Harrison's Internal Medicine Chapter 3. Decision-Making in Clinical Medicine
Decision-Making in Clinical Medicine: Introduction To the medical student who requires 2 h to collect a patient's history and perform a physical examination, and several additional hours to organize them into a coherent presentation, the experienced clinician's ability to reach a diagnosis and decide on a management plan in a fraction of the time seems extraordinary.
Harrison's Internal Medicine Chapter 5. Principles of Clinical Pharmacology
Principles of Clinical Pharmacology: Introduction
Drugs are the cornerstone of modern therapeutics. Nevertheless, it is well recognized among physicians and among the lay community that the outcome of drug therapy varies widely among individuals. While this variability has been perceived as an unpredictable, and therefore inevitable, accompaniment of drug therapy, this is not the case.
Principles of Dose Selection The desired goal of therapy with any drug is to maximize the likelihood of a beneficial effect while minimizing the risk of adverse effects. Previous experience with the drug, in controlled clinical trials or in postmarketing use, defines the relationships between dose (or plasma concentration) and these dual effects and provides a starting point for initiation of drug therapy.
Figure 5-1 illustrates the relationships among dose, plasma concentrations, efficacy, and adverse effects and carries with it several important implications:
Endocrinology: Basic and Clinical Principles, Second
Edition aims to provide a comprehensive knowledge
base for the applied and clinical science of
endocrinology. The challenge in its presentation was
to produce a volume that was timely, provided integration
of basic science with physiologic and clinical principles,
and yet was limited to 500 pages. This length
makes the volume suitable as a text; and the timeliness
we have striven for allows the book to serve as an offthe-
Starting in the spring of 2009, a fast recovery in global equities and a rise
in house values in many economies (the euro area and Japan are exceptions)
were accompanied by a reduction in corporate bond spreads and other risk
premia (Graphs II.1 and III.2, top panels), though some risk measures have
meanwhile risen again in the context of the Greek sovereign debt crisis.
Reported VaR figures show that risk as measured by potential losses from
banks’ trading positions remains high (Graph III.2, bottom left-hand panel).
as expressed in our mission statement, RREEF Real Estate
seeks to provide our clients with superior long-term returns
while appropriately managing risks to our clients. this goal
directly aligns with our commitment to continuously seek
improvement in the environmental performance of our
assets under management across a variety of value drivers.
being sustainable enhances operating efficiency,
increasingly satisfies investor considerations and
mandates, promotes compliance with growing regulations
and mitigates risks.
The standards in this report harmonise and, where appropriate, strengthen the
existing international standards for payment systems (PS) that are systemically important,
central securities depositories (CSDs), securities settlement systems (SSSs), and central
counterparties (CCPs). The revised standards also incorporate additional guidance for over-
the-counter (OTC) derivatives CCPs and trade repositories (TRs).
Modern medicine is characterized by the continuously growing
spectrum of improving diagnostic methods and therapeutic processes.
It keeps getting more complicated and confusing and therefore
also needs more order.
The main goal of medical documentation is to provide information
for the adequate care of patients. Carefully carried out written
records like a patient history, physician indexes, or, more recently,
patient databases serve to reach this goal.
The Commission is addressing governments, directly and through their various agencies and
ministries. The congregation of governments, gathered in the General Assembly of the United
Nations, will be the main recipients of this report.
The Commission is also addressing private enterprise, from the one-person business to the
great multinational company with a total economic turnover greater than that of many nations,
and with possibilities for bringing about far-reaching changes and improvements.
Despite worldwide efforts to assess and control cardiovascular risk factors, cardiac
diseases and in particular coronary artery disease (CAD) are still the foremost causes
of death in the developed countries of Western Europe, North America and Asia and
are becoming increasingly common in Eastern Europe and the developing world
(Deanfield 2001). Approximately one in five deaths is currently related to cardiac
disease in Europe and the US. Nearly 500,000 deaths caused by CAD are reported
every year in the US, over 600,000 in Europe, 170,000 of these in Germany alone.
The fear of pain after surgery is a common concern
for a woman and her partner. After surgery there may
still be pain and discomfort, in addition to fatigue that
can interfere with sexual pleasure. Finding a
comfortable position to reduce discomfort is
important. Some recommendations are positioning the
woman on top or in a side-lying position to control
depth of penetration, and decrease abdominal
discomfort at the incision site. Placing pillows under
the knees or behind the small of the back may
The general picture is that older people of today are healthier than older people
of two decades ago. There have been improvements in most dimensions of health.
People live longer and have fewer disabilities, have less functioning loss, and
report themselves to be in better health. Over time there has been some reduction
in risk from smoking and a lowering of cholesterol and average triglyceride levels.
However, weight increase has been notable during this period.
The overall approach to learning medicine can be summed up in two questions: What is it? What do you do for it? The
goal is to have a concise review that is readable and easy to follow with algorithms, diagrams, radiographs, and pathologic findings.
This book is divided into subspecialty topics, each chapter written by an author(s) with clinical expertise in the designated
topic. Images and tables are provided. Each chapter has bulleted items that highlight key points. These may be summary points
from previous paragraphs or new points. Bulleted items also address typical clinical scenarios.
Given all these changes, we think itmakes sense to speak of an evolution for Hollywood
ﬁlm, one that increasingly makes presentational aspects of ﬁlm either closer to what we
perceive in the natural world (color, surrounding sound, enlarged images, etc) or aspects that
capitalize on what has been discovered to be perceptually and cognitively acceptable (cuts,
shot-reverse-shot composition and point-of-view editing, the optics of cameramovements
without feedback fromeyemovements, etc).
Equally bewildering to the student are the proper use of diagnostic tests and the integration of the results into the clinical assessment. The novice medical practitioner typically uses a "shotgun" approach to testing, hoping to hit a target without knowing exactly what that target is. The expert, on the other hand, usually has a specific target in mind and efficiently adjusts the testing strategy to it. The second goal of this chapter is to review briefly some of the crucial basic statistical concepts that govern the proper interpretation and use of diagnostic tests.
The past thirty years have witnessed the birth, growth, and evolution of clinical electrophysiology from a field whose initial goals were the understanding of arrhythmia
mechanisms to one of significant therapeutic impact. The development and refinement of implantable devices and catheter ablation have made non-pharmacologic
therapy a treatment of choice for most arrhythmias encountered in clinical practice.
There is no doubt that the introduction and evolution
of regenerative and implant therapies affords
clinicians the opportunity to provide patients with
previously undreamt-of treatment outcomes. However,
such therapeutic approaches must not be visualized
as an end to themselves.
The goals of conscientious and comprehensive
therapy remain the maximization of patient
comfort, function, and esthetics in both the short
and long terms.
The following paragraphs describe a set of activities leading to development of a watershed and water
quality management plan for the MRB. The tasks described below create a framework for the study. It is
anticipated that these tasks will be accomplished in a collaborative fashion; study goals will be set by the
Interagency Study Team, and individual partners will develop data, models, and other pertinent information
to accomplish each task in cooperation with the other partners.
Garbage in equals garbage out. If you do not start a project with the correct goal(s), it is
not likely you will accomplish the goal(s). This must be a team activity to ensure that
everyone is given the opportunity to contribute and "buy-in" to what is going to happen.
At the end of this stage, every team member should have an understanding of what must
This part of the project should end with a document that lists the goals with a short
statement providing some detail. The statement should include a definition of success.
This is a...
In this book, the term Zen is used to roll together all of these con-
cepts. This is not an orthodox treatment of Zen. The book could have
been called the Yoga, Tao, or Way of Managing Projects. In the end all
of these terms are pointing to the same basic strategy—regard every-
thing as a part of a holistic, integrated system, set your intention to
include all of your personal and nonpersonal goals, apply objectivity
and subjectivity in dynamic balance, seek to perfect yourself and your
performance while not being hung up about your imperfections, and
recognize that a...