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Book Reviews

Oxford Handbook of Clinical Specialities

As medical students progress through their clinical years, they are exposed to the varied streams of medicine, which not only functions as a key component in their broader medical training, but serves as a degustation for potential specialities they may choose to pursue after medical school. Students often find themselves starting a specialty term without knowing what they need to know, let alone which is the best student-friendly textbook.

The Oxford Handbook of Clinical Specialties (OHCS) is divided into twelve chapters, covering streams such as obstetrics and gynaecology, paediatrics, primary care, psychiatry and accident and emergency, which are part of the core teaching in most medical schools. It also covers a number of other important specialities, such as otolaryngology, dermatology, ophthalmology and anaesthetics.

Made as a companion to the Oxford Handbook of Clinical Medicine – often referred to as the ‘medical student’s bible’ – this book is another in the Oxford Handbook series which provides a solid summary of many clinical streams that will be encountered by medical students as part of general medicine, as well as during speciality rotations.

Like most books in the series, this book is extremely user-friendly. It is divided into different sections based upon fields, with coloured tabs used to help identify each section. Most chapters in the OHCS begin with summary pages which deal with the fundamentals of each stream, allowing students to familiarise themselves with the essentials and identify important learning areas. Following this, most chapters spend one or two pages discussing important clinical entities, covering the common, the classical and the critical conditions that medical students should be aware of. Students who have used other Oxford handbooks will be familiar with the structure used to discuss each condition. Where relevant, the book covers the basics – signs and symptoms, investigations, treatment and management, and complications.

Where this book may fail students is in its lack of detail. While the succinct nature of the OHCS is useful in the first few clinical years, its brevity also means that the level of knowledge expected of more senior students is lacking. For example, the psychiatry section is an area where this textbook fails to compete with a more comprehensive text. Since psychiatry is a stream that is quite removed from the rest of medicine, the brief summary pages on schizophrenia and affective disorders will doubtless leave students wanting. The dermatology section is also underdone, with not enough space in this pocket-sized textbook to include images of the myriad of integumentary conditions, which is vital for the inexperienced student.

Having said this, the OHCS certainly does not purport to be a comprehensive textbook of each of the streams it covers. Tutors will recommend their favourite textbook – the ‘must have’ for each speciality – which will serve to work biceps as much as brains. Like most Oxford handbooks, the selling point for OHCS is that it can fit in one’s pocket and is a handy guide to confirm what has already been learned. Overall this is a great textbook for junior-year students entering the clinical environment for the first time, and a useful reference text for senior students.

Collier J, Longmore M, Turmezei T, Mafi A. Oxford Handbook of Clinical Specialties. 8th ed. Oxford (UK): Oxford University Press; 2009.

RRP $97.95

Conflict of Interest

None declared.

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Book Reviews

‘Moore’ than just a doorstop: Clinically Oriented Anatomy vs. Gray’s Anatomy for Students

The study of anatomy is often a challenging endeavour for many medical students. Central to the learning process is the use of a good textbook. Two of the most often recommended texts for medical students are Gray’s Anatomy for Students (GAS), descended from the iconic text by Henry Gray, and Clinically Oriented Anatomy (COA), by Moore, Dalley and Agur.

Both texts employ a regional approach to the study of anatomy. GAS separates each chapter into four sections: Conceptual Overview, Regional Anatomy, Surface Anatomy and Clinical Cases. The conceptual overview aims to provide the very basic concepts of each region in a concise summary before moving on to an increasingly detailed description. While this approach may be useful for the beginner or reviewer, the inevitable repetition creates a degree of redundancy. COA presents information in a ‘bones up’ format, progressively adding surrounding structures before detailing the arthrology of each region. Each chapter concludes with a series of radiographic images to complement integration and understanding.

Certain striking distinctions are evident in the textual quality of each book. GAS aims to strip away irrelevant information into an easy-to-read summation while leaving intricate details for other texts. While this provides an excellent introduction for the neophyte, COA includes more rigorous explanations concerning the finer points and the complex interaction with surrounding structures. An enlightening example of the differing styles can be observed through the treatment attributed to the sternocleidomastoid (SCM) muscle. A concise, tabular description of muscular attachments, innervations and basic function is provided in GAS in association with a stylised diagram indicating its position in the neck. Conversely, COA devotes an entire four page sub-section to a detailed discussion of the manner in which body position and the use of synergist muscle groups can alter function of the SCM beyond an isolated view of the muscle acting independently in the anatomical position. Thus, while simplified to enhance the initial integration of basic concepts, GAS may simultaneously perpetuate certain erroneous notions concerning the nature of anatomical function. On the other hand, the text in COA may reduce its effectiveness for the uninitiated, while GAS may prove to be too simplistic for the interested student.

Both books approach diagrammatical representation through the use of computer-generated imagery, though distinct dissimilarities are visible. COA depicts each region by incorporating detailed and realistic diagrams which are thoroughly labelled. In contrast, GAS represents analogous images through a distinctly stylised fashion. Major structures are portrayed in an idealistic mode, which, in combination with relatively sparse labelling, may impede practical application, particularly in medical courses focussed on anatomical dissections. However the simplified overview, devoid of extensive detail, is potentially easier to comprehend for the less experienced anatomist. In addition to detailed, accurate labels, COA consolidates diagrammatic elements through representations in various anatomical planes. The depiction of distinct layers within each system aids the appreciation of the detailed nature of such structures. Ultimately, COA associates these illustrative characteristics through the use of numerous, detailed figures within each specified anatomical region. The use of COA may prove to be beneficial, both in dissection and in providing a broader scope of understanding.

The integration of clinical aspects throughout a text is essential to the effective understanding of anatomical information. Both books appear to have achieved a relatively streamlined integration of such information through the utilisation of clinical vignettes. Complemented with relevant diagrams, topics covered in the text of these vignettes include information relating to development, anatomical variation, radiology and pathology. For those without significant exposure to anatomy, having clinical information presented in such a fashion is an ideal mode for the consolidation of vital concepts. The use of end of chapter case studies in GAS allows the reader to evaluate their own level of understanding, a feature that is absent in COA. Radiological correlations in GAS are discussed further through an in-text approach. Alternatively, COA utilises radiological imaging juxtaposed with easily understood computer generated diagrams, allowing the student to…

Drake R, Vogl W, Mitchell A. Gray’s Anatomy for Students. London: Churchill Livingstone; 2009.

RRP: $138.00

Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy, Sixth Edition. Baltimore: Lippincott Williams & Wilkins; 2009.

RRP: $129.80

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Review Articles

What do medical students think about pharmaceutical promotion?

Abstract

Aim: The aim of this review was to produce an overview of surveys of medical students’ exposure to and attitudes towards pharmaceutical promotion. Methods: PubMed was searched for studies featuring surveys of medical students regarding their interactions with pharmaceutical promotion and tabulated the findings for survey questions relating to the main themes. Results: Students have significant exposure to promotion, and they generally view receiving gifts as acceptable, but do regard some gifts as more appropriate than others. Most students think pharmaceutical sales representative (PSR) presentations are biased but still of educational value and should not be banned. Most students do not believe promotion will affect their prescribing behaviours. A large majority of students want more education in their curricula on how to interact with PSRs. Conclusions: Many medical students think that pharmaceutical promotion is biased and feel underprepared for interactions with the pharmaceutical industry. Despite this, they accept exposure to pharmaceutical promotion believing that it will not influence them. There is scope for improved education in medical schools about this issue.

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Review Articles

Information and support needs of adolescents with Familial Adenomatous Polyposis

Familial adenomatous polyposis: the mucosal surface of the colon is carpeted by numerous polypoid adenomas. (Copyright, UNSW Department of Pathology, from the ‘Images of Disease’ collection.)

Abstract

Familial Adenomatous Polyposis (FAP) is a dominantly inherited bowel cancer predisposition syndrome presenting with hundreds of premalignant polyps in the colon. The standard form of treatment is preventative surgery which involves removal of the entire colon. The rectum and colon may also be removed. Predictive testing is usually done at ten to fourteen years of age, and surgery is recommended by the age of 20. Thus, adolescents face a wide variety of difficult decisions and situations. The aim of this review is to critically evaluate existing literature which examines the experiences of these young people and their families, including their information and support needs, psychosocial adjustments and satisfaction with current genetic services.

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Review Articles

Complementary and alternative medicine use among children with asthma in Australia

Abstract

Aim: To explore current complementary and alternative medicine (CAM) use by children with asthma in Australia. Methods: The results of an audit of CAM use by one of the authors (AMD) in 212 parents of children with a history of asthma, recruited from three different settings (outpatient clinic at a tertiary paediatric hospital, metropolitan and rural practices) were compared to three published studies of CAM use in children with asthma in Australia, as identified by literature review. Results: The prevalence of CAM use amongst children with asthma in Australia is 45-61%. Common CAM modalities used include chiropractic methods, vitamins and minerals, homeopathy/naturopathy, spiritual/psychological modalities and diet therapy. CAM was used more commonly in female children and those with persistent asthma, poor control of symptoms or using high doses of medication. Importantly, only a small number of parents report their child’s CAM use to their doctors. Conclusion: Recent surveys of CAM use among children with asthma in Australia demonstrate a high prevalence which has important implications for those managing paediatric asthma.

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Review Articles

An overview of respiratory disease in Indigenous communities: A comparison to the wider Australian population

Abstract

Aim: The objective of this article is to compare the differences in long term health outcomes between Indigenous and non-Indigenous populations with respect to respiratory disease. In order to gain a deeper understanding of the knowledge presented regarding differences in Indigenous and non-Indigenous health, the epistemological grounds for the study will be considered. Methods: A literature review was conducted. The data for this review was assembled through searching Medline, Informit, PubMed and the Indigenous Healthinfonet for English language peer- reviewed publications containing the keywords: respiratory disease, Indigenous, rural and Queensland. Thirty-two documents were selected. Results: Respiratory disease is distributed disproportionately and occurs with peculiar frequency among Indigenous Australians. Key health indicators such as the disability adjusted life year highlight the inequality between Indigenous and non-Indigenous Australians in terms of health outcomes, although to a much lesser extent than in the past. Conclusions: An innovative approach to public health has seen Indigenous communities become more actively engaged in medical care. Of particular note is the increasing frequency with which Indigenous health workers are being integrated into rural practice to follow up patients and bridge cultural and societal gaps. Environmental antecedents are important contributors to health which may be responsible for the high burden of disease seen in many Indigenous communities. These challenges must be addressed as part of a new public health drive to bring health equality to all Australians.

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Review Articles

Novel approaches to cancer therapeutics

Abstract

Advancements in our understanding of the biology of cancer have progressed dramatically over the past decade. The application of cutting-edge molecular profiling techniques analysing the cancer genome is elucidating an appreciable amount of information. This data is now being integrated into a catalogue that is providing researchers with a revolutionary roadmap of the molecular mechanisms behind cancer. Recent accomplishments in cancer research are also being introduced into the clinic through the development of innovative diagnostic technologies and targeted therapies. Lessons from the past, along with novel therapeutic approaches being developed today, have stimulated an optimistic promise for tomorrow’s fight against cancer.

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Review Articles

Ovarian carcinoma: Classification and screening challenges

Removal of a large ovarian tumour

Abstract

Primary ovarian cancer is the leading cause of death from gynaecological malignancy and the sixth most common cause of cancer death in Australian women. Our understanding of the underlying pathophysiology of epithelial ovarian cancers is incomplete, which poses difficulties for screening, diagnosis and treatment. This review summarises the current knowledge and debate regarding classification of epithelial ovarian cancers, including a proposed new classification system. Current screening methods and the evidence behind them are also presented. The outcomes of large, ongoing trials are awaited to provide more conclusive evidence regarding the effectiveness of screening for ovarian cancer.

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Review Articles

Minimally invasive mitral valve repair: A new surgical option for mitral insufficiency

Long-shafted instruments in use during mitral valve repair

Abstract

Minimally invasive mitral valve repair (MIMVR) is a relatively new alternative to median sternotomy for valvular heart surgery, and has become increasingly appealing due to its improved cosmetic results and more rapid recovery time. Patients suffering mitral valve disease are increasingly turning to their medical practitioners for advice regarding this procedure. It is the aim of this article to provide a review of MIMVR to allow students and doctors to better understand this recent development in cardiac surgical therapy.

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Case Reports

Use of retrograde intra-operative cholangiogram for detection and minimisation of common bile duct injury

Intraoperative cholangiogram during a laproscopic cholecystectomy

Abstract

Iatrogenic bile duct injury (BDI) is a known complication of laparoscopic cholecystectomy with serious consequences for the health of the patient. Intra-operative cholangiogram (IOC) has been shown to reduce the incidence of a major BDI, and is currently used routinely by the majority of surgeons in Queensland. This case report details the use of a ‘retrograde IOC’ for the detection of a BDI after inadvertent cannulation of the common bile duct (CBD). Application of this method has the potential to improve patient outcomes in two ways. Firstly, by limiting the degree of damage to the CBD, it may facilitate a simpler and more successful repair. Secondly, it provides a method of laparoscopic confirmation of BDI and, where laparoscopic hepaticojejunostomy is available, can entirely prevent the need for an open procedure.