... appreciation ofthe patient's perception ofthe illness, the patient's expectations ofthe physician and the health care system, and the financial and social implications ofthe illness to the patient ... defines the art of medicine, which is as necessary to thepracticeofmedicine as is a sound scientific base Clinical Skills History-Taking The written history of an illness should include all the ... appreciation ofthe role of stem cells in normal tissue function and in the development of cancer, degenerative disease, and other disorders The knowledge gleaned from the science ofmedicine has...
... precision, they often gain an aura of authority regardless ofthe fallibility ofthe tests themselves, the instruments used in the tests, and the individuals performing or interpreting them Physicians ... relieve the physician from the responsibility of carefully observing, examining, and studying the patient It is also essential to appreciate the limitations of diagnostic tests By virtue of their ... significance in the context ofthe patient's condition and other test results The development of technically improved imaging studies with greater sensitivity and specificity is one ofthe most rapidly...
... charges of malpractice and society from the excessive costs associated with the overuse of medical resources There are, however, caveats associated with clinical practice guidelines since they tend ... for the uniqueness of each individual and his or her illness The physician's challenge is to integrate into clinical practicethe useful recommendations offered by experts without accepting them ... and to help the physician decide how best to manage that individual's condition The battery of diagnostic tests complements the history and the physical examination The accuracy of a given test...
... understanding ofthe mechanisms of gender differences in the course and outcome of certain diseases For a more complete discussion of women's health, see Chap Care ofthe Elderly The relative proportion of ... 5% of hospitalized patients, and the incidence increases with use of a large number of drugs No matter what the clinical situation, it is the responsibility ofthe physician to use powerful therapeutic ... approach to decision-making in thepracticeofmedicine Evaluation of Outcomes Clinicians generally use objective and readily measurable parameters to judge the outcome of a therapeutic intervention...
... by the interplay of genetic and environmental factors Indeed, we have just begun to scratch the surface of possibilities that the era of genomics will provide to thepracticeofmedicineThe ... travel may be offset by the quality of care at these distant locations As much as any other factor influencing global aspects of medicine, the Internet has transformed the transfer of medical information ... complete discussion of global issues, see Chap Medicine on the Internet On the whole, the Internet has had a very positive effect on thepracticeof medicine; a wide range of information is available...
... students ofmedicine and related professions, and with their patients Thepracticeofmedicine is dependent on the sum total of medical knowledge, which in turn is based on an unending chain of scientific ... ages, to track to their sources the causes of disease, to correlate the vast stores of knowledge, that they may be quickly available for the prevention and cure of disease—these are our ambitions ... learning is an integral part of being a physician and must be given the highest priority Research, Teaching, and thePracticeofMedicineThe title doctor is derived from the Latin docere, "to teach,"...
... "hand-offs" from the outpatient to the inpatient environment, from the critical care unit to a general medicine floor, and from the hospital to the outpatient environment Clearly, one ofthe important ... American Board of Internal Medicine, working together with the American College of Physicians– American Society of Internal Medicine and the European Federation of Internal Medicine, has published ... aspects of diagnosis and treatment; (4) the need for numerous physicians to be involved in the care of most patients who are seriously ill; and (5) an increased number of malpractice suits, some of...
... disease, is a complex decision; it depends on the clinical features ofthe disorder, the desires ofthe patient and family, and whether the results of genetic testing will alter medical decision-making ... limitations of genetic testing in the management of a number of diverse diseases This is a difficult task, as scientific advances in genetic medicine have outpaced the translation of these discoveries ... influence the severity of infirmity, effect of treatment, and progression of disease The primary care clinician is now faced with the role of recognizing and counseling patients at risk for a number of...
... disease, they should be extended to include additional family members The determination of risk for an asymptomatic individual will vary depending on the size ofthe pedigree, the number of unaffected ... mutations would greatly impact the cost of testing without significantly influencing the effectiveness of mass screening Nevertheless, the individual who carries one ofthe less common cystic fibrosis–associated ... the relative risk ranges from two- to fivefold, underscoring the importance of family history for these prevalent disorders Pending further advances in genetic testing, the key to assessing the...
... history of breast and ovarian cancer on the paternal side of her family The early age of onset, as well as the co-occurrence of breast and ovarian cancer in this family, suggests the possibility of ... alteration in the proband and other family members, if they so desire In the example shown, if the proband's father has the BRCA1 mutation, there is a 50:50 probability that the mutation was transmitted ... carrying the disease-associated alleles will manifest a clinical disorder Furthermore, genes associated with some of these disorders often exhibit variable expression of disease For example, the breast...
... genes The pattern of disease transmission, clinical course, and treatment may differ significantly, depending on the specific gene affected In these cases, the choice of which genes to test is often ... integrated into thepracticeofmedicine In most cases, however, the discovery of disease-associated genes has greatly outpaced studies that assess clinical outcomes and the impact of interventions ... analysis ofthe gene of interest In addition, PCR enables genetic testing on minimal amounts of DNA extracted from a wide range of tissue sources including leukocytes, fibroblasts, epithelial...
... of their personal likelihood of disease in preparing pretest educational strategies Often, patients harbor unwarranted fear or denial of their likelihood of genetic risk Genetic testing has the ... that is comprehensible to the patient, who should be made aware ofthe disposition of test results Informed consent should also include a discussion ofthe mechanics of testing Most molecular ... mutation often express considerable anxiety and despair as they address the issue of risk to their children When a condition does not manifest until adulthood, clinicians will be faced with the question...
... and limitations ofthe various genetic testing options; Assist the patient, family, and referring physician in the interpretation ofthe test results; and Refer the patient and other at-risk family ... ultimate expression of disease; Address medical management issues; Assist in determining the role of genetic testing for the individual and family; Ensure that the patient is aware ofthe indications, ... both for themselves and for others in their family; Assess and enhance the patient's ability to cope with the genetic information offered; Discuss how nongenetic factors may relate to the ultimate...
... presymptomatic diagnosis ofthe disorder However, up to onethird of individuals who are homozygous for the HFE mutation not have evidence of iron overload Consequently, in the absence of a positive family ... contrast to the issue of population screening, it is important to test and counsel other family members when the diagnosis of hemochromatosis has been made in a proband Testing allows the physician ... also permits presymptomatic detection of iron overload and the institution of treatment (phlebotomy) before the development of organ damage Table 64-2 Examples of Genetic Testing and Possible Interventions...
... clinical course Although genetic diagnosis of these and other disorders is only beginning to be used in the clinical setting, predictive testing holds the promise of allowing earlier and more targeted ... heterozygous or homozygous for this allele should therefore avoid the use of oral contraceptives and receive heparin prophylaxis after surgery or trauma The field of pharmacogenomics seeks to identify genes ... hyperthermia, dihydropyrimidine dehydrogenase deficiency, the porphyrias, and glucose-6-phosphase dehydrogenase (G6PD) deficiency As noted above, the identification of genes that increase the...
... with the right level of challenge Much ofthe teacher's work in the classroom concerns getting the level of challenge right: this involves the type of tasks set, the speed expected from the student, ... words, e.g 'The girl loved the man', 'The 29 American ate the hamburger', 'The artist painted the boy' In other words the sentence has changed, but the rule has stayed the same We can go further than ... position to affect his or her attitude as will other members ofthe student's community Another factor affecting the attitude of students is their previous experiences as language learners If they were...
... similar way [19] When comparing the MLC region ofthe 2D gels between TA from PV– ⁄ – and PV+ ⁄ + mice, the pattern is virtually identical with the exception ofthe lack ofthe PV spot in PV– ⁄ – mice ... levels of MLC3 and PV are much higher in TA than in SOL, the ratio ofthe two proteins in each ofthe two muscles seemed to be constant (Fig 2C) A high degree of homology between short segments of ... transcription of mitochondrial genes has been observed as the result of permanent activation of some components of Ca2+ signaling pathways [13,14,24] Based on this, we hypothesized that the prolongation of...
... interesting encounters they recover the basic valuesofthe human being such as the mystery of love and affection, to find that we only remain in the memory of those who loved us, of those we learned ... of patients and their families, while facilitating the acquirement of skills that allow the professionals to offer ethical responses to the concern and dilemmas proper to this stage of life The ... grief and the bioethical education of health workers Acknowledgements The Editors would like to thank the translation team ofthe Languages Service ofthe University of Salamanca for their collaboration...
... standards ofpractice are based upon the principles ofethicalpractice embodied in the NBCC Code of Ethics Therefore, these standards should be used in conjunction with the most recent version ofthe ... between the responses ofthe counselor and the client Asynchronous interaction occurs with a gap in time between the responses ofthe counselor and the client The selection of a specific form of counseling ... in light of delivery systems existing at the moment rather than at the time the standards were adopted In addition to following the NBCC® Code of Ethics pertaining to thepracticeof professional...
... History of Medicine, the University of Michigan, the University of Pittsburgh, the Cleveland Clinic, the New York Consortium for the History ofMedicine at the New York Academy of Medicine, and the ... about to create In short, the concept ofthe physician as a professional in the intellectual and moral senses ofthe term and therefore the concept ofthe profession ofmedicine in its intellectual ... began in the second decade ofthe eighteenth century By then James was the mediciner Professor of Medicine, at Kings College and he gave Rob Roy the hospitality of his home the charm ofthe Gregorie...