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.

This book is a personal testimony of faith in the future and in the progression to better health and a better life. It is the testament of a rough and ready measuring device - a practising physician who sought to compare and contrast three systems of medical care to see what can be distilled from them to help us all in achieving better services for medical care. Medical care as a human and civic right is the con cern of us all. Seeking to live longer and in good health we depend on medical, social and welfare services to attain this goal. Yet it is quite obvious that there are limits and dilemmas that prevent anything but an unsatisfactory compromise. The resources that are available cannot meet all the calls. How then can we make the best use of the resources that we have? This must be the theme for this book. What can we learn from each other for the com mon good? Since we all are facing the same common prob lems, how do we go about resolving them? For example, how do the medical care services in the USSR, USA and UK cope with an acute heart attack, with a middle-aged woman with depression, with a brain-damaged child, with a road accident or with a case of measles? These are the common human factors involved."

One of the few real and lasting benefits of international medical meetings is the opportunity to meet, talk, gossip and get to know colleagues from other countries. So it was that we met, talked and planned at WONCA (World Organization of National Colleges and Academies and Academic Associa tions of General Practitioners/Family Physicians) meetings at Montreux and New Orleans. We realized that although we worked in different places and in different practices 'primary health care' was essentially the same the world over. Our roles, our problems, our clinical content, our challenges and objectives were similar whether we work in Europe, North America, Australasia, South Africa or developing countries. With such similarities we asked ourselves - 'why not share our common experiences for mutual benefits?' The question developed into an idea and the idea into this book. We started by selecting what we considered were important topics and then we invited friends and colleagues to join us in putting our experiences and beliefs from years of practice to readers from all over the world to demonstrate our common concerns and to learn from one another."

Following up on Mindful Medical Practice, this book describes in detail how mindfulness is being taught to medical students, residents, practicing physicians, and allied health care professionals. Steps to set up and integrate programs into curricula are featured and educators' questions concerning practical aspects of doing this work are addressed. The argument on how to promote the kinds of leadership and cultural changes necessary are also discussed along with the many challenges facing health professionals in multiple settings. Mindful Medical Practitioners is an invaluable resource that raises interest, provides a rationale and details how to integrate mindfulness into clinical work and serves as a guide for those qualified to teach it.

This book provides an in-depth review of state-of-the-art orthopaedic techniques and basic mechanical operations (drilling, boring, cutting, grinding/milling) involved in present day orthopaedic surgery. Casting a light on exploratory hybrid operations, as well as non-conventional techniques such as laser assisted operations, this book further extends the discussion to include physical aspects of the surgery in view of material (bone) and process parameters. Featuring detailed discussion of the computational modeling of forces (mechanical and thermal) involved in surgical procedures for the planning and optimization of the process/procedure and system development, this book lays the foundations for efforts towards the future development of improved orthopaedic surgery. With topics including the role of bone machining during surgical operations; the physical properties of the bone which influence the response to any machining operation, and robotic automation, this book will be a valuable and comprehensive literature source for years to come.

This new edition presents information and knowledge on the field of biomedical devices and surgical tools. The authors look at the interactions between nanotechnology, nanomaterials, design, modeling, and tools for surgical and dental applications, as well as how nanostructured surfaces can be created for the purposes of improving cell adhesion between medical devices and the human body. Each original chapter is revised in this second edition and describes developments in coatings for heart valves, stents, hip and knee joints, cardiovascular devices, orthodontic applications, and regenerative materials such as bone substitutes. There are also 8 new chapters that address: Microvascular anastomoses Inhaler devices used for pulmonary delivery of medical aerosols Surface modification of interference screws Biomechanics of the mandible (a detailed case study) Safety and medical devices The synthesis of nanostructured material Delivery of anticancer molecules using carbon nanotubes Nano and micro coatings for medical devices This book is appropriate for engineers, material scientists, chemists, physicists, biologists, medical and dental professionals with an interest in biomedical devices and tools, and researchers in the same fields.

This book covers the principles of advanced 3D fabrication techniques, stem cells and biomaterials for neural engineering. Renowned contributors cover topics such as neural tissue regeneration, peripheral and central nervous system repair, brain-machine interfaces and in vitro nervous system modeling. Within these areas, focus remains on exciting and emerging technologies such as highly developed neuroprostheses and the communication channels between the brain and prostheses, enabling technologies that are beneficial for development of therapeutic interventions, advanced fabrication techniques such as 3D bioprinting, photolithography, microfluidics, and subtractive fabrication, and the engineering of implantable neural grafts.There is a strong focus on stem cells and 3D bioprinting technologies throughout the book, including working with embryonic, fetal, neonatal, and adult stem cells and a variety of sophisticated 3D bioprinting methods for neural engineering applications. There is also a strong focus on biomaterials, including various conductive biomaterials and biomimetic nanomaterials such as carbon-based nanomaterials and engineered 3D nanofibrous scaffolds for neural tissue regeneration. Finally, two chapters on in vitro nervous system models are also included, which cover this topic in the context of studying physiology and pathology of the human nervous system, and for use in drug discovery research. This is an essential book for biomedical engineers, neuroscientists, neurophysiologists, and industry professionals.

Systems-level neuronal mechanisms that coordinate the temporally, anatomically, and functionally distributed neuronal activity into coherent cognitive operations in the human brain have remained poorly understood. In humans, neuronal oscillations and synchronization can be recorded non-invasively with electro- and magnetoencephalography (EEG and MEG) that have excellent temporal resolution and an adequate spatial resolution when combined with source-reconstruction methods. In this book, leading authors in the field describe how recent methodological advances have paved the way to several major breakthroughs in the observations of large-scale synchrony from human non-invasive MEG data. This volume also presents the caveats influencing analyses of synchronization. These include the non-homogeneous sensitivity of MEG to superficial cortical sources, and, most importantly, the multitude of consequences of linear mixing. Linear mixing is an immense confounder in the sensor-level analyses of synchronization, but is also present at the source level. Approaches that can be used to avoid or compensate for these issues are then discussed. Thereafter, several authors take up a number of the functional roles that large-scale synchronization has in cognition. The authors assess how the spatio-temporal and -spectral organization and strength of both local and large-scale synchronized networks are associated with conscious sensory perception, visual working memory functions, and attention. These chapters summarize several lines of research showing how the strength of local and inter-areal oscillations in both cortical and subcortical brain structures is correlated with cognitive functions. Together these data suggest that synchronized neuronal oscillations may be a systems-level neuronal mechanism underlying the coordination of distributed processing in human cognition. In line with this argument, other authors go on to describe how oscillations and synchronization are altered in clinical populations, complementing the data presented on healthy subjects. Importantly, this book includes chapters from authors using many different approaches to the analyses of neuronal oscillations, ranging from local oscillatory activities to the usage of graph theoretical tools in the analyses of synchronization. In this way the present volume provides a comprehensive view on the analyses and functional significance of neuronal oscillations in humans. This book is aimed at doctoral and post-doctoral students as well as research scientists in the fields of cognitive neuroscience, psychology, medicine, and neurosciences.

This book covers the state-of-the-art research on molecular biology assays and molecular techniques enabled or enhanced by microfluidic platforms. Topics covered include microfluidic methods for cellular separations and single cell studies, droplet-based approaches to study protein expression and forensics, and microfluidic in situ hybridization for RNA analysis. Key molecular biology studies using model organisms are reviewed in detail. This is an ideal book for students and researchers in the microfluidics and molecular biology fields as well as engineers working in the biotechnology industry. This book also: Reviews exhaustively the latest techniques for single-cell genetic, epigenetic, metabolomic, and proteomic analysis Illustrates microfluidic approaches for inverse metabolic engineering, as well as analysis of circulating exosomes Broadens readers' understanding of microfluidics convection-based PCR technology, microfluidic RNA-seq, and microfluidics for robust mobile diagnostics

This book is designed to present the clinical geriatric trends within general internal medicine and family practice, which practitioners often encounter in caring for their older adult patients. Chapters focus on increasingly difficult clinical decisions that practitioners have to make in caring for older adults, who often experience medical complications due to memory loss, physical disability, and multiple chronic conditions. Written by experts in geriatric medicine, each of these chapters start with the most up-to-date clinical geriatric research and provide specific examples or case studies on how to use this information to address the clinical needs of older adult patients. In addition, there is a set of concise "take-home points" for each chapter that are easy to commit to memory and implement in clinical care of aging patients. As the only book to focus on current trends in geriatric research and evidence-based eldercare practice, Clinical Trends in Geriatric Medicine is of great value to internists, family practitioners, geriatricians, nurses, and physician assistants who care for older adults.

Administering the National Health Service (NHS) is asking to navigate without reliable and sufficient information. It is amazing how a national service costing more than GBP15,OOOM (1984) and employing more than 1 million has existed since 1948. It is likely that with better appropriate data there could be economies and great efficiency and effectiveness. Paradoxically there is much data on the NHS, published and unpublished, that has remained unexploited and unused. In this book we have taken up the challenges of showing the availability of data and its presentation so that clinicians, adminis trators, committee members and politicians can better understand the state and needs of the NHS. Why this book? Because it is not possible to make decisions without facts. There is too much data around that is unrelated to the needs of clinicians, administrators, committee members and politicians. It can be brought together to provide bases for de cisions and, more important, to show the gaps that exist and the need for more information. What does it contain? It includes social and demographic data, NHS facts and figures, manpower data on the use of the NHS and some examples of how quality can be assessed and promoted.

This book focuses on biomaterials of different forms used for medical implants. The authors introduce the characteristics and properties of biomaterials and then dedicate special chapters to metallic, ceramic, polymeric and composite biomaterials. Case studies on sterilization methods by biomaterials are also presented. Finally, the authors describe the degradation and effects of biomaterials in living tissue.

This book has been written primarily for general practitioners; it describes the social problems which are presented by patients to their doctors for help and advice. The aim of the book is to help the doctor manage these problems, both through his own interventions and by involving or referring the patient on to other agencies. While the more common problems have been considered in detail, those rarely encountered have been omitted. The book also concentrates on help available from non-medical sources, as these will be less familiar to the general practitioner than other medical or nursing services. There is often a close association between social difficulties and health problems, both physical and psychiatric. It is, there fore, vital that an attempt is made to meet the social needs of patients in order to promote good physical and mental health. R. H. Corney 8 Series Foreword This series of books is designed to help general practitioners. So are other books. What is unusual in this instance is their collect ive 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."

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."

TO ACUPUNCTURE A Practical Guide for GPs and other Medical Personnel Peter Pearson, MBBS, MRCGP, DRCOG The Medical Centre, Yateley, Cambedey, Surrey GU17 7LS Publisht;d in. the UK and Europe by MTP Press Limited Falcon House Lancaster, England British Library Cataloguing in Publication Data Pearson, Peter An introduction to acupuncture: a practical guide for GPs and other medical personnel. 1. Acupuncture I. Title 615. 8'92 RM184 ISBN-13: 978-94-010-7935-8 e-ISBN-13: 978-94-009-3199-2 DOl: 10. 1007/978-94-009-3199-2 Published in the USA by MTPPress A division of Kluwer Academic Publishers 101 Philip Drive Norwell, MA 02061, USA Copyright (c) 1987 MTP Press Limited Softcover reprint of the hardcover 1st edition 1987 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from the publishers. CONTENTS Preface 7 Acknowledgements 8 1 What is acupuncture? 9 2 Local dysfunction of channels 13 3 The channels and points 15 4 Technique 37 5 Specific conditions 45 6 Systemic treatment 53 7 Other forms of acupuncture 65 8 Academic considerations 73 9 Further information 79 References 83 Index 87 PREFACE Several years ago, a patient consulted me, and requested 'aquapuncture'. This sounded more like an underwater sexual activity than anything else, but I confessed ignorance! Several more requests highlighted my complete lack of knowledge of this subject and stimulated me into activity.

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 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. Their ad vantages 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 a relatively short period of time two-dimensional echo cardiography has become the most important non-invasive diagnostic tool in the daily practice of a pediatric cardiologist who predominantly deals with congenital structural heart disease in neonates and infants. Consequently, one-dimensional M-mode echocardiography has lost most of its importance particularly in this field. Therefore, an atlas showing exclusively two-dimensional echocardiograms of the most common and some less frequently occurring malformations appeared to be a useful addition to the existing literature. The confinement to two dimensional imaging alone allowed an elaborate presentation of the various defects with more than 200 selected still frames and many additional explanatory drawings and diagrams. The material was collected from patients who were referred to the Department of Pediatric Cardiology of the Wilhelmina University Children's Hospital in Utrecht during a period of about 2 years. The two-dimensional echocardiographic findings were correlated with cardiac catheterization data and/or surgical procedures and/or post mortem investigations. The necessary echocardiographic equipment was aquired with financial aid from the Dutch Heart Foundation. We are indebted to Mrs. J. W. Wetselaar for her outstanding artwork. We also thank P. D. Woltema and F. J. van Waert for the photographic reproductions, Jacomine Bosma for preparing and type-setting the entire manuscript and Dr. N. Middleton for critically reading the English text. G. J. van Mill, M. D. A. J. Moulaert, M. D. E. Harinck, M. D. CONTENTS 1. Introduction and the normal heart Introduction The normal heart 2 2."

This book is designed for use by medical students, nurses, young practitioners, internists, family physicians and all those initially involved with the problem of diagnostics. It is struc tured to provide a concise logical approach to the diagnosis of common illness and disorders in adults. The elucidation of an illness cause is not easy for the inexperienced. Although text books and guidance notes can be referred to for clarification of assembled thought - once a medical history has been taken - a system-orientated reference guide has considerable value for aiding and checking the logic of diagnosis. It is hoped that this book will fulfil that purpose. It could not have been written without the help of R. G. Brackenridge's Essential Medicine (1979, MTP, Lancaster, England), and J. Fry's Common Diseases (1979, MTP, Lancaster, England), to which the reader is referred and to which generous acknow ledgement is made. The tables of Differential Diagnosis that follow Chapters 3-7 are adapted from some that have appeared in Handbook of Differential Diagnosis, vols 1-3, published by Rocom Press, Hoffman La Roche Inc., New Jersey, 1968-1974 - an invaluable publication now unfortun ately out of print, and permission to do so is gratefully apprec- 7 8 DIFFERENTIAL DIAGNOSIS iated. Finally without the stimulus and encouragement of Mr David Bloomer (MTP) and the particular assistance of Mrs J. C. Robinson, this book would never have been written. ALEXANDER D. G."

Cardiology embraces a number of different conditions and disease processes. Cardiovascular disease is now responsible for most of the deaths of adults, especially premature deaths, in the developed world. The development of effective preventive measures, new drugs and surgical techniques makes it increasingly important to recognise those at risk, to diagnose accurately those suffering from disease and to prescribe, monitor and refer appropriately. This book is intended to focus attention on the opportunities which family' practice provides for this and to look at the need for a change in emphasis in approaching the problems. The book is in five parts. Part 1 is a reminder of some of the basic principles, which are essential if sensible cardiology is to be practised. Part 2 is about cardiac drugs, their use, effectiveness and risks. Part 3 looks at the diagnostic process; it comprises the history, examination, investigation and referral of patients, who might have cardiac disease and also the drugs which are most likely to be used. Part 4 is devoted to specific conditions. In Part 5, we look at the need for prevention and consider how it may be tackled in general practice. This is not a comprehensive textbook of cardiology. It is not intended for students. It is hoped that it may be useful to experienced doctors, struggling to provide a sound, sensible service in an environment of ever expanding technology.

This book provides a state-of-the-art update, as well as perspectives on future directions of research and clinical applications in the implementation of biomechanical and biophysical experimental, theoretical and computational models which are relevant to military medicine. Such experimental and modeling efforts are helpful, on the one hand, in understanding the aetiology, pathophysiology and dynamics of injury development and on the other hand in guiding the development of better equipment and protective gear or devices that should ultimately reduce the prevalence and incidence of injuries or lessen their hazardous effects. The book is useful for military-oriented biomedical engineers and medical physicists, as well as for military physiologists and other medical specialists who are interested in the science and technology implemented in modern investigations of military related injuries.