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Special Subjects

Care of the Surgical Patient
Chronic Fatigue Syndrome
- Chronic Fatigue Syndrome
Clinical Decision Making
Complementary and Alternative Medicine
Dietary Supplements
The Dying Patient
- The Dying Patient
- Symptom Relief for the Dying Patient
Exercise
- Overview of Exercise
- Exercise in the Elderly
Financial Issues in Health Care
General Principles of Medical Genetics

Idiopathic Environmental Intolerance
- Idiopathic Environmental Intolerance
Limb Prosthetics
Medical Aspects of Travel
Medicolegal Issues
Nonspecific Symptoms
- Fatigue
- Involuntary Weight Loss
Principles of Radiologic Imaging
Rehabilitation
Tobacco Use
- Tobacco
- Smoking Cessation
Recreational Drugs and Intoxicants

Some medical topics do not fit easily into a category. Fatigue and generalized weight loss are nonspecific symptoms that could be a manifestation of a number of diseases that span many specialties. Complementary and alternative medicine and medicinal herbs and nutraceuticals also are topics that merit discussion but are not categorized by body system. This section provides a home for topics that do not fit easily elsewhere.

Special SubjectsSections (A-Z)

Care of the Surgical Patient

Before elective surgical procedures, a thorough preoperative medical evaluation by nonsurgical consultants (eg, internists, cardiologists, pulmonologists) may be necessary to help assess surgical risk. Such consultants may also help manage preexisting disease (eg, diabetes) and help prevent and treat perioperative and postoperative complications (eg, cardiac, pulmonary, infectious). Psychiatric consultation is occasionally needed to assess capacity or help deal with underlying psychiatric problems that can interfere with recovery.

Introduction to Care of the Surgical Patient
Preoperative Evaluation
Perioperative Management
Outpatient Procedures
Antibiotic Prophylaxis for Surgical Procedures
Postoperative Care

Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is a syndrome of life-altering fatigue lasting > 6 mo that is unexplained and is accompanied by a number of associated symptoms. Management includes validating the patient's disability, treating specific symptoms, cognitive-behavioral therapy, and a graded exercise program.

Chronic Fatigue Syndrome

Clinical Decision Making

Clinicians must integrate a huge variety of clinical data while facing conflicting pressures to decrease diagnostic uncertainty, risks to patients, and costs. Deciding what information to gather, which tests to order, how to interpret and integrate this information to draw diagnostic conclusions, and which treatments to give is known as clinical decision making.

Introduction to Clinical Decision Making
Evidence-Based Medicine and Clinical Guidelines
Clinical Decision-Making Strategies
Cognitive Errors in Clinical Decision Making
Understanding Medical Tests and Test Results
Economic Analyses in Clinical Decision Making

Complementary and Alternative Medicine

(See also Overview of Dietary Supplements .)

Overview of Complementary and Alternative Medicine
Types of Alternative Medicine
Alternative Whole Medical Systems
Mind-Body Medicine
Biologically Based Practices
Manipulative and Body-Based Practices
Energy Medicine
Ayurveda
Homeopathy
Naturopathy
Traditional Chinese Medicine
Biofeedback
Guided Imagery
Hypnotherapy
Meditation
Relaxation Techniques
Chelation Therapy
Diet Therapy
Orthomolecular Medicine
Chiropractic
Massage Therapy
Reflexology
Structural Integration
Postural Reeducation
Acupuncture
Magnets
Therapeutic Touch

Dietary Supplements

(See also Overview of Complementary and Alternative Medicine .)

Overview of Dietary Supplements
Black Cohosh
Chamomile
Chondroitin Sulfate
Chromium
Coenzyme Q10
Cranberry
Creatine
Dehydroepiandrosterone (DHEA)
Echinacea
Feverfew
Fish Oil
Garlic
Ginger
Ginkgo
Ginseng
Glucosamine
Goldenseal
Green Tea
Kava
Licorice
Melatonin
Milk Thistle
S -Adenosyl- l -Methionine
Saw Palmetto
St. John’s Wort
Valerian
Zinc

Exercise

Exercise stimulates tissue change and adaptation (eg, increase in muscle mass and strength, cardiovascular endurance), whereas rest and recovery allow such change and adaptation to occur (1,2) . Recovery from exercise is as important as the exercise stimulus. Regular physical activity reduces the likelihood of medical illness, decreases the incidence of the major causes of death, and improves the overall health and quality of life for patients with most medical conditions.

Overview of Exercise
Exercise in the Elderly

Financial Issues in Health Care

Health care in the US is technologically advanced but expensive, costing about $3.0 trillion dollars in 2014, which was 17.5% of gross domestic product (GDP) ( 1 ). For decades, health care spending in the US has increased more than the rate of growth for the overall economy. The percentage of GDP spent on health care in the US is significantly higher than that in any other nation. According to the Organization for Economic Cooperation and Development (OECD), in 2013 the US spent 16.4% of GDP on health care compared to around 11% for the next highest countries, including the Netherlands, Switzerland, Sweden, Germany, and France ( 2 ).

Overview of Health Care Financing
Causes of High Health Care Costs
Containing Health Care Costs

General Principles of Medical Genetics

A gene, the basic unit of heredity, is a segment of DNA containing all the information necessary to synthesize a polypeptide (protein). Protein synthesis, folding, and tertiary and quaternary structure ultimately determine much of the body’s structure and function.

Overview of Genetics
Single-Gene Defects
Factors Affecting Gene Expression
Multifactorial (Complex) Inheritance
Unusual Aspects of Inheritance
Mitochondrial DNA Abnormalities
Genetic Diagnostic Technologies
Clinical Uses of Genetics
Ethical Controversies in Genetics

Idiopathic Environmental Intolerance

Idiopathic environmental intolerance is characterized by recurrent, nonspecific symptoms attributed to low-level exposure to chemically unrelated substances commonly occurring in the environment. Symptoms are numerous, often involving multiple organ systems, but physical findings are unremarkable. Diagnosis is by exclusion. Treatment is psychologic support and avoidance of perceived triggers, although triggers rarely can be defined.

Idiopathic Environmental Intolerance

Limb Prosthetics

A prosthesis is an artificial device that replaces a missing body part.

Overview of Limb Prosthetics
Prosthetic Parts
Options for Limb Prostheses
Preparing to Use a Limb Prosthesis
Fitting the Prosthesis
Skin Care of the Residual Limb
Edema of the Residual Limb
Loosening of the Prosthesis
Pain in the Residual Limb

Medical Aspects of Travel

Planning and preparation reduce medical risks of travel, particularly risks involved with air travel and foreign travel . Travelers should carry their drugs, extra eyeglasses or other corrective lenses (as well as a current written prescription for either), and hearing-aid batteries in a carry-on bag in case their checked baggage is delayed, lost, or stolen. Drugs should be kept in their original labeled containers. Travelers who need to carry opioids, syringes, or large amounts of drugs should have a prescription or verifying letter from a physician to avoid possible security or customs complications. A medical record summary (including ECG for those with significant cardiac history) is invaluable if a traveler becomes ill. Travelers subject to disabling illness (eg, epilepsy) or those with chronic disease should wear a medical identification bracelet or necklace.

Introduction to Medical Aspects of Travel
Air Travel
Foreign Travel

Medicolegal Issues

Historically, “incapacity” was considered primarily a clinical finding, and “incompetency” was considered a legal finding. That distinction, at least in terminology, is no longer firmly recognized; most state laws now use “incapacity” rather than “incompetency,” although the terms are frequently used interchangeably. The more useful distinction in terminology now is between clinical incapacity and legal incapacity to make a health care decision.

Capacity (Competence) and Incapacity
Informed Consent
Consent and Surrogate Decision Making
Confidentiality and HIPAA
Advance Directives
Do-Not-Resuscitate (DNR) Orders and Physician Orders for Life-Sustaining Treatment (POLST)
Medical Malpractice

Nonspecific Symptoms

Fatigue occurs most often as part of a symptom complex, but even when it is the sole or main presenting symptom, fatigue is one of the most common symptoms.

Fatigue
Involuntary Weight Loss

Principles of Radiologic Imaging

Imaging helps with initial diagnosis, staging, and monitoring. Primary care physicians and specialists work with radiologists who specialize in diagnostic imaging to choose the best imaging test; choice is based on the type of lesion suspected and its anatomic location.

Radiation and Imaging
Risks of Medical Radiation
Radiographic Contrast Agents and Contrast Reactions
Angiography
Computed Tomography
Magnetic Resonance Imaging
Conventional Radiography
Mammography
Radionuclide Scanning
Positron Emission Tomography (PET)
Ultrasonography

Recreational Drugs and Intoxicants

Body packing and body stuffing involve swallowing drug-filled packets or placing them in body cavities to evade detection by law enforcement. The risks and consequences vary depending on the amount and type of drug and the way it is packaged.

Body Packing and Body Stuffing
Drug Testing
Injection Drug Use
Alcohol Toxicity and Withdrawal
Alcohol Use Disorders and Rehabilitation
Amphetamines
Anabolic Steroids
Anxiolytics and Sedatives
Cannabinoids, Synthetic
Cathinones
Cocaine
Gamma Hydroxybutyrate
Hallucinogens
Ketamine and Phencyclidine (PCP)
Korsakoff Psychosis
Marchiafava-Bignami Disease
Marijuana (Cannabis)
Methylenedioxymethamphetamine (MDMA)
Opioid Toxicity and Withdrawal
Opioid Use Disorder and Rehabilitation
Volatile Nitrites
Volatile Solvents
Wernicke Encephalopathy

Rehabilitation

Rehabilitation aims to facilitate recovery from loss of function. Loss may be due to fracture, amputation, stroke or another neurologic disorder, arthritis, cardiac impairment, or prolonged deconditioning (eg, after some disorders and surgical procedures). Rehabilitation may involve physical, occupational, and speech therapy; psychologic counseling; and social services. For some patients, the goal is complete recovery with full, unrestricted function; for others, it is recovery of the ability to do as many activities of daily living (ADLs) as possible. Results of rehabilitation depend on the nature of the loss and the patient’s motivation. Progress may be slow for elderly patients and for patients who lack muscle strength or motivation.

Overview of Rehabilitation
Physical Therapy (PT)
Occupational Therapy (OT)
Speech Therapy
Therapeutic and Assistive Devices
Rehabilitative Measures for Treatment of Pain and Inflammation
Cardiovascular Rehabilitation
Stroke Rehabilitation
Leg Amputation Rehabilitation
Hip Surgery Rehabilitation
Rehabilitation for Other Disorders

The Dying Patient

(See also Death and Dying in Children and see also Advance Directives .)

The Dying Patient
Symptom Relief for the Dying Patient

Tobacco Use

Tobacco use is a major individual and public health problem. Dependence develops rapidly. Major consequences include premature death and morbidity caused by coronary artery disease, lung cancer, COPD, and other disorders. Smokers should be offered smoking cessation interventions.

Tobacco
Smoking Cessation

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Also of Interest

Test your knowledge

Evidence-based medicine (EBM) is a systematic approach to identifying the most appropriate strategy for managing an individual patient. This approach is based on which of the following?

Advice gleaned from recently published literature Strategies effective in previous patients Analyses of relevant medical literature Advice given by mentors and colleagues