BOOK REVIEWS

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patients with cystic fibrosis, irrespective of whether they are in tertiary, secondary or primary care. This book should be part of every paediatric library and will be ...
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BOOK REVIEWS Cystic fibrosis care—a practical guide Edited by Allison Peebles, Gary Connett, Judi Maddison, Joan Gavin. Published by Elsevier, Amsterdam, 2005, £34.99 (paperback), pp 309. ISBN 0-443-10003-9

Cystic fibrosis in the 21st century Edited by A Bush, E W F W Alton, J C Davies, U Griesenbach, A Jaffe. Published by Karger, Basle, 2006, £103.41 (hardback), pp 322. ISBN 3-8055-7960-8 Cystic fibrosis care—a practical guide is a book that fully delivers on its title. It is indeed a practical guide to the care and management of children with cystic fibrosis, although if you took the cover photographs too literally you might think that the disease occurred only in sporting and artistic girls (although the point about the athletic achievements of children with cystic fibrosis is well made)! Cystic fibrosis is a model disease in paediatrics in that it is truly multifaceted and involves virtually all areas of paediatric practice. The contributing authors, all from Southampton, have consistently written chapters that provide accessible and up-todate guides to all the relevant specific aspects of current management. Although originating from only one geographical centre, I do not think there are noticeable differences from what is practised throughout the country. I enjoyed reading all the chapters, but particularly liked the first chapter on organisation of cystic fibrosis services, which gives a bird’s-eye view of the structure of care both nationally and more locally. I also commend the chapter on psychological issues, which contained some very good advice that is certainly relevant to cystic fibrosis but is generalisable to much of clinical practice. The chapter on primary care is by far the shortest at only two pages, but ends with a request or suggestion that care roles should be clearly defined between general practitioners and secondary services—making the case for clear pathways of care, which are still poorly developed in cystic fibrosis and unfortunately many paediatric disorders. I appreciated the deliberate mistake, presumably for doctors in training or the obsessive

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proofreader (MRCPCH candidates look away now), as fig 2.2 is mislabelled and shows lower sweat sodium in patients with cystic fibrosis than in controls! Many chapters usefully contain the equivalent of practice points, with captions entitled ‘‘remember’’—even though they seem to have been forgotten from the chapter on gastrointestinal problems in this edition! This book replaces a previous 1998 edition, and I am pleased to say that this edition is both bigger and better. The layout is generally more ‘‘reader friendly’’. The images, particularly in the radiology section, are larger and clearer. Although this edition has no colour images, I do not think this detrimental. As we would expect, there are more references to Cochrane and evidence-based medicine. I strongly recommend this book to all health professionals as an introduction to caring for patients with cystic fibrosis, irrespective of whether they are in tertiary, secondary or primary care. This book should be part of every paediatric library and will be of interest to all paediatricians in training and those taking part in the shared care of these patients. Cystic fibrosis in the 21st century is a different volume that neatly complements the previous ‘‘practical guide’’. This is definitely not a textbook, but does rather successfully present an upto-date review of knowledge and research on cystic fibrosis, with some references being less than 1 year old! The five editors have commissioned a range of experts from around the world who present the state of the art on 39 topics. Part 1, entitled ‘‘the basics’’, provides detailed molecular biology on the cystic fibrosis transmembrane regulator, genetics and so on to an advanced level. Certainly, much is well beyond my comprehension as a general paediatrician with an interest in cystic fibrosis. The chapter on genotype–phenotype correlations in cystic fibrosis explains why this is an issue without easy answers. Subsequent chapters present organspecific problems, which relate to understanding pathogenesis and therapeutics, with plenty of information about infectious agents. Other topics include anti-inflammatory treatments and other newer and experimental approaches. This book is of value to all those associated with understanding the science of cystic fibrosis, particularly respiratory paediatricians and their trainees, researchers and anyone presenting cystic fibrosis at ground rounds, who wants to be up to date without using the ubiquitous Google! I Pollock

Crohn’s & colitis: understanding and managing IBD Allan Hillary Steinhart. Toronto: Published by Robert Rose, 2006, £12.95 (paperback), pp 224. This book, which is primarily aimed at lay people, was written by specialists in the field of inflammatory bowel disease (IBD) at the Gastroenterology Department, Mount Sinai Hospital, Toronto, Ontario, Canada. The book is divided into two major parts—

‘‘Understanding Crohn’s disease & ulcerative colitis’’ and ‘‘Managing inflammatory bowel disease’’. The first part covers simplified anatomy with illustrations, pathogenesis, symptoms of IBD and investigations. The third chapter—titled ‘‘What can I expect now that I have IBD’’—resembles a collection of frequently asked questions. Nevertheless, these seem to be highly relevant to affected people and may be raised in the clinical context; examples include ‘‘Can I die from the disease?’’, ‘‘Will my disease improve/get worse?’’, ‘‘Can I still go to school/work?’’. The answers are generally quite detailed and well explained in layman’s terms. The second part is dedicated to management and treatment of IBD. Throughout, the authors highlight that although IBD is essentially not curable (with the exception of colectomy for ulcerative colitis), there are a variety of diseasemodifying treatment options, which can help to reduce symptoms as well as potential complications and facilitate a relatively normal lifestyle. Particularly the extensive chapter on dietary strategies is worth a read, even for health professionals. The authors explain elimination diets, lactose-restricted diets, a variety of supplements, as well as polymeric, semielemental, elemental and modular feeds. The authors also cover the latest ‘‘hype’’, such as probiotics, antioxidants and omega-3 fatty acids. Other options, including tube feeding and intravenous nutrition, are discussed, albeit briefly. The next section elaborates on the psychological aspects related to IBD. The authors illustrate different coping strategies and provide useful advice on when to seek help and from whom. Particularly interesting is the part that contains suggestions on how to cope with the medical system, including how to manage medical appointments efficiently, from the patient’s perspective. The following two chapters contain extensive up-to-date information on treatment with drugs and surgical interventions, including anti-tumour necrosis factor-a treatment. The surgical chapter is surprisingly detailed and elaborates on the actual procedures (again with illustrations) as well as the potential problems after surgery, such as the implications of living with a stoma. The final, rather short chapter covers IBD in children. Specific paediatric problems, such as delayed growth and puberty, as well as psychological issues are unfortunately only touched on briefly. The final chapter is probably the only disappointing part of this brilliantly structured and written book. After having read through these 224 pages, I can now understand why the parents of one of our patients—who has Crohn’s disease—have called it ‘‘invaluable’’. It allows patients (or their parents) to understand the origins, course and complications of IBD and helps them to develop at least some degree of autonomy when it comes to management and treatment choices. However, I also strongly recommend this book to any health professional looking after patients with IBD—apart from providing factual knowledge, it should further understanding of the psychological effect of these conditions and illustrates how to support patients appropriately.

M Tebruegge