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Book review. Helping the hard-core smoker. A clinician’s guide
Coronary Health Care (2000) 4, 54–56 © 2000 Harcourt Publishers Ltd DOI: 10.1054/chec.1999.0062, available online at http://www.idealibrary.com on
Book Reviews
auditory signals – and may therefore reduce some of the symptoms of schizophrenia. Older smokers have particular problems when they try to quit smoking. As a group, they tend to be more sceptical about the benefits, and are less concerned about the health gains associated with cessation. They also see smoking as a means of controlling weight: considered a more important health risk than smoking. These beliefs are clearly unwarranted. In one study, people who quit smoking at the age of 55 years or more had a 70% less risk of death than those who continued to smoke. The chapter considering intervening with older smokers reviews this evidence as well as a number of therapeutic approaches for use in this group. The first involves a self-help programme developed by the chapter authors, then they consider ‘the physician’s role’, a computer-based programme, and pharmacological interventions. Unfortunately, few details of any of the interventions described are given and the interested reader will necessarily have to spend some time accessing primary sources. The chapter on nicotine replacements considers their use with patients who have coronary heart disease, and concludes that the risks of using such medication outweigh the risks of continued smoking and cites two studies which have shown no excess cardiac morbidity with the use of nicotine replacements. It reviews the clinical efficacy of four nicotine replacement systems: nicotine gum, spray, patches and vapour. Patches appear to be particularly effective, although the authors suggest that as participants in six out of the relevant 11 studies failed to sustain cessation levels following the end of nicotine treatment, this is best accompanied by a structured therapeutic programme to help successful quitters more effectively sustain long-term abstinence. The chapter also considers the combined impact of the various approaches (not that good) as well as the potential for combining nicotine replacements with other types of medication which may enhance its effectiveness, including one anti-hypertensive agent (mecamylamine). An alternative is the use of citric inhalers; this has no pharmacological benefit, but seems to reduce craving. A series of chapters reviews a number of psychological interventions and relevant studies. The first provides both clear examples of simple clinical techniques and a case history in situations where smoking is used to help control negative emotions such as anger or anxiety. The second reviews the benefits and
Helping the hard-core smoker. A clinician’s guide. (1999) Edited by D.F. Seidman, L.S. Covey Mahwah, NJ: Lawrence Erlbaum Associates ISBN 0 8058 2755 2 Smoking is an important contributor to the development of coronary heart disease. Following the onset of smoking-related diseases, including coronary heart disease, many people spontaneously quit. However, many continue to place themselves at greater risk of re-infarction than those who quit. This text focuses on the treatment of these and other difficult to treat smokers. This edited book is targeted at all professionals involved in the care of such materials, including physicians and nurses, as well as educators, pharmacists and others. It is written by an exclusively North American group of authors: both clinicians and academics. As a general text, it is targeted at a wide readership and several of the chapters re not directly related to the care of the coronary patients. Such chapters include topics as diverse as implementing pre-natal screening programmes, the role of the dental profession in tobacco cessation, and preventing cigarette smoking among children and adolescents. However, the majority of the chapters have either a direct or indirect relevance to the readers of Coronary Health Care, with the most relevant chapters dealing with ‘intervening with older (>49 years) smoker, current issues in nicotine and non-nicotine medications for smoking cessation, and several chapters focusing on psychological approaches to cessation and the prevention of relapse following cessation. The first chapter provides an excellent and readable review of the biological underpinnings of nicotine dependence. It emphasizes that, although nicotine may impact on mood through its direct effect on nicotinic receptors in the limbic system (the area of the brain controlling mood and ‘pleasure’), it has a much wider impact as nicotine enhances activity of other neurotransmitters such as serotonin and norepinephrine, involved in depression and anxiety. Indeed, the wide impact of nicotine on the brain may explain the high level of smoking among people diagnosed with a variety of mood disorders as smoking may form a sort of self-medication helping people control their symptoms. Perhaps the most intriguing issue raised is that smoking enhances ‘auditory gating’ – the ability to filter out repeated or extraneous 54
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
Book Reviews
auditory signals – and may therefore reduce some of the symptoms of schizophrenia. Older smokers have particular problems when they try to quit smoking. As a group, they tend to be more sceptical about the benefits, and are less concerned about the health gains associated with cessation. They also see smoking as a means of controlling weight: considered a more important health risk than smoking. These beliefs are clearly unwarranted. In one study, people who quit smoking at the age of 55 years or more had a 70% less risk of death than those who continued to smoke. The chapter considering intervening with older smokers reviews this evidence as well as a number of therapeutic approaches for use in this group. The first involves a self-help programme developed by the chapter authors, then they consider ‘the physician’s role’, a computer-based programme, and pharmacological interventions. Unfortunately, few details of any of the interventions described are given and the interested reader will necessarily have to spend some time accessing primary sources. The chapter on nicotine replacements considers their use with patients who have coronary heart disease, and concludes that the risks of using such medication outweigh the risks of continued smoking and cites two studies which have shown no excess cardiac morbidity with the use of nicotine replacements. It reviews the clinical efficacy of four nicotine replacement systems: nicotine gum, spray, patches and vapour. Patches appear to be particularly effective, although the authors suggest that as participants in six out of the relevant 11 studies failed to sustain cessation levels following the end of nicotine treatment, this is best accompanied by a structured therapeutic programme to help successful quitters more effectively sustain long-term abstinence. The chapter also considers the combined impact of the various approaches (not that good) as well as the potential for combining nicotine replacements with other types of medication which may enhance its effectiveness, including one anti-hypertensive agent (mecamylamine). An alternative is the use of citric inhalers; this has no pharmacological benefit, but seems to reduce craving. A series of chapters reviews a number of psychological interventions and relevant studies. The first provides both clear examples of simple clinical techniques and a case history in situations where smoking is used to help control negative emotions such as anger or anxiety. The second reviews the benefits and
Helping the hard-core smoker. A clinician’s guide. (1999) Edited by D.F. Seidman, L.S. Covey Mahwah, NJ: Lawrence Erlbaum Associates ISBN 0 8058 2755 2 Smoking is an important contributor to the development of coronary heart disease. Following the onset of smoking-related diseases, including coronary heart disease, many people spontaneously quit. However, many continue to place themselves at greater risk of re-infarction than those who quit. This text focuses on the treatment of these and other difficult to treat smokers. This edited book is targeted at all professionals involved in the care of such materials, including physicians and nurses, as well as educators, pharmacists and others. It is written by an exclusively North American group of authors: both clinicians and academics. As a general text, it is targeted at a wide readership and several of the chapters re not directly related to the care of the coronary patients. Such chapters include topics as diverse as implementing pre-natal screening programmes, the role of the dental profession in tobacco cessation, and preventing cigarette smoking among children and adolescents. However, the majority of the chapters have either a direct or indirect relevance to the readers of Coronary Health Care, with the most relevant chapters dealing with ‘intervening with older (>49 years) smoker, current issues in nicotine and non-nicotine medications for smoking cessation, and several chapters focusing on psychological approaches to cessation and the prevention of relapse following cessation. The first chapter provides an excellent and readable review of the biological underpinnings of nicotine dependence. It emphasizes that, although nicotine may impact on mood through its direct effect on nicotinic receptors in the limbic system (the area of the brain controlling mood and ‘pleasure’), it has a much wider impact as nicotine enhances activity of other neurotransmitters such as serotonin and norepinephrine, involved in depression and anxiety. Indeed, the wide impact of nicotine on the brain may explain the high level of smoking among people diagnosed with a variety of mood disorders as smoking may form a sort of self-medication helping people control their symptoms. Perhaps the most intriguing issue raised is that smoking enhances ‘auditory gating’ – the ability to filter out repeated or extraneous 54
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