Primer on medical professionalism.

Medicine as a profession depends on a unique social contract between the public and health-care professionals. We define professionalism in medicine, provide examples of challenges in professionalism relevant to podiatric medicine, and offer resources on ethics and professionalism in medicine. "Medical professionalism" is the set of attitudes, values, and conduct exhibited by medical providers resulting from placing patients' and society's interests above their own.

Laboratory medicine and diagnostic testing.

The clinical laboratory is a vital component of modern podiatric medical practice. In order to interpret laboratory data correctly, the practitioner must understand the essentials of diagnostic testing. These essentials include precision, accuracy, sensitivity, specificity, and prevalence-based values of a given test.

Rheumatologic conditions of the foot.

Podiatric physicians are frequently the first clinicians with the opportunity to diagnose a rheumatologic disease. Awareness of the multisystem nature of the more common rheumatologic conditions will assist podiatrists in making the appropriate diagnosis. The specific joints affected, the temporal pattern of joint involvement, and the distribution of affected joints give clues to the diagnosis.

Acute and chronic renal failure.

Renal failure is defined as a deterioration of kidney function that results in the retention of nitrogenous waste products. It is increasingly prevalent in older populations, individuals with diabetes or hypertension, and postoperative patients. Therefore, podiatric physicians caring for these populations can expect to encounter this condition frequently.

Pulmonary disease: pneumonia, chronic obstructive pulmonary disease, asthma, and thromboembolic disease.

Although many medical problems are generally managed in concert with a general medical physician, it is important for the podiatric physician to be familiar with some of the major diseases of the lung. Pneumonia, an infectious process within the lung, is the sixth-leading overall cause of death. Antibiotic treatment, oxygen administration, and supportive care are the mainstays of its therapy.

Evaluation of common liver problems.

Diseases of the liver and abnormalities of liver enzyme levels are among the most common reasons for gastroenterology consultation for surgical patients. Although the differential diagnosis of liver disease is exceedingly broad, the majority of patients will have one of several common disorders. A familiarity with the major disorders affecting the liver and the approach to patients with liver disease is therefore useful for clinicians from all disciplines.

Infection and fever in the elderly.

The elderly make more frequent use of general podiatric medical services than the younger population. It is therefore important for podiatric physicians to become familiar with the general principles of infectious disease as applied to an elderly population, which is susceptible to a wider spectrum of disease with more subtle and unusual clinical signs and symptoms. This article reviews the diagnosis and evaluation of suspected infection, appropriate laboratory testing, patterns of specific infectious disease syndromes, and antibiotic use in the elderly.

Changes in mental status.

Change in mental status is a common symptom in the older, hospitalized patient. Often referred to as delirium, it may be the first indication of a serious medical condition. If delirium is not identified and treated promptly, it may lead to severe complications.

Perioperative medical assessment of the podiatric surgical patient.

Patients undergoing podiatric surgery should receive a thorough perioperative evaluation. Medical "clearance" is no longer sufficient; rather, formal risk assessment should be performed and risk-reducing strategies provided. A collaborative, multidisciplinary approach involving practitioners in internal medicine, anesthesiology, and podiatry is generally most appropriate.

Aging does not affect beta-agonist responsiveness after methacholine-induced bronchoconstriction.

Objectives: To assess the response to an inhaled beta-agonist alone or in combination with an anticholinergic agent after methacholine-induced bronchoconstriction in four age groups.

Design: Retrospective analysis.

Setting: Pulmonary function laboratory in a university-affiliated hospital.

Ratio between forced expiratory flow between 25% and 75% of vital capacity and FVC is a determinant of airway reactivity and sensitivity to methacholine.

Study Objective: The ratio between forced expiratory flow between 25% and 75% of vital capacity (FEF(25-75)) and FVC is thought to reflect dysanapsis between airway size and lung size. A low FEF(25-75)/FVC ratio is associated with airway responsiveness to methacholine in middle-aged and older men. The current study was designed to assess this relationship in both male and female subjects over a broader range of ages.

Pulmonary function characteristics in patients with different patterns of methacholine airway hyperresponsiveness.

Study Objectives: The American Thoracic Society guidelines for methacholine-induced airway hyperresponsiveness include a > or = 20% reduction in FEV(1) or a > or = 40% reduction in specific airway conductance (sGaw). The objectives of the current study are to assess the concordance between these two criteria and to characterize the pulmonary function and respiratory symptoms of patients with different patterns of methacholine hyperresponsiveness.

Study Design: A prospective study of 248 consecutive patients referred for methacholine bronchoprovocation testing.

Cognitive and behavioral features discriminate between Alzheimer's and Parkinson's disease.

Objective: To compare the cognitive and behavioral profiles of Alzheimer's disease (AD) and cognitively impaired patients with Parkinson's disease (PD) and to determine the individual measures that best discriminate the two patient groups.

Background: Neuropsychologic studies of patients with AD and PD have generated debate over the distinction between "cortical" and "subcortical" dementias, with some studies showing significant differences and others showing little difference in the cognitive profiles of these groups. Studies evaluating behavioral differences between the patient groups have been somewhat more successful in adequately discriminating these syndromes.