Coat Pocket Research Articles

Cardiac Drug Therapy, Sixth EditionM. Gabriel Khan, Saunders, 2003

This is an unusual book. It is a single author soft cover text of some 550 pages which would fit into most white coat pockets. It is, thus, by no means intended to be an encyclopaedic volume of cardiac pharmacotherapy but a practical book for use on a day-to-day basis in the clinics, the offices and the wards. While this reviewer has not previously been aware of this text, the fact that it has gone through six editions since 1984 suggests that it enjoys a reasonable degree of popularity in at least some countries.

Manual of Travel Medicine and Health

Although the field of travel medicine is relatively young, the number of textbooks about the field is growing. This international trio of authors from Switzerland, the United States, and Singapore recently published the second edition of their textbook, which adds new chapters and updates epidemiologic information. Because of the complexity of travel medicine, good resources for clinicians and travelers are needed. This edition represents a welcome addition to the library of travel medicine. The main audience for this textbook is travel medicine physicians. Like the first edition, it is designed to be a reference book. Although small enough to fit in a pocket of a white coat, this paperback is very readable and comes with an easy-to-use CD. Part 1 of the book, Basics, provides an overview of general topics for physicians to discuss with their traveling patients. The authors encourage a comprehensive strategy, one that discusses prevention measures such as vaccines and their appropriate uses. Appendix C is an excellent table that lists the required and recommended vaccinations for each country. The text also provides excellent information for travelers in varied situations, such as pilgrims to the Hajj, migrants, pregnant women, international adoptees, athletes, and persons who are immunocompromised. In addition to providing current information on immunizations, the authors provide thorough information on malaria, including some individual country maps displaying areas of risk. Although the malaria review is comprehensive, caution should be exercised when deciding not to provide prophylaxis for travelers to a country where malaria is endemic. Part 2, Infectious Health Risks and Their Prevention, is the familiar chronicle of travel-related infectious diseases. This section includes numerous maps and tables describing the epidemiology of the diseases. The authors have updated this part by adding several diseases, including severe acute respiratory syndrome. The book provides pertinent information on travelers' medical kits, water disinfection, and noninfectious health risks such as high altitude, arctic travel, diving, jet lag, and ultraviolet radiation. New for this edition are informative chapters on deep vein thrombosis and pulmonary embolism and in-flight accidents. Another strength of this work is the section on posttravel medical treatment. This chapter presents concise guidelines for the clinician who is treating posttravel patients (with diarrhea, fever, malaria, dermatologic disorders, eosinophilia, sexually transmitted diseases) or screening expatriates after prolonged stays in tropical regions. A particularly useful feature is the dosing recommendations, many of which are for infrequently used drugs. In conclusion, the Manual of Travel Medicine and Health, Second Edition, should be a useful textbook for travel medicine physicians and those in training who want to learn more about the field. While the traditional topics are covered in customary detail, the strength of the book is its comprehensiveness and portability, providing a convenient reference.

You don't know where it's been

Teaspoons being in short supply, I used to give my tea a quick stir with a Bic pen from the pocket of my white coat. My, how times have changed since I was a junior doctor. Hospitals have no more cutlery than they did back then, but there has been a lot more research into hygiene. Had I known then about the range of pathogens lurking on doctors' pens and white coats, I'd have changed my habits immediately. Obviously, the stirring process should be long enough to pasteurise the pen.

Congress of the European Society of Cardiology, 2003.

The voice of Sigmund Freud (1856–1939) was heard at the 2003 Congress of the European Society of Cardiology (ESC), held in his native city of Vienna, Austria. The great biologist and psychologist, had he been alive to attend, would doubtless have paid special attention to presentations on mental disturbance and the heart. An example is depression, an important risk factor for poor outcome after myocardial infarction (MI). At the Congress, a meta-analysis of the published work was reported by Dr J. Van Melle (University Hospital Groningen, Groningen, the Netherlands). His group identified 17 prospective studies of the impact of depression (assessed by established psychiatric methods) on mortality rate and cardiac events in the first 2 years after MI. The 17 studies described results in 3804 patients (12 cohorts), and the combined data pointed to an excess mortality risk of at least twice that of the nondepressed. Odds ratios (with 95% confidence intervals) were 2.58 (1.71 to 3.89) for all-cause mortality, 2.50 (1.71 to 3.68) for cardiac mortality, and 2.75 (1.41 to 5.34) for cardiac events. These results should dispel any residual doubts about the clinical importance of post-MI depression, and other work indicates that physicians can identify the condition with reasonable accuracy simply by asking, “Are you feeling blue or sad? Have you lost interest in your activities?” However, the kind of univariate analyses examined by Dr Van Melle tell us nothing about other relevant factors or even the direction of causation. For example, depression might act indirectly by lessening adherence to drug regimens or by undermining resolve to stop smoking, and an adverse prognostic feature such as left ventricular failure might itself predispose to depression. The matter of cause and effect and the question of whether treatment for depression improves cardiac outcome should both be answerable by prospective trials …

The Maudsley Handbook of Practical Psychiatry, 4th ed

A book described as being about practical psychiatry inevitably suggests there must be a text somewhere that emphasizes impractical psychiatry, but that is probably not the editors' intent here. The adjective practical refers to the inclusion of introductory psychiatric knowledge and skills deemed essential for performance by medical students and residents as psychiatric trainees. Two British professors of psychiatry based at the London Institute of Psychiatry and the Maudsley Hospital edit The Maudsley Handbook of Practical Psychiatry, known in Britain as the “Orange Book.” The text is an excellent summary of the details of the psychiatric interview, the mental status examination, specialized neuropsychiatric assessments, and basic information about psychotherapeutic and psychopharmacologic treatments, including several standardized questionnaires and lists of medications. However, the cultural context of psychiatric care presented in the text probably renders the book less useful to U.S. students and residents. For example, the last chapter addresses “things you need to know about” and includes many aspects of British law related to mental health care, involuntary commitment, children, and criminality. Perhaps, more importantly, the value of any pocket book of this genre is increasingly suspect given the easy availability of PDA-based resources, which are more easily searched, more complete, easily customized and updated, and much tidier than the stuffed notebooks those of us from earlier generations carried in our white coat pockets.

Pocket Guide to Biotechnology and Genetic Engineering. Rolf D. Schmid. Weinheim, Federal Republic of Germany: Wiley-VCH Verlag GmbH & Co. KGaA, 2003, 360 pp., $45.00, softcover. ISBN 3-527-30895-4.

This pocket guide, with beautiful color illustrations by Ruth Hammelehle, would fit in your blazer coat pocket but would more likely be found in your briefcase. As Dr. Schmid tells us in the preface, the history of biotechnology is essentially the history of civilization. Although bread and cheese are properly part of food technology and not extensively covered, beer, ethanol, and other products of fermentation are featured with emphasis on modern biotechnology. This 350-page book can be accessed …

Essential Guide to Acute Care

At last! A book that addresses the needs of every junior doctor faced with the management of acutely sick patients. Concise and readable, its format allows the reader to absorb the principles of human physiology, and to apply them to everyday situations involving critically ill patients. With each chapter being dedicated to a separate physiological ‘insult’, Cooper and Cramp open with a brief outline of what happens under ‘normal’conditions. This is followed by a summary of how physiology adapts under disease conditions. In this way the authors cover oxygen therapy, acid base disturbance,fluid balance, circulatory failure, sepsis, acute renal failure and coma. There are also chapters on identifying the patient at risk, and optimising physiology in the preoperative patient. With a distinct ‘anaesthetic slant’, the layout and emphasis are different to that with which most physicians will be familiar. This is however to its advantage, as it effectively bridges the traditional gap between medicine and critical care. Unlike many texts, the authors have ignored the minutiae and have concentrated on the most relevant and applicable information. Well illustrated throughout, the reader is guided towards establishing a logical approach to the ill patient. With self-test questions relevant to each chapter, it becomes a valuable learning tool. ‘Mini- tutorials’ in each chapter highlight controversies, such as the relative merits of crystalloid versus colloid in f luid resuscitation, or the use of sodium bicarbonate in the treatment of metabolic acidosis. The size of the book lends itself well to being carried in the white coat pocket. However the layout of the text makes it more suited to evening reading, rather than as a bedside reference. Some algorithms summarising the key points of each chapter might have added to the practical uses of the text. Although this book will not help in passing the MRCP examination, it will hopefully make its readers into safer, better clinicians. If you ’ve ever been faced with a sick patient, a blank mind and a room full of expectant faces, then this is the book for you. Dr Stuart Henderson Specialist Registrar in Medicine Southampton University Hospitals NHS Trust

A free lunch in chess and logic?

A cafe in Amsterdam. Claus and Connie are seated at the bar, finishing their drinks. They have been squabbling for much of the evening. Claus has taken a hard-boiled egg from a carousel and is spinning it distractedly on the counter. He places it in his coat pocket.

A Pocket Reference for Psychiatrists, 3rd ed.

Article Abstract From our regular book review column. Clinical manuals and pocket references provide comfort for medical students, psychiatry residents, and other trainees who are faced with the overwhelming challenge of integrating vast amounts of new information into psychiatric practice. Collections of index cards, spiral-bound manuals, and even hand-held computers rest quietly in white coat pockets, waiting to be called on to provide the latest data for clinical rounds. Many clinical manuals and Internet-accessible databases compete for a place in the physician's coat pocket.

School Violence: Assessment, Management, Prevention

Article AbstractFrom our regular book review column.Clinical manuals and pocket references provide comfort for medical students, psychiatry residents, and other trainees who are faced with the overwhelming challenge of integrating vast amounts of new information into psychiatric practice. Collections of index cards, spiral-bound manuals, and even hand-held computers rest quietly in white coat pockets, waiting to be called on to provide the latest data for clinical rounds. Many clinical manuals and Internet-accessible databases compete for a place in the physician's coat pocket. One of the most common resources is A Pocket Reference for Psychiatrists, now in its third edition.

Manual of Pediatric Anesthesia, 5th edition .

Manual of Pediatric Anesthesia, 5th edition .

Lipstick and pearls

Surgery 2002;131:663-4.

Cardiovascular Drugs in the Perioperative Period

Cardiovascular Drugs in the Perioperative Period

Clinical skills for medical students: a hands–on guide

There is a new contender in the fight for a place in your white coat pocket. Comprehensive and comprehensible, Clinical skills for medical students describes the procedure for examining each of the five major systems: cardiovascular, respiratory, alimentary, musculoskeletal, and nervous. The accompanying illustrations are not great, but they are usefully incorporated into the text on the appropriate page, so the reader never faces the frustration of flipping repeatedly from cover to cover in search of an elusive “figure X.” There are boxed sections containing essential learning points, tips on techniques, and acronyms to aid learning. And within its …

Cardiovascular Drugs in the Perioperative Period

P. Foex, G. G. Harrison and L. H. OpieLippincott – Raven Publishers, 1999. 391 pp. £35.50. A large proportion of patients presenting for surgery, cardiac and noncardiac, have coexisting cardiac disease. These patients often present with polypharmacy prescriptions attempting to control the symptoms of cardiovascular dysfunction, thus posing the anaesthetist with the challenge of deciding how best to manage these patients peri-operatively. When looking at this book I hoped this would go someway to helping me. The first thing that strikes you about this book is its unusual size and shape. Presumably the book is designed to be carried in the pocket of a white coat for constant reference, advice and enlightenment. Why then include large sections on detailed cellular physiology and pharmacology? This is probably better left to formal textbooks rather than a book such as this, which has a different agenda. This ‘handbook’ is aimed at all grades of anaesthetists but more specifically trainees progressing through postgraduate examinations. It is designed as a portable compendium and reference book. The book aims to tackle an enormous field encompassing the physiology of myocardial cells, the autonomic nervous system and the cardiovascular system in general. In addition to this, the subjects of clinical cardiovascular pharmacology and the influence of anaesthetic agents upon all aspects of the cardiovascular system are included. All this is brought together in the later chapters by the application of these principles in the clinical setting of everyday encountered cardiac morbidity. The book attempts to be a ‘jack of all trades’ in covering such a large scope in a handbook. The organisation of the book is good with a clear table of contents enabling easy access to a specific topic. The eminent editors have collated chapters from a variety of authors. Each chapter is extensively referenced and provides an excellent source for detailed reading on the aspects included in the chapter. However, as is often the case with multi-author books, the chapters are increasingly repetitive. The editors cite this issue and explain it as preparing stand-alone chapters, but the repetitive nature is irritating. Failings of the chapters are somewhat rectified by the clear concise summaries at the end of each section. The sections involved in the pharmacokinetics and pharmacodynamics of the various drugs are detailed synopses. The figures included attempt to summarise the detailed prose. The result, however, is too complex to follow the principles involved clearly and this is exacerbated by the size of the book. The second half of the book conversely is more of interest to the practising clinician. This section provides current evidence-based reviews on the optimal methods of maximising cardiac function in various states of cardiac morbidity. The quality of these reviews is generally very good but the important issue of institution of peri-operative beta-blockade is only touched upon, but the references are provided for further investigation. The last two chapters involving ICU and resuscitation provide little new information and are much better covered elsewhere. All faults considered, in my opinion, this book provides a generally good quality evaluation of the evidence to support treatment regimens in cardiovascular disease. It includes details on more of the newer drugs available and how they fit into the current armamentarium of the clinician. Did it fulfil what I wanted? Well, yes, but after ploughing through two-thirds of the book. In the role as a reference book for cardiovascular pharmacology for anaesthetists generally, it does attain its goal. I would certainly recommend this book for inclusion in any anaesthetic library, more than for the individual though. Change the shape and size, and stop pretending that people will actually carry it around with them.

Book Review

Haematopoietic and lymphoid cell culture. Margaret J. Dalman and Jonathan R. Lamb. Cambridge University Press, 2000. Pp. 188. £55·00. ISBN: 0-521-62969-1 (paperback). This is a most succinct and clearly written handbook describing the characteristics and methods of isolation and culture of the major types of haematopoietic cells. The cell types discussed are embryonic stem cells, dendritic cells, murine thymic explant cultures, T cells, B lymphocytes, monocytes and macrophages, NK and LAK cells, and, lastly, mast cells and basophils. An obvious omission, however, are multipotent haematopoietic stem cells and their progenitors. Each chapter is devoted to each of the above cell types and written by appropriate experts in the field. The chapters are well laid out and structured, each with a clear and comprehensive introduction summarizing the origin, localization, development, phenotypic features, culture requirements and functions of each cell type. This is followed by a detailed and practical summary of methodologies for their isolation and in vitro culture. The book includes helpful explanatory diagrams and well-presented photographs of the various cells types grown in culture. The chapter on embryonic stem cells describes the conditions for growth, aggregation and differentiation of embryonic stem cells and analysis of differentiated progeny. For dendritic cells, their generation in culture from mouse bone marrow in human peripheral blood monocytes is discussed, as well as an assessment of the migratory properties. The chapter on thymic explant cultures discusses the culture of murine, fetal and newborn thymic organ, and the reaggregate thymus organ cultures, to assess the interaction of isolated lymphoid cells and thymic stromal cells as an in vitro model of the thymus. The chapter on T cells discusses the isolation and expansion of T cell lines and clones. For B lymphocytes, the culture of early bone marrow-derived B cells, and mature B lymphocytes from spleen and the peritoneal cavity in human and mouse, are described. In addition, flow cytometry and molecular techniques for phenotypic analysis are included. The chapter on monocytes and macrophages describes the isolation and culture of these cells from a variety of tissues in mouse and human, and the chapter on NK and LAK cells describes the identification, culture and cloning of murine and human NK cells. Finally, the culture of mast cells and basophils in mouse and human is detailed, together with the growth of mast cells from human CD34+ progenitor cells. Protocols for the detection of these two cell types are also included. In conclusion, this handbook is an invaluable and easily readable reference. Its attractively compact size makes it easily accessible not only on book shelves, but it will also slip easily in to briefcases and laboratory coat pockets. It is just the type of eagerly sought after book that can easily sprout legs and wander off into neighbouring offices and pockets!

Hands-on Guide to Clinical Pharmacology

Since the publication of the Oxford Handbook of Clinical Medicine in 1985, a plethora of similar pocket-sized guides to a wide variety of medical specialities has appeared in the white coats of both medical students and junior doctors. The popularity of these books can be attributed to the concise and well-structured ‘page per topic’ format introduced by the original handbook and employed almost universally by subsequent authors. This slim volume applies the same successful formula to the subject of Clinical Pharmacology, aiming to provide a concise source of relevant information on commonly used drugs. The authors (themselves medical undergraduates) have written their book as both a revision guide for medical students and as an aide-memoire for junior doctors, but have they been successful? The book certainly passes the first test, fitting easily into a white coat pocket. Approximately 100 drugs are described, grouped into chapters by organ system in a similar fashion to the British National Formulary. One page is devoted to each drug, the information presented in consistent tabular format. Indications, mechanism of action, adverse effects, contra–indications and interactions are listed, although drug doses have not been included. The authors have coped well with the limitation of space imposed by the ‘pocket’ format, including only the most clinically relevant information. Although most major drug classes are dealt with in adequate depth, future editions may need to find room for pages describing the newer anticonvulsants and antiplatelet agents. Some extra space could be found with the omission of the guides to management of common conditions, which have been presented at the beginning of each chapter in heavily truncated bullet point format. These are too brief to be of practical use and are much better addressed by the more general medical handbooks. The Hands-on Guide to Clinical Pharmacology will prove popular among medical students as it provides answers to commonly asked questions in a format that is concise and easy to use. The omission of drug doses renders it rather less attractive to junior medical staff whom I suspect will continue to rely upon the British National Formulary.

Book Reviews

Unlike other pocket and handbooks on the market this is really pocket-sized. It would comfortably fit into the pocket of a white coat (if anyone wore them anymore) and provide an invaluable source of quick reference. The book is like Dr Who's Tardis — small on the outside but huge on the inside. It is absolutely packed full of information on all areas of diabetes care. If you don't want a door-stop get this small cheap alternative.

Acute Paediatric Pain Management: A Practical Guide.

Assistant Professor of Anesthesiology Wake Forest University School of Medicine Winston-Salem, North CarolinaAcute Paediatric Pain Management: A Practical Guide. Edited by Neil S. Morton. Philadelphia, Saunders, 1998. Pages: 296. List Price: $29.95.This book is edited by Neil S. Morton from the Department of Anaesthesia, Intensive Care, and Pain Management in the Royal Hospital for Sick Children at the University of Glasgow. All of the contributors are currently in practice in Europe, either Scotland or Denmark.The book is divided into 10 sections that include pain prevention and management, developmental pain, pain assessment, pharmacology of analgesics, local and regional anaesthesia, opioids, nonpharmacologic alternative techniques, sedation, and specific plans for pain management. At the end of each chapter, the key learning points are summarized in a list and highlighted. The book has no pictures and very few diagrams. Tables are used frequently, are easy to locate, and often contain important clinical information. A list for further reading concludes each chapter. The book has several appendices that contain examples of protocols and general information on specific techniques.The initial chapter is entitled, “Pain Prevention and Management,” but is really about the rationale for pain management and education. It is concise, with useful summary tables. The book continues with an adequate overview of the development of pediatric pain perception but does not incorporate this information into the clinical management of pain during development.The pain assessment section makes good use of tables. An excellent overview of the value of the different pain scales is provided, but it contains no description of the content of the actual scales themselves. However, the appendix does contain the more practical face scale, analog scale, and the poker chips scale.The book continues with a section on pharmacology of analgesics. This chapter is written at the basic level, with many sweeping generalizations and little or no explanation or discussion of the exceptions to the generalities.The local and regional, opioid, and nonopioid technique sections are better written. However, not all techniques are given the same attention, and some are only mentioned as possibilities. The local and regional section does not use enough tables and is further hampered by the lack of diagrams and pictures. The opioid section provides many tables, recipes, and protocols that are useful as guidelines with better references than elsewhere. Many different uses of the opioids are covered, with a good discussion of their side effects.The section on nonpharmacologic techniques is poorly developed. In addition, many of the alternative approaches to pain management, both pharmacologic and nonpharmacologic, are not mentioned.The sedation section is well written and contains good, sound information. Included are sample protocol sheets from the Royal Hospital for Sick Children. Numerous techniques are discussed with the focus on entonox, benzodiazepines, and opioids. Propofol is not mentioned, and the discussions of ketamine, barbiturates, and chloral hydrate are limited. The subsequent section on specific plans for pain prevention and control is a valuable addition; it outlines the concerns and considerations for many common pediatric procedures. This is a unique section and provides benefit for those learning about these procedures.In summary, the book provides a good overview of basic pain management in children. Specific referencing would have added to the scientific validity of several of the chapters. Objectives are clearly stated for each chapter, and tables are used liberally to enhance understanding and emphasize salient points. Overall, the book is well written and easy to understand. It is small, compact, and fits into the pocket of a laboratory coat. This book would be of most benefit to those interested in gaining a better understanding of pain and pain management in children from the anesthesiologist’s and perioperative physician’s perspective, particularly those in training in anesthesia and the surgical specialties.

Precious Lord

Precious Lord David Pilgrim (bio) Reverend Aaron James Jamison sat, alone, crying in his car, three blocks from the church where he was to preach in twenty minutes. He cried hard. Mutilating surgery. That’s what the doctor said. If only your father had come earlier. But, of course, he hadn’t. Believing in signs, he prayed instead. Prayed! Because that’s what old black folks do; they pray. Because Deacon Jamison believes that Jesus can fix it, will fix it. He loves to talk, but how will he talk without a tongue? No tongue. No left cheek. If only he hadn’t waited. His tongue, for Christsakes! The thought of his father’s face, mangled and unholy, caused him to cry aloud. Entering Mount Sinai Baptist Church, he was a man crawling through a fog. They knew him there; women pulled him forward, men beat his back, children stared, and the fog thickened. A cannonade of thrusting hands, of begging voices: Bless you, Brother Jamison. Give me a hug. Sho, looking good, Preacher. Shake my hand, Sir. Preach good tonight. Come here, Son. Let me shake your hand. You forgot me? Hug my neck. How’s your daddy? Tear it up today, Preacher. He extended his hand and voice, by rote, but he needed a place to turn, to walk, to sit. They had not expected to get this close, so they drew closer. “Let him through,” said Pastor Samuel Ely, making his way to Reverend Jamison. The young preacher, surrounded, his back pressed against a wall, nodded, smiled, and mumbled: “Yes, good to see you. Good to see you. Yes, good to see you. Yes.” His eyes hurt. And the back of his head hurt. “Come on, people, let him through.” The pastor, though embarrassed, managed a smile. “Please, go inside,” he pointed the crowd toward the sanctuary, “we’ve already begun.” They obeyed reluctantly. The older man, his arm on his guest’s shoulder, led him into the pastor’s study. “Yes, so good to see you. Yes, so glad to be here. Yes.” On the day before his seventh birthday, Aaron James’ mother, tired, returning from a trip to visit her sister in Atlanta, had ignored a flashing red light and raced a train to the crossing at Old Mill Junction. The train slammed into her car, lifted it, then, with the vehicle stuck like iron to a magnet, shoved it along for several miles. She died, her face lacerated grotesquely. When Aaron James was nine years old he had preached his trial sermon. His home church, Pine Grove Baptist, was packed with the curious and the bored that Sunday night. His father, not yet a deacon, had introduced him, saying, “If Aaron only says ‘Jesus is good,’ then he has said enough.” How could he have known? Aaron James hadn’t said much, but when he sat down it was to a stunned congregation, weeping [End Page 825] and dazed. Sister Marie Gross had been told that Jesus loved her for four decades; when Aaron James preached, she finally believed it, nor was she the only one. “Doesn’t He love you? Won’t He find you? Let Him in.” Perhaps it was because he was only nine, or was cute, or because his voice cracked when he shouted—“Say He loves you. Say you will let Him in.”—or perhaps it was the smile, the ease, the left hand in his suit coat pocket, the right hand punching the air. Or was it the way he shouted—“Do you love Him?”—and then looked at his nodding father, but, whatever it was, it drew two dozen of his neighbors forward to hug him and to accept Jesus. Aaron James began singing “Precious Lord,”—I am tired, I am weak, I am worn. Sister Gross got happy and began to shout. That night the elder Jamison knelt beside his bed to thank God for his son. Aaron James saw him and heard him. Come See And Hear God’s Little Preacher. Aaron James preached throughout Alabama. Small churches, big crowds. He stood on a peach basket or a chair. In Selma, over five hundred people...