Practical Guide to the Care of the Geriatric Patient

Edited by Fred F. Ferri, Marsha D. Fretwell and Tom J. Wachtel. Pp. 653. Price, $29.95. 2d ed. Mosby, 11830 Westline Industrial Dr., St. Louis, MO 63146-3318, 1997.

In a busy practice, family physicians often need a quick, easy reference when they have a question about a patient. Looking through big, thick textbooks can be a cumbersome task when physicians need to find out what test to order, what the starting dose of a medication is, or whether they missed something in the differential diagnosis. At times like these, physicians don't want to wade through sections on pathophysiology or biochemical pathways. Practical Guide to the Care of the Geriatric Patient nicely fills this niche. With this small, comprehensive guide, information is quickly located.

To test this textbook, I took it to the assisted living facility where I see patients on a weekly basis. I often visit patients in their rooms, so I need something small enough to fit in my black bag. I found that this textbook is concise and easy to use.

In general, each chapter gives the definition and epidemiology of the condition, the etiology and pathogenesis, and the work-up and treatment. Many chapters contain useful lists, algorithms and diagrams. For example, the section titled “Pressure Sores” contains several checklists such as the Braden scale for predicting pressure sore risk and a sample pressure assessment guide. There are also several useful diagrams, including an overview of pressure sore management and bacterial colonization/infection management.

The appendix and formulary at the end of the book also contain useful information. The appendix not only lists many useful assessment tools, such as the Folstein Mini-Mental State Examination and the Katz Index of Activities of Daily Living, but also commonly used clinical formulas, a sample Durable Power of Attorney and enteral nutrition products. I also found the formulary and accompanying comparison table of drugs to be very useful. The formulary lists many commonly prescribed medications along with dosage, dosage forms, adverse effects, drug interactions and cost. The comparison table lists drugs by class of action along with dosage, dosage forms and cost.

I found only a few minor problems with the book. I could not easily locate information concerning Paget's disease; there was no separate section on this disease. Serendipitously, I found a section in the formulary that listed drugs for osteoporosis and Paget's disease of the bone. This section was not cross-referenced in the index. Similarly, I found acarbose in the formulary but not in the section on diabetes mellitus. In some sections, differential diagnoses or laboratory evaluation is merely listed with no indication of which are the most common diagnoses or which tests should be ordered. For example, the section on laboratory evaluation of dementia lists numerous tests with no indication if all are necessary or in what order they should be performed. Similarly, the section titled “Gait Disorders” lists all of the etiologic factors that underlie gait disorders, but it gives no indication of which factors are the most common. And, lastly, a medication occasionally cannot be found in the formulary.

The problems with the book are minor and don't detract from its overall usefulness. If one is looking for a practical pocket guide for geriatrics, Practical Guide to the Care of the Geriatric Patient is worth the price. I plan to keep it in my black bag.

Evidence Based Medicine: How to Practice and Teach EBM

By David Sackett, W. Scott Richardson, William Rosenberg and R. Brian Haynes. Pp. 250. Price, $24.99. Churchill Livingstone, 650 Avenue of the Americas, New York, NY 10011, 1997.

Evidence Based Medicine is a practical, well-written primer on the art and science of critically reading the medical literature. It is written by some of the world's leading experts in the field of evidence based medicine (EBM), some of the same group who wrote the “Users Guide to the Medical Literature” series in JAMA. This sturdy, pocket-sized guide is meant to be carried and used in everyday practice on the wards or in the office. The book can stand on its own as an introduction to the topic of EBM, but it can act as a more comprehensive guide if some of the articles cited at the end of each chapter are also read. Students, residents, academicians and practicing clinicians will all find this book useful.

The book has five chapters. The first four guide readers logically through the component steps of the EBM process: formulating answerable clinical questions; searching the literature; critically appraising the gathered evidence; and applying the evidence to clinical practice. In keeping with the tenets of EBM, the fifth chapter reviews the process of self-evaluation to determine if the student of EBM is progressing and if the process is at all worthwhile. Each chapter is divided into sections on diagnosis, prognosis, treatment, harm and providing quality care (cost-effectiveness and decision analysis). These headings will immediately be familiar to those who have read the “Users Guide to the Medical Literature” series in JAMA. The authors make an important addition to these headings with a section in each chapter on how to teach EBM.

For those with an interest in EBM but little working knowledge, this book is an excellent introduction. Many physicians have an interest in EBM but have difficulty applying its principles systematically in everyday practice. By means of numerous well-chosen examples, this book demonstrates to the reader that EBM can indeed be practiced by the average clinician. To learn the most from the book, the reader should work through the exercises outlined in the first several chapters. The book also offers excellent explanations of EBM concepts such as likelihood ratios and numbers needed to treat.

Those already initiated into the world of EBM will also find the book useful, both as a reference and as a teaching tool. There are many concise tables that summarize important information. For instance, the section on evaluating randomized controlled trials has a table giving the five key points for verifying the validity of such a study. The most important information is summarized again on ready-reference cards that are contained in a pocket in the back cover of the book.

If the book has a flaw, it may be that it tries to encapsulate a large amount of information in such a thin volume. The authors of Evidence Based Medicine certainly have set themselves to an ambitious task. However, in my opinion they have succeeded admirably in making a complex subject understandable. The information is well presented and never dry. This book represents by far the best attempt to bring the concepts of EBM “to the masses” of students and practicing clinicians. It should be on every clinician's and student's bookshelf (or in his or her pocket).

Also Received

Am I My Brother's Keeper? The Ethical Frontiers Of Biomedicine

By Arthur L. Caplan. Pp. 232. Price, $24.95. Indiana University Press, 601 N. Morton St., Bloomington, IN 47404, 1998.

Antidepressant Therapy

Edited by Mike Briley and Stuart Montgomery. Pp. 359. Price, $49.95. Mosby, 11830 Westline Industrial Dr., St. Louis, MO 63146-3318, 1998.

Asthma and Immunological Diseases in Pregnancy and Early Infancy

Edited by Michael Schatz, Robert S. Zeiger and Henry N. Claman. Pp. 1110. Price, $225.00. Marcel Dekker, 270 Madison Ave., New York, NY 10016-0602, 1998.

Beginnings Count: The Technological Imperative in American Health Care

By David J. Rothman. Pp. 189. Price, $24.95. Oxford University Press, 198 Madison Ave., New York, NY 10016, 1997.

The Biotech Century: Harnessing the Gene and Remaking the World

By Jeremy Rifkin. Pp. 288. Price, $24.95. Penguin Putnam, 200 Madison Ave., New York, NY 10016, 1998.

Chronic Pelvic Pain: An Integrated Approach

Edited by John F. Steege, Deborah A. Metzger and Barbara S. Levy. Pp. 364. Price, $60.00. Saunders, Curtis Center, Independence Square West, Philadelphia, PA 19106-3399, 1997.

Dispelling the Myths About Addiction: Strategies to Increase Understanding and Strengthen Research

By The Institute of Medicine. Pp. 218. Price, $39.95. National Academy Press, 2101 Constitution Ave., NW, Washington, DC 20055, 1997.

Dying Well: Peace and Possibilities at the End of Life

By Ira Byock. Pp. 299. Price, $14.00. Penguin Putnam, 200 Madison Ave., New York, NY 10016, 1997.

Health Communication: Lessons from Family Planning and Reproductive Health

By Phyllis Tilson Piotrow, D. Lawrence Kincaid, Jose G. Rimon II and Ward Rinehart. Pp. 307. Price, $24.95. Praeger Publishers, 88 Post Road West, Westport, CT 06881, 1997.

Infection Highlights 1997

Edited by Mark H. Wilcox. Pp. 88. Price, $11.95. Health Press Limited, Elizabeth House, Queen Street, Oxford-Abingdon, Oxford OX143JR UK, 1998.

Making the Moments Count: Leisure Activities for Care-giving Relationships

By Joanne Ardolf Decker. Pp. 192. Price, $14.95. Johns Hopkins University Press, 2715 N. Charles St., Baltimore, MD 21218-4319, 1997.

Naked to the Bone: Medical Imaging in the Twentieth Century

By Bettyann Holtzmann Keyles. Pp. 384. Price, $18.00. Addison-Wesley, Jacob Way, Reading, MA 01867, 1998.