This book brings together a cutting-edge selection of the most current applications of mindfulness-based cognitive therapy (MBCT), giving clinicians as well as researchers a concise guide to current and future directions. Each chapter begins with in illustrative case study to give readers an example of how MBCT would be used in the clinical setting, followed by an overview of the condition, the theoretical rationale for using MBCT, modifications of MBCT for that disorder, evidence for MBCT use. Chapters also discuss practical considerations of MBCT, including patient selection, home practice, group size, format, and facilitator training. Written by some of the world's leading physicians using MBCT, Mindfulness-Based Cognitive Therapy: Innovative Applications is of great value to psychiatrists, psychologists, social workers, and therapists.

This comprehensive guide covers prescribing controlled substances for patients with acute or chronic pain and provides a balanced discussion on appropriate treatment, addiction, safety and complications. Chapters feature evidence-based strategies and clinical modalities that address diagnostic challenges, treatment guidance, alternatives to opioid management and the significant legal risks within the current regulatory environment. Authored by leaders in pain medicine, physicians and appropriate health care professionals will find Controlled Substance Management in Chronic Pain to be an indispensable resource.

Medicine is news. There is constant public interest in health and disease; in medical miracles and in breakthroughs; in medical disasters, failures and malpraxis ; in deficiencies and defects ofhealth services; and in the rising costs ofhealth care. Medicine is 'big business'. Physicians co me out near the top money earners in most medical care systems. In the Uni ted Kingdom the National Health Service (NHS) now costs over [6000 million a year ($ ro 800 million), a free service that costs every British man, woman and child [120 a year ($216) in direct and indirect taxes. But this is less than the [500 ($900) a year that medical care costs each person in USA and West Germany. In developed countries health care costs are approaching ro% ofthe gross national product (GNP). It is big business also in that in Britain the NHS is one of the largest employers; about I million Britons work as employees of the NHS, caring for the other 54 millions and in the USA the numbers are 5 million caring for 2. 5 millions. The provision of health services is full of problems and dilemmas. These problems and dilemmas cross all' national boundaries. All countries share the same problems and dilemmas. Problems of objectives, of standards, of effectiveness and efficiency, and problems of relations between the medical profession, the public and govern ment. Medical care still is full of mystique.

The purpose of this book is to clarify the use of antibiotics in the management of the eommon respiratory illnesses seen in general practiee. The underlying philosophy, whieh embraees the avoidanee of unneeessary use, is that proper use entails a full understanding of the nature of the illness. The eoneept of seleetive antibiotie use reeognizes that respiratory illnesses eommonly eomprise multiple illness features, and that some of these features have a viral cause and some a bacterial one. In assessing antibiotic need, eaeh feature or eomponent part of an illness may be evaluated individually, so enabling adecision for antibiotie use in the illness as a whole. The nature of eaeh individual illness feature with its antibiotic indication is diseussed in sueeessive ehapters, and this aecumulated knowledge is of value in managing the more eomplex PUO and flu-like illnesses whieh are diseussed at the end of the book. The first two ehapters eneompass the principles of antibiotic use and the relationship between antibiotie preseribing and various states of the patient, e.g. allergy, pregnaney ete. An attempt has been made to justify every reeommendation or decision, and non-antibiotic management is diseussed where relevant.

The second edition of this work continues to address the intimate pathophysiologic relationship between hypertension and stroke. The editors and authors clearly and concisely synthesize our developing knowledge of this relationship and place epidemiologic and physiologic information into a practical clinical context. Comprehensive chapters present the evidence supporting strategies for stroke prevention and care, including blood pressure lowering therapies, anti-coagulation, and management of other cerebrovascular risk factors. In addition to prescriptive measures for first stroke prevention, the book illuminates current regimens for care immediately after acute stroke and for the prevention of recurrent stroke. This latest edition also features extensively updated chapters from the previous edition, as well as new chapters on the effects of hypertension and stroke on the cerebral vasculature, blood pressure management in subarachnoid hemorrhage, and blood pressure variability, antihypertensive therapy, and stroke risk. Written by experts in the field, Hypertension and Stroke: Pathophysiology and Management, Second Edition is of great utility for specialists in neurology and cardiovascular medicine and a valuable practical resource for all physicians caring for older adults and hypertensive patients.

One of the eXCltmg challenges of medicine has been the reaching of decisions based on less than complete evidence. As undergraduates in teaching hospitals future physicians are taught to think in clear and absolute black and white terms. Diagnoses in teaching hospitals all are based on supportive positive findings of in vestigations. Treatment follows logically on precise diagnosis. When patients die the causes of death are confirmed at autopsy. How very different is real life in clinical practice, and particularly in family medicine. By the very nature of the common conditions that present diagnoses tend to be imprecise and based on clinical assessment and interpretation. Much of the management and treatment of patients is based on opinions of individual physicians based on their personal expenences. Because of the relative professional isolation offamily physicians within their own practices, not unexpectedly divergent views and opinions are formed. There is nothing wrong in such divergencies because there are no clear absolute black and white decisions. General family practice functions in grey areas of medicine where it is possible and quite correct to hold polarized distinct opinions. The essence of good care must be eternal flexibility and readiness to change long-held cherished opinions. To demonstrate that with many issues in family medicine it is possible to have more than one view I selected 10 clinical and II non -clinical topics and invited colleagues and fellow-practitioners to enter into a debate-in-print."

This visionary reframing of health and healthcare uses a complexity science approach to building healthcare systems that are accessible, effective, and prepared for change and challenges. Its holistic map for understanding the human organism emphasizes the interconnectedness of the individual's physical, psychological, cognitive, and sociocultural functioning. Applications of this approach are described in primary, specialist, and emergency care and at the organizational and policy levels, from translating findings to practice, to problem solving and evaluation. In this model, the differences between disease and illness and treating illness and restoring health are not mere wordplay, but instead are robust concepts reflecting real-world issues and their solutions. Based on the Proceedings of the 1st International Conference of Systems and Complexity for Healthcare, topics covered include: * Coping with complexity and uncertainty: insights from studying epidemiology in family medicine * Anticipation in complex systems: potential implications for improving safety and quality in healthcare * Monitoring variability and complexity at the bedside * Viewing mental health through the lens of complexity science * Ethical complexities in systems healthcare: what care and for whom? * The value of systems and complexity thinking to enable change in adaptive healthcare organizations supported by informatics * If the facts don't fit the theory, change the theory: implications for health system reform The Value of Systems and Complexity Sciences for Healthcare will interest and inspire health and disease researchers, health professionals, health care planners, health system financiers, health system administrators, health services administrators, health professional educators, and, last but not least, current and future patients.

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.

DDDDDDDDDDDDD 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 concerned more with diagnosis in the widest sense and this series deals more definitively with general care and specific treatment of symptoms and diseases. Good management must include knowledge of the nature, course and outcome of the conditions, as well as prominent clinical features and assess is on what to do best for the ment and investigations, but the emphasis patient. Family medical practitioners have particular difficulties and advantages in their work. Because they often work in professional isolation in the com munity 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 rela tively untried methods compared with those that are 'old' and well proven. 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."

In this innovative title, the authors describe unique patient populations affected by stigma and prejudice and the prevalence of these issues to all healthcare providers. Each chapter covers the forms of prejudice and stigma associated with minority statuses, including religious minorities, the homeless, as well as those stigmatized by medical serious medical conditions, such HIV/AIDS, obesity, and substance misuse disorders. The chapters focus on the importance of recognizing biological differences and similarities within such groups and describes the challenges and best practices for optimum healthcare outcomes. The text describes innovative ways to connect in a clinical setting with people of diverse backgrounds. The text also covers future directions and areas of research and innovative clinical work being done. Written by experts in the field, Stigma and Prejudice is an excellent resource for psychiatrist, psychologists, general physicians, social workers, and all other medical professionals working with stigmatized populations.

Part one of the book presents the gastrointestinal problems that commonly face the general practitioner. Emphasis is placed on analysis of clinical data and how this may provoke the most profitable lines of investigation. Many of the investigation and treatment protocols are within the scope of general practice, but hospital management is also included. It was possible to deal with common oesophageal diseases under the heading of oeso phageal problems in Part 1. In contrast, it proved impossible to discuss adequately all of the common diseases affecting other organs of the digestive system under the problem headings. For this reason, a fuller ac count of many common alimentary diseases is provided in Part two. M. L.-5. K. G. D. W. 9 Series Foreword This series of books is designed to help general practitioners. So are other books. What is unusual in this instance is their collec tive authorship; they are written by specialists working at district general hospitals. The writers derive their own experi ence from a range of cases less highly selected than those on which textbooks are traditionally based. They are also in a good position to pick out topics which they see creating difficulties for the practitioners of their district, whose personal capacities are familiar to them; and to concentrate on contexts where mistakes are most likely to occur. They are all well-accustomed to working in consultation."

Over several years working in a district general hospital as a physician with a cardiological interest, the common problems in this field are clearer. This knowledge has come through normal out-patient clinic referrals, care of in-patients, and by working in a domiciliary consultative capacity. The problems that concern family physicians nowadays are somewhat different from the problems of two or three decades ago. The accent now is very much on the implications of hypertensive and ischaemic heart disease. Rheumatic fever is rarely seen, though its sequelae may still be discovered. Hence the approach of this book is to the common problems of today in family practice, and the book is not intended to be a reference text book of cardiology. It does not include references because it has been written from personal experience gained from the treatment and management of patients with common cardiac problems. It is hoped that it will be of value primarily to family physicians because it has been written in an attempt to fill a need as measured by the problems that are referred to specialists in the cardiological field. It may prove of value to those medical students and nurses who wish to consider medical problems in a practical way, that is from the ways that cardiac problems present in practice.

The fact that there are special problems in the care of the elderly in the community is ample justification for writing a separate volume on the subject. The knowledge that there are increasing numbers of older people in virtually every country in the world makes it all the more important that the family physician should have sympathy with and understanding of the problems of them, since they are lilcely to make up a significant part of his worlcload and, increasingly, will take up more of his time and energy. There is a progressive amount of disability with advancing years, and this is particularly true of those aged 75 years and over. Increasing age is associated with serious impairment of hearing and vision, senses which younger people take for granted. Old age sees the arrival of major diseases of middle age with much greater frequency, such as ischaemic heart and cerebrovascular disease, diabetes mellitus and osteoarthritis. There are other disorders that are virtually confined to the elderly, such as fractures of the femoral neck, Paget's disease and myeloma. We now know that the disintegration of the con ducting tissue of the heart is largely an age-related phenomenon. Ageing processes affect every major organ system in the body and the impairment of physiological perfor mance resulting from these affects the elderly individual's response to infections, disease and environmental changes in complex ways that are not seen in younger people."

This series of books is designed to help general practitioners. So are other books. What is unusual in this instance is their collec tive authorship; they are written by specialists working at district general hospitals. The writers derive their own experi ence from a range of cases less highly selected than those on which textbooks are traditionally based. They are also in a good position to pick out topics which they see creating difficulties for the practitioners of their district, whose personal capacities are familiar to them; and to concentrate on contexts where mistakes are most likely to occur. They are all well-accustomed to working in consultation. All the authors write from hospital experience and from the viewpoint of their specialty. There are, therefore, matters important to family practice which should be sought not within this series, but elsewhere. Within the series much practical and useful advice is to be found with which the general practitioner can compare his existing performance and build in new ideas and improved techniques. These books are attractively produced and I recommend them."

Lifestyle - the manner in which people live - is fundamental to health, wellness, and prevention of disease. It follows that attention to lifestyle is critically important to effective and successful health care. But here's the challenge: health care professionals receive very little, if any, formal training about lifestyle counseling and therefore are ill equipped to incorporate lifestyle issues into clinical practice. In response, "Lifestyle Medicine" is evolving as a means to fill this knowledge gap. Lifestyle medicine approaches health and wellness by harnessing the power of lifestyle-related behaviors and influencing the environment we live in. It is a formal approach that promises to enhance and strengthen a re-invigorated health care system that is still outpaced by the epidemic proportions and complexity of chronic diseases like obesity, diabetes, depression, hypertension, and cancer, among others. Lifestyle Medicine: A Manual for Clinical Practice presents this formal approach in a pragmatic context. This unique and practical manual provides clear and succinct guidance on nearly all aspects of lifestyle medicine. The approach is both explanatory and pragmatic, providing case studies and bulleted translation of academic information into clinical practice recommendations. There is an emphasis on scientific evidence wherever possible as well as opinions by the expert chapter authors who practice lifestyle medicine. There is a "how-to" rationality to the book, consistent with a premise that any and all health care professionals should, and perhaps must, incorporate lifestyle medicine. A valuable checklist is included at the close of the book that summarizes key points and provides a practical tool for routine patient encounters.

In writing this short monograph on 'Problems in Peripheral Vascular Disease', I have tried to steer a course between a simplistic dogmatic approach more appropriate to an under graduate text, and a detailed specialist treatise of interest only to vascular surgeons. Although arterial surgery has been performed for centuries, the main indications in the past were to deal with the effects of trauma and aneurysm formation. The development of arterio graphy and the ability to see arterial blocks and stenoses allowed surgeons to carry out increasingly sophistidated operations for an enlarging range of pathological conditions. Even today, arterial surgery continues to develop, and although we are often dealing with the 'surgery of ruins', a successful outcome is just as rewarding for surgeon and patient alike. In this book I have also included a discussion on venous problems including a note about recent developments in direct surgery of the deep veins of the lower limb which could be a re warding field of endeavour for the vascular surgeon. The original descriptions by Buerger and Raynaud are taken from 'Classic Descriptions of Disease' by Ralph H. Major. While reviewing my own surgical practice, I have had the pleasure of reading once again the publications of H.H.G. Eastcott (arterial surgery), J.T. Hobbs (varicose veins), G.L. Hill (Buerger's disease), Adrian Marston (intestinal ischaemia), Martin Bimstingl (vasospastic disorders) and C.H. Hawkes (lumbar canal stenosis)."

This third edition of the Beecham Manual has its origins in a manual produced by Selwyn Carson for his general practice in Christchurch, New Zealand. He produced loose-leaf sets of instructions for his practice team and colleagues. Beecham Research Laboratories of New Zealand did a great service for the medical profession by publishing and distributing Dr Carson's manual there. The British version of the Beecham Manual had different objectives. The vocational training programme needed basic resources and the British Manual was created as an easy to read reference book on common prob lems and methods in general practice. The first and second editions met with enthusiastic approval from princi pals, trainers and trainees. This third edition follows the same general format but has been completely revised and updated and includes many new additions. The five sections are: o planned care of definable population and other groups o principles of teaching and learning o emergencies and their management o psychiatry o clinical care of common conditions We have kept to simple, clear and brief presentations of our conjoint views based on our experiences in our own practices. We dedicate this third edition to our colleagues involved in caring, learning and teaching. They may not agree with us completely but we hope that we will make them consider our suggestions and use them for thought, debate and discussion. We hope also that it will be used as a work book for the whole practice team."

The topics chosen for discussion represent the most common problems referred by family doctors to chest clinics. It was taken for granted that the reader will be familiar with the symptoms, signs, and natural history of respiratory diseases, so that the stress is on differential diagnosis and treatment. Tuberculosis once occupied nearly all the time of chest physicians. At present weeks go by without a single case presenting itself. There has been no comparable improvement in cancer of the lung, which remains one of the most intract able problems. Asthma was seldom referred to out-patient clinics when the disease was regarded as more unpleasant than dangerous. The hazards of severe attacks and the advan tages of liaison with a hospital department are now widely recognized. A similar change of attitude to the management of chronic bronchitis brought many new patients to the chest clinics in place of the vanishing tuberculous population. Some uncommon pulmonary diseases are included: allergic alveolitis, because of the importance of early diagnosis, and sarcoidosis in order to discourage unnecessary treatment. The book is intended to be a practical guide and is not a critical review. This might serve as an excuse for its didactic style and the exclusion of controversial subjects. Some statements are repeated at more than one place in order to help readers who wish to consult individual chapters bearing on some current problem. Source references are omitted and are replaced by a short list of books recommended for further reading."

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 analyis of symptoms and on knowledge of the individual patient and family. This series follows that on Problems in Practice which was concerned more with diagnosis in the widest sense and this series deals more defini tively with general care and specific treatment of symptoms and diseases. Good management must include knowledge of the nature, course and outcome of the conditions, as well as prominent clinical features and as sessment 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 islation in the com munity 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 rela tively untried methods compared with those that are 'old' and well proven. 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."

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.

This clear-sighted volume introduces the concept of "disruptive cooperation"- transformative partnerships between the health and technology sectors to eliminate widespread healthcare problems such as inequities, waste, and inappropriate care. Emphasizing the most pressing issues of a world growing older with long-term chronic illness, it unveils a new framework for personalized, integrative service based in mobile technologies. Coverage analyzes social aspects of illness and health, clinically robust uses of health data, and wireless and wearable applications in intervention, prevention, and health promotion. And case studies from digital health innovators illustrate opportunities for coordinating the service delivery, business, research/science, and policy sectors to promote healthier aging worldwide. Included among the topics: Cooperation in aging services technologies The quantified self, wearables, and the tracking revolution Smart healthy cities: public-private partnerships Beyond silos to data analytics for population health Cooperation for building secure standards for health data Peer-to-peer platforms for physicians in underserved areas: a human rights approach to social media in medicine Disruptive Cooperation in Digital Health will energize digital health and healthcare professionals in both non-profit and for-profit settings. Policymakers and public health professionals with an interest in innovation policy should find it an inspiring ideabook.

JOHN JOHN FRY FRY All All examinations examinations create create problems problems and and stresses stresses in in examinees. examinees. The The examination examination for for the the Membership Membership of of the the Royal Royal College College of of General General Practitioners Practitioners is is no no exception. exception. Although Although the the examiners examiners state state that that their their objectives objectives are are to to pass pass candidates candidates wherever wherever and and whenever whenever possible, possible, nevertheless nevertheless the the failure failure rate rate remains remains con sistently sistently at at 30% 30% plus plus of of those those taking taking the the examination. examination. The The reasons reasons for for failure failure fall fall into into a a number number of of groups. groups. The The candidate candidate may, may, through through over-confidence, over-confidence, not not have have prepared prepared for for the the examination. examination. He He may may have have assumed assumed that that it it is is not not necessary necessary to to read, read, learn learn and and digest digest data, data, facts facts and and experience experience on on general general practice. practice. How How wrong wrong that that is, is, he he will will discover discover when when he he sits sits the the exam. exam."

WHY WE MUST PRACTISE TRANSCULTURAL MEDICINE Health professionals and GPs should concern themselves with ethnicity, religion and culture as much as with the age, sex and social class of their patients. Transcultural medicine is the knowledge of medical and communication encounters between a doctor or health worker of one ethnic group and a patient of another. It embraces the physical, psychological and social aspects of care as well as the scientific aspects of culture, religion and ethnicity without getting involved in the politics of segregation or integration. English general practitioners and health professionals tend to regard everyone as English, and to assume that all patients have similar needs. Would that it were as simple as that! For economic reasons - based on supply and demand - the mass migration of working populations from the new Commonwealth countries, along with their dependent relatives (including their parents) to Britain took place during one decade - the 1960s. Broadly speaking, the workers were in their thirties and forties, and their dependent parents were in their fifties and sixties. All these will, of course, be 30 years older in the 1990s.

This newly expanded and updated fifth edition will be the largest and most comprehensive of the five editions and new topics and chapter authors have been added. The authors have created the most comprehensive and up-to-date review of the nutritional strategies available for the prevention of disease and the promotion of health through nutrition. Patients are looking for credible information from their health care providers about a whole range of subjects covered here, including ss-carotene, lycopene, antioxidants, folate, and the myriad of bioactive phytochemicals found in garlic and other foods. With sections on cardiovascular disease, diabetes, and pregnancy among many others, this volume will be of great value to practicing health professionals, including physicians, nutritionists, dentists, pharmacists, dieticians, health educators, policy makers, health economists, regulatory agencies and research investigators. An entire section covers nutrition transitions around the world including Eastern Europe, Latin America and Asia as well as goals for preventive nutrition in developing countries. Preventive Nutrition: The Comprehensive Guide for Health Professionals, 5th Ed. is an important resource for thousands of health professionals who have been utilizing the previous editions since 1997.