Web Site Reviews

http://www.alzforum.org/members/index.html

Official Web site of the Alzheimer's National Forum.

Alzheimer's disease is an inadequately understood condition. A Web site shedding light on this progressive illness is a welcome one.

Such a site is found at http://www.alzforum.org/members/index.html. This site is quite comprehensive, covering Alzheimer's disease from historical, microbiologic and research perspectives. The Alzheimer's Research Forum, which maintains the site, is a nonprofit, nonpartisan organization aiming to provide a “collaborative environment for discussing and debating scientific issues.”

The site is divided into three main sections, covering the research front, online forums and resources. Large portions of the site are devoted to current Alzheimer's disease hypotheses and molecular genetics. The site also provides an online edition of The Journal of Neuropathology and Experimental Neurology.

Many of these sections would be too extensive for the practicing physician who encounters only a handful of patients with this disease. However, the “AD Diagnosis and Treatment Guide” page found in the research section provides pertinent information a clinician should know. Included in this section are diagnostic criteria for Alzheimer's disease, other conditions that mimic Alzheimer's disease and a suggested work-up for a patient suspected of having Alzheimer's disease. Approved treatments are discussed, in addition to a variety of approaches for use with these patients. A review of current phase II and phase III trials for Alzheimer's disease is also provided, and in each section references are linked to their MEDLINE abstracts.

Several pages are devoted to examining treatments touted in the lay press, including pages devoted to approved and over-the-counter medications and alternative treatments. Each section takes the agent in question, such as estrogen replacement therapy, and summarizes its role in the treatment of Alzheimer's disease, its possible pharmacologic mechanism as it relates to Alzheimer's disease, and contraindications, side effects and evidence supporting and disputing its use in the treatment of Alzheimer's disease. References are also supplied. The agents discussed include vitamin E, selegiline, nonsteroidal anti-inflammatory drugs and melatonin, as well as gingko biloba and wine. Other methods of treatment that may be pursued by patients and their families are discussed, such as aromatherapy and phototherapy. These sometimes brief summaries at least enable the physician to discuss the lack of evidence supporting the efficacy of these methods.

“Milestone Papers” is also a site of interest, in that it lists the seminal works in the history of Alzheimer's disease research. Another important area for patients or family members who wish to learn more about the disease is the section entitled “Papers of the Week for Patients and Caregivers.” A variety of links is provided to other Web sites with information about Alzheimer's disease for clinicians, researchers and caregivers. The search function seems adequate and accurate, and uses standard search methods.

This free site is updated frequently and is easily navigated. Although portions of the site are highly research oriented, other areas will be helpful for family physicians. Residents can also benefit from the review of diagnosis and treatment, and from the section devoted to ethical questions, such as driving, death and dying, and a discussion about respecting the patient's autonomy.

Book Reviews

Field Guide to Clinical Dermatology

By David H. Frankel. Pp. 240. Price, $29.95. Lippincott, Williams & Wilkins, 227 E. Washington Sq., Philadelphia, PA 19106-3780, 1999. Phone: 800-633-1851. ISBN: 0-781-71730-2.

David H. Frankel, M.D., has structured a superb guidebook to basic dermatology, a concise effort worthy of considerable praise.

Frankel, a noted internist and dermatologist who serves as the North American Editor of Lancet, has enlisted widely respected and talented colleagues to help in the production of this book. The contributors include Jeffrey P. Callen, M.D. (Head of Dermatology, University of Louisville School of Medicine), Larry E. Millikan, M.D. (Head of Dermatology, Tulane University School of Medicine) and Lawrence Charles Parish, M.D. (Head of the Center for International Dermatology, Jefferson Medical College).

This beautifully prepared book is a uniquely organized and easily readable “field guide” complete with 220 pages of excellent color illustrations. By forsaking traditional and often confusing algorithms, Frankel has created a work of maximum value for all physicians, including those who lack an advanced knowledge of dermatology. Simple terminology, clear organization and unmistakable information cement this as one of the best quick-reference dermatology sources available today. The basic outline allows for and even promotes the successful use of this reference by physicians who do not often encounter dermatologic problems in their practice. For example, major headings include “rashes that itch a lot,” “red rashes on the face” and “red rashes not on the face.”

This little gem should be a favorite of family physicians around the world.

The Only EKG Book You'll Ever Need

By Malcolm S. Thaler. Pp. 300. Price, $31.95. 3d ed. Lippincott, Williams & Wilkins, 227 E. Washington Sq., Philadelphia, PA 19106, 1999. Phone: 800-633-1851. ISBN: 0-781-71667-5.

While The Only EKG Book You'll Ever Need may not be the only electrocardiogram book you'll ever need, it is an excellent place to start. Dr. Thaler successfully maintains his easy-going writing style in this third edition, and his pleasure in teaching is apparent. He states in his preface,“This book is about learning. It's about keeping simple things simple and complicated things clear, concise and, yes, simple, too. It's about getting you from here to there without scaring you to death, boring you to tears, or intimidating your socks off … all with a bit of fun.” The author must remember the angst so commonly associated with learning EKG interpretation and has made a successful attempt at minimizing the frustration.

After many years of observing the learning styles of countless medical students and residents, I've come to the conclusion that reading EKGs involves a combination of mental processes. These include concepts of pattern recognition, vector theory, memorization, electrophysiology and basic mechanics. Different learners master these skills with different strengths and at different rates. The approach in this book allows for these various learning styles and yet may still be helpful to the more experienced clinician interested in a different perspective for reviewing the fundamentals.

Many EKG texts delve heavily into the physics and myocardial electrophysiology associated with EKGs and overwhelm and confuse the early learner. This book avoids lengthy discussions of theory and uses wide spacing, open pages, simple text and diagrams to allow for a speedier mastery of the basics. However, this simplicity occurs at the expense of detail. Omissions are especially apparent in the sections covering conduction blocks and hypertrophy. On the other hand, the chapters covering myocardial infarction and axis determination, while brief and succinct, are actually quite thorough and adequately cover the essentials. The biggest deficit is the small number of practice EKGs appearing at the end of each chapter. Learning the theory about why an EKG change occurs must take place in the context of visual identification of that change, to be clinically useful.

The sketches and artwork are basic but, again, by keeping it simple, the teaching message is left clear and uncluttered. This book would probably be highly valuable to a visual learner. The final section does a nice job of highlighting the key EKG changes noted in electrolyte disturbances, drug effects and the changes seen with chronic medical disorders. The discussion of stress testing is simple and avoids controversy and excessive detail. The last review pages are adapted for cutting out and compiling a “memory jogger” that could be kept in a pocket for quick reference. This is an excellent book with a casual tone and an unusual approach. This text will no doubt be helpful to those learning the important key features of EKG interpretation, but for those seeking a more comprehensive study, the more classic texts should prove more appropriate.

Also Received

The American Pharmaceutical Association Drug Treatment Protocols

Pp. 467. Price, $200.00. American Pharmaceutical Association, 2215 Constitution Ave., NW, Washington, DC 20037, 1999. Phone: 202-628-4410. ISBN: 0-917-33098-6.

Measuring and Managing Health Care Quality: Procedures, Techniques and Protocols

By Norbert Goldfield, Michael Pine and Joan Pine. Price, $210.00. Volumes 1 & 2. Aspen Publishing, 200 Orchard Ridge Dr., Gaithersburg, MD 20878, 1999. Phone: 800-638-8437. ISBN: 0-834-21265-4.

Promise to Deliver: The True Story of One Woman's Eleven-year-battle to Overcome Infertility

By Rhonda Kanan. Pp. 246. Price, $21.95. Wow! WomenInk, 4850 Marieview Court, Ste. 402, Cincinnati, Ohio 45236-2012, 1999. Phone: 212-687-8633. ISBN: 1-893-06450-6.