Best Evidence 2: Linking Medical Research to Practice (CD-ROM)

By ACP Journal Club. Price, $49.00. American College of Physicians, Electronic Products, Independence Mall West, Philadelphia, PA 19106, 1998.

Best Evidence 2 is a CD-ROM compilation of 1,000 evidence-based medicine (EBM) abstracts of journal articles from the print versions of ACP Journal Club from 1991–1997 and Evidence Based Medicine from 1995–1997. Evidence Based Medicine and ACP Journal Club abstract and summarize articles from over 80 journals. The articles contained on this CD-ROM are in the same standardized format in which they appear in these evidence-based abstracting and critical appraisal services. They are usually one page in length and include a synopsis of articles on diagnosis, therapeutics or other selected topics, a one-or two-sentence “action summary” and a brief commentary. ACP Journal Club covers internal medicine topics, while Evidence Based Medicine covers topics of interest in primary care and family medicine.

While it is almost as difficult to be against the idea of EBM in principle as it is to be against motherhood and apple pie, the fear among many practicing clinicians is that the practice of subjecting every diagnostic and therapeutic decision to rigorous scrutiny seems to require an unrealistic input of time and energy. This CD-ROM is meant to help cut the time it takes to find the best available evidence in order to put the practice of EBM within reach of all family physicians. Rather than the physician having to take on the laborious (and unlikely) task of searching and evaluating the original research literature, he or she can use evidence-based abstracting services to find information. The Web sites for the Cochrane Library on CD-ROM and the Journal of Family Practice POEMs are other evidence-based aids.

In light of its purpose as a tool to make the application of EBM more easily attainable, one of the main criteria used in evaluating this software was its ease of use and speed. Installation was easy and took less than a minute. The interface used is a standard multimedia viewer, which is familiar to anyone who uses the CD-ROM version of American Family Physician, for instance. The interface functions similarly to a Web browser, with the capability of easily calling up previously viewed screens or bookmarking useful pages for later reference.

The search screen allows the user to do the equivalent of MEDLINE text word searches, but the search can be limited by type of article (e.g., therapy, diagnosis, prognosis) or by Boolean operators. The small database makes it easy to locate relevant articles without as much hassle as is required on MEDLINE.

On the other hand, there are many clinical questions whose answers will not be found in the database. So, this CD-ROM can only be considered one component in the armamentarium of the EBM physician. For instance, the database is weighted toward internal medicine topics. A search of pneumonia returned 67 results, whereas eclampsia returned seven, and otitis media, three.

While quick and easy to use, this product is not for the faint of heart. The articles freely use epidemiologic terms such as “absolute risk reduction,”“numbers needed to treat” and “positive predictive value.” On the other hand, a glossary contains detailed definitions of these and other terms. It would have been helpful to have the technical terms highlighted and to have links to the definition. There are also editorials covering topics such as the need for evidence-based decision making in primary care and useful techniques for evaluating different types of journal articles.

All of the information needed to practice EBM is contained on the CD-ROM, but without an easy-to-use tutorial format for the beginner. Someone should not buy this CD-ROM hoping to learn EBM, but it will be a welcome addition to the library of those who are already familiar with EBM. A user who is just getting started in EBM would probably be well advised to buy this CD-ROM along with a brief textbook on the subject. In any case, even with this caveat, this is a useful product at an affordable price.

Book Review

The Washington Manual of Medical Therapeutics

Edited by Keith F. Woeltje, Charles F. Carey and Hans Lee. Pp. 624. Price, $37.95. 29th ed. Lippincott-Raven, 227 E. Washington Square, Philadelphia, PA 19106, 1998.

Was there ever a family practice resident who survived his or her residency without a well-worn copy of The Manual of Medical Therapeutics stuffed in his or her lab coat pocket? Whether used by an intern or someone who has practiced medicine for 50 years, this manual remains the standard reference for adult care. Previously known as the Washington Manual, the name of the 29th edition was changed to The Washington Manual of Medical Therapeutics.

The 28th edition was published in 1995, and one may be assured that the 29th edition includes the new therapies that have been developed over the past few years. Included in the text is the use of troglitazone in diabetes, raloxifene in osteoporosis, zafirlukast and zileuton in asthma, and triple-drug therapies in human immunodeficiency virus infection, demonstrating the timeliness of the edition.

This is the book to have when a practitioner simply wants to know how to diagnose and manage a problem. There is some discussion of pathophysiology, but the focus is on pertinent clues in the history and physical examination, relevant laboratory and other diagnostic tests, and treatment options. Each chapter is written in an outline format with the first sentence and other important information in boldface type, which makes it very easy to find facts quickly. References are very recent, even as late as 1997, and are conveniently included in the text. The 55-page index is excellent and expedites the reader's ability to access subjects. There are eight appendices in the back with good information about subjects such as drug interactions, pregnancy and medical therapeutics, and dosage adjustments of drugs used in patients with renal failure.

New in this edition is a chapter on allergy and immunology. Topics include drug reactions, anaphylaxis, allergic rhinitis, asthma, urticaria and angioedema, and immunodeficiency. The book also contains a new chapter on critical care that covers respiratory problems encountered in the intensive care unit, along with hemodynamic monitoring and shock. The chapter on medical emergencies is also new and includes heat- and cold-induced illness, drowning, toxic inhalants and near-drowning.

However, the manual does not substitute for a textbook of medicine. It has no illustrations and very few algorithms or graphs. Tables are included to convey information concerning differential diagnoses or drug choices and doses. Almost one third of the manual is about cardiovascular disease. Some sections seem too brief, such as the discussion on pain control or the section on management of seizures. Also, the editors have chosen to use only the chemical or generic names of drugs. For many practitioners, it would be helpful if the trade names were also included.

If a family physician could have only one reference about internal medicine, this would be the one to own. There is no question that the information is up to date and allows for state-of-the-art care. The Washington Manual of Medical Therapeutics is useful for medical students, residents, family physicians, internists and any specialist who wants to have the latest information available on how to care for their adult patients with any of a myriad of medical conditions.

Also Received

Clinical Management of the Child and Teenager with Diabetes

By Leslie Plotnick and Randi Henderson. Pp. 268. Price, $24.95. Johns Hopkins Press, 2715 N. Charles St., Baltimore, MD 21218–4319, 1998.

Eating Hints for Cancer Patients: Before, During and After Treatment

By National Institutes of Health. Pp. 60. National Cancer Institute, Bethesda, MD 20892, 1998.

Keeping Them Healthy, Keeping Them Home: How to Care for Your Loved Ones at Home

By Ellen M. Caruso. Pp. 198. Price, $12.95. Health Information Press, 4727 Wilshire Blvd., Los Angeles, CA 90010, 1998.

Making Medical Decisions

Edited by Richard Gross. Pp. 119. Price, $18.00. American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106, 1998.

Managed Care: What It Is and How It Works

By Wendy Knight. Pp. 267. Price, $29.00. Aspen Publishers, 200 Orchard Ridge Dr., Ste. 200, Gaithersburg, MD 20878, 1998.

Management of Acute Coronary Syndromes

Edited by Christopher P. Cannon. Pp. 660. Price, $125.00. Humana Press, 999 Riverview Dr., Ste. 208, Totowa, NJ 07512, 1998.

Pancreatic Cancer: Pathogenesis, Diagnosis and Treatment

Edited by Howard Reber. Pp. 352. Price, $125.00. Humana Press, 999 Riverview Dr., Ste. 208, Totowa, NJ 07512, 1998.

Patients Who Deceive: Assessment and Management of Risk in Providing Health Care and Financial Benefits

By Loren Pankratz. Pp. 264. Price, $55.95. Charles C. Thomas, 2600 S. First St., Springfield, IL 62794–9265, 1998.

Psychiatric Dimensions of Medical Practice

By Phillip R. Slavney. Pp. 123. Price, $15.95. Johns Hopkins Press, 2715 N. Charles St., Baltimore, MD 21218–4319, 1998.

The Second Brain

By Michael Gershon. Pp. 409. Price, $24.00. Harper Collins, 10 E. 53rd St., New York, NY 10022-5299, 1998.