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.

In the decade since AIDS was first recognised the enormous and worldwide social and medical implications of this disease have been increasingly recognised. The exponential increase in the number of people infected with HIV has been paralleled by the written literature on the subject. When this book was initially conceived the question was why another book? It seemed to me at that time and since, that as HIV presented ever more complex problems, they were best solved when considered within a wider context, using basic principles of individual medical specialties and applying them. For this reason, all the chapter authors were experienced in a particular field and applied that knowledge to HIV. All the authors were working at the Middlesex Hospital in London when the AIDS services there were expanding to fill a need, from 2 beds in 1986 to two wards today. The authors were frontline staff looking after all aspects of HIV infection within a wider general medical context. Many are now consultants or senior lecturers. It is the aim of the book to provide an insight into HIV and AIDS as a overview for someone starting to work in this field or who sees such patients occasionally and requires some basic guidelines. For this reason the chapters are based predominantly on organ systems and are divided into sections covering the presenta tion, methods of investigation and treatment or action required of relevant conditions."

Antibiotics will soon no longer be able to cure common illnesses such as strep throat, sinusitis and middle ear infections as they have done for the last 60 years. Antibiotic-resistant bacteria are increasing at a much faster rate than new antibiotics to treat them are being developed. The prescription of antibiotics for viral illnesses is a key cause of increasing bacterial resistance. Despite this fact, many children continue to receive antibiotics unnecessarily for the treatment of viral upper respiratory tract infections. Why do American physicians continue to prescribe inappropriately given the high social stakes of this action? The answer appears to lie in the fundamentally social nature of medical practice: physicians do not prescribe as the result of a clinical algorithm but prescribe in the context of a conversation with a parent and a child. Thus, physicians have a classic social dilemma which pits individual parents and children against a greater social good.
This book examines parent-physician conversations in detail, showing how parents put pressure on doctors in largely covert ways, for instance in specific communication practices for explaining why they have brought their child to the doctor or answering a history-taking question. This book also shows how physicians yield to this seemingly subtle pressure evidencing that apparently small differences in wording have important consequences for diagnosis and treatment recommendations. Following parents use of these interactional practices, physicians are more likely to make concessions, alter their diagnosis or alter their treatment recommendation. This book also shows how small changes in the way physicians present their findings and recommendations can decrease parent pressure for antibiotics. This book carefully documents the important and observable link between micro social interaction and macro public health domains.

Based on the Commonwealth Harvard Alcohol Research and Teaching Program, this clinically oriented work is designed to give internists and primary care practitioners the knowledge and skills necessary to recognize and care for patients with alcoholism.

The purpose of this particular NATO Advanced Study Institute is to contribute to the dissemination of advanced knowledge and the formation of contacts between scientists from different countries. The Institute is meant to have a substantial teaching component while also providing a forum for discussion at the highest level. The NATO Advanced Study Institute on Progress in Biomechanics was held July 10-21, 1978 in Ankara, Turkey and the Proceedings are presented in this volume. Sixty-four engineers, mechanicians, medical and biological scientists from fourteen countries attended. Prof. R.M. Kenedi of the University of Strathclyde, Glasgow, Scotland and Prof. W. Goldsmith of the University of California, Berkeley, USA were the other members of the Organizing Committee. As Director of the Institute, I wish to thank them for their assistance without which the Institute would not have taken place. Time will show whether the Institute has served its purpose; namely, exciting interdisciplinary communications and developing a lasting and productive link from which significant academic and technological advances might emerge.

This fourth edition of Common Diseases comes just over 10 years after the first. There has been change and counterchange in the primary health care (PHC) field. One change has been the tendency to replace 'general practice' by 'PHC'. Vocational training has become compulsory. With larger group practices have come formalized teams and teamwork, increasing con cern with the business side of general practice and attempts to achieve best values for money and maximal profits. On the clinical side there have been enthusiasms for prevention, early diagnosis, anticipatory care, screening and quality initiatives. As a counterchange it is necessary to remind ourselves that the real essence of general practice, PHC, or whatever title we give it, is 'personal doctoring' of people as individuals in family units. All the changes mentioned will achieve less than expected without good continuing doctor/ patient personal care. But even this is not enough. Good general practice demands a sound knowledge of the nature of disease in the community. Not only are traditional diagnostic and therapeutic skills necessary, but also application of an understanding of the frequency and distribution of the diseases and an awareness of their likely natural history - their course and outcome."

A fine team of state-of-the-art researcher/clinicians who know their fields, have contributed to the advancement of knowledge, and are in a position to judge what is truly important have here pooled their thoughts in a series of chapters on the cutting edges of gastroenterology. Four attributes render this volume superior to other update-oriented publications. The first striking feature, which is immediately evident upon scanning the table of contents, is the imaginative choice of subjects, ranging from trav eler's diarrhea and sexually transmitted GI infections through TPN and interventional endoscopy to geriatrics and iatrogenic disease. A second outstanding feature of this volume is its success in balanc ing basic pathophysiology with practical considerations of clinical man agement. This is achieved in the discussions of such diverse topics as acid-peptic diseases, infectious and other diarrheal syndromes, and hep atitis immunization. Throughout the book we are led smoothly from basic science principles to specific recommendations for diagnosis and therapy. This practical emphasis appears repeatedly and sometimes pro duces a delightful surprise, such as a chapter on radiology that is not tech nology-based but instead problem-oriented."

My conviction is that the matters addressed in this volume are of transcendental importance if we are to face up to the challenges of the 1990s and beyond. How, for instance, are we to cope with a truly ecological approach to public health and all its concomitant changes of risk groups worldwide unless there is a full appre ciation of the popUlation perspective throughout the health establishment? The global village has achieved a measure of interdependence requiring recognition by all concerned with the health of both individuals and communities that there is an urgent need to share our knowledge and deploy our resources in the best interests of people everywhere. The history of public health initiatives, the origins of epidemiology, and the tragic separation-virtually a divorce--of public health from medicine recounted in the chapters that follow argue strongly for an early rapprochement. Health professionals who complement each other's knowledge and skills can be reunited through their common reliance on epidemiology as a major fundamental science for the entire health enterprise. Henceforth, epidemiology should be ranked in importance with cellular and molecular biology, immunology, and the social and systems sciences; all are essential if we are to cope with the vast array of diseases and disorders that face us in both the developed and developing worlds. We need more first-rate laboratory scientists, clinicians, nurses, aides, village health work ers, and managers committed to serving the public."

Cell Immobilisation Biotechnology Biotechnology is divided into two volumes. The first volume is dedicated to fundamental aspects of cell immobilisation while the second volume deals with the diverse applications of this technology.
The first volume, Fundamentals of Cell Immobilisation Biotechnology, comprises 26 chapters arranged into four parts:

• Materials for cell immobilisation/encapsulation,
• Methods and technologies for cell immobilisation/encapsulation,
• Carrier characterisation and bioreactor design, and
• Physiology of immobilised cells: techniques and mathematical modelling.

More than half a million people worldwide are now sustained by renal replacement therapy, mainly hemodialysis at a cost exceeding USD 30 billion per year. Each case of ESRD that is delayed or prevented saves funds that may be applied to other aspects of health care. Edited by an internationally renowned nephrologist, Prognosis for Kidney Disorders provides a timely summary of exciting work in progress directed toward renoprotection and of ultimate interdiction of ESRD.
Suitable for researchers and clinicians, Dr. Morrell Michael Avram has collected and commented on promising initiatives likely to enter everyday practice in the immediate future. Suitable for renal trainees, experienced kidney doctors, nurses, nutritionists and cardiologists.

Decoding the significance of proteinuria as an indicator of severity or prognosis in kidney disease is a stimulating challenge to students and practitioners of nephrology. Sir Richard Bright in 1827 associated pro with the disease that bears his name. In the subsequent more teinuria than a century and a half, however, the meaning of the linkage between proteinuria and renal disease remains elusive. Proteinuria is discovered on routine urinalysis in about 10 million Americans, most of whom express no symptoms of kidney disease, each year. From the studies of Robinson (updated in these pages), we know that proteinuria, per se, can be present for 20 years without change in re nal function, as described in orthostatic proteinuria. By contrast, pro teinuria may be the harbinger of swift kidney destruction, rarely cul minating in clinical collapse, a syndrome typifying "malignant proteinuria" as detailed herein by Avram. Although proteinuria is ubiquitous, an orderly management strategy for rational handling of proteinuria of less than nephrotic range is lack ing. Separation of tubular proteinuria and transient proteinuria of fever is now possible routinely. This book provides a record of the contribu tions of investigators and clinicians whose work forms the substrate for production of understanding and, ultimately, marching orders for prac titioners seeking optimized management for their proteinuric patients."

Primary care medicine is the new frontier in medicine. Every nation in the world has recognized the necessity to deliver personal and primary care to its people. This includes first-contact care, care based in a positive and caring personal rela tionship, care by a single healthcare provider for the majority of the patient's prob lems, coordination of all care by the patient's personal provider, advocacy for the patient by the provider, the provision of preventive care and psychosocial care, as well as care for episodes of acute and chronic illness. These facets of care work most effectively when they are embedded in a coherent integrated approach. The support for primary care derives from several significant trends. First, technologically based care costs have rocketed beyond reason or availability, occurring in the face of exploding populations and diminishing real resources in many parts of the world, even in the wealthier nations. Simultaneously, the primary care disciplines-general internal medicine and pediatrics and family medicine-have matured significantly. They have become viable alternatives to the specialty approach to care with its potential dehumanization, coordination problems, and increased cost."

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."

This book clearly elucidates many of the key issues found in the disparate literature on sex-based differences in health and illness. It provides primary care clinicians with a practical, up-to-date source of information that can lead to optimal, targeted care for women. Among the topics examined in this comprehensive volume are treating and preventing osteoporosis, diabetes, cervical cancer, eating disorders, and more.

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.

This unique and authoritative book presents an up-to-date overview of the many aspects of energy balance and its relationships to disease processes resulting from excess energy consumption and storage. It provides a comprehensive treatment of important research and clinical aspects of energy metabolism and obesity. It will be a valuable resource for endocrinologists, diabetes specialists, internists and family practitioners.

This timely and important work looks at the collaborative health care model for the delivery of mental health care in a primary care setting. This has become the ideal model for the treatment of comorbid medical and psychiatric or psychological disorders. There is also an increased awareness that pharmacological intervention, the most frequently delivered intervention for psychological disorders, is often of limited effectiveness without concurrent specific psychological intervention. The book includes more than two dozen case studies, co-written by clinical psychologists and primary care physicians. It is essential reading for any psychology practitioner in a clinical setting, as well as for health care administrators.

The NATO Advanced Study Institute (ASI) on Physics and Engineering of Medical Imaging has addressed a subject which in the wide area of biomedical technology is one of those which are showing greater impact in the practice of medicine for the ability to picture both Anatomy and Physiology. The information and accuracy obtained by whatever imaging methodology is a complex result of a multidisciplinary effort of several sciences such as Physics, Engineering, Electronics, Chemistry, Medicine, etc ... Development has occurred through work performed in different environments such as basic and applied research laboratories, industries and clinical centers, with the aim of achieving an efficient transfer of know-how and technology for the improvement of both investigation possibilities and health care. On one hand, such an effort requires an ever-increasing committment of human and financial resources at research and industrial level, and, on the other, it meets serious difficulties in recruiting the necessary human expertise oriented to this technology which breaks with the tradi tiona I academic borders of the single disciplines. Furthermore, the scientific community is continually dealing with the problem of increasing the performance and, at the same time, complexity and costs of instruments, applying more and more sophisticated technology in an effort to meet the demand for more complete and accurate clinical information. The scientific program of this ASI and the qualification of the authors reveals the intrinsic complexity of the development process of the Imaging methodologies.

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.

Recognizing the clinician's need for quick access to a comprehensive and immediately useful presentation of evidence-based material, the authors and editors have condensed the research on the most common otorhinolaryngological complaints into this indispensable volume. Their unique approach color-codes the level of research backing each set of evidence in order to make assessment of the evidence as quick and useful as possible. Each clinical problem is presented with a "color key," letting the physician know the level of evidence available: green (high-level evidence), yellow (low-moderate levels of evidence), or red (major disagreement or only minimal low-level evidence). The content of each chapter is structured in the same manner so the reader quickly becomes accustomed to finding precisely the information needed for each new case.

Featuring sections on general otolaryngology, head and neck surgery, pediatrics, and otology, Evidence-Based Otolaryngology not only presents the research, but gives the clinician immediately applicable recommendations for patient treatment.

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.

Psychocutaneous Medicine offers an overview of diseases in psychosomatic dermatology and creates a bridge between cutaneous and emotional disorders using extraordinary illustrations and clinical images of psychosomatic dermatology. It covers both common and rare diseases and helps doctors and psychologists recognize and deal with psychosocial features in dermatology and venerology. This superbly illustrated clinical atlas with concise text passages follows the American diagnosis classification DSM-V and current evidence-based guidelines. It allows rapid recognition of masked emotional disorders and thus administration of the most effective and efficient treatment as early as possible.

Hone your diagnostic vision for psychosomatic disorders. Treat your patients efficiently and effectively. Psychocutaneous Medicine is a picture atlas and textbook that is indispensable for dermatologists, psychologists, pediatricians and general practitioners.

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.