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Harrison’s Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)

Harrison’s Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2) PDF

Author: J. Larry Jameson

Publisher: McGraw-Hill Education


Publish Date: August 13, 2018

ISBN-10: 1259644030

Pages: 4048

File Type: PDF

Language: English

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Book Preface

The Editors are pleased to present the 20th edition of Harrison’s  Principles of Internal Medicine. This 20th edition is a true landmark in  medicine, spanning 68 years and multiple generations of trainees and  practicing clinicians. While medicine and medical education have  evolved, readers will appreciate how this classic textbook has retained  enduring features that have distinguished it among medical texts—a  sharp focus on the clinical presentation of disease, expert in-depth  summaries of pathophysiology and treatment, and highlights of  emerging frontiers of science and medicine. Indeed, Harrison’s retains  its conviction that, in the profession of medicine, we are all perpetual  students and lifelong learning is our common goal.

Harrison’s is intended for learners throughout their careers. For  students, Part 1, Chapter 1 begins with an overview of “The Practice of  Medicine.” In this introductory chapter, the editors continue the tradition of orienting clinicians to the science and the art of medicine, emphasizing the values of our profession while incorporating new advances  in technology, science, and clinical care. Part 2, “Cardinal Manifestations and Presentation of Diseases” is a signature feature of Harrison’s.  These chapters eloquently describe how patients present with common  clinical conditions, such as headache, fever, cough, palpitations, or anemia, and provide an overview of typical symptoms, physical findings,  and differential diagnosis. Mastery of these topics prepares students  for subsequent chapters on specific diseases they will encounter in  courses on pathophysiology and in clinical clerkships. For residents and  fellows caring for patients and preparing for board exams, Harrison’s remains a definitive source of trusted content written by internationally  renowned experts. Trainees will be reassured by the depth of content,  comprehensive tables, and illuminating figures and clinical algorithms.  Many exam questions are based on key testing points derived from  Harrison’s chapters. A useful companion book, Harrison’s Self-Assessment and Board Review, includes over 1000 questions, offers comprehensive explanations of the correct answer, and provides links to the  relevant chapter in the textbook. Practicing clinicians must keep up with an ever-changing knowledge base and clinical guidelines as part of  lifelong learning. Clinicians can trust that chapters are updated extensively with each edition of Harrison’s. The text is an excellent point-ofcare reference for clinical questions, differential diagnosis, and patient  management. In addition to the expanded and detailed Treatment sections, Harrison’s continues its tradition of including “Approach to the  Patient” sections, which provide an expert’s overview of the practical  management of common but often complex clinical conditions.

This edition has been modified extensively in its format as well  as its content. We have reincorporated chapters that in previous editions were available only online. The 20th edition marks the return of  Harrison’s “Further Reading” citations at the end of each chapter, providing references carefully selected by our contributors. The authors  and editors have rigorously curated and synthesized the vast amount  of information that comprises general internal medicine—and each  of the major specialties—into a highly readable and informative twovolume book. Readers will appreciate the concise writing style and  consistency of format that have always characterized Harrison’s. This  book has a sharp focus on essential information with a goal of providing clear and definitive answers to clinical questions.  In addition to the printed book, Harrison’s is available on multiple digital platforms, including eBook and app versions, and via an  online subscription available through McGraw-Hill’s popular Access  Medicine ( collection. The digital editions feature an array of supplementary videos, databases, and photographic  atlases as well as new literature updates, tutorials, animations, and  audio discussions covering key topics in medicine. Harrison’s Manual  of Medicine is a condensed pocket version of clinical essentials derived  from the more comprehensive Harrison’s Principles of Internal Medicine.  The Manual is also available as an eBook and an app and via Access  Medicine. Together, these platforms form a potent Harrison’s collection  of reference, test prep, and point-of-care online content.  In the 20th edition, examples of new chapters include “Promoting  Good Health,” focusing on prevention and practical lifestyle changes to  enhance longevity and well-being; “Health Care Systems in Developed  Countries,” providing a comparison of health delivery models from  around the world; “Pharmacogenomics,” applying new approaches  for selecting precision medicines and appropriate doses; “Bacterial  Resistance to Antimicrobial Agents,” highlighting the widespread and  often inappropriate use of antibiotics in clinical care and agriculture;  “LGBT Health,” outlining strategies to enhance access and care models  for populations with distinctive health care needs; “Neuromyelitis  Optica,” summarizing disorders with similarities to multiple sclerosis  but requiring different treatments; “Worldwide Changes in Patterns  of Infectious Disease,” reviewing the dynamic evolution of new infectious diseases and the containment of older disorders, some of which  have plagued humankind for centuries; and “Approach to the Medical  Consultation,” providing practical advice to ensure that the consultant addresses the needs of the referring clinician. In addition to these and  other new topics, the 20th edition presents a fascinating new series of  chapters entitled “Frontiers,” which foreshadows cutting-edge science  that will change medical practice in the near term. Examples of new  Frontier chapters include “Telomere Disease,” “The Role of Epigenetics  in Disease and Treatment,” “The Role of Circadian Biology in Health  and Disease,” and “Behavioral Economics and Health.”  In addition to these new topics, major advances in each subspecialty  of internal medicine have been incorporated into this edition. Of particular note in this 20th edition are critical updates in the classic chapter  on HIV/AIDS, which offers a clinically pragmatic focus as well as a  comprehensive and analytical approach to pathogenesis. The updates  cover the latest treatment protocols and address the issue of combination prevention modalities, making the chapter the most up-to-date  treatise on HIV disease available.

Readers will find expanded coverage of neurodegenerative diseases,  highlighting important advances in their classification and management and delineating new mechanisms responsible for the deposition  and spread of pathogenic protein aggregates in these disorders. Practical guidance for the use of highly effective therapies for multiple  sclerosis is another highlight of the new edition. The chapter on chronic  hepatitis discusses in detail the dramatic new discoveries in the use  of direct-acting antiviral agents for the treatment and cure of chronic  hepatitis C virus disease; these agents are responsible for some of the  most exciting therapeutic advances in medicine today. The promise of the Human Genome Project continues to be realized  in clinical medicine. This is reflected throughout the book but particularly highlighted by advances in our understanding of genetic heterogeneity of cancers, including molecular nosology that distinguishes  distinct entities that share histologic similarities. The tools of genetics  also inform the use of therapies targeting specific genetic lesions and  immune system activation. Genetic counseling for patients with genetic  predisposition to cancer (e.g., BRCA 1/2) is informing prevention  strategies and reducing cancer risk. Our understanding of the microbiome, its relevance to normal physiology and disease pathogenesis,  and its implications for treatment of a variety of diseases is expanding  rapidly, and these advances are captured in a completely rewritten  chapter “The Human Microbiome” and a thoroughly updated chapter  “Microbial Genomics and Infectious Disease.” The classification and  management of diabetes has been thoroughly updated on the basis of  new studies, clinical guidelines, and treatments. Updated guidelines  for testosterone management and replacement are based on the results  of new clinical trials.

We have many people to thank for their efforts in producing this  book. First, the authors have done a superb job of producing authoritative chapters that synthesize vast amounts of scientific and clinical  data to create informative and practical approaches to managing  patients. In today’s information-rich, rapidly evolving environment,  they have ensured that this information is current. We are most  grateful to our colleagues who work closely with each editor to facil xli – itate communication with the authors and help us keep Harrison’s content current. In particular, we wish to acknowledge the expert  support of Patricia Conrad, Patricia L. Duffey, Gregory K. Folkers,  Julie B. McCoy, Elizabeth Robbins, Anita Rodriguez, and Stephanie  Tribuna. Scott Grillo and James Shanahan, our long-standing partners  at McGraw-Hill Education’s Professional Publishing group, have  inspired the creative and dynamic evolution of Harrison’s, guiding  the development of the book and its related products in new formats.  Kim Davis, as Managing Editor, has adeptly ensured that the complex  production of this multi-authored textbook proceeded smoothly and  efficiently. Priscilla Beer and Armen Ovsepyen oversaw the production  of our videos and animations. Jeffrey Herzich, along with other members of the McGraw-Hill Education staff, shepherded the production  of this new edition.

We are privileged to have compiled this 20th edition and are enthusiastic about all that it offers our readers. We learned much in the  process of editing Harrison’s and hope that you will find this edition  uniquely valuable as a clinical and educational resource.
The Editors

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