Name: Netter’s Internal Medicine – 2nd Edition
Author: Marschall S Runge
Category: Medical Books
Size: 167 MB
Format: E-Book (PDF)
Total Pages: 1242
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Summary : Netter’s Internal Medicine – 2nd Edition
High-quality health care requires not only treatment of medical conditions but also attention to eff ective preventive care. Prevention is defi ned as the reduction of risk for future adverse health events. A number of disparate services are regarded as prevention, including immunizations, screening, individual and group interventions for lifestyle change, and prophylaxis. As many as 50% of deaths in the United States are potentially preventable with current knowledge.
2 Summary : Netter’s Internal Medicine – 2nd Edition
Like other medical care, preventive services can cause harm as well as benefi t. Unlike treating serious medical problems, the risk that is addressed by prevention is small when seen in individual terms. For example, the probabil-ity of an asymptomatic 50-year-old woman having breast cancer detectable by her next mammogram is 4 to 5 in 1000, and the probability that her life will be extended by this mammogram is less than 1 in 1000. But, because so many people are involved, the absolute number of lives affected by preventive care can be large. For example, the lives of some 10,000 women each year in the United States either are or could be extended by breast cancer screening. Thus, it is most useful to think of the benefi ts and harms of prevention in terms of a practice’s total patient popula-tion.
3 Summary : Netter’s Internal Medicine – 2nd Edition
Such lifestyle issues as tobacco use, obesity, lack of physical activity, alcohol abuse, not using car restraints or bicycle helmets, and unsafe storage of fi rearms contribute to many deaths in the United States. Changing such unhealthy life-styles would have potentially large benefi t for the health of the public. Studies are clear that, properly done, coun-seling by clinicians can help patients stop smoking ciga-rettes and reduce problematic alcohol intake. Changing such behaviors as physical inactivity and unhealthy weight gain, however, is more diffi cult to accomplish in the context of a clinical offi ce visit. Growing evidence suggests that broader programs that target groups with behavioral and social interventions as well as information can have posi-tive effects on unhealthy lifestyles. Such programs may be developed and offered within the community or by health plans. Clinicians should consider referring appropriate patients to these programs.
4 Summary: Netter’s Internal Medicine – 2nd Edition
Because screening is conducted in people who have a small (though not zero) risk for a condition, most screening tests result in more false-positive results than true-positive results. For example, less than 10% of “positive” mam-mograms lead to a diagnosis of breast cancer; more than 90% are falsely positive. People with false-positive screen-ing tests often experience considerable anxiety until they have a negative confi rmatory test. If the confi rmatory test is itself not completely sensitive (e.g., prostate biopsy for an elevated prostate-specifi c antigen screening test), this anxiety can be prolonged. In addition, if the confi rmatory test carries some discomfort or risk (e.g., laparoscopy for a positive ovarian cancer screening test or lung biopsy for a positive spiral computed tomography screening test).
5 Summary: Netter’s Internal Medicine – 2nd Edition
A small number of preventive activities, widely performed, could effectively reduce the large burden of cardiovascular disease. These include appropriate treatment of risk factors, counseling for smoking cessation, and aspirin prophylaxis. The approach begins with an assessment of a patient’s “global cardiovascular risk.” People at high global risk should be offered aggressive risk factor control (see USPSTF recommendations on hypertension, lipids, aspirin, and smoking cessation). People at even moderate risk should still consider aspirin, smoking cessation, and moderate control of other risk factors. The most important risk factors to consider are those in the Framingham model: blood pressure, cholesterol, smoking, diabetes, age, and gender.In addition to prevention of coronary artery disease and stroke, a single screening for large (>5.5 cm) abdominal aortic aneurysm (AAA) among men ages 65 to 75 years who have ever smoked could reduce the number of deaths from AAA rupture.
Typically, clinicians ask whether a test was positive or negative so that. They can “rule out” or “rule in” a disease. Tests, however, are not dichotomous variables; Convey increasing levels of information the further they deviate from “normal.”A patient with 4-mm ST-segment depression and crushing chest pain during an electrocardiographic (ECG). Exercise test is much more likely to have coronary artery disease than a patient with 2-mm ST-segment depression. No pain, even though both tests are “positive.” Conversely, vitamin B12 defi -ciency is just as likely to be present. Levels of 192 ng/mL and 194 ng/mL, even though. The former is “abnormal” and the latter is “normal” by laboratory nomograms.
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