This book helps doctors and students to arrive at a diagnosis, and to explain and to justify their reasoning, especially when seeing patients with new problems that lie outside their personal range of experience. This will happen very frequently to students, frequently to house officers, but will still happen regularly to very experienced senior hospital doctors and general practitioners. The book adopts the approach used by experienced diagnosticians, by focusing on the finding with the shortest differential diagnosis (i.e. the best diagnostic lead). It describes the differential diagnoses of such findings that may be encountered by a reader in the history, examination and usual preliminary tests and how the diagnoses can be confirmed. It describes what tactics to adopt in order to find better leads, while not losing sight of the patient’s original concern. The probability and set theory of this process is explained in Chapter 3. The entries on each page of the book resemble a traditional past medical history with multiple diagnoses.
The reader scans down the page to see which of the diagnoses with its findings match the patient’s findings so far. The compatible findings can then be used as evidence for the diagnosis and treatment, to be shared with the patient and other members of the multidisciplinary team, such as nurses, pharmacists, physiotherapists, and other professionals allied to medicine. It can be used to create high-quality discharge or handover summaries. Patients or their carers may wish to share in the diagnostic and decision-making process. In order to do this, they need to know what problems have been identified and the tests and treatments being proposed. They will need to know which of these diagnoses explain each problem and treatment. They may also need to know which findings are being used to confirm each diagnosis, and to choose its treatments and to mark the outcome. The book describes how this information can be provided in writing. The patient or carer will then be in a position to explain all this to another doctor, if necessary.

Basics of Blood Management 2nd Edition PDF Free Download

Much has been done in blood management since the fi rst edition. This is not only true for the many scientifi c studies that elevate blood management out of the low plains of experience – driven action into the realms of evidence – based medicine. Many of the things that blood managers over the decades have observed have now been proven in randomized clinical trials. Other things in blood management that may have been driven by tradition and belief have come into question. These developments contribute greatly to the maturation of this new specialty of blood management. It is interesting, though, to note that the defi nition of blood management is still not accepted by all who claim to practice blood management. Some use the term blood management to effi ciently distribute the ever more scarce resource of banked blood to those patients who are deemed to be in the greatest need. Others consider blood management as the outcome – oriented part of transfusion medicine that delivers allogeneic blood products in an evidence – based manner. Still others see blood management as a mix of transfusion medicine and hematology. And another group of medical practitioners consider blood management to be a religiously motivated restriction of modern medicine.
However, blood management is none of these. At the core of blood management are two foci: one is the patient ’ s own blood as a precious, live – saving, and potentially fi nite resource; and the other is the patient ’ s outcome. To manage the patient ’ s resource “ blood ” skillfully to optimize his or her outcome is the philosophy that drives blood management. Practically speaking, blood management is a multidisciplinary, multimodality concept that focuses on the patient by improving his/her outcome. Every medical specialty, from neonatology to geriatrics, from anesthesiology to urology, and including all clinical specialties as well as laboratory – based specialties such as diagnostic laboratory medicine, can contribute to a successful blood management program.

Oncology Clinical Trials PDF Free Download

In 2006, a group of colleagues were discussing the days events at ASCO and the topic turned to people that were retiring at the end of the year or changing career directions. Many of us were initially taken back, yet, also excited, to learn that some of our long time colleagues were turning a new leaf in their lives. These individuals were giants in the field who had not only helped shape modern oncology, but also had long and generously provided guidance to us. Many had been our mentors and we always felt that they would be there to ask: “How did you design this pivotal trial in colon cancer? Why did you use this endpoint for this lung trial? Can we really use this as a surrogate marker?” They were always were a voice of reason which reflected years of experience in doing clinical research and they played a vital role in our own scientific and intellectual development. Having the benefit of their experience underscored the importance, and declining prevalence, of mentoring the next generation of clinical trialists.
Many of us have now inherited these perilous challenges. This book is a collaborative effort and is based on the knowledge and expertise of leading oncologists, statisticians and clinical trial professionals from academia, industry and government who have years of experience in designing, conducting, analyzing, and reporting clinical trials in cancer. This collective experience was created to allow these seasoned investigators to pass on their knowledge to those who are entering the field. In so doing, our mission is to enhance the successful design, development, management and analysis of oncology clinical trials for the next generation. While this book focuses on oncology clinical trials, the fundamental concepts and basic principles are applicable to all trials in many medical disciplines. We hope that this work will aid the junior investigator’s academic, industry or government career in order to improve the quality of clinical trials. In so doing, their discoveries can be quickly and efficiently translated into improved patients outcomes and future care.

Textbook of Hemophilia 3rd Edition PDF Free Download

Jewish writings of the second century AD are the earliest written references about hemophilia and a ruling of Rabbi Judah the Patriarch exempted a woman’s third son from being circumcised if two elder brothers had died of bleeding after circumcision [1]. The first article written in America about hemophilia entitled “An account of a hemorrhagic disposition existing in certain families” was published in the Medical Repository in 1803 by Dr John Otto, a physician in the New York Hospital [2,3]. This was a case of a woman carrier, and the sex-linked inheritance was noted as well as the occurrence of premature death: “About seventy or eighty years ago, a woman by the name of Smith, settled in the vicinity of Plymouth, New-Hampshire, and transmitted the following idiosyncrasy to her descendants. It is one, she observed, to which her family is unfortunately subject, and had been the source not only of great solitude, but frequently the cause of death.” Many people became aware of this rare sex-linked disorder because Queen Victoria of the UK, who reigned from 1837 to 1901, was a carrier [1] (Figure 1). She had two carrier daughters, Alice and Beatrice [4], and a son with hemophilia, Leopold [5].
Alice was the grandmother of Alexis, the Tsarevich, whose repeated hemophilic bleedings resulted in his mother, Alexandra, coming under the influence of Rasputin, and it has been suggested that hemophilia may have had a profound effect on the course of Russian history [6]. Beatrice, born in 1856, was the last child of Victoria and Albert; her daughter Ena became Queen of Spain and had two hemophilic sons, Alphonso and Gonzalo [4]. It is now known, following forensic DNA examination of bones from the murdered Russian Royal family, recovered from graves near Yekaterinburg, that the royal disease was hemophilia B. [7] The Treasury of Human Inheritance, published in 1911 by Bulloch and Fildes, described “for students of haemophilia . . . [their] Shakespeare for its drama and human warmth and their bible for its towering authority” contains 1000 references and case reports and 200 pedigrees of hemophilic families [1,8]. It includes a description of seven generations of the Appleton- Swain family, originating from a small town near Boston, USA, from the early part of the 18th century to the later years of the 19th century. This family was first described by Hay who noted, “None but males are bleeders . . . whose daughters only have sons thus disposed.” William Osler reinvestigated the kindred in 1885 and recorded that many of the hemophilic males died an early death from bleeding [8]. The severe morbidity and early mortality of hemophilia without treatment was reported in great detail in a monograph published by Carol Birch in 1937 from the USA [9] and later summarized by Biggs [10]. The cause of death in 113 patients was recorded—many died from very trivial injury—82 died before 15 years of age and only eight survived beyond 40 years

Attention Deficit Disorder Practical Coping Mechanisms 2nd Edition PDF Free Download

The biggest challenge of specializing in the diagnosis and treatment of attention deficit disorder and attention deficit hyperactivity disorder (ADD/ADHD) for the last 15, going on 20, years has been the controversy and the vast array of opinions regarding one disorder. I recall being on a panel with rather esteemed colleagues for a large pediatric conference several years ago. Every time the audience asked a question, none of us agreed with one another. While attempting to be polite and not to dispute one another publicly, it was rather clear that no one agreed on what ADD/ADHD was and what it wasn’t. The result was a lot of confusion for the public, who probably left this meeting with more questions than answers. Since that day I have always dreamed of having a book in which professionals from all types of disciplines could express their opinions about this rather controversial and disputed over- and under-diagnosed disorder in order to help other professionals and the public to have a better sense of exactly what ADD is.
Although there are opinions expressed in this book that differ based upon the discipline of the writer, there are even more themes that are similar and represent agreement in the field. Many, many books have been published on ADD/ ADHD. What makes this book different is that its contributors and the wide range of professionals who contributed their opinion represent one of the first times — if not the first time—that experts from all of the professional fields—functional medicine; neurology; sleep medicine; psychiatry; cardiology; neuropsychology; psychology; family practice; academic, speech and language pathology; tutorial, weight/nutrition, and respiratory therapy,—united their efforts. I hope that this will be the beginning of a new era in the world of ADD/ADHD, where professionals from different disciplines gather to exchange knowledge rather than to dispute one another in their correct opinion.

Psychiatry 3rd Edition PDF Free Download

Psychiatry is the field of medicine that concerns itself with those illnesses that have emotional or behavioral manifestations. Psychiatric illnesses are extremely common and exact a great personal and social cost in disability, suffering, and even death. This book is intended as an introductory text that prepares medical students, physicians, and other health professionals for the clinical task of working with psychiatric patients. As such, it emphasizes recognition and assessment of psychiatric illness. The text’s clinical orientation is equally well suited for medical students during their preclinical introduction to psychiatry course and core psychiatry clerkship, as well as nonpsychiatric physicians, psychiatric residents, and other health professionals who work with patients with psychiatric disorders, including psychologists, social workers, nurses, and occupational therapists. Patients with emotional and behavioral difficulties are often discouraged from seeking help by the stigma that they, their families, and even physicians tend to attach to psychiatric illnesses. All health care providers should be sensitive to the shame that patients with psychiatric problems may have.
Being well informed about the signs and symptoms of the most common psychiatric disorders improves the physician’s chances of recognizing these disorders in patients. Familiarity with the course and prognosis of these conditions enhances the ability to refer patients for appropriate treatment and to complete the first step in the referral process, which is frequently education and reassurance. The first two chapters in the book provide a framework for the evaluation of psychiatric patients, focusing on clinical assessment and the psychiatric interview. These chapters demonstrate how to obtain and synthesize clinical data and generate an appropriate differential diagnosis and treatment plan. Subsequent chapters cover the major psychiatric disorders; the special topics of suicide, violence, and the medically ill patient; and an overview of the stages of child, adolescent, and adult development. An additional chapter is devoted to the assessment and treatment of children and adolescents. The book concludes with chapters covering pharmacotherapy and psychotherapy.

OSCEs for the MRCOG Part 2 Second Edition PDF Free Download

The examination for membership for the Royal College of Obstetricians and Gynaecologists aims to set a standard of competent, safe practice for anyone pursuing a career in obstetrics and gynaecology. The oral part of the examination now consists of Objective Structured Clinical Examinations (OSCEs). We have both been past chairs of the RCOG OSCE Committee, and convenors of the RCOG Part 2 course. We therefore have extensive experience in teaching and preparing candidates for this examination, and in examining candidates. In this new edition we have tried to update the questions and give comprehensive examples of the type of OSCEs that may appear in the exam. Advice is given on how to approach these stations and the common problems that we have seen candidates encounter. Since the first edition of this book, clinical governance has become an increasingly important aspect of how we deliver care.
Questions on clinical governance are therefore included in this book as there is every likelihood that this aspect of practice may feature somewhere in the MRCOG exam. Remember that the written part of the examination concentrates on your knowledge, and the OSCEs will assess your application of knowledge, and skills. In our specialty, communication skills are especially important and we would hope that by going through this book and practising the OSCEs stations you will be competent in all the skills that the Royal College of Obstetricians and Gynaecologists expects you to have. We hope that you find this book invaluable in your preparation for the examination and we wish you luck.

Diabetes Care A Practical Manual 2nd Edition PDF Free Download

Who is this book for?
• All health care staff in any discipline, e.g. doctors, nurses, dietitians, podiatrists, physiotherapists, occupational therapists, speech and language therapists, psychologists, pharmacists, health care assistants, medical secretaries, managers and care planners, and others • Primary, community, secondary, NHS, or private care services • Are you a person with diabetes who wants to learn more, or a family member of a person with diabetes? This book is written for health staff but many patients will find it of interest For example: • Do you see people with diabetes? • Are you a GP or practice nurse working in primary care running your own diabetic clinic? • Do people with diabetes ask for your advice? • Are you a diabetologist or a GP with a special interest in diabetes who teaches other staff about diabetes? • Are you a nurse working in A&E?
• Are you working on a hospital ward or clinic caring for diabetic patients—often or sometimes? • Are you a doctor admitting emergency patients? • Have you just started work with a diabetes team in a hospital? • Are you a student of medicine, nursing, dietetics, podiatry, physiotherapy, occupational therapy, biochemistry? Diabetes Diabetes is a common long-term condition. Some numbers for 2012/2013: • The International Diabetes Federation (IDF) estimated that there were 382 million people with diabetes worldwide • Half were undiagnosed • 56 million live in Europe, 20 million undiagnosed • 3.2 million live in the UK • 15 % of UK hospital beds occupied by people with diabetes • Primary care prescriptions for glucose-lowering drugs in England cost £764 million • Nationally total UK expenditure on people with diabetes has been estimated at ~ 10 % of national health expenditure • Diabetes prevalence rises every year in every country • Where 2013–14 information is available, numbers have already increased

CBT A Clinician’s Guide to Using the Five Areas Approach PDF Free Download

We hope you tear up this book … Tear it up? Well, yes, because it’s a book to be used. It contains a wealth of practical learning from research and clinical delivery, and is based on feedback from clinicians, voluntary sector colleagues and people who have used the approach in practice. From this we have distilled a range of practical ‘how to’ learning points that address the key questions that are asked again and again: MM Who can use the cognitive behavioural therapy (CBT) approach? MM How do you best introduce and support the resources in everyday clinical work? MM What if someone feels stuck? MM How do you decide which resource is the most helpful? MM What if you only have limited time? and more…
Who is this book for? These resources are aimed at: MM Health, social and voluntary sector workers wanting to gain an overview of the Five Areas CBT approach and specific skills on how to assess, introduce and support people in using the various Five Areas resources. MM Managers and commissioners planning to redesign their services to include a range of high and low intensity approaches. Why use the Five Areas approach? Mental health problems are common and distressing. Words used in formal clinical diagnoses of depression and anxiety such as ‘mild’ and ‘moderate’ to describe severity fail to do justice to just how nasty low mood and anxiety are for the person, their family and friends. Fortunately, effective treatments exist – and these include both medication, such as antidepressants, and also psychotherapeutic approaches. Evidence-based reviews confirm that the CBT approach has the widest application across mental and physical health disorders. However, the biggest current challenge is how to provide wide access to the CBT approach. Currently, for many, access to CBT delivered by specialists is still restricted. This restriction is not only because of a lack of specialised practitioners but also other issues that restrict use, including the need for patients to travel, attend during normal working hours and then have to spend some of their already flagging mental energy learning the complex language used in CBT. A key issue in CBT (as indicated by initials such as CBT) is therefore how to communicate the model clearly without the use of jargon.