Elsevier
Australia has kindly provided me with inspection copies of the following
medical books.
1. ECG Workbook. (Professor) Rohan
Jayasinghe.
Churchill
Livingstone/Elsevier Australia, 2012. Paperback, 224 pages. RRP $59.95.
(A sample
chapter is available: http://www.elsevierhealth.com.au/media/anz/samplechapters/9780729541091/ECG_Workbook_9780729541091_Jayasinghe_SampleChapter.pdf)
For many
people ECGs are a bit like "Who's afraid of the big bad wolf”? In reality this
includes quite a few of us. In medical school there are people who "just
seem to get it" while others continue to struggle, and still "have
their L-Plates on" after many years of medical experience.
This
refreshing book is aimed at the clinical interpretation of ECGs. It is
worthwhile to quote from the Preface written by the author:
“ECG
Workbook provides an easy but systematic algorithm to follow when attempting to
read an ECG. The exercises are aimed at training the reader to practise this
algorithm repeatedly with different ECGs. The real-life clinical synopsis
essentially links the ECG findings to the patient’s clinical context. This
information guides the reader to make a clinical diagnosis with the help of the
ECG findings, and then to decide on the optimal treatment or management plan. …
It is hoped that by completing this workbook the reader will gain the required
mastery to use ECG as a clinical diagnostic tool effectively and to make
suitable management decisions with confidence.”
It is
divided into three sections: 1. Basics of the ECG; 2. ECG-based diagnosis:
pathology by ECG; and 3. ECGs and pathologies. There is also an Appendix
listing the NYHA functional classes, and a detailed Index.
Beginning
with Section 1, the pages are cleanly set out, with ample use of coloured
headings, colour-shaded boxes for important points and plentiful use of
explanatory diagrams. This chapter of 19 pages does indeed cover the basics in
a very understandable fashion. It includes the cardiac cycle, the cardiac
conduction system, ECG rate, scale and calibration, leads and direction of
current travel, determining the cardiac axis and the causes of axis deviation,
placement of electrodes and the difference between electrodes and leads,
correlation of the leads to the region of the heart, and finally, reading the
ECG. This includes a system for doing this together with the parameters of the
normal ECG. To compliment rather than insult the author, for those craving a
"Dummies' guide to the ECG", this is exactly the sort of thing you
are looking for. The chapter is pitched at a good level and easy to follow, and
puts the reader in a good position to approach the chapters on pathology that
follow.
Section 2
is a chapter of 27 pages. It is set out in the same clean and comprehensive
fashion as Section 1. An introduction on reading rate and abnormalities on an
ECG is followed by a discussion of various pathologies, starting with different
types of tachycardia and their management. Also discussed are bradyarrhythmias
and bradycardia, heart block, abnormalities of the cardiac rhythm, normal and
abnormal segments of the ECG, ventricular hypertrophy, myocardial infarction
and ischaemia, other pathologies with mixed ECG changes, and finally
pacemakers. All the common pathologies are discussed as well as some more
obscure ones. Section 2 sets up the background for Section 3, which contains
the ECG worksheets. After a brief introduction, 45 case studies follow.
The case
studies are beautifully set out in two sections each. The first section
contains an ECG on the left-hand page and a template for systematic interpretation
on the right-hand page, including the various aspects of the ECG, further
investigations and management. Before you start to feel that familiar rising
sense of panic regarding "but what is the answer?", relax! The second
section of each case study includes all the answers, and helps to drill the
reader in the recommended approach to systematic interpretation, and helps to
build confidence, as your answers can be directly compared to the recommended
ones.
Being a
paperback of around 250 pages, this book is very portable, and as well as being
a workbook is also a handy reference, both in terms of Sections 1 and 2, but
also the wide variety of ECGs included in Section 3. It is well-written,
accessible and user-friendly. I would certainly recommend it, especially for
those who feel a need to improve their ECG skills in a systematic fashion.
2. Robbins Basic Pathology. 9th Edition.
Editors: Kumar, Abbas and Aster.
Elsevier Saunders, 2012. Hardback,
928 pages. RRP $103.99
Owners of
the book can register it at studentconsult.com, which provides the facility to
access the full text online, download images, add notes and bookmarks and to
search across all individually owned Student Consult resources online. The online
version of the book contains a special additional feature, "Targeted
Therapy" boxes (stemming from an understanding of the molecular basis of
disease), intended to provide examples of "bench-to-bedside"
medicine.
When I was
a medical student, our pathology 'Bible' was Robbins Pathologic Basis of
Disease by Cotran, Kumar and Collins. I am the proud owner of the sixth edition
and its little pocket handbook. This new book is the latest in a trusted and
proud lineage. Many of the earlier products are also available via the Elsevier
website. Back in those days material available on CD-Rom was considered pretty
special and computer-based learning was fairly rudimentary. Since then there
has been an explosion of Internet-based resources, and the editors are to be
congratulated for "keeping up with the times". In one of the medical
student tutorials that I take, students must report back and share with the rest of the class on Fridays the information that they have gleaned concerning
the 'learning issues' for the week. Some students will bring their laptops and
tablets and read off the screen. Such is the power of learning resources such
as the online version of this book - provided there is an internet connection,
students and health professionals can access this material wherever they are
and use it as a resource in their everyday work.
The book
contains 23 chapters over 870 pages, plus a detailed Index at the back. It is
visually attractive, with a coloured strip at the top of each page making the
chapters easy to distinguish. There is liberal use of coloured headings,
diagrams, photographs, tables, orange "Morphology" boxes and blue
"Summary" boxes. Even though the text is dense (as is to be expected
in any serious medical textbook) the judicious use of colour, illustrations,
boxes and space between the various elements makes it appear welcoming and
engaging, as opposed to the forbidding nature of many 'old-fashioned' black and
white textbooks. Each chapter has a "Chapter Contents" box in its introductory
header, listing the key sections and their page numbers. This is a very handy
navigation aid. There is also a bibliography at the end of each chapter.
The authors
have strived to organise the chapters in such a way that the various groupings
of pathologies and organ systems are logical. Some chapters do not have a
specific attribution of authorship, whilst many of the chapters are written by
other specialist contributors. As we have come to expect, the standard of the
content is universally high. Many of the images will be familiar from earlier
editions, but there are also many new ones, often showcasing the latest
research discoveries.
These are
the chapter headings:
1. Cell
Injury, Cell Death, and Adaptations
2.
Inflammation and Repair
3.
Hemodynamic Disorders, Thromboembolism, and Shock
4. Diseases
of the Immune System
5.
Neoplasia
6. Genetic
and Pediatric Diseases
7.
Environmental and Nutritional Diseases
8. General
Pathology of Infectious Diseases
9. Blood
Vessels
10. Heart
11.
Hematopoietic and Lymphoid Systems
12. Lung
13. Kidney
and Its Collecting System
14. Oral
Cavity and Gastrointestinal Tract
15. Liver,
Gallbladder, and Biliary Tract
16.
Pancreas
17. Male
Genital System and Lower Urinary Tract
18. Female
Genital System and Breast
19.
Endocrine System
20. Bones,
Joints, and Soft Tissue Tumours
21.
Peripheral Nerves and Muscles
22. Central
Nervous System
23. Skin.
In the
interests of time and space and maintaining the attention of you the reader, it
is probably not wise to attempt to review every single chapter, so I have
selected one chapter as an example to demonstrate the general approach to
layout and contents and the topicality and prescience of the authors in
"walking the talk" as stated in the Preface: "This is an
exciting time for students of medicine because the fundamental mechanisms of
disease are being unveiled at a breathtaking pace. Pathology is central to
understanding the molecular basis of disease, and we have tried to capture the
essence of this new knowledge in the ninth edition ... We firmly believe that
pathology forms the scientific foundation of medicine, and advances in the
basic sciences ultimately help us in understanding diseases in the individual
patient."
“Chapter 7:
Environmental and Nutritional Diseases” examines diseases which are caused or
influenced by environmental factors, including both the external environment
and things that humans do to themselves (e.g., diet, drugs and alcohol). After
the Introduction, the authors bravely enter into a discussion about the Health Effects
of Climate Change and provide scientific evidence for the existence of climate
change and list some of the serious consequences which are already occurring.
The next key section deals with the Toxicity of Chemical and Physical Agents.
This is divided into sub-sections (each with Morphology and Summary boxes)
dealing with Environment Pollution - Air, Environmental Pollution - Metals,
Effects of Tobacco, Effects of Alcohol, Injury by Therapeutic Drugs and Drugs
of Abuse (oestrogens/contraceptives, paracetamol and aspirin; cocaine, heroin,
marijuana and a list of "other illicit drugs"), and Injury by
Physical Agents (trauma, thermal injury, hyperthermia, hypothermia, electrical
injury and ionising radiation). Although one might perhaps argue that more substances
could have been included, and more detail included on some of the given topics,
a text such as this "cannot be all things to all men" and there are
many other excellent references which do provide further information in these
areas. However, what is included does serve an important function in
"whetting the appetite" and encouraging readers to think beyond the
superficial in terms of environmental injuries. The second key section is
devoted to Nutritional Diseases and follows the same general layout principles.
This covers malnutrition, eating disorders, vitamin deficiencies, obesity
(another very topical inclusion) and concludes with short sections on Diet and
Systemic Diseases and Diet and Cancer.
One small
frustration is that, being an American text, the units of measurement may be
different to those used in the Australian context e.g., Fahrenheit for
temperature as opposed to Celsius.
The more
that I looked at this book, the more that it was like opening a beneficent
"Pandora's Box". It draws you in and engages your attention, and like
those enraptured of the 'siren song' of old, you don't want to put it down. An
odd thing to say about a text book, I know, but much of what the authors
present to us about the underlying science of medicine is utterly fascinating.
For those who wish that they had paid more attention in medical school, this is
your "get out of jail free card", and for those embarking on the
journey of learning, it is a marvellous road map. Highly recommended!
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