to hypoxia. The topics covered include visitors to high altitude, the latest developments on high-altitude cerebral and pulmonary edema, the brain in hypoxia, high-altitude headache, and similarities between ischemic and hypoxic injury to the brain. In addition topics are covered such as blood-brain barrier in hypoxia, hypoxia interactions with vascular growth, and how humans adjust to extreme hypoxia.

In the previous two volumes of this series, we presented classic problems in internal medicine as illustrated by actual cases cared for in our institution. It has been gratifying for us to see the interest that these volumes have generated with students and trainees. We remain committed to the case method of instruction, and believe that there is no better method to learn medicine than to have an individual patient problem as the basis for study of pathophysiology, natural history, diagnosis and management. We hope that our readers find this third volume as enjoyable and instructive as the editors found it. Juan M. Bowen, MD Ernest L. Mazzaferri, MD, FACP xiii Acknowledgement The editors are grateful to Jeff Smith and Jenny Riegler for their unflagging professionalism and patience. xiv Contents Case 1 Mitral Regurgitation - Chronic Versus Acute: Implications for Timing of Surgery * . * * * . . * . . . . . * . . . . . . . . . . . 1 Harisios Boudoulas, MD Charles F. Wooley, MD Advances and diagnostic imaging in a surgical technique have changed the approach to mitral valve regurgitation. This chapter provides an expert's perspective. Case 2 Cystic Fibrosis in Adults .. * ************ 36 Andrew Libertin, MD John S. Heintz, MD As children with cystic fibrosis grow into adulthood, the internist assumes a greater role in their care. Case 3 Thrombotic Thrombocytopenic Purpura . . . . . . . . . . 51 . . . Donald E. Thornton, MD Earl N. Metz, MD, FACP Patients with ITP continue to present difficulties in diagnosis and management. Two experts discuss the current approach to ITP.

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.

The topicS in this book represent the presentations given at the Fifth Annual Meeting entitled "Cardiac Surgery: Current Issues" held at the Frenchman's Reef Beach Resort. St. Thomas. U.S. Virgin Islands. November 11-14. 1992. This symposium was sponsored by the Division of Cardiothoracic Sur gery. the School of Cardiovascular Perfusion and the Department of Nursing Education and QUality Assurance of Cooper Hospital/University Medical Center. the University of Medicine and Dentistry of New Jersey. Robert Wood Johnson Medical School. Camden. New Jersey. as well as the Academy of Medicine of New Jersey. Chapter authors were charged with the task of writing brief overviews of major issues related to the field of cardiac surgery. The book is specifically tailored to the needs of cardiothoracic surgeons. cardiovascular perfusionists. allied health professionals and nursing personnel involved in all phases of caring for the cardiac surgical patient. Although intended as a reference source with emphasis on up-dated approaches applied in cardiac surgery. it is hoped that the discussion of these topics will compliment other texts and manuscripts. Obviously.';ibook of this length cannot cover the whole multidiSciplinary and complex field of cardiac surgery. However. co-editors are certain that the annual appearance of this text will highlight comprehensive. new and interesting approaches to the field of cardiac surgery."

Many residency programs in primary care specialties do not provide the education in pediatric orthopedics necessary to effectively deal with the field's challenges. Here, the authors present a framework for the effective evaluation of childhood musculoskeletal problems in a practical and problem-based manner. The volume contains case studies and over 200 illustrations.

Aaron I. Vinik, M.D., Ph.D. I IEastem Virginia Medical School The Diabetes Institutes Norfolk, Virginia 23510 This symposium, held in June 1991, was a gathering of international scientists to exchange their views on current concepts of cell growth and differentiation. Each scientist was asked to present a topic of their research related to cell growth and regeneration and to participate in a round table conference elaborating on current knowledge and sharing their experiences. By furthering this promising area of endeavor, a means of understanding ontogeny of cell development and of providing insights into tumor biology would prevail. Of prime importance was the anticipation that new information from a better understanding of the normal evolution of the pancreatic islet would generate alternative approaches to curing diabetes. This forward serves as a short introduction to the concept of pancreatic islet regeneration and the models currently in use to study the process. DEVELOPMENTAL ORIGIN OF ISLETS DURING EMRYOGENESIS The developing pancreas appears as a protrusion from the dorsal surface of the l embryonic gut. The different islet cell types appear sequentially during development in vivo. It therefore seems reasonable to propose that coordinated growth is dependent upon specificity of growth factors.

Cardiovascular disease is a leading cause of death throughout the world. Chronic negative emotions such as depression and anxiety place cardiac patients at greater risk for death and recurrence of cardiovascular disease. In 2008 the editor published a book related to this topic, titled Psychotherapy with Cardiac Patients: Behavioral Cardiology in Practice (American Psychological Association). Aside from that book, there are very few resources specifically written for clinicians who treat psychologically distressed cardiac patients. Unlike other medical specialty areas such as oncology, the field of cardiology has been slow to integrate behavioral treatments into the delivery of service. Perhaps because the field has been largely defined and dominated by researchers, mental health clinicians are only starting to recognize behavioral cardiology as a viable arena in which to practice. There is a large void in the practitioner literature on behavioral cardiology. In a review of Psychotherapy with Cardiac Patients, Paul Efthim, Ph.D. wrote, "Her new book goes well beyond previous works by giving specific and detailed guidance about how to tailor psychological interventions with this variegated population." He added, "It would benefit from even more details about treatment approaches." This proposed volume goes beyond the editor's previous volume by providing in-depth descriptions of behavioral treatments for distressed cardiac patients written by eminent leaders in behavioral cardiology. This book describes a wide range of behavioral treatments for the common psychologically based problems encountered by clinicians who treat cardiac patients. The book is organized as follows: Part I focuses on the most psychologically challenging and common presentations of cardiac diagnosis; coronary artery disease, arrhythmia, and heart failure. This section also includes a chapter on heart transplantation, which is a treatment, not a diagnosis, but a treatment that incurs profound psychological impact for the individual. In Part II, behavioral interventions for the general cardiac population are described. Mainstream therapies such as stress management, cognitive-behavioral therapy, and medical family therapy are described, along with approaches that have less empirical support but considerable practical significance such as personality-guided therapy and interventions aimed at altering type D personality traits. The literature in behavioral cardiology has a rich history of investigating maladaptive personality traits and thus it is important to include behavioral approaches that target personality in this volume. Part III focuses on common behavioral problems encountered by clinicians who work with this patient population. Most patients who seek psychological help do so because they perceive themselves to be stressed due to their job or overextended in all areas of their life. Other people with heart disease present with sleep problems and/or an inability to motivate themselves to exercise or quit smoking. There are many practical behavioral approaches that can be helpful for patients with these difficulties and these are detailed in this section of the book. The conclusion of the book focuses on how to integrate the behavioral treatments described in the preceding chapters into a comprehensive treatment model.

Oncology has developed as a subspecialty of medicine with unique and often complex clinical problems. This handbook ofhematologic and oncologic emer gencies provides a compact, concise, yet comprehensive guide to the manage ment of a variety of difficult clinical situations. The authors of the various chapters are all clinicians with experience in the management of these difficult patients. Their efforts provide insight and a ready source of practical infor mation which lends itself to use in the clinic and in the inpatient ward. The authors sincerely hope that this handbook will be of service to house officers and fellows alike, as they develop skills in the management of the emergent problems of patients with hematologic and other neoplasms. Janice P. Dutcher Peter H. Wiernik Bronx, New York;; Contents 1. Syndrome of Inappropriate Antidiuretic Hormone Secretion and Hyponatremia . . . . . . . . . . . . . . . . . . . . . . . . 000 . . . . . . . . . . . Stuart L. Marcus, M.D., Ph.D., and Joachim Z. Fuks, M.D. 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2. Mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3. Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4. Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 5. Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2. Acute Tumor Lysis Syndrome: Prevention and Management . . 9 Stuart L. Marcus, M.D., Ph.D., and Avi I. Einz;ig, M.D. 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2. Risk Factors for the Development of Azotemia in Acute Tumor Lysis Syndrome........................................... 10 3. Metabolic Abnormalities That Occur during Acute Tumor Lysis Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . . . 4. Prevention of Acute Tumor Lysis Syndrome: Management prior to Beginning Chemotherapy . . . . . . . . . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . 5. Posttreatment Management: Indications for Dialysis . . . . . . . . . . 14 . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . . ."

This year marks the tenth anniversary of the International Symposium on Medical Virology. In the Foreword to the book of the 1980 Symposium, we stated, "However, the challenges still lying ahead are more numerous than our past accomplishments". Little did we know at the time, that within a few years the spread of human immunodeficiency virus type I was going to occur. This worldwide epidemic has, like no other disease in recent history, awakened the scientific community and the public at large. It is a reminder to all of us that regardless of our vast technical advances, Nature provides such great opportunity for biological diversity, that it will always be one step ahead of our scientific knowledge. Although our understanding of virology, molecular biology and immunology have increased by leaps and bounds over the last decade, we are still at the point of being unable to effectively control the spread of this viral infection. We hope that our Symposium this year has helped researchers to come together and exchange' ideas, so that our growing knowledge of viral infections will help produce better approaches to control them. Luis M. de la Maza Irvine, California Ellena M. Peterson March, 1991 v ACKNO~EDGEMENTS It would be impossible to single out all those individuals who helped us make this Symposium a reality, however, we would like to take this oppor tunity to express our appreciation for their efforts.

ACE inhibitors are one of the most exciting and interesting of recent medical developments. They fit the patho-physiologica1 processes of cardiovascular disease with fascinating precision and are a constant stimulus to the acquisition of greater understanding of the mechanisms involved and of the mode of action of the drugs themselves. There is still much to be learned, especially about the wider effects of the drugs, their precise mode and site of action and about differences between the different preparations. ACE inhibitors are of proven benefit to patients with chronic congestive heart failure and are the latest in the series of drugs used in the treatment of hypertension. Interest in the treatment of hypertension has paralleled the development of hypotensive drugs and the realisation that long-term prognosis could be significantly improved. The treatment of hypertension has progressed in stages following the development of a succession of increasingly effective drugs, each allowing a greater proportion of patients to be treated with fewer and fewer side-effects. First, the ganglion-blocking agents such as hexamethonium and guan ethidine transformed the outlook for patients with malignant hypertension but proved too unpleasant for routine use in other forms of hypertension."

As we move into the 21st century it is becoming increasingly difficult to offer appropriate introductory clinical experiences for medical students. Many schools offer clinical experiences in the first year of medical school, when the learner has little background in the traditions and origins of the doctor-patient interaction. Others begin this process in the second year, after a professional language base has been established, but concise educational materials are scarce that integrate the meaning of the privileged clinical encounter with the process and content of interviewing and examining patients. In the tertiary hospitals, where most medical schools are based, the educators must provide an orienta tion to the clinical encounter, an intensely personal experience, in the midst of glittering technological marvels that easily distract both the novice physician and the wizened teacher. Understanding the context and historical basis for the privilege of interviewing and examining another person about intimate matters relating to health and disease is essential to this process. Considering these factors, this textbook is written to assist medical educators and medical students involved in early clinical training. As the demand for "high-tech" medicine has accelerated, so has the public concern over the loss of "high-touch" or compassionate, humane interactions with physicians. Physicians are perceived as more concerned with readouts from machines and fiberoptic views of the patient than with understanding and car ing about the people we have labeled as patients."

Fundamentals of Clinical Practice, Second Edition presents medical students with a comprehensive guide to the social ramifications of a physician's work, and more experienced practitioners with the tools to augment their own patient-centered techniques.