- Email: [email protected]
Book review. Contemporary Nutrition Support Practice. A Clinical Guide
Book reviews practicalities of group interventions, while a third reviews strategies of relapse prevention. The quality of these chapters, and in particular the last, is very high and they are of benefit to those looking for simple strategies based on clinical skills and sophisticated models of smoking and smoking cessation. Overall, I found this an extremely useful and readable text. However, it may be a text for someone who already has some knowledge of smoking cessation methods. For those without this knowledge, a less specialist text may be of more benefit. SIMON SHERRELL
© 2000 Harcourt Publishers Ltd DOI: 10.1054/chec.1999.0035, available online at http://www.idealibrary.com on
Contemporary Nutrition Support Practice. A Clinical Guide (1998) L. E. Matarese, M. M. Gottschlich London: W. B. Saunders ISBN 0 7216 5999 3 This is an impressive publication which would sit well on the bookshelf of clinical practitioners. It runs to nearly 700 pages divided into clearly defined sections and it is generally well indexed. The individual chapter headings are unambiguous and reflect the key areas in which nutritional support is a component of clinical management. The layout within chapters guides the reader in a structured way through each topic. The book has nine sections addressing all aspects of the subject ranging from nutritional assessment and nutrients for nutritional support through the life cycle to nutritional support provision in specific clinical situations. There is a very useful section dealing with management and professional issues. Chapters on ethical considerations and the economics of nutritional support are particularly welcome. It is debatable whether nutritional support in the home situation should be included in this section. The content of the chapters is variable both in quality and quantity and the differences in practice between the USA and the UK can be distracting. The authors are, without exception, Registered Dietitians and they have, collectively, a wealth of higher degrees. While this has many advantages it also exposes one of the major weaknesses of the text. The provision of clinical nutritional support is a multiprofessional undertaking and its success is often a reflection of each area of expertise. There can be little doubt that dietitians are key players (and this book has been written for dietitians) but some input from colleagues in other disciplines would have been welcome. The opening chapter on nutrition support teams does not do justice to other team members although there is a good insight into some aspects of team functions. More information in this chapter would have been helpful – particularly for those contemplating setting up a nutritional support team. © 2000 Harcourt Publishers Ltd
55
The next section on nutritional assessment provides an excellent theoretical background to clinical practice but could have costly resource implications if used uncritically. The chapter on history and physical examination is enlightening and is usefully, albeit generally, described. The next chapter describes some of the anthropometric techniques commonly used in specialized units. Unfortunately, such resources, e.g. metabolic carts, are not often available on general wards and relatively little emphasis is placed on the benefit of a pragmatic bedside approach – although the relevant techniques together with their limitations are well described. The laboratory monitoring chapter is, again, very clearly laid out – it is always helpful to be reminded of clinical applicability and limitations. Depressed immunocompetence can result from impaired nutritional status and this is a useful chapter although the effect of immune modulating diets is not discussed. Subsequent sections can be similarly criticised. It was disappointing not to find some summary guidance about the calculation of nutritional requirements although energy needs together with the need for major nutrients are individually described. Appropriate fluid balance and electrolyte provision are fundamental components of nutritional support provision and this chapter is well presented – including clear descriptions of osmolality, oncotic and osmotic pressure. Treatment of abnormal electrolyte levels is presented although precise dosages are not always given. Dietary fibre is the subject of current clinical interest and, while there was a significant contribution on the effects of fibre in the healthy individual, there was relatively little about its relevance and use in supporting the sick patient. Comprehensive information is presented about enteral formulations and delivery equipment. Two key reservations relate to the typicality of the text – market changes are frequent in a developing field and regular updates will probably be necessary. The extensive citing of American products may limit the usefulness of this particular section in other countries. However, the practicalities are well (although not exhaustively) covered. The complications of enteral nutrition are addressed in a structured way with good reference to the commoner problems of diarrhoea and aspiration. The lack of information about drug/nutrient interactions is a notable omission. Similar comments pertain to the chapters on parenteral nutrition which are, generally, not as comprehensive as those on enteral nutrition. There is helpful information about patient selection together with considerable detail about a range of formulations. The management of complications is particularly well presented including the problems resulting from overfeeding. It was, however, very disappointing to find no mention of the critical roles of the nurse or the clinical pharmacist. Coronary Health Care (2000) 4 (1), 54–56
56
Coronary Health Care
The second half of the book (Chapters 21–43) deals with nutritional support in particular clinical situations. Without commenting in detail (and at great length) these chapters provide, at worst, good general information upon which to base treatment and, at best, state-of-the-art descriptors of current clinical practice. Dietitians involved in the provision of nutritional support will be best placed to interpret the advice given into practical regimens for their patients. The only significant weakness is in the chapter on paediatrics. A huge amount of information is presented in this book. The text is easy to read and the layout is clear. There are several useful diagrams together with an abundance of tables. The inclusion of some flow charts might have simplified some concepts, but this is a small point. Knowledge of the optimal provision of
Coronary Health Care (2000) 4 (1), 54–56
nutritional support is constantly changing to reflect current research and technological development. There is extensive referencing – ranging from 20 to over 350 per chapter – which is up-to-date although largely American. The appendices are useful although somewhat scant, being exclusively composed of various anthropometric standard tables. In conclusion, and despite any reservations, this is a commendable general reference textbook, particularly for dietitians working in nutritional support. It will complement the range of shorter, more practically based guides which are currently available in the UK. J. P. HOWARD Head of Nutrition and Dietetic Services United Bristol Healthcare NHS Trust
© 2000 Harcourt Publishers Ltd
© 2000 Harcourt Publishers Ltd DOI: 10.1054/chec.1999.0035, available online at http://www.idealibrary.com on
Contemporary Nutrition Support Practice. A Clinical Guide (1998) L. E. Matarese, M. M. Gottschlich London: W. B. Saunders ISBN 0 7216 5999 3 This is an impressive publication which would sit well on the bookshelf of clinical practitioners. It runs to nearly 700 pages divided into clearly defined sections and it is generally well indexed. The individual chapter headings are unambiguous and reflect the key areas in which nutritional support is a component of clinical management. The layout within chapters guides the reader in a structured way through each topic. The book has nine sections addressing all aspects of the subject ranging from nutritional assessment and nutrients for nutritional support through the life cycle to nutritional support provision in specific clinical situations. There is a very useful section dealing with management and professional issues. Chapters on ethical considerations and the economics of nutritional support are particularly welcome. It is debatable whether nutritional support in the home situation should be included in this section. The content of the chapters is variable both in quality and quantity and the differences in practice between the USA and the UK can be distracting. The authors are, without exception, Registered Dietitians and they have, collectively, a wealth of higher degrees. While this has many advantages it also exposes one of the major weaknesses of the text. The provision of clinical nutritional support is a multiprofessional undertaking and its success is often a reflection of each area of expertise. There can be little doubt that dietitians are key players (and this book has been written for dietitians) but some input from colleagues in other disciplines would have been welcome. The opening chapter on nutrition support teams does not do justice to other team members although there is a good insight into some aspects of team functions. More information in this chapter would have been helpful – particularly for those contemplating setting up a nutritional support team. © 2000 Harcourt Publishers Ltd
55
The next section on nutritional assessment provides an excellent theoretical background to clinical practice but could have costly resource implications if used uncritically. The chapter on history and physical examination is enlightening and is usefully, albeit generally, described. The next chapter describes some of the anthropometric techniques commonly used in specialized units. Unfortunately, such resources, e.g. metabolic carts, are not often available on general wards and relatively little emphasis is placed on the benefit of a pragmatic bedside approach – although the relevant techniques together with their limitations are well described. The laboratory monitoring chapter is, again, very clearly laid out – it is always helpful to be reminded of clinical applicability and limitations. Depressed immunocompetence can result from impaired nutritional status and this is a useful chapter although the effect of immune modulating diets is not discussed. Subsequent sections can be similarly criticised. It was disappointing not to find some summary guidance about the calculation of nutritional requirements although energy needs together with the need for major nutrients are individually described. Appropriate fluid balance and electrolyte provision are fundamental components of nutritional support provision and this chapter is well presented – including clear descriptions of osmolality, oncotic and osmotic pressure. Treatment of abnormal electrolyte levels is presented although precise dosages are not always given. Dietary fibre is the subject of current clinical interest and, while there was a significant contribution on the effects of fibre in the healthy individual, there was relatively little about its relevance and use in supporting the sick patient. Comprehensive information is presented about enteral formulations and delivery equipment. Two key reservations relate to the typicality of the text – market changes are frequent in a developing field and regular updates will probably be necessary. The extensive citing of American products may limit the usefulness of this particular section in other countries. However, the practicalities are well (although not exhaustively) covered. The complications of enteral nutrition are addressed in a structured way with good reference to the commoner problems of diarrhoea and aspiration. The lack of information about drug/nutrient interactions is a notable omission. Similar comments pertain to the chapters on parenteral nutrition which are, generally, not as comprehensive as those on enteral nutrition. There is helpful information about patient selection together with considerable detail about a range of formulations. The management of complications is particularly well presented including the problems resulting from overfeeding. It was, however, very disappointing to find no mention of the critical roles of the nurse or the clinical pharmacist. Coronary Health Care (2000) 4 (1), 54–56
56
Coronary Health Care
The second half of the book (Chapters 21–43) deals with nutritional support in particular clinical situations. Without commenting in detail (and at great length) these chapters provide, at worst, good general information upon which to base treatment and, at best, state-of-the-art descriptors of current clinical practice. Dietitians involved in the provision of nutritional support will be best placed to interpret the advice given into practical regimens for their patients. The only significant weakness is in the chapter on paediatrics. A huge amount of information is presented in this book. The text is easy to read and the layout is clear. There are several useful diagrams together with an abundance of tables. The inclusion of some flow charts might have simplified some concepts, but this is a small point. Knowledge of the optimal provision of
Coronary Health Care (2000) 4 (1), 54–56
nutritional support is constantly changing to reflect current research and technological development. There is extensive referencing – ranging from 20 to over 350 per chapter – which is up-to-date although largely American. The appendices are useful although somewhat scant, being exclusively composed of various anthropometric standard tables. In conclusion, and despite any reservations, this is a commendable general reference textbook, particularly for dietitians working in nutritional support. It will complement the range of shorter, more practically based guides which are currently available in the UK. J. P. HOWARD Head of Nutrition and Dietetic Services United Bristol Healthcare NHS Trust
© 2000 Harcourt Publishers Ltd