Clinical complexity

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  • Professor D. R. Laurence was either author or coauthor of this textbook from its 1st edition in 1960 to its 8th in 1997. This is a long life for any textbook. Its achievement bears testimony to a style of presentation that strives to be clear and readable, and to retain the reader's interest whilst imparting information about a subject that can be at times both complex and confusing.

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  • Clinical pharmacology comprises all aspects of the scientific study of drugs in man. Its objective is to optimise drug therapy and it is justified in so far as it is of practical use. Over recent years pharmacology has undergone great expansion resulting from technology that allows the understanding of molecular action and the capacity to exploit this. The potential consequences for therapeutics are enormous. All cellular mechanisms (normal and pathological), in their immense complexity are, in principle, identifiable.

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  • The principally pharmacological aspects of vitamins are described here.The nutritional aspects, physiological function, sources, daily requirements and deficiency syndromes (primary and secondary) are to be found in any textbook of medicine. • • • • Vitamin A: retinol Vitamin B: complex Vitamin C: ascorbic acid Vitamin D, calcium, parathyroid hormone, calcitonin, bisphosphonates, bone • Treatment of calcium and bone disorders • Vitamin E:tocopherol that subclinical vitamin deficiencies are a cause of much chronic ill-health and liability to infections.

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  • A third of all general practice consultations are for musculoskeletal complaints. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used, and their gastrointestinal effects account for an estimated 1200 deaths per year in the UK. A hitherto unsuspected inflammatory component is now known to accompany conditions such as atherosclerosis. As understanding of the complex mechanisms underlying the inflammatory process increases, new ways of influencing it are developed, as witness therapies directed against specific cytokines, and COX-2 specific NSAIDs (COXIBs). ...

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  • Psychiatrists and diverse other mental health and broader healthcare professionals are faced with many challenges in effectively evaluating and treating persons with psychiatric illnesses and substance use disorders. Resources are often stretched thin, especially for those with the most serious and disabling conditions, and many people who would benefit from treatment are untreated, undertreated, or treated only after extended delays for complex reasons. Clinicians clearly have difficulties and barriers in their efforts to provide comprehensive, efficacious, and timely treatment.

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  • The reality is more complex since the receptor binding profile of clozapine and the newer atypical antipsychotic agents suggests that D2-receptor blockade is not essential for antipsychotic effect. The atypical drugs act on numerous receptors and modulate several interacting transmitter systems. Clozapine is a highly effective antipsychotic. It has little affinity for the D2-receptor compared with classical drugs but binds more avidly to other dopamine subtypes (e.g. D1, D3 and D4). It blocks muscarinic acetylcholine receptors, as do certain classical agents (e.g.

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  • The pathophysiology of cardiac arrhythmias is complex and the actions of drugs that are useful in stopping or controlling them may seem equally so. Nevertheless many patients with arrhythmias respond well to therapy with drugs and a working knowledge of their effects and indications pays dividends, for irregularity of the heart-beat is at least inconvenient and at worst fatal.The mechanisms by which the failing heart may be sustained are now better understood; carefully selected and monitored drugs can have a major impact on morbidity and mortality in this condition.

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  • Esthetics (also spelled aesthetics) is a subdiscipline of value theory or axiology, which is a branch of philosophy that studies sensory values, sometimes called judgments of sentiment or taste. Esthetics is closely associated with the philosophy of High Art. Esthetics includes art as well as the very purpose behind it. Esthetics as a branch of philosophy studies art, the methods of evaluating art, and judgments of art. Art has existed through all recorded human history. Art is unique to human beings because of our innate ability to abstract.

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  • Statistical Prediction Models Bayes' theorem, as presented above, deals with a clinical prediction problem that is unrealistically simple relative to most problems a clinician faces. Prediction models, based on multivariable statistical models, can handle much more complex problems and substantially enhance predictive accuracy for specific situations. Their particular advantage is the ability to take into account many overlapping pieces of information and assign a relative weight to each based on its unique contribution to the prediction in question.

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  • This book examines how professionals practising in various health and welfare settings go about the ordinary, but complicated, business of making sense of the symptoms and troubles with which their patients or clients present. Our motivations for writing the book are varied, but are the result of our conversations with each other about the problem of judgement in clinical practice, which have taken place over many years of professional, academic and research collaboration.

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  • Understanding the rapid changes in the evaluation and management of peripheral neuropathies, as well as the complexity of their mechanism, is a mandatory requirement for the practitioner to optimize patient's care. The objective of this book is to update health care professionals on recent advances in the pathogenesis, diagnosis and treatment of peripheral neuropathy. This work was written by a group of clinicians and scientists with large expertise in the field.

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  • Increasing diversity in the U.S. population has sharpened concerns about the vitality and diversity of the clinical research workforce, concerns that have persisted for two decades. Our nation’s unprecedented level of investment in biomedical research has led to an explosion of new knowledge about human health and disease, but basic research achievements must be translated into treatments and therapies in order to benefit human health.

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  • Health care in America presents a fundamental paradox. The past 50 years have seen an explosion in biomedical knowledge, dramatic innovation in therapies and surgical procedures, and management of conditions that previously were fatal, with ever more exciting clinical capabilities on the horizon. Yet, American health care is falling short on basic dimensions of quality, outcomes, costs, and equity.

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  • Gynaecology outpatients are a complex clinical area that requires team working across many professional and non-professional groups. We have combined as a team of a consultant gynaecologist, consultant nurse and service manager to write this book in an attempt to cover the processes that have to take place in order for a patient to be seen and treated appropriately. It includes chapters on the organization and problems undertaken by the clerical and secretarial staff often behind the scenes.

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  • At the beginning, specialists tried to diagnose the stage of periodontal disease depending on the relation between the clinical appearances and the presence of some specific cell populations or specific matrix components (Havemose-Poulsen & Holmstrup, 1997; Romanos et al., 1993).

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  • As the science and technology of clinical stem cell and bone marrow transplantation has grown, so has the need for a comprehensive guide to caring for these complex patients. As the number of advanced practice nurses, specialty nurses, physician's assistants, fellows, residents, and medical students who care for such patients grows, so does the need for relevant and practical information. We decided to put our combined 30-plus years of stem cell and bone marrow transplant experience to good use, and thus, this handbook was developed....

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  • Endourology is one of the most important subspecialties in the field of urology because of the widespread use of endoscopy for the diagnosis and treatment of a variety of upper genitourinary tract pathologies. Although most clinical urologists incorporate some basic endourology into their practices, complex upper tract pathology and anatomy require more advanced endoscopic skills and instrumentation. Advanced Endourology: The Complete Clinical Guide is intended as a resource guide for all aspects of clinical endourology, particularly the more advanced procedures.

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  • The clinical and basic science of allergic disease is moving and evolving so rapidly that it is nearly impossible to keep up full of information regarding the news mechanisms, signalling cell markers, cellular plasticity and expression, biological mediators targets or molecular and genetic discovers aspects related to the allergy. Moreover the systemic impact of this pathology determines the complexity of the more recent evidence demonstrates that the rapid regulation of central immune organs in clinical response of the mucosa to the allergen or offending agent.

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  • The head and neck is a region of considerable anatomical and functional complexity, making the accurate staging of a head and neck neoplasm a challenging task. The clinician often detects pathology, but may not appreciate, based on the physical examination, the entire submucosal tumor extension, nor the possible regional and distant disease spread. The introduction of CT and MRI has revolutionized head and neck radiology. Current radiological modalities provide a reliable visualization of the head and neck structures to an unprecedented level of detail.

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  • Increasing evidence suggests that serious mental illness is neurodevelopmental and the onset of pre-psychotic symptoms occurs in adolescence, at a time when the cerebral cortex is still developing. As with many complex disorders (e.g. hypertension, epilepsy, and diabetes), there appear to be many aetiological pathways that might lead to the final mixture of behavioral signs and symptoms we label ‘schizophrenia’.

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