The Double Dynamic Martin Screw (DMS)

The Double Dynamic Martin Screw (DMS): Adjustable Implant System for Proximal and Distal Femur Fractures

Editor by:
Karl-Klaus Dittel
Matthias Rapp

Product Details
Hardcover: 192 pages
Publisher: Steinkopff-Verlag Darmstadt; 1 edition (October 1, 2008)
Language: English
ISBN-10: 3798518416
ISBN-13: 978-379851841

This publication is primarily directed to the amplification of a new treatment modality that addresses only a fraction of the problem. It is, however, a quantum leap in the evolution of fixation with compression hip screws which are still the gold standard for surgical stabilization of pertrochanteric hip fractures.

The Dynamic Martin Screw (DMS) addresses the issue of adjustability of the fixation angle with appropriate mechanical strength characteristics that were lacking in its historical predecessors.

It exhibits the unique ability to allow the surgeon to improve the reduction to a more advantageous valgus angle even after it is rigidly attached to the femur. This provides a more stable construct that will allow for a more successful recovery of the patient to their previous ambulatory life.

In addition, the device is ideally suited for a new challenge in hip fractures, the MRI fracture. These are undisplaced fractures diagnosed almost entirely by magnetic resonance imaging. Since they are, by definition, undisplaced, the infinite adjustment of the femur neck angle of this device is the perfect solution.

The variable angle system has been adapted for paediatric use. While useful for fracture fixation, it is an excellent option for fixation in the varus femoral osteotomy for dysplastic hips and subluxation in children with cerebral palsy.

Further on the supracondylar version is very valuable for distal femur fractures. The supracondylar version with cable extraordinarily is suited for the devastating periprosthetic femoral fracture in the total hip patient. This situation, by the way, is a new epidemic!

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Manual of Psychiatric Nursing Care Plans (Varcarolis, Manual of Psychiatric Nursing Care Plans)

Manual of Psychiatric Nursing Care Plans (Varcarolis, Manual of Psychiatric Nursing Care Plans)
Diagnoses, clinical Tools, and Psychopharmacology

Varcarolis, Manual of Psychiatric Nursing Care Plans
Author by:
Elizabeth M. Varcarolis

Product Details
* Paperback: 816 pages
* Publisher: Saunders; 3 edition (December 28, 2005)
* Language: English
* ISBN-10: 1416029168
* ISBN-13: 978-1416029168


Book Description
Designed to assist in the assessment, formulation of nursing diagnoses, and the design of psychiatric nursing care plans This pocket-sized clinical companion is designed to assist in the assessment of psychiatric nursing clients, formulation of nursing diagnoses, and design of psychiatric nursing care plans. It provides quick and easy access to the detailed and concrete information students need to know as they visit the inpatient unit, community mental health setting, or home care setting. The content is clinically based, rather than theory based. This avoids repetition of material that students already have in their mental health nursing textbooks and makes it a perfect reference for clinical use.

• The latest diagnoses, assessment and treatment strategies, and psychotropic drug information relevant to nursing care of clients with psychiatric disorders.
• A focus on clinical information in order to assist the nurse in providing patient care in the inpatient unit, community mental health setting, or home care setting.
• Coverage of all major disorders commonly encountered in a clinical setting.
• Care plans with a nursing diagnosis etiology, assessment findings/diagnostic cues, outcome criteria, long-term goals, short-term goals, and interventions and rationales.
• A chapter on Major Psychotropic Interventions and Client and Family Teaching provides coverage of psychopharmacology in addition to the content found in each disorder chapter.
• The most recent information in the field, including the DSM-IV-TR taxonomy and 2005-2006 NANDA nursing diagnoses.
• Assessment tools collected in an appendix for quick reference.
• An appendix of drug monographs features the most commonly prescribed psychiatric medications.
• Revised and expanded client outcome sections include additional outcome criteria, short-term goals, and long-term goals for each diagnosis.
• Additional content on forensic issues in psychiatric nursing is integrated throughout as applicable.
• Online drug cards, updated quarterly, provide users with the latest drug information and can be
• printed and carried along with the manual.

Manual of Psychiatric Nursing Care Plans

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Pharmacology for Nursing Care

Pharmacology for Nursing Care

Author by:
Richard A. Lehne

Pharmacology for Nursing Care Details:
Hardcover: 1376 pages
Publisher: Saunders; 6 edition (June 20, 2006)
Language: English
ISBN-10: 1416025529
ISBN-13: 978-1416025528

Pharmacology for Nursing Care Description

Always a student favorite, Pharmacology for Nursing Care offers a clear approach explaining drug prototypes and how they work. It provides the background needed to understand related drugs currently on the market, as well as drugs yet to be released. In simplifying a complex subject, this text focuses on the essentials of pharmacology. Large print is used to show "need-to-know" information, and small print is used for "nice to know" material. At the end of each chapter, a summary of major nursing implications helps in applying the material to real-world situations. This edition includes a new companion CD-ROM featuring NCLEX® examination-style review questions, a variety of electronic calculators, and animations depicting drug mechanisms and effects.

• Uses a prototype drug approach that places a strong emphasis on understanding over memorization  equipping students with the knowledge to learn not only about related drugs currently on the market, but also about those drugs that will be released once the student begins practice. 
• Summaries of Major Nursing Implications at the end of each chapter provide an in-depth look at assessment, implementation, and ongoing evaluations. 
• Utilizes large print for essential information and small print for "nice-to-know" information to help both faculty and students focus their limited classroom and study time on understanding the essentials.
• Concise drug summary tables present detailed information on individual drugs, including class, generic and trade names, dosages, routes, and indications. 
• Key Points at the end of each chapter summarize content in a bulleted format to help students review important concepts.

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Foundations of Psychiatric Mental Health Nursing: A Clinical Approach Fifth Edition

Foundations of Psychiatric Mental Health Nursing: A Clinical Approach

Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, Fifth Edition
Author by:
Elizabeth M. Varcarolis
Verna Benner Carson
Nancy Shoemaker

Details Foundations of Psychiatric Mental Health Nursing: A Clinical Approach
Hardcover: 864 pages
Publisher: Saunders; 5 edition (October 7, 2006)
Language: English
ISBN-10: 1416000887
ISBN-13: 978-1416000884

Foundations of Psychiatric Mental Health Nursing: A Clinical Approach The new edition of this popular text offers a clear, straightforward way to understand the often intimidating subject of psychiatric nursing. Its practical, clinical perspective and user-friendly writing style engage the reader in a learning process that both informs and enlightens. Clinical chapters progress consistently and logically from theory to application. Specific psychobiological disorders are organized from moderate to severe along the mental health continuum. The nursing process is the strong, visible framework throughout.

•  User-friendly writing style and a full-color design make psychiatric nursing content come alive! Case studies and personal stories show a compassion and understanding unique among psychiatric nursing texts. Special features are easily located and identified. 
• Nursing process framework provides a strong underpinning for all clinical chapters. A sixth step, Outcome Criteria, identifies specific patient outcomes, then justifies the subsequent nursing interventions based on results.
• Assessment Guidelines boxes provide summary points for client assessment. 
• Spiritual assessment is found in Assessment Strategies and the Nursing Process and Care for the Dying and for Those Who Grieve. 
• Biologic Basis for Understanding Psychotropic Drugs lays the foundation for the study of psychotropic drug therapy to treat psychobiologic disorders.

Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, Fifth Edition

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Current Medical Diagnosis and Treatment 2009

Current Medical Diagnosis and Treatment 2009

Current Medical Diagnosis and Treatment 2009
Product Details:
Author by:
Stephen McPhee
Maxine Papadakis (Author)
Paperback: 1728 pages
Publisher: McGraw-Hill Professional; 48 edition (October 2, 2008)
Language: English
ISBN-10: 0071591249
ISBN-13: 978-0071591249

The first annually updated text in internal medicine — trusted, authoritative, and essential to daily practice CMDT delivers the most current insights into signs, symptoms, epidemiology, etiology, and treatment for over 1,000 diseases and disorders. Turn to any topic, and you’ll find on-the-spot, evidence-based answers that reflect the most recent developments in diagnosis and treatment. This concise, authoritative reference gets you up to speed–fast–on the latest medical advances, prevention strategies, cost-effective treatments, and more.

Comprehensive coverage of inpatient and outpatient care, focusing on the diagnostic tools relevant to your day-to-day practice.

• Full review of all primary care topics, including gynecology, obstetrics, dermatology, ophthalmology, otolaryngology, psychiatry, neurology, toxicology, and urology.
• Only text with an annual review of advances in HIV treatment.
• Essentials of Diagnosis? for most diseases/disorders.
• Hundreds of quick-access drug treatment tables, with indexed trade names and updated drug prices.
• ICD codes featured on inside covers.
• Diagnostic and treatment algorithms present important information in an at-a-glance style.
• Up-to-date references provide peer-reviewed, evidence-based information

New to this Current Medical Diagnosis and Treatment 2009 edition:

• Color insert expanded to 16 pages.
• Latest developments in HIV infection, including new drugs, recommended treatment regimens, and antiretroviral drug resistance.
• All new chapter on hemostasis and antithrombotic therapy.
• Completely revamped End of Life Chapter, now called Palliative Care And Pain Management to reflect its new emphasis.
• Sections on asthma (includes 2007 NAEPP guidelines) and palpitations.
• More algorithms throughout and increased coverage of Canadian and International Guidelines

CURRENT Medical Diagnosis & Treatment 2009 CONTENTS:
Chapter 1 Disease Prevention & Health Promotion
Chapter 2 Common Symptoms
Chapter 3 Preoperative Evaluation & Perioperative Management
Chapter 4 Geriatric Disorders
Chapter 5 Palliative Care & Pain Management
Chapter 6 Dermatologic Disorders
Chapter 7 Disorders of the Eyes & Lids
Chapter 8 Ear, Nose, & Throat Disorders
Chapter 9 Pulmonary Disorders
Chapter 10,11 Heart Disease, Systemic Hypertension
Chapter 12 Blood Vessel & Lymphatic Disorders
Chapter 13 Blood Disorders
Chapter 14 Disorders of Hemostasis & Antithrombotic Therapy
Chapter 15 Gastrointestinal Disorders
Chapter 16 Liver, Biliary Tract, & Pancreas Disorders
Chapter 17 Breast Disorders
Chapter 18 Gynecologic Disorders
Chapter 19 Obstetrics & Obstetric Disorders
Chapter 20 Musculoskeletal & Immunologic Disorders
Chapter 21 Fluid & Electrolyte Disorders
Chapter 22 Kidney Disease
Chapter 23 Urologic Disorders
Chapter 24 Nervous System Disorders
Chapter 25 Psychiatric Disorders
Chapter 26 Endocrine Disorders
Chapter 27 Diabetes Mellitus & Hypoglycemia
Chapter 28 Lipid Disorders
Chapter 29 Nutritional Disorders
Chapter 30 Common Problems in Infectious Diseases & Antimicrobial Therapy
Chapter e1 Anti-infective Chemotherapeutic & Antibiotic Agents
Chapter 31 HIV Infection & AIDS
Chapter 32 Viral & Rickettsial Infections
Chapter 33 Bacterial & Chlamydial Infections
Chapter 34 Spirochetal Infections
Chapter 35 Protozoal & Helminthic Infections
Chapter 36 Mycotic Infections
Chapter 37 Disorders Due to Physical Agents
Chapter 38 Poisoning
Chapter 39 Cancer
Chapter e2 Basic Genetics
Chapter 40 Clinical Genetic Disorders
Chapter 41 Complementary & Alternative Medicine
Chapter e3 Diagnostic Testing & Medical Decision Making
Chapter e4 Information Technology in Patient Care: The Internet, Telemedicine, and Clinical Decision Support
Appendix: Therapeutic Drug Monitoring & Laboratory Reference Intervals

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Kaplan NCLEX-RN Exam 2008-2009 with CD-ROM: Strategies for the Registered Nursing Licensing Exam

Kaplan NCLEX-RN Exam 2008-2009 with CD-ROM: Strategies for the Registered Nursing Licensing Exam

Author by:
Barbara Irwin
Judith A. Burckhardt

Product Details
Paperback: 368 pages
Publisher: Kaplan Publishing (February 5, 2008)
Language: English
ISBN-10: 1419551817
ISBN-13: 978-1419551819

Features:
Two practice tests, one in the book and one on the CD-ROM
Detailed answer explanations
In-depth analysis of NCLEX-RN, exam, question types
Online question bank

Inside This Book
Most up-to-date info on based on 2007 test change It really gives you a good background in diseases and understanding the basics. I would also recommend lippincot and kaplan to pass the boards. It is true what they say you really cannot study per say for the boards, if you understand what CHF is and all the other disease processes you will pass. One thing they do not stress enough in school is in order to pass the boards you need to do a lot of studing on your own aside from what you get in class. Class is just that enough to pass the class, but may not be enough to pass the boards. Best advise I ever got was do 60 questions in any nclex review book 5 days per wk. take 60 min. then on the other two days of the wk. go back and do a through review of those questions, don't just read what the correct answer is, lots of review books like lippincot will also tell you why the other 3 answers were wrong therefore you get 4 questions and answers from 1 question. book to help you prepare for applying AND studying for the NCLEX-RN exam

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Nursing 2009 Drug Handbook with Web Toolkit (Nursing Drug Handbook)

Nursing 2009 Drug Handbook with Web Toolkit (Nursing Drug Handbook)

Editor by:
Springhouse

Product Details

Paperback: 1536 pages
Publisher: Lippincott Williams & Wilkins; Twenty-ninth Edition edition (June 1, 2008)
Language: English
ISBN-10: 078179286X
ISBN-13: 978-0781792868

Books Description

The 29th edition of the best-selling, original drug handbook for nurses has been revamped expressly to appeal to the education market as well as the practice market. This comprehensive reference provides complete monographs for more than 900 generic and 3,000 trade drugs. The monographs are consistently formatted for ease of use, and they focus on the practical information that practicing nurses need. Each monograph consists of generic and trade names, pregnancy risk category, controlled substance schedule (if applicable), available forms, indications and dosages (including dosage adjustments) administration for all routes (plus I.V. drug incompatibilities (for I.V. drugs), drug action (including tables showing route, onset, peak, and duration), adverse reactions, interactions, effects on lab test results, contraindications, nursing considerations, and patient teaching. A new chapter on drug classes is being added to the front of the book. The back-of-book CD is being ported to a Web toolkit with videos about medication administration, a color-photo pill guide, dosage calculators, interactions algorithms, and much more. NDHnow.com keeps the book up to date with partial monographs for new drugs.

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Respiratory Nursing: A Core Curriculum

Respiratory Nursing: A Core Curriculum
Author:
Michele J. Geiger-Bronsky MSN, APNP, BC

Product Details
Hardcover: 680 pages
Publisher: Springer Publishing Company; 1 edition (June 16, 2008)
Language: English
ISBN-10: 0826144446
ISBN-13: 978-082614444

Book Description

By the 1990s, it became clear to many in the nursing community that certification for respiratory nursing practice was desirable, even necessary, but that this could not take place without a carefully designed CORE Curriculum. This book, nearly a decade in the making, sets out such a curriculum. Put together by an expert team of respiratory nurse practitioners, the book includes 42 chapters, each blindly peer reviewed by at least 3 people for clinical content and timeliness. The book will therefore be essential for all nurses seeking the expertise needed to care for persons with respiratory disease or compromised function. Respiratory Nursing should be read by all respiratory and intensive care specialists, related health care professionals, and teachers and students in graduate and undergraduate nursing programs.

When we began the CORE for Respiratory Nursing, its intent was to:

• Provide the basis and direction for clinicians who provide direct clinical care across all settings
• Create a foundation for development of staff education and curricula at the undergraduate and graduate level
• Serve as a resource by which respiratory nursing practice could be evaluated and
• Provide the basis for the development of a certifi cation process for Respiratory Nursing

I believe that this CORE has met those objectives that RNS envisioned a decade ago

Contents:
SECTION I THE SPECIALTY OF RESPIRATORY NURSING
SECTION II BASIC KNOWLEDGE
SECTION III NURSING CONCEPTS: HUMAN RESPONSE TO RESPIRATORY DYSFUNCTION
SECTION IV COMMON RESPIRATORY DISEASES AND DISORDERS
SECTION V PEDIATRIC SPECIFIC DISORDERS
SECTION VI THERAPEUTIC MODALITIES
SECTION VII LEGAL AND ETHICAL ISSUES

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Nurse’s Pocket Drug Guide 2009

Nurse’s Pocket Drug Guide 2009

Author:
Judith Barberio. Clinical Assistant Professor. Rutgers University.

Product Details
Paperback: 368 pages
Publisher: McGraw-Hill Professional; 5 edition (August 18, 2008)
Language: English
ISBN-10: 0071549706
ISBN-13: 978-0071549707

The style of drug presentation includes key “must know” facts of commonly used medications and herbs, essential information for the student, practicing nurse, and health care provider. The inclusion of common uses of medications rather than just the official FDA-labeled indications are based on the uses of the medication and herbs supported by publications and community standards of care. All uses have been reviewed by our editorial board

It is essential that students, registered nurses, and advanced-practice nurses learn more than the name and dose of the medications they administer and prescribe. Certain common side effects and significant contraindications are associated with most prescription medications. Although nurses and other health care practitioners should ideally be completely familiar with the entire package insert of any medication prescribed, such a requirement is unreasonable. References such as the Physicians’ Desk Reference and the drug manufacturer’s Web site make package inserts readily available for many medications, but may not highlight clinically significant facts or key data for generic drugs and those available over the counter.

The limitations of difficult-to-read package inserts were acknowledged by the Food and Drug Administration in early 2001, when it noted that health care providers do not have time to read the many pages of small print in the typical package insert. Newer drugs are producing more user-friendly package insert summaries that will highlight important drug information for easier nursing reference. Although useful, these summaries do not commingle with similarly approved generic or “competing” similar products.

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European Heart Journal: Volume 30 Number 4 February 2009

European Heart Journal: Volume 30 Number 4 February 2009
Journal of the European Society of Cardiology

• Pharmacotherapy of pulmonary arterial hypertension
• Intra-aortic balloon pump in STEMI
• Aldosterone and left ventricular dysfunction
• Atrial fibrillation after surgery
• Euro Heart Failure Survey II

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Leg Pain

Leg Pain

Leg Pain
Author by:
Magruder C. Donaldson, MD

This small volume is devoted to one of the commonest patient complaints encountered by practitioners of adult medicine, and one which frequently presents the initial examining physician with a diagnostic conundrum. Few primary care physicians, emergency room physicians, or for that matter, medical or surgical subspecialists are thoroughly familiar with the neurologic, orthopedic, immunologic, and vascular causes of leg pain. Moreover, help from the medical literature requires access to multiple texts from diverse medical and surgical specialties. Leg Pain should go a long way towards solving this dilemma since it brings together, in a compact and easily transportable volume, expertise from the fields of vascular surgery,neurology, orthopedics, and rheumatology, to offer insights into the clinical signs and symptoms associated with leg pain of diverse origins. As a practical point, many of the authors of the eight chapters in the volume have emphasized distinguishing features of the various types of leg pain, which can be determined by a simple history and physical examination. Most chapters also include data in tabular form, which can greatly aid in arriving at a correct diagnosis. This compact volume I believe will be particularly useful for medical students, medical and surgical house officers, primary care physicians and emergency room physicians. It should make the next encounter with a patient complaining of leg pain a good deal less perplexing.


Content:
1 Overview, Magruder C. Donaldson, MD
2 Pathophysiology of leg pain, Srdjan S. Nedeljkovi´c, MD
3 The initial encounter, Magruder C. Donaldson, MD
4 Mechanical leg pain, Tamara L. Martin, MD and Scott D. Martin, MD
5 Inflammatory leg pain, Sang Cheol Bae, MD and Matthew H. Liang, MD
6 Vascular leg pain, Magruder C. Donaldson, MD
7 Neuropathic leg pain, David C. Preston, MD
8 Other leg pain, Magruder C. Donaldson, MD
Appendix: Normal lower extremity anatomy

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The Financial Management of Hospitals and Healthcare Organizations

The Financial Management of Hospitals and Healthcare Organizations

The Financial Management of Hospitals and Healthcare Organizations
Book Description
A clear introduction to healthcare financial management Using the same nontechnical approach as previous editions, this book introduces nonfinancial managers to the fundamental concepts and skills necessary to cost-effectively manage operations. Revised to include new developments in the field New and revised material includes: The financial impact of patient safety, The public s concern about accounting integrity, The costs associated with charity care policies resulting from the rising number of uninsured, The growing need to reduce operating expenses due to Medicare margins, How to bridge the gap between, strategic planning and budgeting, The consumer movement and the impact on pricing policies, How Medicare and Medicaid have been affected by the Deficit Reduction Act of 2005 and the Tax Relief and Healthcare Act of 2006, Various state proposals for healthcare reform

Author:
Michael Nowicki

Product Details

Hardcover: 350 pages
Publisher: Health Administration Press; 4th edition (November 1, 2007)
Language: English
ISBN-10: 1567932770
ISBN-13: 978-1567932775


CONTENTS
PART I Financial Management
1 Financial Management in Context
2 Organization of Financial Management
3 Tax Status of Healthcare Organizations
PART II Operating Revenue
4 Third-Party Payment
5 Medicare and Medicaid
6 Cost Accounting
7 Setting Charges in Healthcare
PART III Working Capital
8 Managing Working Capital
9 Managing Accounts Receivable
10 Managing Materials
PART IV Resource Allocation
11 Strategic and Operational Planning
12 Budgeting
13 Capital Budgeting
PART V Financial Analysis
14 Financial Analysis and Management Reporting
PART VI Healthcare’s Future
15 Future Trends

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Nursing Theories and Nursing Practice

Nursing Theories and Nursing Practice

Nursing Theories and Nursing Practice
Editor by:
Marilyn E. Parker

Product Details
Paperback: 477 pages
Publisher: F. A. Davis Company (January 15, 2001)
Language: English
ISBN-10: 0803606044
ISBN-13: 978-0803606043

Book Description
Florida Atlantic Univ., Boca Raton. Contains chapters written by the original theorists or by recognized authorities in the specific theories presented. Provides resources needed to choose, analyze, and evaluate the major nursing theories for use in practice, education, and research. Softcover. DNLM: Nursing Theory--Biography

Overview of Contents:
SECTION I Perspectives on Nursing Theory
An introduction to nursing theory includes: definitions of nursing theory, nursing theory and nursing knowledge, types of nursing theory, and nursing’s need for theory. Choosing, analyzing, and evaluating nursing theory focuses on questions from practicing nurses about studying and using nursing theory, a guide for choosing a theory to study, and several frameworks for theory analysis and evaluation. A guide for the study of nursing theory for use in nursing practice is presented, along with questions for selecting theory for use in nursing administration.

SECTION II Evolution of Nursing Theory:Essential Influences
This section opens with a chapter on Florence Nightingale and a description of her profound influence on the discipline and practice of nursing. Subsequent chapters present major nursing theories that have both reflected and influenced nursing practice, education, research, and ongoing theory development in nursing during the last half of the twentieth century

SECTION III Nursing Theory in Nursing Practice, Education, Research, Administration, and Governance
The major nursing theories in use at the end of the twentieth century are presented in this section. Most chapters about particular nursing theories are written by the theorists themselves. Some chapters are written by nurses with advanced knowledge about particular nursing theories; these authors have been acknowledged by specific theorists as experts in presenting their work. Each chapter also includes a section illustrating the use of the theory in nursing practice, research, education, administration, or governance.

SECTION IV Nursing Theory: Illustrating Processes of Development
Two nursing theorists’ unique processes of developing nursing theory are presented in this section. Each theorist has written about research and development of middle-range theory as well as about further exploration of theory in the contexts of programs of research and theory development. The political and economic dimensions of one of the theories in contemporary nursing practice is illustrated.

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Dementia: WPA Series in Evidence and Experience in Psychiatry

Dementia WPA Series in Evidence and Experience in Psychiatry

Dementia
Editor by:
Mario Maj
Norman Sartorius

Product Details
Paperback: 412 pages
Publisher: Wiley; 2 edition (February 21, 2003)
Language: English
ISBN-10: 0470849630
ISBN-13: 978-0470849637

Book Description

It is a great compendium of up-to-date facts and opinions..." (British Journal of Psychiatry, April 2001) --This text refers to an out of print or unavailable edition of this title.

Dementia is most frequently associated with aging and is, at present, under diagnosed and under-represented all over the world. Discrepancies in the diagnostic procedures and therapeutic interventions implemented in the various clinical contexts are significant and consequently, the need for a review of the currently available research evidence and a discussion of different clinical practices is urgently needed. This book provides a much needed review of the diagnostic procedures and the implementations of therapeutic interventions.

knowledge of dementia has significantly increased. The diagnosis of the dementia syndromes has been considerably refined. New types of the disorder, such as the Lewy body dementia, have been described. Our understanding of the risk factors and the pathogenesis of Alzheimer's disease has considerably improved. Clinical and neuropsychological tools for the early diagnosis and the staging of dementia have been developed, and their usefulness in ordinary practice has been demonstrated. Promising leads for pharmacological treatment have been developed, and much has been done to facilitate the life and work of carers, by increasing training and support programmes in numbers and quality in many countries. Psychosocial interventions have also been developed and seen to be helpful in maintaining a person with dementia at a particular level of functioning without further loss and in improving the quality of life of the patients and their caregivers.

The WPA series Evidence and Experience in Psychiatry has been initiated as part of the effort of the World Psychiatric Association to bridge the gap between research evidence and clinical practice concerning the most prevalent mental disorders. Because of its increasing frequency, severity and ubiquity, and because the application of knowledge is so limited, dementia should be a priority for research, teaching and care. We hope that this volume will contribute to making it such.

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Cardiac Pacemakers and Defibrillators Second Edition

Cardiac Pacemakers and Defibrillators Second Edition

Cardiac Pacemakers and Defibrillators, 2nd Edition

Author:
Charles J. Love, M.D.
Ohio State University Medical Center
Columbus, Ohio

Product Details
Paperback: 174 pages
Publisher: Landes Bioscience, Inc.; 2nd edition (June 1, 2006)
Language: English
ISBN-10: 1570596913
ISBN-13: 978-1570596919

Contents

1. NBG Codes for Permanent Pacing
2. Basic Concepts of Pacing
3. Basic Single Chamber Pacing
4. Dual Chamber Pacing
5. Upper Rate Behavior in Dual Chamber Pacing
6. Sensor Driven Pacing
7. Advanced Pacemaker Features
8. Indications for Permanent Pacemaker Implantation
9. Follow-Up of Permanent Pacemakers
10. Preoperative, Operative and Postoperative Considerations
11. Evaluation of Pacemaker Malfunction
12. NBD Code for Implantable Cardioverter Defibrillators
13. Basic Concepts of Implantable Cardioverter Defibrillators
14. Indications for Implantable Cardioverter Defibrillators
15. Preoperative, Operative and Postoperative Considerations for Implantable Cardioverter Defibrillators
16.  Evaluation of Defibrillator Malfunction
17. Follow-Up of Implantable Cardioverter Defibrillators
18. Biventricular Pacemakers and Defibrillators

This book is intended for the physician, nurse, student or technician who occasionally comes in contact with patients who have implanted heart rhythm control devices. It is meant as a reference and basic resource to provide quick explanations and answers to situations that are likely to be encountered relating to pacemakers and implantable cardioverter defibrillators. The terminology and language unique to the professionals who deal with these devices is explained and examples of basic and advanced pacemaker function are covered. Figures are used extensively to show examples of normal and abnormal device function. Common malfunctions are described and an approach to the diagnosis and remedy of these problems is presented. The indications for the use of pacemakers and defibrillators are discussed as well as the contraindications. Surgical issues and patient concerns are covered. The rationale for follow-up and the follow-up procedures for these devices are explained.

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Learning Disability Nursing

Learning Disability Nursing

Learning Disability Nursing

Editor by:
John Turnbull

Book Description
Learning disability nurses play a leading role in the care and support of people with learning disabilities. Learning Disability Nursing explores the theory and practice of learning disability nursing, with an emphasis on understanding the experiences of learning disability nurses as they seek to practice effectively. It examines key issues faced by people with learning disabilities and those who support them and promotes the role of knowledgeable and reflective practitioners.
Develops a framework for learning disability nursing practice

• Examines key issues for people with learning disabilities
• Identifies distinctive features of learning disability nursing
• Supports learning disability nurses in developing their roles and to support those with learning disabilities in exercising their rights.
• Explores ethical and moral dilemmas, challenges and successes

In recent years, learning disability nurses have embarked on two important journeys. The publication of Valuing People (Department of Health, 2001) the White Paper signaled the fact that we have entered a different and exciting era in the care and support of people with learning disabilities and their families. This is an era in which the emphasis will no longer be on where people live but how people live and, in particular, how they can be supported to exercise their rights and to lead full and satisfying lives. I firmly believe that learning disability nurses can play a key role in this future by using their distinctive knowledge and skill to work with individuals with learning dis- abilities, to provide support to families and other professionals and to influence the course of social change for the benefit of people with learning disabilities. If learning disability nurses are going to achieve this, they will need to develop their understanding of nursing practice and the sources of knowledge that nurses draw upon as well as make positive use of the factors that have combined to shape a learning disability nursing identity. A book like this might not be able to fulfill all of these needs but it was written to help learning disability nurses make a start on this journey. It was also written to help others understand learning disability nursing better so that they can provide support for their colleagues.

At the same time that services in which nurses work are undergoing change, there has never been a greater demand on professionals to account for their practice. Part of this means describing and explaining their practice to others in order to build trust and confidence. Part of this also means being able to demonstrate where success has been achieved. In the past learning disability nurses have had problems in describing and providing evidence of their contribution to people's lives. Therefore, this book was written to provide some signposts for nurses in their other journey into a future in which there will be clearer role expectations of learning disability nurses. Given this, the contributors to this book and I hope that readers will use it to approach the future with greater confidence in their practice but ultimately in the expectation of healthier and more valued lifestyles for people with learning disabilities.

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Professional Learning In Nursing; CONTINUING EDUCATION SERIES

Professional Learning In Nursing; CONTINUING EDUCATION SERIES

Professional Learning In Nursing; CONTINUING EDUCATION SERIES
Author by:
Jenny Spouse

Product Details

Paperback: 256 pages
Publisher: Wiley-Blackwell; 1 edition (December 3, 2002)
Language: English
ISBN-10: 0632059915
ISBN-13: 978-0632059911

Book Description
Explores how professional development can be better understood, following the progress of six nurse learners. Places narratives in the context of nurse education and looks at the implications of 'fitness for practice & purpose' and 'making a difference.' Includes critical and reflective analysis and key references. Softcover. DNLM: Education, Nursing, Continuing
The way nurses are taught is constantly evolving and changing. Workplace learning is seen as key to developing practitioners. In this book Jenny Spouse discusses how students learn in a range of different clinical settings and how best to facilitate this process. How do students learn to become nurses? What knowledge and understanding do they need to acquire? How do their preconceptions, beliefs about the learning process, and social needs affect their development? What do they find helpful and unhelpful? What makes clinical settings good for learning? Is it helpful for students to document their learning? What are the best ways for lecturer/ practitioners to facilitate student learning and what other factors influence their progress?

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Rheumatology for Nurses: Patient Care

Rheumatology for Nurses: Patient Care

Rheumatology for Nurses: Patient Care

Edited by:
Patricia le Gallez RGN, MPhil

Product Details

Paperback: 336 pages
Publisher: Wiley; 1 edition (June 15, 1998)
Language: English
ISBN-10: 186156032X
ISBN-13: 978-1861560322

Rheumatism--Nursing, Rheumatism--Patients--Care.

The book has been written mainly for nurses, though allied health professionals, i.e. occupational therapists, physiotherapists, social workers, podiatrists and dieticians, all of whom are fully involved in caring for the patient with a rheumatic condition, will also be interested, and even more so because a number of their professional colleagues have contributed to the book. The book will be a significant addition to the required reading list of all centres running ENB 983, Principles of Care and Rehabilitation of People with Rheumatic Disease and will also be of particular interest to all members of both the Rheumatology Nursing Forum and the British Health Professionals in Rheumatology.

Rheumatology is an expanding speciality, with new consultant rheumatologists being appointed at an increasing rate; also, more and more nurses are specialising in rheumatology. In addition, practice nurses are now acknowledging their responsibility for the care of such patients, and as a result see the urgent need to increase their knowledge, rather than leave the care of the patient to the staff in the local district or general hospital. Arthritis Care, the charity devoted solely to people with an arthritic condition, has a recommended

When a nurse encounters a rheumatology patient for the first time the problem all too often arises whereby there is no one available with the required expertise to help, advise, direct and support him or her in providing adequate and specialised care. The situation can arise on a medical or surgical ward, in the community or in the outpatient department. Sadly, it can also happen on specialist rheumatology wards or more usually on wards which have only a small number of designated rheumatology beds.

Each chapter in the book is complete in itself and is well cross-referenced. A chapter on osteoporosis has been included as this condition is rapidly becoming a major issue in which rheumatology nurses, both in hospital and in the community, are becoming involved.

 

Contents
Chapter 1 The patient's perspective
Chapter 2 The role of the nurse specialist in rheumatology
Chapter 3 The rheumatology ward and investigations
Chapter 4 Rheumatology: care in the community
Chapter 5 Patient education and self-management
Chapter 6 Drugs in rheumatology
Chapter 7 The role of physiotherapy in rheumatology
Chapter 8 The role of the occupational therapist in rheumatology
Chapter 9 The role of the podiatrist in rhuematology
Chapter 10 Surgery in rheumatic diseases
Chapter 11 Arthritis and employment
Chapter 12 Osteoporosis: its significance in rheumatoid disease

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Fungal Infection: Diagnosis and Management

Fungal Infection: Diagnosis and Management

Fungal Infection: Diagnosis and Management
Author by:
Malcolm D. Richardson
D. W. Warnock

Product Details
Paperback: 249 pages
Publisher: Blackwell Publishers; 2nd edition (January 15, 1997)
Language: English
ISBN-10: 0865427240
ISBN-13: 978-0865427242

Books Description
Fungal Infection: Diagnosis and Management summarises the clinical manifestations, diagnosis and management of fungal infection. Infections are dealt with according to the affected system and clinical presentation rather than individual fungal infection making this a problem-orientated book designed to help clinicians make the best use of the often time-consuming laboratory
Noticeably larger than the previous edition and covers several new areas, The introductory chapters have been updated and The next chapter on antifungal drugs has been undergone extensive changes The newly licensed antifungal drugs are also covered For the first time in this edition relevant references have been included at the end of each chapter, which provide a useful starting point if further information is required ... . This book is ideal to dip into for specific pieces of information Overall, the book is very useful and one to which many people will refer regularly. It succeeds in its stated aim of being “concise and up to date” and for those who have to deal with fungal infections in clinical practice, it is a valuable source of information.
Mycoses Newsletter, International Society for Human and Animal Mycology

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Multiple Sclerosis: The Questions You Have, the Answers You Need

Multiple Sclerosis: The Questions You Have, the Answers You Need

Multiple Sclerosis: The Questions You Have, the Answers You Need

Author by:
Rosalind C. Kalb

This book, developed under the auspices of the Consortium of Multiple Sclerosis Centers and made possible by an educational grant to the consortium by Bertex Laboratories, the manufacturer of Betaseron, the first drug approved by the FDA for treatment of multiple sclerosis, represents an interdisciplinary approach to the disease. Its goal is to help those with MS and their families formulate questions to ask their healthcare providers so they can manage life with MS. Written by experts, chapters cover topics ranging from neurology and treatment to emotional, sexual, and employment issues. Introductory material is followed by a series of questions most often asked of the authors in their work with MS, as well as questions received by the Information Center at the National Multiple Sclerosis Society. Chapters conclude with a list of recommended readings and other available resources. Appendixes include information sheets about drugs commonly used to treat and manage MS, as well as a comprehensive glossary of terms. This work is more inclusive and comprehensive than most single-authored, consumer-oriented publications, and the authors recommend it not necessarily be read cover to cover but treated as a reference source to be referred to according to individual need. Recommended to supplement other, more traditional sources such as Louis Rosner Jr. and Shelley Ross's Multiple Sclerosis (S. & S., 1992) in consumer health collections.?Sue Hollander, Univ. of Illinois Lib. of the Health Sciences at Rockford Copyright 1996 Reed Business Information, Inc. --This text refers to an out of print or unavailable edition of this title.

Product Details
Paperback: 640 pages
Publisher: Demos Medical Publishing; 4th edition (October 28, 2007)
Language: English
ISBN-10: 193260345X
ISBN-13: 978-1932603453

Contents:
Part I: MS: What’s It All About?

• What Should I Know About This Book?
• Multiple Sclerosis: An Introduction to the Disease
• The Epidemiology of Multiple Sclerosis—Who Gets MS and Why?
• Symptom Management at a Glance

Part II: How Is Multiple Sclerosis Treated?

• How Multiple Sclerosis Treatments Are Developed
• Considering Options for Managing Relapses and the Disease Course
• Complementary and Alternative Medicine
• Nursing Care to Enhance Wellness
• The Role of Physical Therapy: Strategies to Enhance Mobility and Safety and Conserve Energy
• The Role of Occupational Therapy: Strategies to Enhance I ndependence and Productivity at Home and at Work
• How MS Affects Sexuality and Intimacy
• Speech and Voice Problems: Assessment and Management
• Swallowing Problems: Assessment and Management
• Cognitive Challenges: Assessment and Management

 Part III: How Do Individuals and Families Cope with the Challenges of MS?

• Coping and Adaptation: Making a Place for MS in Your Life
• Emotional Changes and the Role of Stress
• How Multiple Sclerosis Affects the Family
• Fertility, Pregnancy, Childbirth, and Gynecologic Care
• Children Get MS, Too

Part IV: What Are the Recommended Financial and Life Planning Strategies?

• Maximizing Employment Options
• Managing the Insurance Maze
• Thinking Proactively About Long-Term Care
•  Effective Life Planning Begins Now

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Advances in MDCT, An Issue of Radiologic Clinics (The Clinics: Radiology)

Advances in MDCT, An Issue of Radiologic Clinics (The Clinics: Radiology)

Advances in MDCT, An Issue of Radiologic Clinics (The Clinics: Radiology)

Author by:
Vahid Yaghmai
Dushyant Sahani

Book Description

Despite technical advances using MR and the emergence of PET imaging, CT continues to be a frequently used imaging modality that has not stood still while others have thrived. Advances in CT have continued apace with other modalities which have taken CT into new areas of imaging that just a few short years ago it could not approach. With the advent of 64-slice CT, a greater number of images can be taken in a much quicker period of time. The use of CT perfusion in the brain and abdomen are reviewed in this issue. Cutting edge techniques such as 4D CT and dual energy CT will be discussed, as well as CT applications for imaging of the coronary arteries and cardiac valves.

Despite the availability of MDCT scanners for a decade, the technology remains in flux. In the recent past, 64-MDCT scanners were considered the top of the line equipments; however, several newinnovations inCTare nowavailable oremerging to embrace the patient care by using more detector rows (128-320 detector rows), new detector materials for higher sensitivity andultrafast energyswitching (Gemstone technology), two X-ray sources (dual-source CT), detectors with 2 layers to permit spectral analysis of the X-ray beam, and systems with flat-panel detectors (dynamic volume CT).

These exciting new opportunities available with MDCT would not have been feasible without focus and dedication of countless passionate physicians, scientists and engineers. We have a distinct privilege to introduce this issue of Radiologic Clinics of North America that focuses on these new or emerging technologies in MDCT. We are honoured that our panel of distinguished MDCT scientists have contributed articles to this issue in their respective area of expertise. We thank the Radiologic Clinics of North America for giving us this opportunity to present this interesting issue and also acknowledge the contribution of Barton Dudlick from Elsevier for his tremendous support on this project. We feel confident that this issue will enhance the reader’s knowledge of newer.

Product Details
Hardcover
Publisher: Saunders; 1 edition (February 20, 2009)
Language: English
ISBN-10: 1416063498
ISBN-13: 978-1416063490

Content:

• CT Technology Overview: 64-Slice and Beyond
• Optimal Vascular and Parenchymal Contrast Enhancement: The Current State Of The Art
• Strategies for Reducing Radiation Dose in CT
• Dual-Energy and Dual_source CT: Is There a role In he Abdomen and Pelvis?
• Advanced Postprocessing and Emerging Rol Of Computer-Aided Detection
• The ‘‘Post-64’’ Era Of Coronary Ct Angiography: Understanding New Technology from Phisical Principles
• Coronary CT Angiography: Applications
• Multimodal CT in Strok Imaging: New Concepts
• CT Enterography Concept, Technique, and Interpretation
• CT Colonography: Techniques and Applications
• Positron Emission Tomography/Computed Tomography: The Current Technology and Applications
• Body Perfusion CT: Techniques, Clinical Applications, and Advances

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Cell Diagnostics Images, Biophysical and Biochemical Processes in Allelopathy

Cell Diagnostics Images, Biophysical and Biochemical Processes in Allelopathy

Editors
V.V. Roshchina
S.S. Narwal

Product Details
Hardcover: 203 pages
Publisher: Science Publishers; 1st edition (June 30, 2007)
Language: English
ISBN-10: 1578085101
ISBN-13: 978-1578085101

Allelopathy is newly emerging multidisciplinary field of agricultural research. A lot of allelopathy research work has been done in various fields of agriculture and plant sciences. However, standard methods are not being used by workers due to lack of a compendium on the techniques, and hence the results obtained are not easily comparable with each other. This causes problems to researchers working in underdeveloped/third world countries in small towns, where library and research facilities are not available. Therefore, to make available the standard methods for conducting allelopathy research work, this multi-volume book has been planned, with one volume each for each discipline. In all the conferences held since 1990’s a need has always been felt for a manual on allelopathy research methods. This book series aims to provide basic information about various methods to research workers, so that they can conduct research independently without the requirement of sophisticated equipments. The methods have been described in a simple way just like a DO IT YOURSELF book.

This book will serve as ready reference in the laboratory or class room and help to solve many problems of cell studies in agriculture and allied fields including allelopathy. Information provided can be use to determine the effects and mechanism of action of allelochemicals at the cellular levels. It will be useful for undergraduate and graduate students pursuing allelopathic work, plant physiologists, biochemists and other plant science specialists. We have tried to provide appropriate solutions to the problems of cell studies. The users of this book can select suitable methods, according to the available facilities.

Contents:
Foreword
Preface
List of Contributors
Section 1 Cellular Model Systems
1. Allelopathy and Plant Cell Diagnostics
2. Cellular Models as Biosensors
3. Microalgae for Determing the Effects of Allelochemicals
4. Bryophytes to Test Allelochemicals in vitro
Section 2 New Methods of Microscopy in Cellular Diagnostics
5. Microscopic Methods to Study Morpho-cytological Events during the Seed Germination 53
6. Optical Coherence Tomography and Optical Coherence Microscopy to Monitor Water Absorption 71
7. Optical Coherence Microscopy: Study of Plant Secretory Structures
8. Laser-scanning Confocal Microscopy (LSCM): Study of Plant Secretory Cell 93
9. Luminescent Cell Analysis in Allelopathy 103
Section 3 Methods of Analytical Biochemistry and Biophysics
10. Biochemical Approach to Study Oxidative Damage in Plants Exposed to Allelochemical Stress: A Case Study
11. Cholinesterase Activity as a Biosensor Reaction for Natural Allelochemicals: Pesticides and Pharmaceuticals
12. Methods to Study Effect of Allelochemicals on Algae Membrane Integrity 147
13. Total Phenolics and Phenolic Acids in Plants and Soils 155
14. Computational Methods to Study Properties of
15. Allelochemicals and Modelling of Molecular Interactions in Allelopathy 169
15. Allelopathic Pollen: Isolating the Allelopathic Effects
Index

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AHFS Drug Information 2008

AHFS Drug Information 2008

AHFS Drug Information 2008
by American Society of Health-system
Corporate Author)

Product Details
Paperback: 3824 pages
Publisher: American Society of Health-System Pharmacists; 1 edition (January 31, 2008)
Language: English
ISBN-10: 1585282065
ISBN-13: 978-158528206

Product Description
First published in 1959, the "Big Red Book," as it's come to be known, has gone the extra mile for pharmacists and healthcare professionals seeking answers to the most detailed questions. It provides more extensive evidence-based data than any other drug reference. AHFS DI is the only reference free from the influence of manufacturers, insurers, regulators, and other special interests, giving you an unbiased source of drug information.

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Intracranial Atherosclerosis

Intracranial Atherosclerosis

Intracranial Atherosclerosis

Author by :
Jong S. Kim
Louis R. Caplan
K. S. Lawrence Wong

Product Details
Hardcover: 272 pages
Publisher: Wiley-Blackwell; 1 edition (November 24, 2008)
Language: English
ISBN-10: 1405178221
ISBN-13: 978-1405178228


Product Description

Intracranial atherosclerosis is the dominant cause of stroke in over 70% of the world’s population. Globalization is leading to an increasingly heterogeneous society everywhere. Advances in imaging techinology allow this previously inaccessible pathology to be clinically studied.

From the Back Cover
FACT: Intracranial atherosclerosis is the major cause of stroke worldwide

Intracranial atherosclerosis is the dominant cause of stroke in over 70% of the world’s population. Globalization is leading to an increasingly heterogeneous society everywhere. Advances in imaging technology allow this previously inaccessible pathology to be clinically studied.

This inconvenient fact can no longer be ignored in stroke medicine

Edited by internationally renowned clinicians, Intracranial Atherosclerosis is the first book to examine intracranial causes of stroke. Clinical practice is allied with basic science to guide all those with an interest in stroke on the diagnosis and management of intracranial atherosclerosis.

Know the facts: read this book!

Contents
List of contributors
Preface
Foreward
Epidemiology and risk factors
1 Anatomy of intracranial arteries
2 Pathologic characteristics
3 Epidemiology
4 Risk factors
Stroke mechanism and clinical consequence
5 Stroke mechanisms
6 Anterior circulation disorders
7 Posterior circulation disorders
8 Cognitive dysfunction, dementia and emotional disturbances
9 Natural course and prognosis
Diagnostic imaging studies
10 Vascular imaging
11 Application of magnetic resonance imaging
12 Transcranial doppler
Treatment
13 Antiplatelet therapy
14 Anticoagulation,
15 Angioplasty and stenting
16 Surgical therapy
17 Other miscellaneous treatments
Uncommon causes of intracranial arterial disease
18 Immunologic and vasoconstrictive disorders
19 Arterial dissection, CNS infection and other miscellaneous diseases
20 Moyamoya disease
Index

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Principles Of Clinical Gastroenterology

Principles Of Clinical Gastroenterology

Principles Of Clinical Gastroenterology

EDITED BY:

Tadataka Yamada, MD

ASSOCIATE EDITORS:

David H. Alpers, MD

Anthony N. Kalloo, MD

Neil Kaplowitz, MD

Chung Owyang, MD

Don W. Powell, MD

Product Details:

Hardcover: 672 pages

Publisher: Wiley-Blackwell; 1 edition (June 23, 2008)

Language: English

ISBN-10: 1405169109

ISBN-13: 978-1405169103

A Concise, Symptom-Based Textbook for Diagnosis and Decision Making in Clinical Practice

Over the past twenty years, thousands of physicians have come to depend on Yamada’s Textbook of Gastroenterology. Its encyclopaedic discussion of the basic science underlying gastrointestinal and liver diseases as well as the many diagnostic and therapeutic modalities available to the patients who suffer from them was—and still is—beyond compare. This new textbook, Principles of Clinical Gastroenterology, is designed to inform practitioners on the features of the major clinical disorders in gastroenterology and hepatology from the point of view of the clinician observing signs and symptoms of a patient under care and management.

It is a practical guide to diagnosis and decision making in clinical practice and provides a rich source of information on diseases of the gastrointestinal tract and liver. Covering the full range of examinations in gastroenterology and hepatology, with extremely timely chapters on patients with dyspepsia, eating disorders, jaundice, hepatitis, cirrhosis, and on screening, Principles of Clinical Gastroenterology gives you easy access to approaches that a clinician might take to common symptoms and signs presented by patients with such disorders. The chapters include the epidemiology, history, signs and symptoms, diagnosis, treatment, and prognosis of the most commonly encountered disorders in gastroenterology and hepatology.

Contents

Contributors

Preface

1. Clinical decision making; Philip S. Schoenfeld
2. Economic analysis in the diagnosis and treatment of gastrointestinal diseases; John M. Inadomi
3. Psychosocial factors in the care of patients with functional gastrointestinal disorders; Bruce D. Naliboff, Jeffrey M. Lackner, Emeran A. Mayer
4. Approach to the patient with dyspepsia and related functional gastrointestinal complaints; Nicholas J. Talley, Gerald Holtmann
5. Approach to the patient with dysphagia, odynophagia, or noncardiac chest pain; Chandra Prakash Gyawali, Ray E. Clouse
6. Approach to the patient with gastroesophageal reflux disease; Joel E. Richter
7. Approach to the patient with dyspepsia and peptic ulcer disease; Andrew H. Soll, David Y. Graham
8. Approach to the patient with gross gastrointestinal bleeding; Grace H. Elta, Mimi Takami
9. Approach to the patient with occult gastrointestinal bleeding; David A. Ahlquist, Graeme P. Young
10.  Approach to screening for colorectal cancer; Graeme P. Young, James E. Allison
11. Approach to the patient with unintentional weight loss; Andrew W. DuPont
12. Approach to the patient with obesity; Louis A. Chaptini, Steven R. Peikin
13. Approach to the patient with nausea and vomiting; William L. Hasler
14. Approach to the patient with abdominal pain; Pankaj Jay Pasricha
15. Approach to the patient with gas and bloating; William L. Hasler
16. Approach to the patient with acute abdomen; Rebecca M. Minter, Michael W. Mulholland
17. Approach to the patient with ileus and obstruction; Klaus Bielefeldt, Anthony J. Bauer
18. Approach to the patient with diarrhea; Don W. Powell
19. Approach to the patient with suspected acute infectious diarrhea; John D. Long, Ralph A. Giannella
20. Approach to the patient with constipation; Satish S.C. Rao
21. Approach to the patient with abnormal liver chemistries; Richard H. Moseley
22. Approach to the patient with jaundice; Raphael B. Merriman, Marion G. Peters
23. Approach to the patient with ascites and its complications; Guadalupe Garcia-Tsao
24. Approach to the patient with central nervous system and pulmonary complications of end-stage liver disease; Javier Vaquero, Andres T. Blei, Roger F. Butterworth
25. Approach to the patient with acute liver failure; Ryan M. Taylor, Robert J. Fontana
26. Approach to the patient with chronic viral hepatitis B or C; Sammy Saab, Hugo Rosen
27. Approach to the patient with a liver mass; John A. Donovan, Edward G. Grant
28. Approach to gastrointestinal and liver diseases in pregnancy; Willemijntje A. Hoogerwerf
29. General nutritional principles; David H. Alpers, Beth Taylor, Samuel Klein
30. Approach to the patient requiring nutritional supplementation; David H. Alpers, Beth Taylor, Samuel Klein
31. Genetic counseling for gastrointestinal patients; Cindy Solomon, Deborah W. Neklason, Angela Schwab, Randall W. Burt

Index

Sample

Chapter 1 Clinical decision making

What is evidence-based medicine?

David Sackett, the “father” of evidence-based medicine (EBM) stated that EBM is “the conscientious and judicious use of current best evidence from clinical care research in the management of individual patients” [1]. Terms used in this definition can be explained as follows

Conscientious use implies that physicians review articles

about clinical research and apply this information to clinical

decision making.

• Current best evidence from clinical care research implies that physicians systematically appraise the methods and results of clinical research articles using EBM tools. With these tools, physicians can separate the “wheat from the chaff” when reading medical journals and identify poorly designed studies that will produce biased results and should be discarded before being applied to patient care. This chapter will focus on techniques to identify and interpret the best evidence from properly designed research articles.

• Judicious use implies that a physician’s experience and patient’s preferences are crucial components of decision making and that these judgments must be balanced with the data from best evidence.

Judicious use of best evidence is a particularly important concept to understand [2]. Many critics state that the practice of EBM is “cookbook” medicine that devalues the judgment of a clinician and the values of an individual patient. This interpretation is inaccurate. Physicians must consider a patient’s preferences about the potential benefits and side effects and costs of a medication when deciding a specific

treatment. Also, a specific patient may not fit the criteria for enrollment of patients into a randomized controlled trial (RCT). For example, an RCT demonstrated that rifaximin, a nonabsorbable antibiotic, improved bloating in Lebanese patients [3]. Will bloating (and other gastrointestinal symptoms) improve if rifaximin is used in patients with irritable bowel syndrome (IBS) in the United States? If we assume that these results are applicable to patients with IBS in the United States, then is it worthwhile to use a treatment that may only produce a temporary relief of symptoms? What if the patient had a past history of Clostridium difficilecolitis after a course of ciprofloxacin? Would the patient be willing to risk another case of C. difficile colitis? What if the patient does not have insurance and would have to pay $200 for this prescription? These questions are qualitative questions that require clinical judgments on the part of the patient and the physician [4]. Although the best evidence from an RCT [3] may identify an effective treatment for bloating, both physician judgment and patient preferences must also be used for effective clinical decision making. Thus, EBM and a reliance on best evidence is not intended to be “cookbook” medicine [2].

Nevertheless, EBM is a helpful tool for the quantitative aspect of clinical decision making, which arises from a systematic examination of study methodology and study results [2]. The medical literature is expanding at an exponential rate [5], and the time available for reading may be hurried and fragmented. Physicians need tools to build a framework for the rapid evaluation of the methodology and results of published studies, and EBM provides these tools (Tables 1.1 and 1.2). With these frameworks, physicians can rapidly identify well-designed studies that produce accurate and unbiased results and should be applied to patient care. Studies using improper methodology and biased results are quickly identified and ignored.

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