Australian Family Physician
Australian Family Physician


Volume 41, Issue 4, April 2012

Book reviews

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Hyperlipidemia in Primary Care – A Practical Guide to Risk Reduction

Matthew J Sorrentino, editor

New York: Humana Press, 2011
ISBN 978 1603 275 019, $65.00

Hyperlipidemia in Primary Care – A Practical Guide to Risk Reduction

This 228 page book consists of 12 chapters, and one of its strengths is the attention to detail in each of these chapters, starting with cardiovascular risk assessment, metabolic syndrome and the role of imaging in cardiovascular risk assessment and then moving to hyperlipidaemia. In particular, the chapter on inherited lipoprotein disorders and the chapter about HIV and dyslipidaemia are well written. There is a good focus on nonpharmacological treatment and lifestyle interventions in order to lower risk from hyperlipidaemia throughout the book. Pharmacological treatment options and indications for medication intervention are also explained in great detail.

I was impressed with the strong reference to studies and the evidence provided throughout the book. The tables and algorithms in each chapter are helpful. The last five chapters each contain a case study each, which is a valuable addition to the text.

A weakness of this book however, is that for a medical professional who is not used to mg/ dl measurements it is difficult to read. All the units for lipids are only provided in mg/dl and not mmol/L, body weights are only given in pounds, not kilograms, and there is no conversion table for units. This forces the reader unfamiliar with mg/L and pounds to convert units with tables for every value provided. This could have been avoided if mmol/L units and kilograms had been either provided in brackets behind each given value or if the book contained conversion tables.

I found Hyperlipidemia in Primary Care interesting to read: it presents all the evidence from studies as the basis for treatment of hyperlipidaemia. Cardiovascular risk factors, inherited lipoprotein disorders, lifestyle interventions for lipid lowering and pharmacological treatment options are all well explained. Some of the information provided is very specialised and almost in the field of lipidologist expertise. For example, the chapter on advanced lipid testing is very specialised and the tests suggested reach well beyond current standard testing recommendations in Australia. But because of the detailed nature of this book it really explains the background of lipid disorders and current trends in testing and increasingly acknowledged cardiovascular risk factors.

In summary, Hyperlipidemia in Primary Care lays a solid foundation for the interested reader for understanding and treatment of hyperlipidaemia. I recommend it to any health professional who has a deeper interest in lipid metabolism, genetic predisposition to lipid disorders and their treatment.

Heinz Tilenius
Melbourne, Vic

The ABC of Stroke

Jonathan Mant and Marion F Walker, editors

John Wiley & Sons Australia, Ltd, 2011
ISBN 978 1405 167 901, $39.95

The ABC of Stroke

In Australia and England stroke is respectively the second and third leading cause of death behind heart disease and the leading cause of disability. These statistics suggest the need for a book aimed at general practitioners, as they have frequent and long term relationships with their patients and thus the best chance to decrease stroke prevalence. So the ABC of Stroke is a valuable and timely addition to the ‘ABC’ series.

This 52 page book, with its comprehensive glossary, is a cover-to-cover read. It has 12 clearly titled, concise chapters for future reference with a strong focus on ischaemic stroke.

This book provides an accurate, concise, up-to-date understanding of stroke and transient ischaemic attack (TIA), emphasising risk factors and presenting current best evidence based treatments regarding lifestyle modification and drug therapy in the primary and secondary prevention setting. It covers the RE-LY trial, comparing warfarin to the new agent dabigitran for treatment of atrial fibrillation and the summary of randomised controlled trials for pharmacological agents for use in TIA.

One aspect which could have been added was a more comprehensive written/ pictorial explanation of the pathophysiological mechanisms underlying stroke and TIA and how various treatments act on these mechanisms. For example, how hypertension and atrial fibrillation cause TIA and stroke and how lifestyle modifications and pharmacotherapy combat these. An understanding of these processes would enable doctors to better explain to patients why they should exercise, stop smoking or take their antihypertensive agent and hopefully result in increased compliance.

The ABC of Stroke also focuses on poststroke issues and care, and includes chapters on the medical complications of stroke, rehabilitation, mobility, communication and swallowing after stroke, psychological problems after stroke and long term support for stroke survivors and their carers. These chapters make GPs aware of the various complications, comorbidities and care requirements that stroke sufferers, their families and carers face. They include issues of independence for the sufferer, the need for long term speech therapy, psychological comorbidities poststroke and issues of sex for the stroke sufferer and their partner. General practitioners who are well informed on these issues will be better able to inform patients and coordinate various aspects of multidisciplinary care and treatment.

The ABC of Stroke is a new resource to help GPs and junior doctors quickly orient themselves to the at risk TIA/stroke patient in primary or secondary prevention settings, as well as to understand the multidisciplinary nature and requirements of poststroke care.

Daniel Varma
Adelaide, SA

ABC of Colorectal Cancer, 2nd edition

Annie Young, Richard Hobbs and David Kerr, editors

Great Britain: Wiley-Blackwell, 2011
ISBN 978 1405 177 634, $39.95

ABC of Colorectal Cancer, 2nd edition

The ABC series of medical books is a terrific condensation of what were initially articles from the British Medical Journal. This series was of great use to me during my medical schooling with the neonatal, early childhood and ophthalmology books in the series being very good.

There are now 63 books in the series, ranging from the standards of ABC of electrocardiogram, hypertension, rheumatology out to more esoteric topics such as patient safety, brainstem death and the ABC of Tubes, Lines, Drains and Frames.

The ABC of Colorectal Cancer is like the others in the series with a focused general practitioner, registrar and medical student view of the topic. The information is presented in A4 size with both small print and diagrams, derived from the British Medical Journal format. The book opens with a patient story about their advanced colorectal cancer and proceeds through epidemiology, carcinogenesis, screening, imaging, pathology and then surgical and medical management. Some sections do not apply to us in Australia – they are based around United Kingdom screening guidelines and multidisciplinary decision making computer programs. Only two Australians are listed as contributors, pathologist Michael Christie from the Royal Melbourne Hospital and scientist Oliver Sieber from the Ludwig Colon Cancer Laboratory.

The information in the ABC of Colorectal Cancer is very well presented and the coverage is more than a GP would need in clinical practice.

Details around carcinogenesis, epidemiology and pathology would be very useful for medical students and specialist registrars. However, many of these details are beyond what I would have used to study for the FRACGP exam or use in daily practice.

In an era of systemic reviews and varying local protocols and guidelines, it is difficult to produce a book which contains information which is valid across different countries.

As a result, although this is an excellent book in terms of content, I would not recommend it to a practising Australian GP. It would be good for a medical library or possibly a practice with full time medical students.

Simon Wilson
Castlemaine, Vic

Greater Expectations – Living with Down syndrome in the 21st century

Jan Gothard

Freemantle Press, 2011
ISBN 978 1921 361 777, $26.95

Greater Expectations – Living with Down syndrome in the 21st century

Dr Jan Gothard, a professor of history at Murdoch University, brings an academic historian, parental and a Western Australian perspective to this subject. The strength is that it is extremely well written and researched and has the authenticity of someone who has the personal experiencing of bringing up a daughter, Maddie, who has Down syndrome. The focus on Western Australia, especially in the sections on schooling, nongovernment organisations and community agencies, necessarily provides a parochial view of these supports which may not reflect the situation in all Australian jurisdictions.

Greater Expectations is an oral history after interviewing 60 diverse families, including interviews with individuals with Down syndrome and drawing on the author’s own personal experience of raising a child with Down syndrome. The rich use of quotes makes this book both readable, insightful and reflects a broad range of views.

It starts with reactions to the birth of a baby with Down syndrome, then moves to choices around perinatal diagnosis and initial care, acceptance of disability, medical issues, parenting and support organisations, adjusting to society, schooling, opportunities for employment, long term care and finally, the enormous potential of individuals with Down syndrome.

The choices around a child with Down syndrome are bigger today and they are not only personal but also made in the context of social, cultural and community influences, ‘few of which are straightforward or transparent’. This book lays out the breadth of views around important decision points and presents the often very significant struggles with each decision.

There is only one graph in the book and this illustrates that the prevalence of Down syndrome in Western Australia has remained steady over the past 30 years at one per 1000 births with actual conceptions with Down syndrome increasing but matched with equal numbers of terminations.

Greater Expectations is especially beneficial for all families who have a member with Down syndrome and for those making prenatal decisions about Down syndrome. There are significant messages for medical students, doctors in training and experienced medical practitioners as well. This includes the importance of avoiding assumptions and choosing words carefully around making choices at critical decision points. Often, listening carefully is more important than advice giving. However, it also encourages all health professionals to become more aware of contemporary issues in the care of people with Down syndrome and to provide advice based on best practice and knowledge of the most effective resources.

The book’s title highlights the greater expectations we have for people with Down syndrome in the 21st century. It opens a window into the decisions families make and ‘a different way of looking’ at people with Down syndrome who see themselves like us except they may need ‘a little bit of extra help’.

Nick Cooling
Hobart, tas

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