Non-Parametric Statistical Diagnosis

There are many changes in the skin, hair, and nails during and after pregnancy. Patients are certainly aware that those changes are occurring, but few physicians and even fewer patients know how to predict the course of those changes. Pigmentary changes occur, but are they permanent? Can they be prevented or reversed? Hair may become thicker during pregnancy, only to fall out in the postpartum period. When will hair stop falling out? Will it grow back? What hormonal changes are occurring to produce these effects on the skin, hair, and nails? Will those hormonal changes affect other organs? Some cutaneous manifestations of pregnancy are common and recognized by most physicians. Abdominal striae, for example, are easily identified, but physicians have many questions about them. Why do they develop? Can they be prevented or treated? Other cutaneous manifestations of pregnancy are less common and recognized by few. For example, pruritic urticarial papules and plaques of pregnancy is a debilitating condition that is treatable once diagnosed. Even more important than the treatment, the knowledge imparted to a worried mother that her child will be fine and that the condition is se- limited is priceless; but the condition must first be recognized by the patient's physician. All of these questions and conditions are addressed in this extraordinary book. Pigm- tary disorders are addressed in detail in Chap. 2.

Skin lesions are often the first sign for an endocrine disease. Their description is thus of relevance for early diagnosis and treatment of endocrine disease for specialists in endocrinology as well as in dermatology.

Lavishly illustrated, this book describes the clinical and histological features of skin lesions observed in endocrine diseases. All features are reader-friendly structured and written in the language of dermatologists in order to enable a simple association between the features observed and the endocrine etiology.

This book provides cardiologists with access to the wealth of imaging from the Royal Brompton Hospital and National Heart and Lung Institute in London to enable them to improve on their own skills and refine their imaging technique. The authors correlate this echocardiography experience with the pathological and surgical aspects of congenital heart defects. They include a review of the pathologic, physiologic and surgical observations of different congenital diseases to assist in understanding the various echocardiographic presentations. The book contains large numbers of echocardiographic images.

Allergy is one of the major health problems of most modern societies. Although allergic diseases are well-known for almost two hundred years, their prevalence has increased dramatically over the last decades. Allergic reactions manifest in various organs, most commonly in the skin and mucous membranes, the frontier surfaces where the contact between the individual and the environment takes place. In a very concise and practical way this book covers all aspects of allergic reactions from pathophysiology to diagnosis, therapy and prevention with a strong focus on relevant aspects for the everyday work of the practising dermatologist and allergist in the hospital or office. This book reflects the rich personal experience of a German allergist with international training and reputation, who is active in immunology and allergy research and practice for almost 30 years. In this book, not only IgE-mediated allergic reactions are covered but all other kinds of allergies such as atopic eczema, contact dermatitis, drug eruptions, anaphylaxis and food allergies are equally represented as well as psychosomatic aspects and problems of environmental intolerances.

In this practical book, the authors of each chapter have synthesized the currently available evidence regarding specific issues in diabetes care. The chapters have been written by an interdisciplinary team of scientists and medical professionals. Such an approach emphasizes the need for collaboration in the care of any individual with diabetes and in the effort to find new therapies for the disease. This reference provides practical guidance in a single resource.

This book by Corey H. Evans, Russell D. White, and coauthorsis a gem. There was a time when exercise testing was largely limited to cardiologists, but no more. Ex- cise testing, which providesinformationon tness, the risk of coronarydisease, and all around vitality, is now being performed in the of ces of primary care physicians across the United States. Although there is a signi cant risk in some populations, a careful doctor who takes the trouble to become knowledgeable in exercise physiology and the pat- physiologyof coronary artery disease can use exercise testing to improve his ability to give excellent, preventive medicine. Over the years I have read many books on this subject, and even contributed to some, andthis oneratesrightup therewith the best. Likemanymultiauthoredbooks thereissomerepetition, butthisisnotallbad.Acarefulstudyofthevariouschapters willprovideadepthofknowledgethatwillcomeingoodsteadwhenproblemsarise. I can especially recommendthe chapter on exercise physiology.When the reader has mastered the material presented in this chapter, he has acquired a knowledge base so that he can become an expert in exercise testing equal to almost anyone. Over the years I have been privileged to know several of the authors and have followed their publications. Their contributions to our knowledge base in this eld havebeenconsiderable.Acquiringthisbookandbecomingfamiliarwithitscontents will set you apart in the eld of exercise testin

Both thyroid dysfunction and heart failure show a high prevalence in the adult population. Frequently, in clinical practice, a multidisciplinary approach is useful to optimize the management of patients with these conditions. Although there is no doubt regarding the close link between cardiovascular pathophysiology and thyroid homeostasis, our understanding of this association is far from being exhaustive. Thyroid hormone regulates the expression of cardiac-specific functional contractile and structural proteins and plays a pivotal role in modulating both diastolic and systolic function as well as peripheral vascular resistance. The close relationship between thyroid and heart dysfunction is strongly supported by recent evidence demonstrating that an altered thyroid profile is a negative prognostic predictor in patients with heart failure. The treatment of chronic heart failure, especially in advanced stages of the disease, continues to be an open and challenging field. The potential of novel thyroid hormone therapies that address the molecular biology of thyroid dysfunction and heart failure thus represents an attractive area of multidisciplinary scientific interest. This book is a readable, integrated, and highly up to date presentation of the clinical, pathophysiological, and basic science aspects of thyroid-heart failure interactions. It addresses a complex subject in an approach that targets a large audience of readers.

The sober explanation for this book is a call by the Springer-Verlag, London, to edit a publication on 'The functional relevance of the collateral circulation' of the heart. Alternatively, it could be 'sold' as the result of my intention to reduce entropy of 18 years of scientific work on the topic of the coronary circulation, which was itself meant to diminish the amount of 'useless' energy. Such a process of reducing disarray in a system with the aim of grasping it better is related to simplification, which carries the risk of introducing error. This can be exemplified by the historic view of angina pectoris, which used to be simplified as being always fatal, thus obscuring for nearly two centuries the view of a 'self-healing' mechanism such as the collateral circulation of the heart. It would be na?]ve, to assume the present work to be free of erroneous oversimplification, because the very nature of scientific work is related to generating (simple) hypotheses with their subsequent falsification. In that context and bluntly, my primary interest in the field of the collateral circulation was not initiated with a vision of eradicating the consequences of coronary artery disease (CAD) by promoting the growth of natural bypasses. The time for such sizeable ideas had passed in the 1970s with the start of the work by Wolfgang Schaper."

Completely revised and including new additional material, this second edition of the bestselling Get Through MRCGP: Clinical Skills Assessment provides candidates with a definitive, one-stop revision resource for the CSA part of the MRCGP examination.

• Fully revised in accordance with the current MRCGP and MRCGP(INT) curriculum
• Mock examinations cover a spread of topics and skills outlined in the RCGP curriculum
• Comprehensive discussion of areas that stations test and detailing points needing to be covered to achieve the best results
• Brand new material including six new cases and task boxes to refocus the reader's attention on the different challenges of each station
• Completely rewritten introductory chapter
• Offers valuable advice on how to approach the exam, focus time in day-to-day GP surgeries and how to develop skills required to pass the CSA

Written by an experienced author team that has extensive knowledge of both national and international primary care clinical skills assessment, Get Through MRCGP: Clinical Skills Assessment, Second Edition is essential reading for postgraduate candidates preparing for this challenging examination.

Physicians recognize the importance of patients' emotions in healing yet believe their own emotional responses represent lapses in objectivity. Patients complain that physicians are too detached. Halpern argues that by empathizing with patients, rather than detaching, physicians can best help them. Yet there is no consistent view of what, precisely, clinical empathy involves. This book challenges the traditional assumption that empathy is either purely intellectual or an expression of sympathy. Sympathy, according to many physicians, involves over-identifying with patients, threatening objectivity and respect for patient autonomy.
How can doctors use empathy in diagnosing and treating patients rithout jeopardizing objectivity or projecting their values onto patients? Jodi Halpern, a psychiatrist, medical ethicist and philosopher, develops a groundbreaking account of emotional reasoning as the core of clinical empathy. She argues that empathy cannot be based on detached reasoning because it involves emotional skills, including associating with another person's images and spontaneously following another's mood shifts. Yet she argues that these emotional links need not lead to over-identifying with patients or other lapses in rationality but rather can inform medical judgement in ways that detached reasoning cannot. For reflective physicians and discerning patients, this book provides a road map for cultivating empathy in medical practice. For a more general audience, it addresses a basic human question: how can one person's emotions lead to an understanding of how another person is feeling?
"Jodi Halpern presents a scholarly and cogent exposition of the philosophic underpinnings of the concept of empathy may be rightly viewed as a seminal work in developing a scholarly understanding of the subject of empathy and will assist in the development of sound training and evaluation methods for imparting this skill to physicians." - Sharon K. Hull, MD JAMA
"I would recommend this book not as a manual, but as a vital reminder of how things should be, and as an insightful and philosophically educational analysis of how things probably are for the luckiest patients in our practice and hospitals." - Philip Berry, British Medical Journal
"This is a beautifully written and beautifully reasoned book. Physician-ethicist Jodi Halpern crafts one of the finest descriptions available of psychiatry's advance toward empathic involvement with patients. Intertwining psychiatry and ethics is no easy task. However in Halpern's hands, a blend of formal research, philosophical modeling, and straight talk shows how neatly psychiatry and ethics work together." - Philip Candilis, M.D., Psychiatric Services
"This is an important book. I recommend it to physicians and members of medical faculties for whom its subject matter is important. It is a serious essay on subjectivity, a topic about which we will be seeing more in the coming years. It repays the work of reading it." - Eric Cassell, M.D., The New England Journal of Medicine
"This lovely volume fixes on a profound truth in medicine: to the degree we are moved by our patients suffering we are better able to help them. The age of proteomics and genomics is the age of 'objective reality', yet for the patient it is all about humane empathetic care. Halpern in this scholarly and wonderful readable volume shows us that empathy is just as critical for the physician and without it healing cannot begin. This book is a must read for all of us with an interest in medical practice." - Abraham Verghese MD, author of CUTTING FOR STONE, Professor of Medicine, Stanford University

Physicians in most developed countries are at a great disadvantage when confronted with geographic and tropical diseases. They may be faced with prevention for patients who are outward bound or with diagnosis and treatment on their return. The practitioners' difficulties relate to inade quate teaching in medical schools and to the infrequency with which they are confronted with these exotic diseases. It is quite surprising to realize the extent of travel by Americans to areas where the tropical diseases abound: in 1979 there were 3 million trips by U. S. residents to Central and South America and almost 1 million to Africa and Asia. I Further, the influx from the tropics to the United States in 1978 involved 4. 5 million visitors and more than half a million immigrants. I The single most danger ous ofthese infections is malaria, which is now averaging about 500 cases yearly in the United States; it is important to realize that infection with one species of this organism (Plasmodium falciparum) can be lethal within a few days of the onset of fever. Highly contagious infections such as the newly discovered and extremely lethal Lassa and Ebola fevers may be imported to our shores, plus cholera, antibiotic-resistant bacillary dys entery, and amebic dysentery and liver abscess. Chronic worm infections such as schistosomiasis, although rarely lethal, may have severe conse 2 quences such as paraplegia or hematemesis."

The widespread occurrence of the various forms of arthritis not only results in a great waste of manpower, but also causes immeasurable pain and suffering for the patients. Due to the limited understanding of its etiology, the currently available treatments are directed at the effects of the disease rather than its causes. The solutions available to the clinician at the advanced stages of arthritis are frequently surgical and include prosthetic replacement arthroplasty. Many advances have been made in the last decade in the basic understanding of the kinematics and kinetics of anatomical joints, as well as in the technology of joint replacement. The NATO Advanced Study Institute held in Portugal during June 20-July 1, 1983 addressed these topics and provided instruction on the advances in biomechanics of diarthrodial joints. The proceedings of this Institute are presented in this volume. Many different areas of specialization contribute to the field of joint biomechanics. Due to the complexity of each individual topic, it was not attempted here to present a complete treatise of each of these areas. Each chapter typically gives a review and a flavor of the subject matter, as well as discussing the state-of the-art advances in general or in specific research areas. Some of the chapters, such as those on lubrication and muscle mechanics, are more mathematically oriented than the others. Nevertheless, the reader with a non-engineering background, I trust, would still find most of the book informative and easy to read."

During September 10-14, 1984, we held a Research Workshop at the Lake Arrowhead Conference Center, California, bringing togeth er leaders in the field of electronic spatial sensors for the blind from the psychology, engineering, and rehabilitation areas. Our goal was to engage these groups in discussion with one another about prospects for the future of electronic spatial sensing, in the light of emerging technologies and the increasing sophistica tion of behavioral research related to this field. The papers in this book give an update on several of the key research traditions in thi s fi e 1 d. Broader overvi ews are provi ded in the paper by Brabyn, and in our Historical Overview, Final Commentary and the Introductions to each section. In a field as complex as this, some overlap of discussion is desirable and the reader with a serious interest in this field is advised to sample several opinions. This volume, and the conference on which it is based, received assistance from many people and organizations. The Scientific Affai rs Divi sion of the North Atl antic Treaty Organization sup ported the conference as part of their program of Advanced Research Workshops, and the Science and Technology to Aid the Handicapped Program of the National Science Foundation provided additional major financial support. The Center for Social and Behavioral Sciences Research of the University of California, Riverside provided financial as well as major logistical support."

The very first international working discussion on slow infections of the nervous system was entitled "Slow, Latent, and Temperate Virus Infec tions" and was held at the National Institutes of Health (NIH) in December 1964. The primary impetus was the discovery and investigation of kuru in New Guinea by D. Carleton Gajdusek, M. D. This working discussion brought together investigators in human and veterinary medicine, virolo gists, microbiologists, and neuropathologists actively engaged in laboratory work with viruses that illustrated properties of latency, masking, slowness, or temperateness, with emphasis on subacute and chronic neurologic dis eases of unknown etiology. In the Preface to the monograph of published papers presented at the working discussion, Gajdusek and Gibbs wrote the following: After microbiology had given solution to the etiology of most acute infections of the central nervous system and after fungi and bacteria had been incriminated in impor tant chronic disorders of the nervous system such as torula and tuberculosis men ingitis, we have been left, in neurology, with a wide range of subacute and chronic affections of the central nervous systems of unknown etiology. Some of these diseases, still listed as idiopathic, are among the most prevalent afflictions of the central nervous system. Many others with familial patterns of occurrence do not yet have their basic pathogenesis or underlying metabolic defect elucidated, although we tend to think of them as genetically mediated."

When Pascal James Imperato, MD, assumed the edi * Exclusion by the New York State Departm~nt of Health of qualified laboratories from HIV testmg torship of the New York State Journal of Medicine in 198~, the acquired immunodeficiency syndro. me (AIDS) epI * Protection of health care workers * Responsibilities of physicians and other health care demic in the United States was already SIX years old. Dur ing the time of his editorship, two thematic issues of the workers Journal have been devoted to AIDS. In addition, a large * Public education number of original communications have been regularly * AIDS confidentiality published on the subje~t. This volume ?rings together The Symposium on AIDS in Washington, DC, had important articles published on AIDS m the Journal been so successful that the MSSNY, under the auspices of during 1987 and 1988. . . the task force and the Division of Governmental Affairs, In the early years of the epidemic the Medical Society of held two informational symposia for state senators and the State of New York (MSSNY) was aware that it had a assemblymen and their staffs in Albany, New York. Thes. e responsibility to both the professi?~ an~ the public to add were presented in February 1988 and. March. 1989. ,!,hIS its efforts to those already mobIlized m the attempt to effort has convinced the MSSNY that It has given legisla understand and control this tragic disease. Early on, the tors a better understanding of the overall AIDS problem.

Preventing Disease, the offspring of an extraordinary collaboration between the U.S. and Canadian Preventive Services Task Forces, presents a meticulous and objective review of the published evidence on preventive measures. Examining such diverse and relevant topics as screening for endometrial cancer, exercise counselling for healthy adults, and the evidence for a causal relation between dietary lipids and coronary heart disease, this volume reflects the editors' shared conviction that recommendations for preventive action should rarely exceed what is well justified by the evidence. In the current period, characterized as the Second Public Health Revolution, the authors' hard-nosed approach leads them to ask the tough questions. Are preventive measures cost-saving? Does preventive screening actually lead to treatment in clinical practice? Does the treatment do more good than harm? To what extent does our desire to eliminate causes of serious disability, ill health and premature death cloud our objectivity? All concerned about preventive medicine, community health, and primary care will find valuable stimulation for thought and action in this book: the contributions have gone beyond the rhetoric.

The author has organized basic, core information on the diagnosis, treatment and prevention of chemical dependence into a readily understandable format. His approach teaches the physician what steps to take from a practical point of view: how to prevent addiction in the first place, how to diagnose the condition, how to aid the family get the addict into treatment, and how to increase the chances of long-term recovery. The book is divided into three sections. The first section covers basic definitions and concepts. The second section describes the pharmacology of the various psychoactive substances: depressants, opioids, stimulants, cannabinoids, hallucinogens, phencyclidines, and inhalants. The third section discusses chemical dependence in special groups: women, adolescents, the elderly, ethnic minorities, dual diagnosis patients, HIV- positive patients, and impaired physicians.

Developments in teleradiology are progressing at great speed. As a consequence, there is a need for a broad overview of the field. This first-ever book on teleradiology is presented in such a way that it should make it accessible to anyone, independent of their knowledge of technology. The text is designed to be used by all professionals, including radiologists, surgeons, nurses and allied health professionals, and computer scientists. In a very short time, driven by technical developments, the field of teleradiology has become too extensive to be covered by only a small number of experts. Therefore, Teleradiology has been written with chapter contributions from a host of renowned international authorities in teleradiology (see the Contents and the Contributors). This ensures that the subject matter focusing on recent advances in teleradiology is truly up to date. Our guiding hope during this task was that as editors of multiple chapters we could still write with a single voice and keep the content coherent and simple. We hope that the clarity of this book makes up for any limitations in its comp- hensiveness.

Patients with mental health issues present frequently in primary care and their consultations are often more challenging and time-consuming than those involving physical illness. For many patients there remains a significant stigma associated with mental ill-health and overcoming this adds further complexity to the consultation. Improving the Mental Health Consultation provides a simple 'short circuit' tool to help GPs and other healthcare professionals to explain mental health problems simply and effectively to their patients. The tool is straightforward, easy to convey within the confines of a 10-minute consultation and extremely effective in helping to break down the stigma that patients often feel. The tool has been developed and refined during over ten years of consultations in primary care. The detailed explanations of how to use the tool during the consultation, along with the extensive case studies, will help you to improve your mental health consultations and so help your patients deal better with their diagnosis. From anxiety to OCD and chronic fatigue to fibromyalgia, the book also provides detailed coverage of diagnosis and classification using ICD-11 and DSM-IV, and management using the latest NICE guidelines.

O ObivoV brac ?vV, eJ de teJcnh makrhv Life is short, the] art long -Hippocrates Pediatric Interviewing: A Practical, Relationship Based Approach by James Binder is filled with a unique blend of wisdom, experience, and evidence, which will serve as a guide and as a reminder that what comes first in the care of the patient is the language and the silences that are shared between patient and physician. The medical interview quickly establishes the type of caring relati- ship the two will share. In this age of electronic medical records, pay-forperformance, and evidence-based medicine it is easy to lose sight that medicine is fundamentally about one person who has knowledge and experience providing care for another individual who is asking for help. How the physician organizes his or her interactions has an important impact on the experience and o- comes for both the physician and for the patient. Dr. Binder presents a conceptual framework with which to approach interviewing and illustrates this framework with pr- tical examples from years of teaching and practice. Physicia- intraining will find this book filled with wisdom and much needed recommendations about how to approach the medical interview. For those of us who have been in practice a number of years, Dr. Binder's book can serve as a refreshing opportunity to reflect in detail about something many of us take for granted - the c- plexity of the medical interview."

Diagnosis and Management of Polycystic Ovary Syndrome is a comprehensive clinical reference work for primary care physicians, internists, general endocrinologists, obstetricians, gynecologists and students. PCOS is a common but frequently misdiagnosed disease. Many symptoms can be alleviated by early intervention and effective management.

Prominent endocrinologists are gathered to detail current research and treatment in this metabolic disorder, affecting a growing population. The chapters are comprehensive, providing cutting edge knowledge on pathogenesis, manifestations, diagnosis and treatment of PCOS. Each chapter will be concise concluding with cogent practice points.

The variety of medical issues presenting in PCOS patients result in late referrals or in- appropriate advice. This title will be a tool in a further understanding of the metabolic and genetic basis of PCOS, while providing management strategies.

Irritant dermatitis is a common condition, accounting for a significant proportion of occupational skin disease. The recent advent of non-invasive skin bioengineering technology has accelerated dermatology research in this field. This book comprises an exhaustive reference text on irritant contact dermatitis, covering all aspects of the condition: clinical features, epidemiology, prevention and therapy, prognosis, mechanisms, pathology and regulatory issues. The book also presents novel in vitro and in vivo research techniques and findings. As irritant dermatitis affects multiple specialties, the audience for this book is wide, including clinical and investigative dermatologists, allergists, toxicologists, pharmaceutical scientists, occupational and environmental physicians, public health physicians, cosmetologists and skin bioengineers.

Many patients experience sleep disturbances secondary to their primary illness and this often has a negative effect on their quality of life. This book provides an evidence-based introduction to the interface between sleep wide range of medical disorders. A clinically focused, comprehensive review for physicians and other health providers, this state-of-the-art reference can also serve as a textbook for those who wish to become familiar with the impact of sleep on quality of life.

This book provides a state-of-the-art, comprehensive overview of the diagnosis and treatment of sleep disorders. It details evidence-based practice recommendations using parameters primarily developed by the American Academy of Sleep Medicine. The book offers a thorough and extensive board review for specialization in sleep medicine and supports primary care clinicians in appropriately using sleep diagnostic testing results in clinical practice.