WHAT IF THE FAMILY YOU WANT... ...ISN'T THE FAMILY YOU NEED? 'It was up to her now; everything was up to her; she needed only to make a choice and step towards it, out from the shadows and into the light.' At forty-three, Christina Lennox thought her future was settled: marriage to Ed, children, a house of their own. But this is not that future: her marriage has ended, fractured by the stress of five rounds of IVF and two miscarriages. Overwhelmed by grief and disappointment, Ed has relocated to San Francisco and Christina's dream of becoming a mother rests on persuading him to let her go ahead with one final round of IVF, using the last frozen embryo they have stored at the clinic. But when Ed drops a bombshell that threatens to undo everything Christina has strived for, she is forced, once again, to realign her plans. Is this the end of her dream, or an opportunity to consider a different - perhaps happier - version of her future?

There are approximately 55,000 practicing ob/gyns in the United States. The obstetrics and gynecology residency training authority (the Accreditation Council for Graduate Medical Education) has now pushed ambulatory primary and preventative care to the top of its list for residency training. Interest in the area of ambulatory gynecology is not just growing in the field of ob/gyn, however; family and primary care practitioners, emergency room physicians, and advance practice nurses all must know how to diagnose, manage, and treat gynecological conditions. Since office technology has expanded and decision-making has become increasingly complex, physicians need a guide through the endless list of treatment options for commonly presenting gynecologic disorders. Ambulatory Gynecology gives practitioners tools for diagnosis, investigation and management of these disorders, including decision-making algorithms. The text is evidence-based. From endocrine disorders to breast disease, preventative measures for osteoporosis to management of an abnormal pap smear, from adolescent gynecology to menopause, this book is crucial for office-based physicians to feel confident practicing in all areas of gynecology.

Respiratory function is a major determinant of the overall quality of health and well-being of an individual. This book runs the gamut of chapters devoted to chronic cough-related conditions in children and adults, health care quality and safety, environmental pollution health effects, efficiency of therapeutic approaches and a mutual dependence of respiratory and non-respiratory illnesses. An integrated approach to the investigation and treatment of sleep disordered breathing as well as the use of new and more efficient diagnostic strategies for pleural tuberculosis are presented. Chapters focus on translating science into practice, with an eye on presymptomatic identification of serious ailments for which there could be more effective therapy, leading to improved general health outcomes. This book includes chapters about disorders which will be of interest to clinicians, family practitioners and medical researchers.

This book has been written with general practitioners primarily in view, describing common paediatric conditions that present in the outpatient clinics and those that require admission to hospital. The book is neither a textbook of paediatrics nor a handbook but is aimed to provide guidelines for the more commonplace conditions. Some aspects therefore, have been dealt with in detail, where felt relevant, while others are omitted on grounds of probable rare encounter. It is hoped that this volume will provide the family practitioner with an insight in the paediatrician's approach to many of the common problems in chifdren and to help him decide on the best course of action to follow. The care of children constitutes a significant and important part of a family doctor's work and practitioners are keen to promote optional care in all circumstances. It is hoped that the endeavours of this book will go in some small way to help put across the practitioner's approach.

Drei erfahrene Experten formulieren hier ein klar verstandliches Gesamt-Konzept fur das Unternehmen Arztpraxis. Dabei betonen sie die Wechselwirkungen und das sinnvolle Zusammenspiel aller Aspekte, die einen langfristigen Erfolg ermoglichen und begrunden: Betriebswirtschaft, Kooperationsformen, Steuer-, Vertragsarzt-, Arbeits- und Haftungsrecht, Marketing, Mitarbeiterfuhrung, Praxisorganisation und Altersvorsorge. So ist zum Beispiel die enge Verbindung von Praxis- und Privatbereich von existenzieller Bedeutung fur niedergelassene Arzte. Einsteiger wie Arzte, die bereits in eigener Praxis tatig sind, werden hier optimal informiert. "

This evidence-to-practice volume deftly analyzes the processes and skills of integrating mental healthcare with primary care, using multiple perspectives to address challenges that often derail these joint efforts. Experts across integrative medicine offer accessible blueprints for smoothly implementing data-based behavioral interventions, from disease management strategies to treatment of psychological problems, into patient-centered, cost-effective integrated care. Coverage highlights training and technology issues, key healthcare constructs that often get lost in translation, and other knowledge necessary to create systems that are rooted in-and contribute to-a robust evidence base. Contributors also provide step-by-step guidelines for integrating behavioral health care delivery in treating cancer, dementia, and chronic pain. Among the topics covered: The epidemiology of medical diseases and associated behavioral risk factors. Provider training: recognizing the relevance of behavioral medicine and the importance of behavioral health consultations and referrals. Screening for behavioral health problems in adult primary care. Health care transformation: the electronic health record. Meeting the care needs of patients with multiple medical conditions. Smoking cessation in the context of integrated care. This depth of clinical guidance makes Behavioral Medicine and Integrated Care an essential reference for practitioners on all sides of the equation, including health psychologists and other professionals in health promotion, disease prevention, psychotherapy and counseling, and primary care medicine.

This comprehensive book thoroughly addresses all aspects of health care transition of adolescents and young adults with chronic illness or disability; and includes the framework, tools and case-based examples needed to develop and evaluate a Health Care Transition (HCT) planning program that can be implemented regardless of a patient's disease or disability. Health Care Transition: Building a Program for Adolescents and Young Adults with Chronic Illness and Disability is a uniquely inclusive resource, incorporating youth/young adult, caregiver, and pediatric and adult provider voices and perspectives. Part I of the book opens by defining Health Care Transition, describing the urgent need for comprehensive transition planning, barriers to HCT and then offering a framework for developing and evaluating health care transition programs. Part II focuses on the anatomic and neuro-chemical changes that occur in the brain during adolescence and young adulthood, and how they affect function and behavior. Part III covers the perspectives of important participants in the HCT transition process - youth and young adults, caregivers, and both pediatric and adult providers. Each chapter in Part IV addresses a unique aspect of developing HCT programs. Part V explores various examples of successful transition from the perspective of five key participants in the transition process - patients, caregivers, pediatric providers, adult providers and third party payers. Related financial matters are covered in part VI, while Part VII explores special issues such as HCT and the medical home, international perspectives, and potential legal issues. Models of HCT programs are presented in Part VIII, utilizing an example case study. Representing perspectives from over 75 authors and more than 100 medical centers in North America and Europe, Health Care Transition: Building a Program for Adolescents and Young Adults with Chronic Illness and Disability is an ideal resource for any clinician, policy maker, caregiver, or hospitalist working with youth in transition.

There is an ever-increasing emphasis on evidence-based medicine that is distinguished by systematic crafting of the patient-centered research question, detailed literature searches, and careful appraisal of the resulting evidence. The consensus that ultimately emerges must then be applied in specific clinical settings, and it is to this process that translational effectiveness analysis refers. This portable and easy-to-use handbook is intended as a practical teaching guide on translational effectiveness for students and clinicians. Specifically, it will serve as a primer on patient-centered outcomes research methodology in the health sciences and explain how to acquire and understand the fundamental data that determine which reports are valued as the "best available" evidence. It presents an accessible and readily intelligible set of principles which doctors, dentists, nurses, and insurance carriers will be able to use in the process of health care-related decision-making.

Meningitis and Encephalitis are associated with high rates of mortality and neurological sequelae. The differential diagnosis includes a wide spectrum of infectious and non-infectious etiologies, some requiring urgent therapy for survival. The current management challenges in patients with meningitis and encephalitis include a low sensitivity of meningeal signs, overutilization of unnecessary screening cranial imaging, delays in diagnosis of urgent treatable causes, a large proportion of unknown etiologies, low sensitivity of current microbiological techniques especially in the setting of previous antibiotic therapy, underutilization of available molecular diagnostic tests, and empiric antibiotic therapy and hospitalization for viral meningitis cases. Even though there are published guidelines, compliance with them is not optimal and physicians do not follow standardized algorithms in their empirical approach. As meningitis and encephalitis is associated with high rates of adverse clinical outcomes, prevention, when feasible is of upmost importance. Adherence to protocols to prevent health-care associated meningitis and ventriculitis are effective but compliance with them is not uniformly performed. This book seeks to improve outcomes for meningitis and encephalitis cases handled by physicians who may or may not be thoroughly trained for these challenges. The text introduces the current guidelines but also discusses the gaps that leave clinicians struggling to implement the most appropriate approaches for these particular neurological infections. Each chapter delivers the tools necessary to identify and adhere to the most appropriate diagnostic technique, management protocols, and prevention approach for each situation. All chapters conclude with discourse on future directions in research and quality improvement. Written by experts in infectious diseases, the book covers topics that are the most devastating, including healthcare-acquired infections, autoimmune encephalitis, and infections as they present in HIV patients. Meningitis and Encephalitis is a well-rounded resource for all medical professionals encountering these neurological syndromes, including infectious disease specialists, neurologists, primary care physicians, and immunologists.

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. vii 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 ambitious resource presents an inventive approach to integrating pediatric and mental health care based in comprehensive, family-centered service delivery. Its framework adds a problem-solving focus to the core principles of pediatric consultation-liaison psychiatry, emphasizing young patients' developmental, family, and social context. An international panel of expert clinicians explores the value of the mental health component in treating complex and chronic cases across varied settings, as well as practical considerations in implementing collaborative pediatric care systemwide, including at the global level. Detailed case histories illustrate skills and traits essential to making this problem-based approach work, such as multidimensional thinking, a prevention mentality, a dedication to lifelong learning, and empathy and respect for young clients and their families. Included in the coverage: * Pediatric medicine for the child psychiatrist. * Safety issues in a general medical facility setting. * "Other medical" presentations and considerations in pediatric consultation-liaison psychiatry. * Principles of biopsychosocial formulation and interventions in the pediatric medical setting. * Preventive models for reducing major causes of morbidity and mortality in childhood. Child and adolescent psychiatrists, child and school psychologists, and physicians in pediatrics, general practice, and family medicine will welcome Pediatric Consultation-Liaison Psychiatry as both a robust training text and a blueprint for the future of children's medicine.

Featuring more than 85 vibrant, fully annotated charts-19 new to this edition-this updated fourth edition of Diseases and Disorders: The World's Best Anatomical Charts is a perfect quick reference for medical and nursing students and an ideal visual aid for patient education. Printed on oversized, cardstock pages and compiled in a convenient, 10" x 12" spiral-bound volume with a laminated cover, these full-color charts created by some of the world's best medical illustrators illustrate and explain common diseases and disorders of the brain; heart; GI tract; eye and ear; endocrine, muscular, skeletal, reproductive, and respiratory systems; dental diseases; infectious diseases; healthy lifestyle issues; and cancer. Nineteen new charts cover Schizophrenia, Ovarian Cancer, Multiple Myeloma, Liver Cancer, Pancreatic Cancer, Prostate Cancer, Heart Failure, Peripheral Artery Disease, UC/Crohn's Disease, Irritable Bowel Syndrome, Age-Related Macular Degeneration, and more. All charts have been reviewed and updated. Medical terminology and easy-to-understand supporting text are printed directly on each chart. Every chart depicts an aspect of human anatomy, physiology, and disease presented in a clear, visual presentation. The book is ideal as a review resource or quick reference for studying human anatomy or for patient consultation and education.

Though mental health recommendations for the elderly is rapidly evolving, the few current textbooks on this subject are either too voluminous or complex for regular review by clinicians, and most do not contain the latest information available in the field. Written by experts in geriatric psychiatry, this book provides a comprehensive yet concise review of the subject.The text covers topics that include the social aspect of aging, treatment and diagnosis options unique to the elderly in need of psychiatric care, policy and ethics, and particular geriatric health concerns that may influence psychiatric considerations. Psychiatric Disorders Late in Life is the ultimate resource for practicing psychiatrists, physicians, geriatricians, and medical students concerned with the mental healthcare of the elderly.

"Heart Failure: From Research to Clinical Practice" contains chapters that describe the current views on the biological mechanisms, clinical assessment, diagnosis and evidence-based treatments of the condition. Topics in this volume range from basic research at cell and molecular level to patient care in everyday clinical practice and provide essential background information and analyses of recent advances for a deeper understanding of the issues involved. With contributions from international experts in their specified fields and are suitable for both beginners and more advanced readers. This volume includes not only the essential information for clinical practice but also the latest information from the contemporary guidelines and the recommendations from leading societies. It also covers ongoing research and puts forward new hypotheses that can be tested in future research. This comprehensive volume will provide a valuable resource for both research students and expert clinicians.

This first-of-its-kind text provides a multidisciplinary overview of a significant problem in hospital-based healthcare: patients who decline inpatient medical care and leave the hospital against medical advice (AMA). Compared to standard hospital discharges, AMA discharges are associated with worse health and health services outcomes. Patients discharged AMA have been found to have disproportionately higher rates of substance use, psychiatric illness, and report stigmatization and reduced access to care. By providing a far reaching examination of AMA discharges for a wide academic and clinical audience, the book serves as a reference for clinical care, research, and the development of professional guidelines and institutional policy. The book provides both a broad overview of AMA discharges with chapters on the epidemiology, ethical and legal aspects, as well as social science perspectives. For clinicians in the disciplines of hospital medicine, pediatrics, emergency medicine, nursing, and psychiatry, the book also provides a patient-centered analysis of the problem, case-based discussions, and a discussion of best practices. This comprehensive review of AMA discharges and health care quality will interest physicians and other health care professionals, social workers, hospital administrators, quality and risk managers, clinician-educators, and health services researchers.

Newly revised and updated, this book provides geriatricians and orthopedic surgeons with the most vital tools to treat elderly patients who sustain a variety of fractures. The text uniquely encompass the etiologies of fracture in the elderly, perioperative management, the surgical treatment of common fractures in the elderly, as well as rehabilitation and prevention in the older patient. It focuses on the most current data and opinions regarding assessment and management of geriatric conditions that predispose the elderly to fracture, perioperative complications and subsequent functional decline. Unlike any other text, experts in both orthopedics and geriatrics review the content of each chapter for readability and appeal to his/her respective discipline, making this the physician's ultimate guide to treating elderly patients with injuries. Fractures in the Elderly, Second Edition is a valuable resource for geriatricians, orthopedic surgeons, physiologists, and rehabilitation specialists.

This unique trainer's resource offers a comprehensive blueprint for preparing clinicians for practice in the changing and challenging environment of integrated care. Based firmly in new evidence-based models of behavioral care in medicine, it sets out the aims and objectives of modern integrated care delivery in a streamlined pedagogy-to-practice framework. Teaching strategies for developing core skills and competencies, suitable across diverse educational and workforce development settings, are presented with data-based rationales and guidelines for design and implementation. Chapters also cover the range of essentials, from research support to business acumen to program evaluation methods, needed to meet bedrock goals of improved quality of care, clinical outcomes, and patient satisfaction. The book's comprehensive coverage: Reviews the evidence base for integrating medical and behavioral care. Provides empirically sound guidelines for training learners in integrated practice. Breaks down skill development into critical training objectives. Offers detailed content of a current degree program in integrative behavioral medicine. Recommends measures to support responsive, patient-centered, and sustainable training programs. A robust guide to a more inclusive and effective future, Training to Deliver Integrated Care expands the healthcare horizon to accommodate trainers working in health psychology, general practice, primary care medicine, and consulting, as well as supervision and coaching professionals.

Motility is a fundamental property of living systems, from the cytoplasmic streaming of unicellular organisms to the most highly differentiated and de veloped contractile system of higher organisms, striated muscle. Although of motility have a long and in scientific investigations into the mechanisms teresting history, the knowledge of molecular processes, especially in the area of regulation of control of motility, has been developing at an ever more rapid pace with the utilization of multidisciplinary approaches from physiology, cell biology, genetics, biochemistry, pharmacology, and biophysics. In Volume 3, Cell and Muscle Motility continues the same philosophy as that of the preceding volumes. 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 in terchange of concepts among various workers in a variety of disciplines and to serve as a reference for students and workers who wish to familiarize them selves with the most current progress in motility. Robert M. Dowben Jerry W. Shay Dallas vii Contents Chapter 1 Intermediate Filaments in Striated Muscle: A Review of Structural Studies in Embryonic and Adult Skelttal and Cardiac Muscle Maureen C. Price and Joseph W. Sanger 1. Introduction ................................................ ."

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. vii 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 handbook gives profound insight into the main ideas and concepts of integrated care. It offers a managed care perspective with a focus on patient orientation, efficiency, and quality by applying widely recognized management approaches to the field of health care. The handbook also provides international best practices and shows how integrated care does work throughout various health systems. The delivery of health and social care is characterised by fragmentation and complexity in most health systems throughout the world. Therefore, much of the recent international discussion in the field of health policy and health management has focused on the topic of integrated care. "Integrated" acknowledges the complexity of patients needs and aims to meet it by taking into account both health and social care aspects. Changing and improving processes in a coordinated way is at the heart of this approach.

1 Shepherd Coronary artery disease, the most important cause of death in the United Kingdom, kills about 200 000 Britons each year. Many victims are struck down out of the blue and in the prime of an active working life. Others survive the fIrst attack but are so debilitated by it that they are compelled to fall back on the efforts of their family and the Social and Health Services for their future survival. The epidemic proportions of the problem and the burden which it places on the community at large has led many health care professionals to reassess their attitudes to heart disease prevention. In the past, the clinician's attention has been directed primarily at the treatment of established ischaemic heart disease rather than focussing on forestalling its appearance by attempting to tackle those life-style habits within the population which appear to predispose to it. A number of recent developments make this approach hard to sustain. First, there is now convincing evidence that action taken against cigarette smoking, hyper tension and hypercholesterolaemia offers signifIcant protection to the individual. Secondly, effective and apparently safe antihypertensive and lipid-lowering agents have recently become available to the practicing clinician. Thirdly, developments in computer technology and laboratory equipment manufacture have brought the measurement of coronary risk factors right into the primary health care setting. And, last, but not least, political attitudes towards prevention now favour the enthusiastic general practitioner with an interest in anticipating and averting the development of degenerative diseases like atherosclerosis."

This informative text details the many changes in everyday life as the result of injury, illness, or aging affecting the brain. Experts across brain-related fields trace mechanisms of conditions such as Parkinson's disease, TBI, and dementia as they impact regions of the brain, and resulting cognitive, emotional, sensory, and motor impairments as they contribute to deficits in personal and social functioning. In addition to symptoms and behaviors associated with insults to the brain (and the extent to which the brain can adapt or self-repair), chapters provide cogent examples of how societal and cultural expectations can shape the context and experience of disability. The book's focus on everyday activities brings new clarity to diverse links between symptoms and diagnosis, brain and behavior. Included in the coverage: *The aging brain and changes in daily function. *Stroke: impact on life and daily function. *Traumatic brain injury (TBI) and the impact on daily life. *Everyday life with cancer. *Real-world impact of HIV-associated neurocognitive impairment. *Disability and public policy in America. *Living after brain changes, from the patient's perspective. Rich in empirical data and human insight, Changes in the Brain gives neuropsychologists, clinical psychologists, clinical social workers, and rehabilitation nurses a robust new understanding of the daily lives of patients, both in theory and in the real world.

Due to the fact that Restless Legs Syndrome/Willis-Ekbom Disease is usually a chronic condition, this book aims to provide physicians with the necessary tools for the long-term management of patients with RLS. The first part of the book addresses the various comorbidities and long-term consequences of RLS on life quality, sleep, cognitive, psychiatric and cardiovascular systems, while the second part focuses on the management of long-term treatment and the drug-induced complications in primary RLS and in special populations. Written by experts in the field, this practical resource offers a high-quality, long-term management of RLS for neurologists, sleep clinicians, pulmonologists and other healthcare professionals.

This book provides a current perspective on alcohol and aging to better understand the trends, costs, benefits, and clinical and community evidenced-based strategies. This book embraces not only the physical, cognitive, psychological, and social health benefits of moderate drinking in the elderly, it also delves into the risks of excessive drinking, including physical and psychiatric morbidity, neurodegeneration, medication complications, and accidents and injuries, and loss of independence. Written by experts in the field, this book is the only current text that includes the most current scientific, research, empirical, and practice information alongside a comprehensive review of the status of the field that will help guide alcohol use management and stimulate future research. Alcohol and Aging is the ultimate resource for all researchers, educators, clinicians, and professionals working with older adults who drink.