The Hands-on Guide to Data Interpretation
August 2011, Wiley-Blackwell
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Whether as a medical student or junior doctor, clinical data is ubiquitous within medicine. The quantity of data that we are required to interpret can often make it seem as though we are in a race to the top of Everest – especially when a well-intentioned consultant thrusts an ECG in front of you and asks you to interpret it... There is nothing worse than being unable to interpret findings in an OSCE or whilst on whirlwind ward rounds. Conversely, being able to understand and use knowledge to interpret clinical information can be thoroughly rewarding. “The Hands-on Guide to Data Interpretation” is the perfect companion and tutor for all data interpretation needs. The Hands-on Guide covers all the main laboratory, clinical and radiological tests used by doctors in the investigation and management of patients. The book is systems based and split into 16 chapters which include specific chapters on microbiology, genetics and imaging. Included at the start of the book is a comprehensive collection of reference ranges including those for hormones and tumour markers. There are also conversion tables for different units for those of us who can’t remember how to change pounds into kilograms. The final chapter on patient data provides practical advice for clerking on the wards. This section places emphasis on the holistic care of patients and demonstrates how knowledge can be applied by bringing specialities together. This 247 page handbook is highly visual and well laid out. It is concise but thorough. The authors have kept the student in mind throughout and have employed a variety of techniques to help make the contents digestible and memorable. Such techniques include the use of mnemonics, tables, graphs, flowcharts, diagrams and clinical images. Mnemonics are used broadly throughout each chapter. They include widely used favourites such as GET SMASHED for the causes of Acute Pancreatitis. Arguably they are used a bit too extensively throughout the book. However, they act to support learning rather than standing as the sole method of learning. Despite their extensive use the layout of such mnemonics prevents them from becoming tedious. Tables are frequently used by the authors to summarise information or to compare and contrast key pathologies. An example which I found particular useful was the comparison between Crohn’s disease and Ulcerative Colitis. The table was concise and provided more detail than was taught in lectures. The information was easy to retain and recall. I’m particularly fond of the table’s ability to make me sound pseudo-intelligent on ward rounds! Graphs are used to emphasise information covered in the text. They are well used throughout and include patterns such as flow-volume loops. Flowcharts are use similarly but also provide greater depth to the information in the text and are excellent in displaying quite complex conceptual data. Particularly useful is a detailed flow chart for adrenal steroid synthesis which all endocrinologists seem to have tattooed on their eyelids! Diagrams are clear and well presented. The majority assist information in tables and the text. Such diagrams are utilised well in presenting dermatomes and myotomes in neurology which support textual information that describes distribution and action in more detail. A unique selling point of this book is the helpful tip boxes which might not be found in a standard text. These handy tip boxes are found in every section and highlight salient points. For a pocket-sized book the contents are particularly impressive. The authors always endeavour to explain key pathology and relate these to findings and patterns in data. Where appropriate, important elements of clinical examination are included, such as the cranial nerve examination. Chapters are further completed by severity scores such as the CURB-65 score for community acquired pneumonia and by risk assessment measures such as the Well’s score for the probability of pulmonary emboli. As alluded to earlier, like many others, I often struggle to understand ECGs. This book covers all the key principles of ECGs thoroughly and includes a simple but detailed 10 step guide to interpretation. There are enough examples to emphasise the points covered but perhaps not enough to become adept at pattern recognition. I similarly feel that examples of x-rays are limited. However, key pathological changes are all excellently described and accompanied by examples. It is also arguable that more examples might have hindered the book’s usefulness as a pocket guide. In both incidences this book proves excellent as a revision tool but is not quite as useful when approaching these modalities for the first time. Other modalities are similarly explained in great detail but are lacking in examples. A separate microbiology chapter is a real advantage of this book. The content is simple and understandable. Flowcharts describe gram staining and identification of bacteria whilst tables are used to cover the general sensitivities of bacteria to antibiotics. I was also particularly impressed by a table offering an introduction to oncological chemotherapeutics. The table succinctly classifies agents and states the most common side effects for each. In conclusion “The Hands-on Guide” is very useful as an introductory text to data interpretation. However, the real strength of this book is apparent when the reader has some previous knowledge of the desired system or is using the book for revision. I feel that the book is an unmatched text in this respect and highly recommend it. (Owen Hibberd, 3rd year medical student, UEA)
"It provides an excellent reminder of background physiology with clear explanations of how this relates to tests and their clinical application. For those doctors in primary care, it is also a useful tool and will be particularly helpful in interpreting those slightly aberrant results that fall into your inbox." (InnovAit, 2 February 2012)
Format: Softbound text consisting of preface, summary of text abbreviations, and 16 chapters, including index.
Audience: Students in medicine and health sciences, interns, residents, physicians, nurses, and other medical professionals for which clinical data interpretation is critical to patient care and management.
Purpose: This is a pocket-sized reference containing supporting information appropriate to clinical application. The use of investigative resources and input by experts in specific medical disciplines help focus the use of data to support and minimize challenges associated with required clinical decision efforts.
Content: The text is divided into 16 chapters addressing clinical data associated with normal ranges (clinical/physiological normals), the cardiovascular system, the respiratory system, gastroenterology, endocrinology, the renal system, neurology, hematology, rheumatology, obstetrics and gynecology, ophthalmology, oncology, microbiology, genetics, imaging, and patient data. Except for the first chapter on normal clinical ranges, all chapters follow the same presentation format. While materials are comprehensive and well structured, references to established sources are only incorporated as adaptations. This textbook is a clinical guide that can be carried during clinical rotations in hospital settings. The textbook is well written, as topic coverage supports differential diagnostic parameters leading to sound conclusions.
Usability: All chapters cover topics in a clear and articulate manner, with consistent formatting that supports introductory information with specific subtopics in the chapter. Each chapter is replete with normal ranges; reference data including diagrams, images, charts, tables, physiological ranges; and notes from specialists within the areas covered. As noted above, tabular data are adaptations from sources, but there is no comprehensive bibliographic section provided. The price of the edition is appropriate and well within reach of students, practitioners, and professionals.
Highlights: The single strength of this textbook is the amount of important and practical data packed into a small, portable textbook. Text presentations are concise and clearly written, supporting practicality in real-world applications. The final chapter addressing patient data is a welcome enhancement to the diverse medical specialties covered in preceding chapters, allowing for effective charting sorely needed for accurate presentation of data in the clinical arena.
Limitations: The material presented is directly aligned with the purpose and intent of the authors. This reviewer finds no limitations associated with the text. However, a listing of additional primary references at the end of each chapter would serve to enhance the quality of the materials presented.
Reviewer's Summary: After reviewing the amount of information provided and comparing it to the intent of the authors, I highly recommend the text to those who require a concise and practical reference source in medical practices. While this textbook serves the clinical informational needs of diverse medical audiences, interpretation and action taken in response to clinical data leading to differential diagnosis should be conducted under the guidance of an experienced medical practitioner. The authors and contributors are to be commended on an excellent job in preparing this textbook." (Peter D. Frade PhD, Wayne State University, in The Annals of Pharmacotherapy, April 2011)
"I found it a useful reference tool in dealing with all those haematology and biochemistry results that we see in our daily practice. . .Overall, an absoloute must for every GP's bookshelf, but also a pertinent book for medical students." (General Practitioner, 16 September 2011)
"This book has been written by a group of junior doctors who chose to address interpretation of the vast amounts of clinical data that clinicians encounter every day. I found it a useful reference tool in dealing with all those haematology and biochemistry results that we see in our daily practice.
It is pocket-sized, yet comprehensive. With care of more complicated medical conditions being transferred to the community, this sort of book will be very useful for GPs.
The book is divided into systems and the approach is logical. What I find most impressive is that the authors have been intelligent in the topics they have included, selecting the most common conditions as well as clinical scenarios doctors tend to struggle with. At the start of each chapter is a summary of the topics covered.
It is written in a readable and simplistic style and the format is clear and concise. There is a plethora of tables, diagrams and charts. I particularly liked the flowchart to differentiate between Gram-positive and Gram-negative bacteria, the summary of antibiotics and the tables for interpreting the minefield that LFTs can be.
Scattered throughout the book are the various mnemonics that we all learnt at medical school, such as 'GET SMASHED' for the causes of acute pancreatitis.
This is just the sort of handbook I wish I had had at medical school and during my clinical training. It is a very succinct synopsis of the common things that clinicians encounter, explaining various clinical examination findings, interpretation of blood results and other investigations, including radiology, ECGs, pleural, ascitic and lumbar puncture fluid.
The beauty of this book is that it effectively simplifies the subject matter and gives you an at-a-glance approach to the task in hand.
Overall, an absolute must for every GP's bookshelf, but also a pertinent book for medical students. I wait with anticipation for an iPhone app." (Dr Mathukia, a GP principal in Ilford, Essex, for GPonline.com)
"What is good about this book?
The aim of this book is to provide a quick reference guide to interpreting the wealth of data that we as doctors come across in our daily working lives. It focuses on common investigations and tests, providing summaries of how to interpret the results and apply them in the clinical setting. Divided into 16 short chapters, it encompasses the major medical and surgical specialties and is easy to use with bullet point sections, clear headings and a full index that aids in rapid retrieval of information. A specialist has reviewed each chapter, and the book includes two GP registrars and a foundation year doctor among its authors, making it highly relevant to the junior doctor working in either hospitals or the community.
This book is set apart from other texts in its field by an extensive use of clear concise physiological explanations for both diseases and tests in the clinical chapters. This works particularly well in specialties such as neurology and haematology, where the complex is made simple. The section on the neurological examination, for example, includes clear easy-to-access diagrams of dermatomes, reflexes and visual fields, and there is a useful guide for how to approach neurological disorders.
While the section on the interpretation of the full blood count and its abnormalities appears rather dry, it is helpful for focused retrieval of information. Good use has been made of tables of blood results, with abnormal results listed alongside the normal together with explanations of their relevance and suggested causes. The liver function, hepatitis B, thyroid function and bone profile tables are excellent, combining large amounts of often complicated data into clear summaries which are invaluable desk or bedside tools.
The chapter on genetics, which is a frequently neglected knowledge area, is brief but thorough and serves well as an aide-mémoire for patterns of disease inheritance. It also provides useful templates for genetic diagrams, which could be used to aid explanations during consultations with patients.
What is bad about this book?
The book can be over-complicated for such a compact reference guide and seems to lose its way at times, including an excessive amount of physiological theory or background detail. This is evident in the discussion of lung volumes and Gram staining. Keen chemists will recognize the Henderson–Hasselbach equation in the respiratory chapter, but this too seems an unnecessary inclusion of theory that adds little for the reader.
The cardiology section appears dense and difficult to follow and readers may be advised to turn to a more straightforward guide for reminders on this investigation and its interpretation. Similarly, different cancers are discussed briefly in relevant speciality chapters and a separate oncology chapter tries to cover this vast and complicated subject with lengthy specific cancer staging examples, which readers may prefer to explore in other books.
Some diagrams have been included with little accompanying explanation and require further reference to the text, which detracts from the ability of the book to act as a quick reference guide. The ophthalmology section also suffers from having only black and white retinal images.
Finally, the book can at times read like revision notes (from where the authors state that they took inspiration) and there is some unnecessary repetition; the anion gap appears in both the respiratory and the renal chapters, for example, and a description of the histological findings in inflammatory bowel disease is repeated within the same chapter.
In conclusion, this is a book largely written for the medical student or hospital-based junior doctor, and overall, it is a succinct and thorough reference guide. It provides an excellent reminder of background physiology with clear explanations of how this relates to tests and their clinical application. For those doctors in primary care, it is also a useful tool and will be particularly helpful in interpreting those slightly aberrant results that fall into your inbox." (Dr Alexandra Davidson, GP Registrar and Academic Fellow, University College London, for InnovAiT, June 2011)