General practice / Family medicine Books

Book SynopsisThis book has been written primarily for general practitioners; it describes the social problems which are presented by patients to their doctors for help and advice. The aim of the book is to help the doctor manage these problems, both through his own interventions and by involving or referring the patient on to other agencies. While the more common problems have been considered in detail, those rarely encountered have been omitted. The book also concentrates on help available from non-medical sources, as these will be less familiar to the general practitioner than other medical or nursing services. There is often a close association between social difficulties and health problems, both physical and psychiatric. It is, there­ fore, vital that an attempt is made to meet the social needs of patients in order to promote good physical and mental health. R. H. Corney 8 Series Foreword This series of books is designed to help general practitioners. So are other books. What is unusual in this instance is their collect­ ive authorship; they are written by specialists working at district general hospitals. The writers derive their own experi­ ence from a range of cases less highly selected than those on which textbooks are traditionally based. They are also in a good position to pick out topics which they see creating difficulties for the practitioners of their district, whose personal capacities are familiar to them; and to concentrate on contexts where mistakes are most likely to occur.Table of ContentsPreface.- Series Foreword.- 1 Social problems — the key role of the doctor.- 2 The social services and sources of help for social problems.- 3 Children and young people.- 4 Problems of adult and family life.- 5 The elderly.- 6 The physically disabled.- 7 Mental illness and handicap.- 8 Housing problems.- 9 Financial, employment and legal problems.- Appendix 1 General co-ordinating bodies and sources of information.- Appendix 2 Voluntary organizations: children and young people.- Appendix 3 Voluntary organizations: adult and family life.- Appendix 4 Voluntary organizations: the elderly.- Appendix 5 Voluntary organizations: the physically disabled.- Appendix 6 Voluntary organizations: the mentally disordered.- Appendix 7 Voluntary organizations: housing problems.- Appendix 8 Voluntary organizations: financial, employment and legal problems.

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Book SynopsisThe idea of producing this book of case histories from general family prac­ tice was only a twinkle in the editors' eyes until October 1980, when in a room in the Marriott Hotel in New Orleans, the editors met with John Fry, Joseph Levenstein and Bill Jackson to discuss new book projects. The idea was put to the group, which endorsed it enthusiastically. Encouraged by this and by John Fry's advice, the conception of The Nature of General Family Practice took place. It was agreed that to illustrate the universal nature of general family prac­ tice it would be useful to collect case histories from all around the world, that for preference they should be brief, and that they should be ac­ companied by major questions and sub-questions, but no answers. The name 'Vignettes' was applied to these cases and their questions. Subsequently, well over a hundred family physicians were asked by letter to provide ten vignettes. Sixty doctors from ten countries accepted the invitation and forwarded their contributions during the second half of 1981. Almost all of those who, for a variety of reasons were unable to contribute, said they liked the idea and looked forward to using the final product. Altogether, over 600 vignettes were received, and 583 selected for final inclusion.Table of Contents1 Why has the Patient Really Come? 1–34.- 2 Problems of Living 35–73.- 3 Family Problems 74–94.- 4 Patient Education and Preventive Care 95–113.- 5 Routine Examination 114–122.- 6 Emergencies 123–146.- 7 Attempted Suicide 147–153.- 8 Dying and Death 154–172.- 9 Contraception and Family Planning 173–187.- 10 Sexual Problems 188–198.- 11 Problems of Pregnancy 199–229.- 12 Headaches 230–246.- 13 Fits, Faints and Funny Turns 247–276.- 14 Eye Problems 277–288.- 15 Upper Respiratory Problems (Including ENT Problems) 289–324.- 16 Breathing Problems 325–357.- 17 Chest Pain 358–383.- 18 Abdominal Problems 384–424.- 19 Genitourinary Problems 425–461.- 20 Skin Problems 462–476.- 21 Lumps 477–483.- 22 Musculoskeletal Problems 484–516.- 23 Injuries 517–540.- 24 Tiredness 541–559.- 25 Weight Loss 560–567.- 26 Iatrogenic Illness 568–583.- Questions and Sub-questions 1–583.

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Book SynopsisThis book has been written with general practitioners primarily in view, describing common paediatric conditions that present in the outpatient clinics and those that require admission to hospital. The book is neither a textbook of paediatrics nor a handbook but is aimed to provide guidelines for the more commonplace conditions. Some aspects therefore, have been dealt with in detail, where felt relevant, while others are omitted on grounds of probable rare encounter. It is hoped that this volume will provide the family practitioner with an insight in the paediatrician's approach to many of the common problems in chifdren and to help him decide on the best course of action to follow. The care of children constitutes a significant and important part of a family doctor's work and practitioners are keen to promote optional care in all circumstances. It is hoped that the endeavours of this book will go in some small way to help put across the practitioner's approach.Table of Contents1 Infant feeding.- Breast feeding.- Bottle feeding.- Vitamins.- Regurgitation.- Vomiting.- Colic.- The hungry baby.- The baby who does not feed.- 2 Respiratory diseases.- Upper respiratory tract infection.- Tonsillitis.- Otitis media.- Stridor.- Croup.- Acute epiglottitis.- Chest infections.- Pneumonias.- Lobar pneumonia.- Airways obstruction.- Asthma.- 3 Gastrointestinal problems.- Gastroenteritis and related problems.- Malabsorption.- Chronic inflammatory bowel disease.- Congenital abnormalities.- Large bowel obstruction.- Appendicitis.- Differential diagnosis.- 4 Urinary tract.- Urinary tract infection.- Congenital abnormalities.- Glomerular disease.- Renal tubular disorders.- 5 Fits in childhood.- Neonatal fits.- Febrile fits.- Epilepsy.- Infantile spasms.- Differential diagnosis of peculiar turns.- 6 Heart disease in children.- Innocent murmurs.- Basic cardiac parameters.- Congestive cardiac failure.- Ventricular septal defect.- Patent ductus arteriosus.- Atrial septal defect.- Co-arctation of the aorta.- Transposition of the great vessels.- Tetralogy of Fallot.- Pulmonary stenosis.- Aortic stenosis.- Truncus arteriosus.- Tricuspid atresia.- Precautions against infection.- 7 Metabolic disorders.- Diabetes mellitus.- Clinical manifestations.- Stabilization.- Insulin.- Oral hypoglycaemic agents.- Diet.- Education.- Urine testing.- Blood glucose monitoring.- Useful services.- Thyroid disorders.- Thyrotoxicosis.- Carcinoma of the thyroid.- Hypothyroidism.- Congenital adrenal hyperplasia.- Growth problems.- Short stature.- Differential diagnosis of short stature.- Tall children.- 8 Common symptoms and problems of doubtful origin.- Abdominal pain.- Headaches.- Nocturnal enuresis.- Faecal soiling and encopresis.- 9 The problem child.- The crying baby.- Breath-holding attacks.- Temper tantrums.- The overactive child.- The child who does not sleep.- The child who does not eat.- School problems.- 10 Developmental assessment and the handicapped child.- Neonatal developmental assessment.- Newborn reflexes and reactions.- Special senses.- General objectives in the assessment of the handicapped.- Useful information.- 11 Surgical conditions.- Common surgical conditions.- Abnormalities of the female external genitalia.- The umbilicus.- Hare lip, cleft palate and tongue tie.- Swellings in the neck.- Ear, nose and throat surgery.- The eyes.- Neurosurgical conditions.- Orthopaedic problems.- 12 Emergencies in paediatrics.- Respiratory emergencies.- Cardiac emergencies.- Fits and coma.- Metabolic emergencies.- Gastro-intestinal emergencies.- Genito-urinary emergencies.- Miscellaneous emergencies.

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Book SynopsisThis series of books is designed to help general practitioners. So are other books. What is unusual in this instance is their collec­ tive authorship; they are written by specialists working at district general hospitals. The writers derive their own experi­ ence from a range of cases less highly selected than those on which textbooks are traditionally based. They are also in a good position to pick out topics which they see creating difficulties for the practitioners of their district, whose personal capacities are familiar to them; and to concentrate on contexts where mistakes are most likely to occur. They are all well-accustomed to working in consultation. All the authors write from hospital experience and from the viewpoint of their specialty. There are, therefore, matters important to family practice which should be sought not within this series, but elsewhere. Within the series much practical and useful advice is to be found with which the general practitioner can compare his existing performance and build in new ideas and improved techniques. These books are attractively produced and I recommend them.Table of ContentsSection 1 General Aspects.- 1 Introduction.- Importance of rheumatology in practice.- Classification of rheumatic disorders.- Frequency of rheumatic disorders in family practice.- The outcome and prognosis of rheumatic diseases.- 2 Some illustrative problems.- Ankylosing spondylitis.- Non-steroidal anti-inflammatory drugs.- Pain and paraesthesiae in arms.- The acute back.- The painful foot.- A gouty attack.- The painful hip.- A knee effusion.- Laboratory investigations.- The acute neck.- Helpful organizations.- Polymyalgia rheumatic.- Early rheumatoid arthritis.- The painful shoulder.- Tennis elbow.- 3 Diagnosis and assessment of rheumatic disorders.- Symptoms, signs and their diagnostic significance.- X-rays and laboratory investigations.- Early diagnosis: indications for referral for further opinion.- 4 Effect of the psyche on rheumatism.- Assessment of the ‘psychological overlay’.- Psychological and emotional disturbance: their manifestations in rheumatology.- pure — psychogenic rheumatism.- 5 Basic management of arthritis and rheumatism.- Pain relief.- Disease activity and its reduction.- Improvement of mobility and function.- Analgesics.- Anti-inflammatory drugs.- Practical procedures in family practice.- Physiotherapy.- Occupational therapy and rehabilitation.- Section 2 The Common Rheumatic Disorders.- 6 Soft-tissue (non-articular) rheumatism.- Classification.- Clinical varieties and treatment.- 7 Osteoarthritis.- Aetiology and pathology.- Clinical varieties.- Management in family practice.- Management in hospital.- 8 Rheumatoid arthritis.- Early recognition.- Complications.- Differential diagnosis.- Management of the early case in practice.- Hospital management.- Rheumatoid arthritis in children and the elderly.- 9 Ankylosing spondylitis and seronegative spondarthritis.- Concept of seronegative spondarthritis.- Ankylosing spondylitis.- Clinical features.- Management in practice.- 10 Gout and crystal deposition arthritis.- Crystal deposition arthritis: clinical varieties.- Gout: investigation of patients.- Treatment of gout.- Investigation and treatment of chondrocalcinosis.- Section 3 Regional Pain Syndromes.- 11 Pain in the neck and back.- Common causes of pain.- Investigation of neck pain syndromes.- Treatment of neck pain syndromes.- Investigation of low back pain.- Treatment of low back pain.- 12 Pain syndromes of the upper limb.- Causes of pain.- Diagnosis and treatment of pain.- 13 Pain syndromes of the lower limb.- Causes of pain.- Diagnosis and treatment of pain.- Causes of painful feet.- Section 4 Appendix.- Glossary of rheumatic disorders.- Further reading.

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Book SynopsisThis book is designed for use by medical students, nurses, young practitioners, internists, family physicians and all those initially involved with the problem of diagnostics. It is struc­ tured to provide a concise logical approach to the diagnosis of common illness and disorders in adults. The elucidation of an illness cause is not easy for the inexperienced. Although text­ books and guidance notes can be referred to for clarification of assembled thought - once a medical history has been taken - a system-orientated reference guide has considerable value for aiding and checking the logic of diagnosis. It is hoped that this book will fulfil that purpose. It could not have been written without the help of R. G. Brackenridge's Essential Medicine (1979, MTP, Lancaster, England), and J. Fry's Common Diseases (1979, MTP, Lancaster, England), to which the reader is referred and to which generous acknow­ ledgement is made. The tables of Differential Diagnosis that follow Chapters 3-7 are adapted from some that have appeared in Handbook of Differential Diagnosis, vols 1-3, published by Rocom Press, Hoffman La Roche Inc. , New Jersey, 1968-1974 - an invaluable publication now unfortun­ ately out of print, and permission to do so is gratefully apprec- 7 8 DIFFERENTIAL DIAGNOSIS iated. Finally without the stimulus and encouragement of Mr David Bloomer (MTP) and the particular assistance of Mrs J. C. Robinson, this book would never have been written. ALEXANDER D. G.Table of Contents1 Introduction — how to use this book for reference.- 2 The medical history.- 3 The cardiovascular system.- 4 The respiratory system.- 5 The gastrointestinal system.- 6 The digestive system (liver, biliary tract and pancreas).- 7 The urinary system.- 8 The central and peripheral nervous system.- 9 The skeletal system.- 10 The skin.- 11 The endocrine-hormonal system.- 12 The nutritional system and acid-base balance.- 13 The blood and lymphatic system.- 14 The psychological system.- 15 The common infections.

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Book SynopsisCardiology embraces a number of different conditions and disease processes. Cardiovascular disease is now responsible for most of the deaths of adults, especially premature deaths, in the developed world. The development of effective preventive measures, new drugs and surgical techniques makes it increasingly important to recognise those at risk, to diagnose accurately those suffering from disease and to prescribe, monitor and refer appropriately. This book is intended to focus attention on the opportunities which family' practice provides for this and to look at the need for a change in emphasis in approaching the problems. The book is in five parts. Part 1 is a reminder of some of the basic principles, which are essential if sensible cardiology is to be practised. Part 2 is about cardiac drugs, their use, effectiveness and risks. Part 3 looks at the diagnostic process; it comprises the history, examination, investigation and referral of patients, who might have cardiac disease and also the drugs which are most likely to be used. Part 4 is devoted to specific conditions. In Part 5, we look at the need for prevention and consider how it may be tackled in general practice. This is not a comprehensive textbook of cardiology. It is not intended for students. It is hoped that it may be useful to experienced doctors, struggling to provide a sound, sensible service in an environment of ever expanding technology.Trade Review`This splendid book is written by two general practitioners hoping to bring the mysteries of cardiology to the fingertips of all those engaged in family practice ..., and does indeed bring commonsense to cardiology. It can be recommended to all those wishing for an introduction to the subject.' Robert H. Anderson, International Journal of Cardiology, No. 28, 1990, pp. 129-131Table of Contents1: The Basics.- 1.1 Introduction.- 1.2 Basic Anatomy.- 1.3 Physiological models.- 1.4 Electrophysiology.- 2: Cardiac Drugs.- 2.1 Introduction.- 2.2 Hazards, safety and effectiveness.- 2.3 Sorting out the drugs.- 3: The Diagnostic Process.- 3.1 Introduction.- 3.2 Clinical history.- 3.3 Sorting out the symptoms.- 3.4 Examination.- 3.5 Electrocardiology.- 3.6 Pathology tests and chest X-rays.- 4: Cardiac Disease.- 4.1 Introduction.- 4.2 Ischaemic heart disease.- 4.3 Heart failure.- 4.4 Essential hypertension.- 4.5 Arrhythmias.- 4.6 Valvular disease.- 4.7 Congenital heart disease.- 4.8 Bacterial endocarditis.- 4.9 Cardiomyopathies.- 4.10 Pulmonary embolism.- 4.11 Pregnancy.- 4.12 Care of the patient dying of heart disease.- 5: The Role of General Practice.- 5.1 Introduction.- 5.2 Risk factors and prevention.- 5.3 The role of the Primary Health Care Team.- Further reading.

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Book SynopsisDDDDDDDDDDDD Effective management logically follows accurate diagnosis. Such logic often is difficult to apply in practice. Absolute diagnostic accuracy may not be possible, particularly in the field of primary care, when management has to be on analysis of symptoms and on knowledge of the individual patient and family. This series follows that on Problems in Practice which was con­ cerned more with diagnosis in the widest sense and this series deals more definitively with general care and specific treatment of symp­ toms and diseases. Good management must include knowledge of the nature, course and outcome of the conditions, as well as prominent clinical features and assessment and investigations, but the em­ phasis is on what to do best for the patient. Family medical practitioners have particular difficu1ties and ad­ vantages in their work_ Because they often work in professional isolation in the community and deal with relatively small numbers of near-normal patients their experience with the more serious and more rare conditions is restricted. They find it difficult to remain up-to-date with medical advances and even more difficult to decide on the suitability and application of new and relatively untried methods compared with those that are 'old' and well proven. Their advantages are that because of long-term continuous care for their patients they have come to know them and their families FOREWORD well and are able to become familiar with the more common and less serious diseases of their communities.Trade Review`The information is clearly laid out and well presented. The need for patient education and information is implicit throughout the book.' Journal of the Institute of Health Education, Vol. 23 (3).Table of Contents1. Making a diagnosis in general practice.- 2. Immunization.- 3. Self-care.- 4. Respiratory tract infections.- 5. Urinary tract infection.- 6. Vaginal discharge and pelvic infection.- 7. Sexually transmitted diseases.- 8. Gastrointestinal infections.- 9. Hepatitis; AIDS.- 10. Central nervous system infections.- 11. The common infectious diseases.- 12. Skin infections.- 13. Imported infections.- 14. Good standards.

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Book SynopsisDDDDDDDDDDDDD Effective management logically follows accurate diagnosis. Such logic often is difficult to apply in practice. Absolute diagnostic accuracy may not be possible, particularly in the field of primary care, when management has to be on analysis of symptoms and on knowledge of the individual patient and family. This series follows that on Problems in Practice which was concerned more with diagnosis in the widest sense and this series deals more definitively with general care and specific treatment of symptoms and diseases. Good management must include knowledge of the nature, course and outcome of the conditions, as well as prominent clinical features and assessment and investigations, but the emphasis is on what to do best for the patient. Family medical practitioners have particular difficulties and advantages in their work. Because they often work in professional isolation in the community and deal with relatively small numbers of near-normal patients their experience with the more serious and more rare conditions is restricted. They find it difficult to remain up-to-date with medical advances and even more difficult to decide on the suitability and application of new and relatively untried methods compared with those that are 'old' and well proven. Their ad vantages are that because of long -term continuous care for their patients they have come to know them and their families well and are able to become familiar with the more common and less serious diseases of their communities.Table of Contents1. Background.- 2. Symptoms and their management.- 3. Radiological investigations.- 4. Catarrhal children.- 5. Chronic bronchitis and emphysema.- 6. Bronchial asthma.- 7. Tumours of the lung.- 8. Management of terminal illness.- 9. Tuberculosis.- 10. Sarcoidosis.- 11. Acute infections of the lungs.- 12. Chronic infections of the lungs.- 13. Fibrotic lung disorders.- 14. Emergencies.- Multiple Choice Questions.

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Book SynopsisThe development of immunization has been one of the most striking features in the control of infectious disease in the twentieth century. This book takes into account the need for a simple, concise account of immunization procedures not only in the UK and USA but also in other countries, and to this end a special chapter on immunization in developing countries has been included. Following two introductory chapters, there are nine chapters on various diseases and the vaccines that have been developed to combat them. In each of these chapters, a short discussion of the epidemiology of the disease and the history of immunization against it is followed by a description of the vaccine, its efficacy, contraindications to its use and future developments. These are followed by four general chapters on vaccines for travel, vaccines for selective use, passive immunization and immunization in tropical environments and the book concludes with a chapter on the smallpox vaccination and one on new vaccines. The demand for this book follows the popularity of a series of articles on immunization which appeared in Update. These have been expanded and largely rewritten. I have drawn on many expert sources and have made an effort to provide a balanced and non-controversial opinion with a discussion of alternative procedures where indicated.Table of Contents1 Introduction.- 2 Vaccines and Schedules.- 3 Diphtheria.- 4 Tetanus.- 5 Whooping Cough.- 6 Poliomyelitis.- 7 Measles (Rubeola).- 8 Rubella.- 9 Tuberculosis.- 10 Vaccines for Selective Use.- Influenza.- Viral Hepatitis.- Mumps.- Meningococcal Meningitis.- Pneumococcal Infections.- Anthrax.- 11 Vaccination for Travel.- Cholera.- Yellow Fever.- Typhoid Fever.- Others.- 12 Immunization in Developing Countries.- 13 Passive Immunization.- 14 Smallpox (Variola).- 15 New Vaccines.

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Book SynopsisOne of the eXCltmg challenges of medicine has been the reaching of decisions based on less than complete evidence. As undergraduates in teaching hospitals future physicians are taught to think in clear and absolute black and white terms. Diagnoses in teaching hospitals all are based on supportive positive findings of in­ vestigations. Treatment follows logically on precise diagnosis. When patients die the causes of death are confirmed at autopsy. How very different is real life in clinical practice, and particularly in family medicine. By the very nature of the common conditions that present diagnoses tend to be imprecise and based on clinical assessment and interpretation. Much of the management and treatment of patients is based on opinions of individual physicians based on their personal expenences. Because of the relative professional isolation offamily physicians within their own practices, not unexpectedly divergent views and opinions are formed. There is nothing wrong in such divergencies because there are no clear absolute black and white decisions. General family practice functions in grey areas of medicine where it is possible and quite correct to hold polarized distinct opinions. The essence of good care must be eternal flexibility and readiness to change long-held cherished opinions. To demonstrate that with many issues in family medicine it is possible to have more than one view I selected 10 clinical and II non -clinical topics and invited colleagues and fellow-practitioners to enter into a debate-in-print.Table of Contents1 Mild-to-moderate hypertension — to treat or not to treat?.- The issues.- The case for treatment (1).- The case for treatment (2).- The case against treatment.- Critique.- Commentary.- 2 Psychotropic pills or psychotherapy?.- The issues.- The case for pills.- The case for psychotherapy.- Commentary.- 3 Alcoholism — disease or self-inflicted vice?.- The issues.- The case for alcoholism as a non-disease (1).- The case for alcoholism as a non-disease (2).- The case for alcoholism as a disease.- Critique.- Commentary.- 4 Acute myocardial infarction — home or hospital care?.- The issues.- The case for home care.- The case for hospital care.- Commentary.- 5 Is obesity worth treating?.- The issues.- The case for treating obesity.- The case against treating obesity.- Commentary.- 6 Diabetes: strict control or flexibility in management?.- The issues.- The case for strict control.- The case for realistic control.- The case for flexibility below 11.0 mmoI/I.- Commentary.- 7 Antibiotics for otitis media and sore throat?.- The issues.- The case for antibiotics.- The case against antibiotics.- Commentary.- 8 Premenstrual tension and the menopausal syndrome — specific treatment?.- The issues.- The case for specific therapy (1).- The case for specific therapy (2).- The case against specific treatment.- Commentary.- 9 Acute backache — active or passive treatment?.- The issues.- The case for active treatment.- The case for conservative management.- Commentary.- 10 Terminal care — at home or in the hospital or hospice?.- The issues.- The case for home care of the dying.- The case for hospital/hospice care (1).- The case for hospital/hospice care (2).- Commentary.- 11 Compulsory immunization, or not?.- The issues.- The case for compulsory immunization.- The case against compulsory immunization.- Commentary.- 12 House calls — more or less?.- The issues.- The case for fewer house calls (1).- The case for fewer house calls (2).- The case for more house calls (1).- The case for more house calls (2).- Commentary.- 13 Teamwork — delegated or shared?.- The issues.- The case for delegation (1).- The case for delegation (2).- The case for sharing.- Commentary.- 14 Patient participation — more or less?.- The issues.- The case for less patient participation (1).- The case for less patient participation (2).- The case for more patient participation (1).- The case for more patient participation (2).- The case for more patient participation (3): self-care benefits for primary care practitioners.- Commentary.- 15 Telling the truth, the whole truth, and nothing but the truth?.- The issues.- The case for telling the patient the truth.- Pallesen The case against telling the patient the truth.- Commentary.- 16 How many patients — more or less?.- The issues.- The case for fewer patients (1).- The case for fewer patients (2).- The case for more patients.- Commentary.- 17 The medical check-up — useful or useless?.- The issues.- The case for a medical check-up.- The case for screening.- The case against a medical check-up.- Commentary.- 18 Solo practice or group practice?.- The issues.- The case for solo practice.- The case for group practice: the future practice model in family medicine.- Commentary.- 19 Vocational training for family medicine — useful or useless?.- The issues.- The case for vocational training.- The case against vocational training.- Critique.- Commentary.- 20 At least one female family physician in every group practice?.- The issues.- The case for a female doctor in every group practice (1).- The case for a female doctor in every group practice (2).- The case against a female doctor in every practice.- Commentary.- 21 Prevention — realistic or not?.- The issues.- The case for realistic prevention.- The case for more prevention.- Critique.- Commentary.

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Book SynopsisDDDDDDDDDDDD Effective management logically follows accurate diagnosis. Such logic often is difficult to apply in practice. Absolute diagnostic accuracy may not be possible, particularly in the field of primary care, when management has to be on analysis of symptoms and on knowledge of the individual patient and family. This series follows that on Problems in Practice which was con­ cerned more with diagnosis in the widest sense and this series deals more definitively with general care and specific treatment of symp­ toms and diseases. Good management must include knowledge of the nature, course and outcome of the conditions, as well as prominent clinical features and assessment and investigations, but the emphasis is on what to do best for the patient. Family medical practitioners have particular difficulties and advantages in their work. Because they often work in professional isolation in the community and deal with relatively small numbers of near-normal patients their experience with the more serious and more rare conditions is restricted. They find it difficult to remain up-to-date with medical advances and even more difficult to decide on the suitability and application of new and relatively untried methods compared with those that are 'old' and well proven. vii Their advantages are that because of long-term continuous care for their patients they have come to know them and their families well and are able to become familiar with the more common and less serious diseases of their communities.Table of Contents1 Viral infections.- 2 Fungal infections.- 3 Bacterial infections.- 4 Tropical infections.- 5 Parasitic infestations.- 6 Eczema.- 7 Psoriasis.- 8 Lichen planus.- 9 Pityriasis rosea.- 10 Acne.- 11 Rosacea.- 12 Urticaria.- 13 Erythema multiforme.- 14 Benign neoplasms.- 15 Skin malignancy.- 16 Disorders of pigmentation.- 17 Bullous disorders.- 18 Hair problems.- 19 Photosensitivity.- 20 Ichthyosis.- 21 Drug eruptions.- 22 Pruritus.- 23 Cutaneous manifestations of metabolic disease.- 24 Erythema nodosum.- 25 Cutaneous vasculitis.- 26 Purpura.- 27 Lupus erythematosus, scleroderma, dermatomyositis.- 28 Hyperhidrosis.- 29 Topical steroids.

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Book SynopsisDDDDDDDDDDDD Effective management logically follows accurate diagnosis. Such logic often is difficult to apply in practice. Absolute diagnostic accuracy may not be possible, particularly in the field of primary care, when management has to be on analysis of symptoms and on knowledge of the individual patient and family. This series follows that on Problems in Practice which was con­ cerned more with diagnosis in the widest sense and this series deals more definitively with general care and specific treatment of symp­ toms and diseases. Good management must include knowledge of the nature, course and outcome of the conditions, as well as prominent clinical features and assessment and investigations, but the emphasis is on what to do best for the patient. Family medical practitioners have particular difficulties and advantages in their work. Because they often work in professional isolation in the community and deal with relatively small numbers of near-normal patients their experience with the more serious and more rare conditions is restricted. They find it difficult to remain up-to-date with medical advances and even more difficult to decide on the suitability and application of new and relatively untried methods compared with those that are 'old' and well proven. vii Their advantages are that because of long-term continuous care for their patients they have come to know them and their families well and are able to become familiar with the more common and less serious diseases of their communities.Table of Contents1. Introduction.- 2. The Pancreas.- 3. Thyroid Disease.- 4. The Parathyroid Gland and Calcium Metabolism.- 5. Endocrine Diseases of the Ovary and Breast.- 6. The Testis.- 7. Disorders of the Pituitary.- 8. Disorders of the Adrenal Gland.

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Book SynopsisJohn P. Horder, President, 1980-82 The first 30 years of the College have been an exciting experience for those most closely involved. Some have already passed on, but this account has been written soon enough for many of the actors to be historians. Future members of the College will be grateful to them for what they have written, as well as for what they did as a remarkably determined and harmonious team. Students of twentieth century medicine in this country will also be grateful for a first-hand account of the development of an institution which has been closely associated with, and partly responsible for, important changes in medical care and education. Those who read these pages may wonder how the builders of this young College could have found time to do much general practice. They did. The three editors of this history, which covers 25 years, and the general practitioner members of the Steering Committee all ran large practices, in which they worked very hard throughout that time. Most of their work for the College was done during off-duty hours, weekends and holidays. The College could not have developed as it did, had they not been personally concerned with the practical problems and needs of clinical medicine. This is also true of many of the contributors. It is impossible to mention everyone who deserves credit. The editors hope that they may be forgiven for any serious omissions.Table of ContentsI Past Attempts to Found a ‘College of General Practitioners’ One and a Half Centuries Ago.- II Events Leading up to the Formation of the Steering Committee.- III The Work of the Steering Committee, and the Birth of the College.- IV The College’s First Year and the Work of the Foundation Council.- V Presidents and Chairmen of Council of the College During its First Twenty-Five Years.- VI Regional Faculties and Regional Councils in the United Kingdom and Eire.- Scottish Council.- Welsh Council.- Irish Council.- VII Undergraduate Education.- VIII Postgraduate Education and Vocational Training.- I: 1953–1965.- II: 1965–1977.- IX The Medical Recording Service and the Medical Audiovisual Library.- X Standards.- The Criteria Committee.- The Board of Censors.- The Examination Committee.- The Examination.- XI The College and Research.- The Research, Education and Scientific Foundations.- XII Practice Organisation, Equipment and Premises.- XIII College Publications.- The Annual Reports.- The College Journal.- Other College Publications.- Faculty Publications.- XIV The Library, Museum and Archives.- I: The Library.- II: The Museum.- III: The Archives.- XV Headquarters, Staff and Administration.- XVI College Finance and Appeal.- XVII Awards and Ethical Committees.- XVIII Incorporation, Royal Prefix and the Royal Charter.- XIX Insignia and the College Grace.- The Insignia.- The College Grace.- X Relations with Other Bodies.- I.- II.- XXI The College Overseas.- Overseas Regional Faculties.- Overseas Councils:.- The Australian Council.- The New Zealand Council.- The South African Council.- XXII The Future.- I.- II.- Appendices.- 1. Honorary Fellows.- 2. Honorary Chaplain.- 3. Honorary Secretaries of Council.- 4. Honorary Treasurers of the College.- 5. James Mackenzie Lecturers.- 6. William Pickles Lecturers.- 7. Foundation Council Awards.- 8. George Abercrombie Awards.- 9. Fraser Rose Gold Medallists.- 10. John Hunt Fellow.- 11. Honorary Registrar.- 12. Administrative Secretaries.- 13. College Solicitors.- 14. College Auditors.- 15. College Publications.

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Book SynopsisThis book is a personal testimony of faith in the future and in the progression to better health and a better life. It is the testament of a rough and ready measuring device - a practising physician who sought to compare and contrast three systems of medical care to see what can be distilled from them to help us all in achieving better services for medical care. Medical care as a human and civic right is the con­ cern of us all. Seeking to live longer and in good health we depend on medical, social and welfare services to attain this goal. Yet it is quite obvious that there are limits and dilemmas that prevent anything but an unsatisfactory compromise. The resources that are available cannot meet all the calls. How then can we make the best use of the resources that we have? This must be the theme for this book. What can we learn from each other for the com­ mon good? Since we all are facing the same common prob­ lems, how do we go about resolving them? For example, how do the medical care services in the USSR, USA and UK cope with an acute heart attack, with a middle-aged woman with depression, with a brain-damaged child, with a road accident or with a case of measles? These are the common human factors involved.Table of Contents1 Medical care — common goals and common problems.- 2 National characteristics.- 3 Structure and patterns of medical services.- 4 First contact care.- 5 Specialist Ambulatory care.- 6 Hospitals.- 7 Preventive aspects of medical care.- 8 Public health and social services.- 9 Maternity and child care.- 10 Mental health care.- 11 The greater medical profession — medical manpower.- 12 Education and training.- 13 The present dilemmas of medical care.

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Book SynopsisJOHN JOHN FRY FRY All All examinations examinations create create problems problems and and stresses stresses in in examinees. examinees. The The examination examination for for the the Membership Membership of of the the Royal Royal College College of of General General Practitioners Practitioners is is no no exception. exception. Although Although the the examiners examiners state state that that their their objectives objectives are are to to pass pass candidates candidates wherever wherever and and whenever whenever possible, possible, nevertheless nevertheless the the failure failure rate rate remains remains con­ sistently sistently at at 30% 30% plus plus of of those those taking taking the the examination. examination. The The reasons reasons for for failure failure fall fall into into a a number number of of groups. groups. The The candidate candidate may, may, through through over-confidence, over-confidence, not not have have prepared prepared for for the the examination. examination. He He may may have have assumed assumed that that it it is is not not necessary necessary to to read, read, learn learn and and digest digest data, data, facts facts and and experience experience on on general general practice. practice. How How wrong wrong that that is, is, he he will will discover discover when when he he sits sits the the exam. exam.Table of Contents1 The MRCGP examination.- 2 The modified essay question paper or MEQ.- 3 The traditional essay question paper or TEQ.- 4 The multiple-choice question paper or MCQ.- 5 The oral examination and log diary.- 6 The problem-solving oral.- 7 Vital statistics.- 8 Sources of information.- 9 Work plan.- 10 Mock examination and answers: MEQ; TEQ; MCQ.

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Book SynopsisThis third edition of the Beecham Manual has its origins in a manual produced by Selwyn Carson for his general practice in Christchurch, New Zealand. He produced loose-leaf sets of instructions for his practice team and colleagues. Beecham Research Laboratories of New Zealand did a great service for the medical profession by publishing and distributing Dr Carson's manual there. The British version of the Beecham Manual had different objectives. The vocational training programme needed basic resources and the British Manual was created as an easy to read reference book on common prob­ lems and methods in general practice. The first and second editions met with enthusiastic approval from princi­ pals, trainers and trainees. This third edition follows the same general format but has been completely revised and updated and includes many new additions. The five sections are: o planned care of definable population and other groups o principles of teaching and learning o emergencies and their management o psychiatry o clinical care of common conditions We have kept to simple, clear and brief presentations of our conjoint views based on our experiences in our own practices. We dedicate this third edition to our colleagues involved in caring, learning and teaching. They may not agree with us completely but we hope that we will make them consider our suggestions and use them for thought, debate and discussion. We hope also that it will be used as a work book for the whole practice team.Table of ContentsSection A Planned Care.- A1 Family Planning.- The Combined Pill.- Starting a Patient on the Pill.- The Morning After Pill.- The Progestogen only Pill.- Injectable Progestogen.- The Sheath ..- The Rhythm Method.- The Vaginal Diaphragm.- The IUCD or Coil.- Sterilization.- Termination of Pregnancy.- A2 Antenatal Care.- Initial Examination (8–12 weeks pregnant).- From 12–28 weeks.- From 30 weeks onwards.- Postnatal Examination (6 weeks after delivery).- A3 Child Care.- Routine Preventive Care in the first 14 years of life.- Developmental Surveillance.- At Birth.- Motor Responses in the few weeks after birth.- Motor Responses 4–6 weeks after birth.- 6 weeks.- Motor Responses: 8-14 weeks.- 7 months.- 18 months.- 2-2 1/2 years.- 4 1/2 years.- Notes on the Use of Percentile Charts.- A4 The Adolescent.- A5 Care of Adults.- Record Keeping.- Using Records to improve Patient Care.- Overseas Travel Advice.- A6 Care of the Elderly.- A7 Terminal Care.- A8 Care of Immigrants.- A9 Care of the Disabled.- Section B Teaching and Learning.- B1 Patient Education.- The Need.- Whose Job is it?.- How is it Done?.- Content.- Methods.- B2 Undergraduate Education.- B3 Vocational Training.- Vocational Training Regulations.- Group Activities for Trainee GPs.- The Trainee Year.- Criteria for Membership of the Royal College of General Practitioners.- The MRCGP Examination.- Continuing Education.- Section C Emergencies.- Emergencies.- Acute Abdomen.- Anaphylaxis.- Back Pain.- Bereavement.- Bleeding.- Blindness.- Breathlessness.- Chest Pain.- Group.- Death — sudden and unexpected.- Dental and Oral.- Diarrhoea and Vomiting.- Earache.- Falls.- Fits, Faints and Convulsions.- Headaches.- Non-accidental Injury.- Psychiatric.- Sexual Assault.- Sore Throat.- Stroke.- The Unconscious Patient.- Vascular.- Vertigo.- Section D Psychiatry in General Practice.- Psychiatry in General Practice.- Anxiety.- Depression (Affective Illness).- Organic Psychoses.- Section E Clinical Care.- E1 Cardiovascular.- Anaemia.- Cardiac Arrhythmias.- Chronic Cardiac Failure.- High Blood Pressure.- E2 Respiratory.- Chronic Bronchitis.- Hay Fever.- E3 Rheumatic.- Ankylosing Spondylitis.- Gout.- Osteoarthritis (Osteoarthrosis).- Polymyalgia Rheumatica.- Rheumatoid Arthritis.- E4 CNS.- Epilepsy.- Migraine.- Multiple Sclerosis.- Parkinsonism.- Stroke.- E5 Gastrointestinal.- Dyspepsia and Functional Disorders of the GI Tract.- Peptic Ulcers.- Irritable Bowel Syndrome (spastic colon, mucous colitis).- Gallbladder Disease.- E6 Endocrine.- Diabetes Mellitus.- Thyroid.- E7 Genitourinary.- Chronic Renal Failure.- Urinary Tract Infection.- E8 The Menopause.- E9 Non-illness.

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Book SynopsisWHY WE MUST PRACTISE TRANSCULTURAL MEDICINE Health professionals and GPs should concern themselves with ethnicity, religion and culture as much as with the age, sex and social class of their patients. Transcultural medicine is the knowledge of medical and communication encounters between a doctor or health worker of one ethnic group and a patient of another. It embraces the physical, psychological and social aspects of care as well as the scientific aspects of culture, religion and ethnicity without getting involved in the politics of segregation or integration. English general practitioners and health professionals tend to regard everyone as English, and to assume that all patients have similar needs. Would that it were as simple as that! For economic reasons - based on supply and demand - the mass migration of working populations from the new Commonwealth countries, along with their dependent relatives (including their parents) to Britain took place during one decade - the 1960s. Broadly speaking, the workers were in their thirties and forties, and their dependent parents were in their fifties and sixties. All these will, of course, be 30 years older in the 1990s.Table of ContentsI: General Aspects.- 1. Avoiding communication problems.- 2. Ethnic terminology and occupations.- 3. History-taking and the examination.- 4. Factors affecting diagnosis and how to avoid diagnostic traps.- 5. Psychiatric disorders among different ethnic groups.- 6. Diet-related diseases.- 7. Avoiding diagnostic traps related to customs.- 8. Diseases related to visits to country of origin.- 9. Therapy and multi-ethnic groups: factors affecting treatment.- 10. Alternative therapies and ethnic groups.- II: Special Considerations.- 11. Cultural conflicts in a mixed marriage.- 12. Disease patterns in mutli-ethnic groups in the UK.- 13. Hidden corners of ethnic medical history.- 14. Gaps and needs in ethnic care.- 15. Transcultural factors in the consultation: the three generations concept.- 16. Management of ethnic Asian patients in general practice.- 17. Obstetric problems in multi-ethnic women.- 18. Family planning and culture.- 19. Paediatric problems in various ethnic groups.- 20. Pharmacists’ understanding of cultural customs and dangers of multi-therapy.- 21. Midwife, health visitor and nurse: dealing with patients from different cultures.- 22. Cultural aspects of the MRCGP examination.- 23. Muslim patients and the British GP.- 24. Nutritional problems in ethnic groups.- 25. Skin problems encountered in multi-ethnic patients.- III: Selected Points.- 26. Multi-cultural medicine: a series in the British Medical Journal.- 27. Transcultural medicine: education and examination.- Appendix: Resources available.

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Book SynopsisIn writing this short monograph on 'Problems in Peripheral Vascular Disease', I have tried to steer a course between a simplistic dogmatic approach more appropriate to an under­ graduate text, and a detailed specialist treatise of interest only to vascular surgeons. Although arterial surgery has been performed for centuries, the main indications in the past were to deal with the effects of trauma and aneurysm formation. The development of arterio­ graphy and the ability to see arterial blocks and stenoses allowed surgeons to carry out increasingly sophistidated operations for an enlarging range of pathological conditions. Even today, arterial surgery continues to develop, and although we are often dealing with the 'surgery of ruins', a successful outcome is just as rewarding for surgeon and patient alike. In this book I have also included a discussion on venous problems including a note about recent developments in direct surgery of the deep veins of the lower limb which could be a re­ warding field of endeavour for the vascular surgeon. The original descriptions by Buerger and Raynaud are taken from 'Classic Descriptions of Disease' by Ralph H. Major. While reviewing my own surgical practice, I have had the pleasure of reading once again the publications of H.H.G. Eastcott (arterial surgery), J.T. Hobbs (varicose veins), G.L. Hill (Buerger's disease), Adrian Marston (intestinal ischaemia), Martin Bimstingl (vasospastic disorders) and C.H. Hawkes (lumbar canal stenosis).Table of Contents1 Arterial occlusive disease.- Presentation.- Examination and risk factors.- Investigations.- Vasoactive drugs.- Surgical treatment.- 2 The surgical treatment of intermittent claudication.- Assessment.- Aortoiliac disease.- Femoropopliteal reconstruction.- 3 The critically ischaemic limb.- Definition.- Clinical features.- Management.- Results.- 4 When should arteries be dilated?.- Percutaneous transluminal angioplasty.- Technique.- Indications.- 5 Acute ischaemia and arterial embolism.- Thrombosis.- Embolism.- Clinical features.- Management.- 6 Amputation in peripheral vascular disease.- Indications.- Technique.- Results.- Rehabilitation.- 7 What is Buerger’s disease?.- Clinical features.- Prognostic factors.- Management.- 8 Aneurysms.- Pathogenesis.- Aortic aneurysms.- Surgery of leaking aortic aneurysms.- Dissecting aortic aneurysms.- 9 What about sex, doctor?.- Physiology.- Vasculogenic impotence.- Prevention of impotence.- Surgical treatment of vasculogenic impotence.- 10 Vascular surgery of the intestinal tract.- Anatomy.- Pathology.- Chronic intestinal ischaemia.- Acute intestinal ischaemia.- 11 Raynaud’s what?.- Physiology.- Raynaud’s syndrome.- Raynaud’s disease.- Raynaud’s phenomenon.- Assessment and investi-ation.- Treatment.- 12 The diabetic foot.- Pathophysiology.- Clinical presentation.- Assessment.- Management.- 13 Lumbar canal stenosis.- Cauda equina syndrome.- Anatomy.- Clinical features.- Diagnosis.- Treatment.- 14 Varicose veins.- Anatomy.- Physiology.- Classification.- Assessment.- Management.- Recurrent varicose veins.- Superficial thrombophlebitis.- Restless leg syndrome.- 15 Compression sclerotherapy for varicose veins.- Patient selection.- Injection technique.- Complications.- 16 Venous thromboembolism.- Pathogenesis.- Prevention of deep vein thrombosis (DVT).- Clinical features of DVT.- Management of DVT.- Recurrent DVT.- Pulmonary embolism.- 17 The post-thrombotic syndrome.- Clinical features.- Venous outflow obstruction.- Venous reconstructive surgery.- 18 Leg ulcers.- Aetiology.- Clinical features.- Diagnosis.- Management.

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Book SynopsisThe aim of this book is to give a short and practical account of the problems related to the ear, nose and throat. The presenta­ tion is orientated towards arriving at a diagnosis based on the presenting symptoms and signs and aid the management of the case. While it is specifically intended for those who have not had the opportunity of devoting much time to the subject, I hope that it may be of some service to the more experienced practitioner. Padman Ratnesar Farn boro ugh, 1984 7 Series Foreword This series of books is designed to help general practitioners. So are other books. What is unusual in this instance is their collective authorship; they are written by specialists working at district general hospitals. The writers derive their own experience from a range of cases less highly selected than those on which textbooks are traditionally based. They are also in a good position to pick out topics which they see creating diffi­ culties for the practitioners of their district, whose personal capacities are familiar to them; and to concentrate on contexts where mistakes are most likely to occur. They are all well­ accustomed to working in consultation.Table of Contents1 Earache.- External ear.- Middle ear.- Referred pain.- 2 Deafness.- Types of hearing loss.- Conductive deafness.- Sensorineural deafness.- 3 The discharging ear.- Otitis extra.- Subacute otitis media.- Chronic otitis media.- 4 Vertigo.- Physiological and pathological vertigo.- Peripheral and central vertigo.- Clinical assessment.- 5 Tinnitus.- Clinical groups.- Management.- 6 Facial paralysis.- Upper motor neuron paralysis.- Lower motor neuron paralysis.- Ascertainment of level of lesion.- Management of facial palsy.- 7 Anosmia.- Anatomy and physiology of sensation of smell and taste.- Causes of anosmia.- Clinical assessment.- Treatment.- Course and outcome.- 8 Nasal obstruction and nasal discharge.- Nasal obstruction.- Nasal discharge.- 9 Nose bleeds.- Age-sex distribution.- Sites of nose bleedings.- Causes.- Associated symptoms.- Management.- 10 Epiphora.- Causes.- Clinical assessment.- Treatment.- Practical points.- 11 Sore throat.- Who gets them and when.- Causes.- Interrelations.- Clinical types.- 12 Hoarseness and stridor.- Children.- Adults.- Aphasia.- Aphonia.- Dysarthria.- 13 Diplopia.- Causes.- Examination.- Investigation.- 14 Dyspagia.- Causes.- types.- 15 Tonsils and adenoids.- Who and when?.- Why?.- The catarrhal child syndrome.- Effects.- Tonsillectomy and/or adenoidectomy?.- Indications.- Results.- Dangers.- 16 Swellings of the neck.- Congenital swellings.- Inflammatory swellings.- Neoplasm.

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Table of Contents1 The Normal Back.- Section I The Vertebral Column.- 1 The locomotion of fish.- 2 The escape from the seas.- 3 The biomechanics of quadrupeds.- 4 From four legs to two.- 5 The uniqueness of man.- 6 The anatomy of posture.- Section II The Motion Segments.- 7 Building blocks.- 8 Spinal mobility.- 9 The role of the discs.- 10 Stability and strength.- 11 The biomechanics of backache.- 2 The Abnormal Back.- 12 Spinal stenosis.- 13 Prolapsed intervertebral disc.- 14 Osteoarthritis of the facet joints.- 15 Facet joint malfunction.- 16 Lesions of ligaments.- 17 Spondylolysis and spondylolisthesis.- 18 The sacroiliac joint.- 19 Muscle spasm.- 20 Muscle fatigue.- 3 Conservative Treatment of the Abnormal Back.- 21 Bed rest, psychoactive drugs and epidural injections.- 22 Analgesics, acupuncture and TENS.- 23 Posture correction and exercise.- 24 Spinal manipulation.- References and further reading.

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Book SynopsisOne of the few real and lasting benefits of international medical meetings is the opportunity to meet, talk, gossip and get to know colleagues from other countries. So it was that we met, talked and planned at WONCA (World Organization of National Colleges and Academies and Academic Associa­ tions of General Practitioners/Family Physicians) meetings at Montreux and New Orleans. We realized that although we worked in different places and in different practices 'primary health care' was essentially the same the world over. Our roles, our problems, our clinical content, our challenges and objectives were similar whether we work in Europe, North America, Australasia, South Africa or developing countries. With such similarities we asked ourselves - 'why not share our common experiences for mutual benefits?' The question developed into an idea and the idea into this book. We started by selecting what we considered were important topics and then we invited friends and colleagues to join us in putting our experiences and beliefs from years of practice to readers from all over the world to demonstrate our common concerns and to learn from one another.Table of Contents1 Access to care.- 2 The health team.- 3 Relations with specialists in clinical and allied health professions.- 4 Providing for emergencies in general family practice.- 5 Promoting health — practice and principles.- 6 Principles of management in patient care.- 7 Patient education.- 8 Medical records.- 9 Group practice management.- 10 Facilities and equipment in general family practice.- 11 Applied research in general family practice.- 12 The general family practice as a teaching and learning environment.- 13 Practising primary care in developing nations.

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Book SynopsisPart one of the book presents the gastrointestinal problems that commonly face the general practitioner. Emphasis is placed on analysis of clinical data and how this may provoke the most profitable lines of investigation. Many of the investigation and treatment protocols are within the scope of general practice, but hospital management is also included. It was possible to deal with common oesophageal diseases under the heading of oeso­ phageal problems in Part 1. In contrast, it proved impossible to discuss adequately all of the common diseases affecting other organs of the digestive system under the problem headings. For this reason, a fuller ac count of many common alimentary diseases is provided in Part two. M. L.-5. K. G. D. W. 9 Series Foreword This series of books is designed to help general practitioners. So are other books. What is unusual in this instance is their collec­ tive authorship; they are written by specialists working at district general hospitals. The writers derive their own experi­ ence from a range of cases less highly selected than those on which textbooks are traditionally based. They are also in a good position to pick out topics which they see creating difficulties for the practitioners of their district, whose personal capacities are familiar to them; and to concentrate on contexts where mistakes are most likely to occur. They are all well-accustomed to working in consultation.Table of ContentsPreface.- Series Foreword.- 1 Common Problems.- 1 Common oesophageal problems.- Heartburn.- Problems with swallowing.- 2 Nausea and vomiting.- 3 The acute abdomen.- 4 Recurrent abdominal pain and discomfort.- Symptoms and diagnosis.- Investigation.- 5 Acute diarrhoea.- Acute infective diarrhoea.- Diarrhoea in travellers.- Diarrhoea due to drugs.- 6 Chronic and recurrent diarrhoea.- Causes and indications.- Investigations.- 7 Malabsorption.- Mechanisms of malabsorption.- Clinical features.- Investigation of suspected malabsorption.- 8 Problems with laxatives.- Laxative abuse.- Problems with specific laxatives.- 9 Constipation and other problems with defaecation.- Constipation.- Other problems.- 10 Gastrointestinal bleeding.- Acute upper gastrointestinal haemorrhage.- Chronic or recurrent bleeding.- Rectal bleeding.- 11 Diagnosis of the common causes of jaundice.- Unconjugated hyperbilirubinaemia.- Hepatocellular and cholestatic jaundice.- 12 Miscellaneous gastrointestinal symptoms.- Anorexia.- The ‘abnormal’ tongue.- Bad breath.- Wind and gaseousness.- 13 Gastrointestinal endoscopy.- 2 Common Diseases.- 14 Peptic ulcer.- Aetiological factors.- Clinical features.- Diagnosis.- Management.- 15 Some diseases that cause malabsorption.- Coeliac disease.- Malabsorption after gastric surgery.- Crohn’s disease.- Malabsorption after small bowel resection.- Small intestinal lymphoma.- Chronic small bowel ischaemia.- Bacterial colonization of small intestine.- Post-infective malabsorption.- Giardiasis — Tropical sprue.- Whipple’s disease.- Pancreatic insufficiency.- 16 The irritable bowel syndrome.- Aetiology and pathogenesis.- Clinical categories.- Management.- 17 Inflammatory bowel disease.- Ulcerative colitis.- Crohn’s disease.- Complications and special problems.- 18 Diverticular disease of the colon.- Diffuse diverticulosis.- Sigmoid diverticulosis.- 19 Common liver diseases.- Viral hepatitis.- Hepatitis type A.- Hepatitis type B.- Hepatitis type non-A, non-B.- Complications of hepatitis.- Chronic hepatitis.- Chronic persistent hepatitis.- Chronic active hepatitis.- Drug induced liver disease.- Direct hepatotoxicity.- Toxicity due to drug metabolites.- ‘Hypersensitivity’ induced damage.- Halothane.- Canalicular cholestasis.- Other hepatic reactions to drugs.- Alcoholic liver disease.- Cirrhosis.- Categories of cirrhosis.- Encephalopathy.- 20 Common pancreatic diseases.- Acute pancreatitis.- Chronic pancreatitis.- Further reading.

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Book SynopsisOver several years working in a district general hospital as a physician with a cardiological interest, the common problems in this field are clearer. This knowledge has come through normal out-patient clinic referrals, care of in-patients, and by working in a domiciliary consultative capacity. The problems that concern family physicians nowadays are somewhat different from the problems of two or three decades ago. The accent now is very much on the implications of hypertensive and ischaemic heart disease. Rheumatic fever is rarely seen, though its sequelae may still be discovered. Hence the approach of this book is to the common problems of today in family practice, and the book is not intended to be a reference text book of cardiology. It does not include references because it has been written from personal experience gained from the treatment and management of patients with common cardiac problems. It is hoped that it will be of value primarily to family physicians because it has been written in an attempt to fill a need as measured by the problems that are referred to specialists in the cardiological field. It may prove of value to those medical students and nurses who wish to consider medical problems in a practical way, that is from the ways that cardiac problems present in practice.Table of ContentsPreface.- Foreword.- 1 Presenting symptoms — chest pain.- Skin.- Intercostal muscles and muscles attached to the chest wall.- Ribs and spine.- costo-chondral junctions.- Pleura and diaphragmatic pleura.- The pericardium.- The myocardium.- The aorta.- The oesophagus.- Anxiety and cardiac neurosis.- 2 Ischaemic heart disease.- Myocardial ischaema.- Myocardial infarction.- 3 Hypertension.- Presentation.- General considerations.- Investigations.- Treatment.- Notes on hypotensive drugs.- 4 Cardiac murmurs.- Systolic murmurs.- Diastolic murmurs.- 5 Syncope.- Dysrhythmias.- Valvular heart disease.- Congenital heart disease.- Hypotension.- Other low output states.- Pulmonary embolism.- Cardiac compression.- 6 Breathlessness.- Presenting symptoms.- Acute cardiac failure.- Chronic heart failure.- The signs of heart failure.- Investigations in cardiac failure.- Treatment of cardiac failure.- 7 Infective and invasive processes of the heart.- Pericardium.- Myocardium.- Endocardium.- 8 Electrocardiography.- Particular value of e.c.g. in practice.- Reading and recording the e.c.g..- Some examples of common e.c.g. abnormalities.- 9 Dysrhythmias.- Presenting symptoms.- Supra-ventricular dysrhythmias.- Ventricular causes of dysrhythmia.- other dysrhythmias.- 10 Changing trends in the investigation and treatment of cardiological problems.- Investigations.- Methods of treatment.- 11 Drug therapy in practice.- Diuretics.- The ?-blocking drugs.- Other antidysrhythmic drugs.- Hypotensive drugs.- Anti-anginal drugs.- 12 Present and future problems.- Changing trends of cardiac disease.- Statistics concerning heart disease.- Epidemiology and prevention.- Logistics.

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Book SynopsisThe topics chosen for discussion represent the most common problems referred by family doctors to chest clinics. It was taken for granted that the reader will be familiar with the symptoms, signs, and natural history of respiratory diseases, so that the stress is on differential diagnosis and treatment. Tuberculosis once occupied nearly all the time of chest physicians. At present weeks go by without a single case presenting itself. There has been no comparable improvement in cancer of the lung, which remains one of the most intract­ able problems. Asthma was seldom referred to out-patient clinics when the disease was regarded as more unpleasant than dangerous. The hazards of severe attacks and the advan­ tages of liaison with a hospital department are now widely recognized. A similar change of attitude to the management of chronic bronchitis brought many new patients to the chest clinics in place of the vanishing tuberculous population. Some uncommon pulmonary diseases are included: allergic alveolitis, because of the importance of early diagnosis, and sarcoidosis in order to discourage unnecessary treatment. The book is intended to be a practical guide and is not a critical review. This might serve as an excuse for its didactic style and the exclusion of controversial subjects. Some statements are repeated at more than one place in order to help readers who wish to consult individual chapters bearing on some current problem. Source references are omitted and are replaced by a short list of books recommended for further reading.Table of Contents1 Symptoms, clinical signs and breathing tests.- Cough.- Sputum.- Haemoptysis.- Dyspnoea.- Pain.- Percussion.- Auscultation.- Clubbing of the fingers-Cyanosis.- Pursed-lip breathing.- 2 Pneumonia.- Defences of the lung-Factors predisposing to infection.- Classification.- Clinicalfeatures.- Investigations.- Complications.- Recurrent pneumonia.- Differential diagnosis.- Treatment.- 3 Chronic bronchitis.- Prevalence.- Pathology.- Clinicalfeatures.- Investigations.- Differential diagnosis.- Complications.- Treatment.- 4 Asthma.- Pathogenesis.- Classification.- Clinicalfeatures.- Investigations.- Differential diagnosis.- Prognosis.- Treatment.- 5 Tuberculosis.- Mortality.- Natural history.- Presentation.- Diagnostic tests.- Investigation of contacts.- Prevention.- Treatment.- 6 Cancer of the lung.- Mortality.- Aetiology.- Classification.- Presentation.- Clinicalsigns.- Progress.- Investigations.- Differential diagnosis.- Prevention.- Treatment.- 7 Pleural effusions.- Aetiology.- Investigations.- Differential diagnosis.- Tumours of the pleura.- Complications.- Treatment.- 8 Recurrent respiratory illness in children.- Viral infections.- Cystic fibrosis.- Immune deficiencies.- Bronchiectasis.- 9 Fibrosing alveolitis.- Diagnosis.- Treatment.- 10 Spontaneous pneumothorax.- Pathogenesis.- Symptoms and signs.- Treatment.- 11 Pulmonary sarcoidosis.- Natural history.- Treatment.- Further reading.

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Book SynopsisThe fact that there are special problems in the care of the elderly in the community is ample justification for writing a separate volume on the subject. The knowledge that there are increasing numbers of older people in virtually every country in the world makes it all the more important that the family physician should have sympathy with and understanding of the problems of them, since they are lilcely to make up a significant part of his worlcload and, increasingly, will take up more of his time and energy. There is a progressive amount of disability with advancing years, and this is particularly true of those aged 75 years and over. Increasing age is associated with serious impairment of hearing and vision, senses which younger people take for granted. Old age sees the arrival of major diseases of middle age with much greater frequency, such as ischaemic heart and cerebrovascular disease, diabetes mellitus and osteoarthritis. There are other disorders that are virtually confined to the elderly, such as fractures of the femoral neck, Paget's disease and myeloma. We now know that the disintegration of the con­ ducting tissue of the heart is largely an age-related phenomenon. Ageing processes affect every major organ system in the body and the impairment of physiological perfor­ mance resulting from these affects the elderly individual's response to infections, disease and environmental changes in complex ways that are not seen in younger people.Table of Contents1 Demographic and social factors.- 2 Disorders of the cardiovascular system (I) Myocardial and valvular disease; blood pressure.- 3 Disorders of the cardiovascular system (II) Disorders of cardiac rhythm and conduction; pacemakers.- 4 Disorders of the cardiovascular system (III) Diseases of the arteries.- 5 Strokes.- 6 Fits, faints and falls.- 7 Failing mobility (‘gone off his feet syndrome’).- 8 Incontinence.- 9 Memory, confusion and sleep.- 10 The use and misuse of drug treatment.- 11 Bone disease and fractures.- 12 Disorders of the blood.- 13 Endocrine diseases.

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Book SynopsisThis series of books is designed to help general practitioners. So are other books. What is unusual in this instance is their collec­ tive authorship; they are written by specialists working at district general hospitals. The writers derive their own experi­ ence from a range of cases less highly selected than those on which textbooks are traditionally based. They are also in a good position to pick out topics which they see creating difficulties for the practitioners of their district, whose personal capacities are familiar to them; and to concentrate on contexts where mistakes are most likely to occur. They are all well-accustomed to working in consultation. All the authors write from hospital experience and from the viewpoint of their specialty. There are, therefore, matters important to family practice which should be sought not within this series, but elsewhere. Within the series much practical and useful advice is to be found with which the general practitioner can compare his existing performance and build in new ideas and improved techniques. These books are attractively produced and I recommend them.Table of ContentsSeries Foreword.- 1 History.- 2 Examination.- visual acuity.- visual fields.- colour vision.- external examination.- internal examination.- opthalmoscopy.- 3 The red eye.- conjunctivitis.- episcleritis.- keratitis.- iritis.- acute glaucoma.- 4 The external eye.- lids.- conjunctiva.- 5 The internal eye.- Examination of the inner eye.- alteration in pigment.- toxoplasmosis.- toxocara.- opaque nerve fibres.- 6 Sudden loss of vision.- migraine.- amaurosis fugax.- renal artery occlusion.- temporal arteritis.- retinal vein occlusion.- vitreous.- retinal detachment.- 7 Slow loss of vision.- cataract.- chronic glaucoma.- macular degeneration.- 8 Trauma.- superficial injuries.- lacerations.- penetrating injuries.- blunt injury.- chemical injuries.- radiation injuries.- 9 Paediatric ophthalmology.- squint.- watering eyes.- ptosis.- congenital glaucoma.- retinoblastoma.- 10 The eye and systemic disease.- thyroid disease.- the fundus.- hypertension.- diabetes.- papilloedema.- multiple sclerosis.- 11 Ocular pharmacology.

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Book SynopsisDDDDDDDDDDDD Effective management logically follows accurate diagnosis. Such logic often is difficult to apply in practice. Absolute diagnostic accuracy may not be possible, particularly in the field of primary care, when management has to be on analyis of symptoms and on knowledge of the individual patient and family. This series follows that on Problems in Practice which was concerned more with diagnosis in the widest sense and this series deals more defini­ tively with general care and specific treatment of symptoms and diseases. Good management must include knowledge of the nature, course and outcome of the conditions, as well as prominent clinical features and as­ sessment and investigations, but the emphasis is on what to do best for the patient. Family medical practitioners have particular difficulties and advantages in their work. Because they often work in professional islation in the com­ munity and deal with relatively small numbers of near-normal patients their experience with the more serious and more rare conditions is restricted. They find it difficult to remain up-to-date with medical advances and even more difficult to decide on the suitability and application of new and rela­ tively untried methods compared with those that are 'old' and well proven. Their advantages are that because of long-term continuous care for their patients they have come to know them and their families well and are able to become familiar with the more common and less serious diseases of their communities.Trade Review`...this book should be considered as a "must" for all doctors interested in better understanding and care of the elderly. It is worthy of being included in any practice library and any potential Diploma of Geriatric Medicine candidate would be well advised to read it.' Journal of the Royal College of General PractitionersTable of ContentsSection 1 The Nature of the Problem.- Epidemiology.- Special factors in the management of disease in the elderly.- Ageing changes.- The causes and prevention of disability and disease.- Attitudes to management.- Principles of prescribing.- The nature of some common diseases.- Organization of care for the elderly.- Section 2 Symptoms and their Differential Diagnosis.- Palpitations.- Breathlessness.- Cough.- Swollen legs.- ‘Going off his feet’ syndrome.- Fits, faints and falls.- Aches and pains.- Constipation and diarrhoea.- Failing eyesight and hearing.- Incontinence.- Confusion.- Misery, apathy and sleep problems.- Collapse.- Section 3 Specific Disease Complexes.- Abnormalities of blood pressure.- Ischaemic heart disease.- Cardiac dysrhythmias.- Heart failure.- Bone disease of ageing.- Diseases affecting muscles and joints.- Strokes.- Parkinsonism and tremor.- Incontinence.- The elderly disabled.- Pain relief.- Anaemia.- Thyroid disorders.- Diabetes mellitus.- Psychiatric disorders.

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Book SynopsisDDDDDDDDDDDDD Effective management logically follows accurate diagnosis. Such logic often is difficult to apply in practice. Absolute diagnostic accuracy may not be possible, particularly in the field of primary care, when management has to be on analysis of symptoms and on knowledge of the individual patient and family. This series follows that on Problems in Practice which was concerned more with diagnosis in the widest sense and this series deals more definitively with general care and specific treatment of symptoms and diseases. Good management must include knowledge of the nature, course and outcome of the conditions, as well as prominent clinical features and assess­ is on what to do best for the ment and investigations, but the emphasis patient. Family medical practitioners have particular difficulties and advantages in their work. Because they often work in professional isolation in the com­ munity and deal with relatively small numbers of near-normal patients their experience with the more serious and more rare conditions is restricted. They find it difficult to remain up-to-date with medical advances and even more difficult to decide on the suitability and application of new and rela­ tively untried methods compared with those that are 'old' and well proven. Their advantages are that because of long-term continuous care for their patients they have come to know them and their families well and are able to become familiar with the more common and less serious diseases of their communities.Table of Contents1. Gastro-oesophageal Reflux.- 2. Dysphagia.- 3. Nausea and Vomiting.- 4. Uncomplicated Peptic Ulcer.- 5. Complicated Peptic Ulcer.- 6. Surgical Management of Peptic Ulcer.- 7. Gastrointestinal Bleeding.- 8. Acute Abdominal Pain.- 9. Chronic Abdominal Pain.- 10. Acute Diarrhoea.- 11. Chronic Diarrhoea.- 12. Malabsorption.- 13. The Irritable Bowel Syndrome.- 14. Ulcerative Proctocolitis and Crohn’s Disease.- 15. Diverticular Disease of the Colon.- 16. Constipation and other Problems with Defaecation.- 17. Miscellaneous Gastrointestinal Problems.- 18. Jaundice and Common Liver Diseases.- Appendix: Patient Information Sheets and Diets.

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Book SynopsisMedicine is news. There is constant public interest in health and disease; in medical miracles and in breakthroughs; in medical disasters, failures and malpraxis ; in deficiencies and defects ofhealth services; and in the rising costs ofhealth care. Medicine is 'big business'. Physicians co me out near the top money earners in most medical care systems. In the Uni ted Kingdom the National Health Service (NHS) now costs over [6000 million a year ($ ro 800 million), a free service that costs every British man, woman and child [120 a year ($216) in direct and indirect taxes. But this is less than the [500 ($900) a year that medical care costs each person in USA and West Germany. In developed countries health care costs are approaching ro% ofthe gross national product (GNP). It is big business also in that in Britain the NHS is one of the largest employers; about I million Britons work as employees of the NHS, caring for the other 54 millions and in the USA the numbers are 5 million caring for 2. 5 millions. The provision of health services is full of problems and dilemmas. These problems and dilemmas cross all' national boundaries. All countries share the same problems and dilemmas. Problems of objectives, of standards, of effectiveness and efficiency, and problems of relations between the medical profession, the public and govern­ ment. Medical care still is full of mystique.Table of Contents1 Health care and its problems.- 2 Primary care: a special field.- 3 What is primary care? Content and implications.- 4 Who comes and why? Self-care and primary care.- 5 Work: quantity and quality-manpower policies.- 6 The nature and natural history of common diseases.- 7 Cure and care.- 8 Prescribing.- 9 The hospital-primary care interface.- 10 Community social services.- 11 The primary care team.- 12 Premises and organization.- 13 Prevention and postponement.- 14 Education and learning.- 15 How much care? Present state and future needs.

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Book SynopsisThe purpose of this book is to clarify the use of antibiotics in the management of the eommon respiratory illnesses seen in general practiee. The underlying philosophy, whieh embraees the avoidanee of unneeessary use, is that proper use entails a full understanding of the nature of the illness. The eoneept of seleetive antibiotie use reeognizes that respiratory illnesses eommonly eomprise multiple illness features, and that some of these features have a viral cause and some a bacterial one. In assessing antibiotic need, eaeh feature or eomponent part of an illness may be evaluated individually, so enabling adecision for antibiotie use in the illness as a whole. The nature of eaeh individual illness feature with its antibiotic indication is diseussed in sueeessive ehapters, and this aecumulated knowledge is of value in managing the more eomplex PUO and flu-like illnesses whieh are diseussed at the end of the book. The first two ehapters eneompass the principles of antibiotic use and the relationship between antibiotie preseribing and various states of the patient, e.g. allergy, pregnaney ete. An attempt has been made to justify every reeommendation or decision, and non-antibiotic management is diseussed where relevant.Table of Contents1 Antibiotics and the Patient.- Allergy.- Antibiotic Diarrhoea.- The Contraceptive Pill.- Pregnancy.- Lactation.- Neonates.- Children.- The Elderly.- Hepatic and Renal Impairment.- Drug Interactions.- Absorption.- 2 Management Principles.- 3 Pyrexia.- Febrile Convulsions.- Delirium.- Rigors.- Symptomatic Management of Pyrexia.- Antibiotic Use.- 4 Sore Throat, Tonsillitis and Pharyngitis.- Definition.- The Non-inflamed Sore Throat.- The Inflamed Throat.- Referral for Tonsillectomy.- 5 Otitis Media.- Use of the Auroscope.- Clinical Features of Acute Otitis Media.- Bacteria in Acute Otitis Media.- Secretory Otitis Media.- Management and Antibiotic Use.- Chronic Otitis Media.- 6 Sinusitis.- Clinical Features.- Bacteriology.- Management and Antibiotic Use.- 7 Laryngitis.- Croup.- Hoarseness or Loss of Voice.- 8 Coughs and Colds.- The Acute Cough.- Cold in the Nose.- Persistent Cough in Children.- Persistent Cough in Adults.- The Absent Cough.- 9 Wheezy Bronchitis in Children.- The Nature of Wheezy Bronchitis.- Recognition of Asthma.- Management of the Acute Episode.- Longerterm Management.- Differential Diagnosis.- 10 Pneumonia.- Clinical Diagnosis.- Investigation.- Infective Causes.- Management and Antibiotic Use.- Differential Diagnosis.- 11 Bronchitis, Bronchiolitis and Bronchiectasis.- Acute Bronchitis.- Acute Bronchiolitis.- Chronic Bronchitis.- Bronchiectasis.- 12 Vomiting and Diarrhoea.- Non-specific Vomiting.- Gastro-enteritis.- Management.- 13 PUO in Children.- Definition.- Emergent Diagnoses.- Management and Antibiotic Use.- 14 Influenza and the ’Flu-like Illness.- The Influenzal Illness.- Viral Causes.- Differential Diagnosis.- Clinical Assessment of the Patient with ’Flu.- Management and Antibiotic Use.

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Book SynopsisThe Membership examination of the Royal College of General Practitioners has evolved and matured as a seal and a test on completion of vocational training. More than 1000 candidates are taking the examination each year and an increasing majority are trainees who have completed their three­ year training period. The whole concept and philosophy of the MRCGP has been questioned by critical cynics who refuse to accept general practice as a field of medical practice worthy of recognition as a specialty with its own core of know­ ledge, skills and expertise and with its own special epidemiology, pathology, clinical presentations and management. These cynical critics are being answered by the growth of the examination and its recognition within the profession as an important and necessary goal to be achieved. The MRCGP exam has arrived, it is here to stay and it will continue to grow and evolve. The exam is no easy obstacle to negotiate. It has a regular failure rate of I in 3 and it requires special preparation and study of its examinees if they are to understand its aims, contents and methods. It must not be assumed that even the brightest trainee can walk off the street, enter the examin­ ation hall and be confident of passing. It requires a few months of careful and guided preparation.Table of ContentsMultiple Choice Questions (MCQ).- Test 1.- Test 2.- Test 3.- Test 4.- MCQ Answers.- Test 1.- Test 2.- Test 3.- Test 4.- Modified Essay Question (MEQ).- Test 1.- Test2.- Test3.- Test4.- MEQ Answers.- Test 1.- Test 2.- Test 3.- Test 4.- Traditional Essay Questions (TEQ).- Tests 1–4.- TEQ Answers.- Test 1.- Test 2.- Test 3.- Test 4.- The Orals.- The Practice Log.- Problem Solving.

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Book SynopsisIn this book, a clinician can experience the most typical medical subjects in a primary care setting, which is the highlight.

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Book Synopsis

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