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Am Fam Physician. 1999;60(4):1265-1266

Comprehensive Adolescent Health Care

Edited by Stanford B. Friedman, Martin M. Fisher, S. Kenneth Schonberg and Elizabeth M. Alderman. Pp. 1,349. Price, $150.00. 2d ed. Mosby, 11830 Westline Industrial Dr., St. Louis, MO 63146-3318, 1998. Phone: 800-633-6699.

Comprehensive Adolescent Health Care, second edition, is a comprehensive compilation of issues that affect adolescents. This second edition includes 20 new chapters, many of which address issues identified by the American Board of Pediatrics for inclusion in the Adolescent Medicine Subspecialty Certifying Examination. The added topics include medical emergencies, an expanded section on psychiatric disorders (e.g., post-traumatic stress disorder, obsessive-compulsive disorder) and other issues not usually included in standard textbooks (e.g., financing adolescent health services, psycho-educational testing for adolescents, attention-deficit/hyperactivity disorder and sexual assault).

In the preface, the editors state that the goal of this very comprehensive textbook is to meet the needs of all physicians who see adolescent patients. This includes general pediatricians, family physicians, internists, gynecologists and other primary care providers. However, most of the contributors refer to “pediatricians” as the providers of care for adolescents, and the vast majority of chapters are written by pediatricians or health care providers in pediatric settings.

The text is organized in a fashion similar to the first edition. The early sections on general principles are written with clear and concise guidelines for approaching the adolescent patient in the medical setting. The next section addresses adolescent medical disorders in a comprehensive manner with current information. The text goes on to discuss psychosocial issues with attention to familial relationships in which family is defined very broadly and inclusively. Cultural and social influences are also covered and include chapters on poverty, affluence and cults.

Other sections address sexuality, behavior problems and educational issues. In the section on education, a new chapter on psycho-educational tests summarizes the many educational examinations used for school-aged children. Another interesting addition is the chapter on literature for adolescents. Other major divisions in the text include gynecologic, urologic and sexual issues, and general surgical procedures in adolescents.

As in all textbooks with many authors, information in various chapters frequently overlaps. The editors have done, for the most part, a good job of referencing other chapters in which similar material might be covered.

This book is extremely comprehensive; however, the lack of a specific section on health care maintenance or prevention for adolescents is disappointing. Although the book contains a chapter on immunizations and references to the Guidelines for Adolescent Preventive Services (GAPS), the omission of a specific chapter on prevention is significant in a comprehensive textbook for family physicians. Also, in its attempt to cover everything, some topics, particularly the psychiatric issues, are covered without sufficient depth to address the problems presented.

Chapters that address the approach to adolescents and their families are well done and have appropriate guidelines for family physicians. The chapter on human immunodeficiency virus infection is particularly well done and includes discussions on behavioral issues. The chapter on dermatology is thorough, with excellent graphics and illustrations. Other exceptionally well-done chapters include those on sexual abuse, violence and sexual activity.

Throughout the textbook, there are illustrated “boxes” that highlight specific areas of attention that could be helpful to family physicians who are looking for quick references in the midst of patient care.

The text does address issues in adolescent care relevant to the family physician. The organization of relatively short chapters with significant points well illustrated and highlighted makes it an appropriate reference for clinicians who work with adolescent patients. The cost of the book may limit its inclusion in the libraries of family physicians who see a significant number of adolescents in their practice and in libraries of providers who are involved in teaching adolescent medicine to medical students and residents.

Book Reviews

Skin Surgery: A Practical Guide

By Richard P. Usatine and Ronald L. Moy. Pp. 319. Price, $69.95. Mosby, 11830 Westline Industrial Dr., St. Louis, MO 63146, 1998. Phone: 800-633-6699.

Skin Surgery: A Practical Guide is a straightforward, easy-to-use textbook on the management of various skin lesions in a primary care office. Written specifically for the family physician, this is an excellent textbook and reference book for both the beginner wanting to know the basics about different surgical techniques and the more experienced practitioner who is curious about the most appropriate management of a specific lesion.

The first few chapters cover things that one needs to know when preparing for a procedure. Specific instruments one may choose to use are detailed, a sample consent form is provided, and universal precautions and sterile techniques are reviewed. A chapter on anesthesia discusses the types of local anesthesia available and the techniques for administration. An excellent table of local anesthetic agents provides information on the onset of action, duration of effect and maximum dose. The chapter also explains how to perform nerve blocks and includes color pictures of various types of blocks. Principles of wound healing and hemostasis are also described.

Subsequent chapters review specific modalities such as cryosurgery, shave biopsy, electrosurgery, intralesional injection, incision and drainage, and punch biopsy. The chapters are complete with beautiful color pictures, easy-to-follow instructions and lists of appropriate lesions for each technique. The chapter on the elliptical excision explains how to plan the incision along existing skin lines for the best cosmetic result. It also has detailed figures and pictures of how to correctly make and repair the incision.

The book emphasizes how to manage specific types of lesions and points out when referral to a subspecialist might be necessary. Chapters on specific techniques include descriptions and pictures of lesions that are appropriately treated by that technique. Furthermore, an entire chapter is dedicated to the differentiation of benign and malignant lesions.

Although this book is very well written, the color photographs are perhaps the most compelling reason to buy it. Most of the skin lesions that one may want to biopsy or remove are shown, often along with step-by-step pictures of how to best manage that lesion. As pictures go, this book provides a good supplement to a dermatology atlas.

The tables included in the book are also very helpful, including some that compare suture material, outline endocarditis prophylaxis and review treatments appropriate for specific lesions. Important points are highlighted in boxes, such as the ABCDE Guidelines for diagnosing malignant melanoma and the phases of wound healing. The appendices provide the family physician with samples of patient instructions and consent forms. The index is quite complete for rapid reference in the office. Every lesion I encountered while reviewing this book could be found in the index under both the medical and common names.

Skin Surgery: A Practical Guide is a well-written, reader-friendly textbook for the family physician who wants to do office procedures. It is well suited for students, residents and practitioners who want to learn about treatment modalities that can be used in the primary care office. Those who quickly want to know the best treatment for a given skin lesion will also find use for this colorful book.

Also Received

Age Right: Turn Back the Clock with a Proven, Personalized Anti-Aging Program

By Karlis Ullis. Pp. 319. Price, $23.00. Simon & Schuster, 1230 Ave. of the Americas, New York, NY 10020, 1999. Phone: 800-233-2336.

Case Law in Health Care Administration

By George D. Pozgar. Pp. 310. Price, $38.00. 2d ed. Aspen Publishers, 200 Orchard Ridge Dr., Ste. 200, Gaithersburg, MD 20878, 1999. Phone: 800-638-8437.

Life in the Womb: The Origin of Health and Disease

By Peter W. Nathanielsz. Pp. 363. Price, $27.50. Promethean Press, P.O. Box 6827. Ithaca, NY 14851, 1999. Phone: 607-257-3278.

Managed Care Ethics: Essays on the Impact of Managed Care on Traditional Medical Ethics

By John LaPuma. Pp. 214. Price, $39.95. Hatherleigh Press, 1114 First Avenue, Ste. 500, New York, NY 10021-8325, 1998. Phone: 800-367-2550.

Management of Stroke: A Practical Guide for the Prevention, Evaluation and Treatment of Acute Stroke

By Harold P. Adams Jr., Gregory J. del Zoppo and Rudiger von Kummer. Pp. 224. Price, $17.95. Professional Communications, 400 Center Bay Dr., West Islip, NY 11795, 1998. Phone: 405-367-9838.

Management Skills for the New Health Care Supervisor

By William Umiker. Pp. 423. Price, $49.00. 3d ed. Aspen Publishers, 200 Orchard Ridge Dr., Ste. 200, Gaithersburg, MD 20878, 1998. Phone: 800-638-8437.

Managing Health Care Demand

By Scott MacStravic and Gary Montrose. Pp. 557. Price, $65.00. Aspen Publishers, 200 Orchard Ridge Dr., Gaithersburg, MD 20878, 1998. Phone: 800-638-8437.

Prostate Cancer

Edited by Nadine Jelsing. Pp. 267. Price, $14.00. Westview Press, 5500 Central Ave., Boulder, CO 80301-2877, 1999. Phone: 800-331-3761.

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