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Am Fam Physician. 1998;57(9):2271-2272

Software Reviews


By Martin J. Cline. Price, $69.00. MC2 Productions, P.O. Box 905, Stinson Beach, CA 94970, 1997.

HemaDx is a computerized hematology program on CD-ROM designed for primary care physicians. It is PC or Macintosh compatible and can be easily used by someone with even minimal computer skills. However, it offers little over a standard hematology handbook, perhaps making its cost of $69 seem unjustified.

Because of its computerized format, the information in the program can be accessed in two different ways. It has an alphabetical index of topics that functions much as the index of a book. From this menu, users can choose from over 100 diagnostic categories and a series of screens on pathogenesis, diagnosis and treatment. It also has a problem-oriented interface from which selections can be made from such categories as anemia, white blood cell disorders and bleeding tendency. After pertinent screening laboratory values, such as mean corpuscular volume, are entered, the program lists the differential diagnosis and the studies necessary to distinguish among the possibilities.

The advantage the program offers over a more standard textbook format is that, even at its relatively low price, it includes images of blood smears generally offered only in more expensive textbooks with color plates. The program also allows users to quickly and efficiently locate the topic of interest. On the other hand, the program does not go into great detail about any of the subjects covered. For instance, the section on “too many red cells” simply states that this condition may be due to polycythemia vera and gives a few of the symptoms without discussing the differential diagnosis, the laboratory evaluation needed to distinguish among the possibilities, or even the cutoff value of hematocrit below which polycythemia vera is unlikely. After classifying the problem by red blood cell size, the section on anemia lists diagnostic possibilities without providing the additional information needed to distinguish among them.

In summary, HemaDx has a pleasing and easy-to-use interface. However, it does not give much detailed information about any of the conditions covered. It would be suitable for medical students or possibly primary care residents who feel they need to quickly review the field of hematology. For the practicing primary care physician in the clinical setting, the program offers no advantage over the combination of a handbook for quick confirmatory reading and the general medicine textbook already on the shelf for more in-depth information.

Book Reviews

Panic Disorder: The Medical Point of View

By William D. Kernodle. Pp 208. Price, $17.95. 4th ed. Rand McNally Book Services Group, 7105 Winding Creek Lane, Chesterfield, Virginia 23832, 1997.

This paperback book is written for use by patients with panic disorder, but “counselors and physicians will also benefit from the information...” After describing panic attacks, panic disorder and agoraphobia, the book addresses differential diagnosis, evaluation and complications. Separate chapters deal with antidepressants, benzodiazepines, maintenance therapy and nondrug treatments. The author then compares panic disorder with ulcer disease, shares his clinical experience working with patients who have panic disorder, summarizes key points and presents a series of case studies. Finally, the book reviews the historical milestones in our understanding of panic disorder.

This book certainly accomplishes the purpose of educating patients with panic disorder. In this sense, it could be valuable to physicians as a patient education tool. However, because the discussion is geared toward patients, the information presented is too basic for physicians to use in patient management.

Because this book provides a more in-depth discussion than discussions in currently available pamphlets, but is more concise than most self-help books, it meets a need for detailed, accurate, patient-oriented information. It is clearly written, logically organized and balanced in its approach. As the author emphasizes, the prevalence, severity and treatability of panic disorder testify to its importance.

Several features of this book make it particularly endearing and useful to patients. In addition to the presentation of case studies and the comparison with ulcer disease, both of which strengthen its appeal to patients, the book begins with a description of four patients, each treated through a different medical approach. This chapter effectively demonstrates the need to take an integrated approach to patient evaluation and management, and sets the tone for the entire book. Finally, the appendix provides information about relevant organizations and educational materials.

This book does have limitations. The author states that infrequent panic attacks rarely lead to disability. This contradicts a growing body of research showing that although patients with infrequent attacks are not as disabled as those with panic disorder, such patients have a poorer quality of life and level of function than panic-free patients. The book offers a good discussion on agoraphobia, but it should emphasize the fact that all patients with agoraphobia need behavioral therapy such as systematic desensitization. One significant omission is the lack of information on the role of diet and exercise in treatment. The book should address the need for avoidance of cardiac stimulants in all patients, not just those receiving treatment with monoamine oxidase inhibitors. New evidence suggests that inositol can reduce the frequency of panic attacks. In addition, exercise may help to decrease levels of anxiety and to improve the patient's ability to cope with stress.

Two years ago, I had the privilege of reviewing the second edition of this book. At that time, I noted six areas of concern. This edition has corrected three of those deficiencies. In addition to presenting criteria from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders instead of those from the third revised edition, the book clearly states that medication is used to prevent panic attacks rather than to abort them. It also has simplified its discussion of specific research studies. However, two years ago I was concerned that the pathophysiology description was difficult to understand and scattered throughout the book. It is still confusing and appears in three nonadjacent chapters. I had also indicated that the cases would be more effectively used if scattered throughout the book, emphasizing particular points. However, most of the cases in this edition appear in one chapter toward the end of the book. Finally, the second edition had an 11th grade reading level; the reading level of the current edition is 11th grade to 16th grade, depending on which readability statistic is used. Hence, this edition is still most appropriate for the well-educated patient with panic disorder.

Although this well-written paperback has some limitations, it is generally accurate and represents an improvement over the second edition. Its balanced approach and useful appendices make it superior to other patient-oriented materials on the market.

Also Received

Assessing the Health Status of Older Adults

Edited by Elena Andresen, Barbara Rothenberg and James G. Zimmer. Pp. 271. Price, $38.95. Springer Publishing Company, 536 Broadway, New York, NY 10012-3955, 1997.

Cardiovascular Disease in Older People

Edited by Fran E. Kaiser, John E. Morley and Rodney M. Coe. Pp. 266. Price, $42.95. Springer Publishing Company, 536 Broadway, New York, NY 10012-3955, 1997.

Cholesterol Treatment: A Guide to Lipid Disorder Management

By David A. Leaf. Pp. 201. Price, $14.95. 3d ed. EMIS Medical Publishers, P.O. Box 1607, Durant, OK 74702, 1997.

Conversations About Asthma

By Lawrence M. Lichtenstein and Kathryn S. Brown. Pp. 157. Price, $14.95. Williams and Wilkins, 351 W. Camden St., Baltimore, MD 21201-2436, 1998.

Earl Mindell's Supplement Bible

By Earl Mindell. Pp. 284. Price, $12.00. Simon and Schuster, 1230 Avenue of the Americas, New York, NY 10020, 1998.

Improving Patient Satisfaction Now

Edited by Anne-Marie Nelson, Steven D. Wood, Stephen W. Brown, Sheryl Bronkesh and Zachary Gerbarg. Pp. 341. Price, $55.00. Aspen Publishers, 200 Orchard Ridge Dr., Gaithersburg, MD 20878, 1997.

Introduction to Clinical Skills: A Patient-Centered Textbook

Edited by Mark B. Mengel and Scott A. Fields. Pp. 494. Price, $59.50. Plenum Publishing, 233 Spring St., New York, NY 10013-1578, 1997.

Living With Hepatitis C: A Survivor's Guide

By Gregory T. Everson and Hedy Weinberg. Pp. 220. Price, $14.95. Hatherleigh Press, 1114 First Ave., Suite 500, New York, NY 10021, 1997.

Pediatric Secrets

Edited by Richard A. Polin and Mark F. Ditmar. Pp. 574. Price, $36.95. 2d ed. Mosby, 11830 Westline Industrial Dr., St. Louis, MO 63146-3318, 1997.

Phantom Illness: Recognizing, Understanding, and Overcoming Hypochondria

By Carla Cantor. Pp. 351. Price, $15.00. Houghton Mifflin, 215 Park Avenue South, New York, NY 10003, 1997.

Taking Our Pulse: The Health of America's Women

By Iris F. Litt. Pp. 349. Price, $45.00. Stanford University Press, Stanford, CA 94305-2235, 1997.

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