Looking for the disorder in conduct disorder.

Besides their well-known externalizing behavior, children with conduct disorder (CD) often have additional impairments outside the criteria for the CD diagnosis. In a 5-year study of 984 treated children (ages 5–17 years), those with CD had an average of 2.2 primary diagnoses. Children with CD showed the worst problem and impairment scores in comparison with 11 common diagnoses. Compared with other treated children, children with CD achieved worse scores on 14 of 15 syndromes, including internalizing problems such as withdrawal and major depression. The average child with CD had larger relapse scores in the 1.5- to 3-year period after admission to treatment. This pattern, pervasive at intake and chronic in course, resembles a global disability more than a circumscribed problem managed with a narrow range of treatments specific to it. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Abstinence is not the only answer

Familial inheritance of congenital diaphragmatic hernia is uncommon. We report two siblings with identical bilateral diaphragmatic defects.     

Looking beyond the walls

Once a risk management process limited to hospitals, the practice of practitioner credentialing has expanded to include many other health care organizations, including insurers, health maintenance organizations, preferred provider organizations, management services organizations, medical groups, and independent practice associations. Standards set by recognized accreditation bodies, including the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission), National Committee for Quality Assurance (NCQA), and American Accreditation Health Care Commission/Utilization Review Accreditation Committee mandate a substantial effort to properly evaluate the credentials of health care practitioners. A sector of commerce called the credentials verification organization (CVO) industry has undertaken the mission to make the process of practitioner credentialing more consistent and efficient, faster, and less expensive.     

Looking back

Fractures of the first rib are extremely rare and are more commonly associated with either multiple rib fractures or life-threatening injuries. First rib fractures are commonly caused by direct trauma, violent muscular contraction or by chronic stress. We present a case of isolated bilateral rib fracture in an elderly patient, in the absence of multiple trauma, where the mechanism of injury appears to be a whiplash injury.     

Looking beyond the presenting problem

General practitioners tend to manage disease within the context of the patient's total life. They also have to deal with illness in its various forms when no overt 'disease' is evident. Looking at the interplay of these two facets of ill health gives a deeper understanding of what general practice is about and how general practitioners deal with the problems of their practice. Two cases are presented from the author's personal practice which display how general practitioners deal with the whole person rather than isolated problems. Analysis reveals that the ability to listen to the patient and the willingness to take adequate time is crucial to successful general practice.