Resources

Patient information on coping with hepatitis C

HEPATITIS C

Authors: Jenny Heathcote, Colina Yim, Quynh Thai, Averell Sherker
Key Porter Books Limited, 70 The Esplanade, 3rd Floor, Toronto, ON M5E 1R2;
Telephone (416) 862-7777; fax (416) 862-2304
2001/160 pp/$19.95

OVERALL RATING Excellent
STRENGTHS A timely, well written book that provides all the basic information needed by people suffering from hepatitis C or their friends, family, and significant others
WEAKNESS The section on current and future therapies might become dated
AUDIENCE Lay public

This book is part of the “Your Personal Health Series” from the Canadian Medical Association; it is well written and easy to understand. The book addresses serious issues a person diagnosed with hepatitis C virus infection or their friends and family might encounter. The book begins with a chapter summarizing the location, structure, and function of the liver and the various conditions and viruses that can cause hepatitis. This introductory chapter provides an excellent background to the hepatitis C virus and the hepatic and extrahepatic complications it might cause. The second chapter introduces the concept of how people might manifest hepatitis C. It also addresses the role and types of liver biopsies and the contraindications to them. The authors address “myths and misconceptions” about infection with the hepatitis C virus.

Mechanisms of transmission and precautions people infected with hepatitis C virus should take in their homes and when interacting with other people are nicely summarized. The authors provide basic statistics about the frequency of spontaneous clearing of hepatitis C and the frequency with which people treated with antiviral therapy are able to clear infection.

Side effects of both infection with the virus and the various treatments available are reviewed. The authors specifically address the “pros and cons” of proceeding with therapy. A very important section addresses coinfection of hepatitis C and other viruses, such as HIV and hepatitis B. For patients with hepatitis C who receive therapy, the authors provide helpful tips on how to avoid complications or minimize symptoms.

The issue of liver transplantation is discussed, specifically addressing the possibility that hepatitis C will return in a newly transplanted liver. The chapter, “What Can I Do To Help Myself?” suggests how patients can influence their outcomes. Another important issue covered is abstinence from alcohol. The authors also discuss complementary therapy and the future use of antiviral therapies.

A glossary defines many of the terms referred to in the book and lists other available resources in both Canada and the United States, including website addresses and other books. The book is well indexed to help readers find specific information.

Overall the authors have done an excellent job in summarizing the key issues associated with hepatitis C infection. The book is well written, straightforward, and concise. I recommend it to anyone with hepatitis C infection.

—John M. Embil, MD, FRCPC, FACP

Dr Embil is an Associate Professor in the Department of Medicine, Section of Infectious Diseases and Medical Microbiology, at the University of Manitoba in Winnipeg. He is also the Director of the Infection Control Unit at the Health Sciences Centre and a consultant in Infectious Diseases for the University of Manitoba teaching hospitals and the Winnipeg Regional Health Authority.

Guide for caregivers of dying patients

A CAREGIVER’S GUIDE. A HANDBOOK ABOUT END OF LIFE CARE

Authors: Karen Macmillan, Jacquie Peden, Jane Hopkinson, Dennie Hycha
The Palliative Care Association of Alberta and The Military Hospitaller Order of St Lazarus of Jerusalem, 35 MacArthur Ave, Ottawa, ON K1L 8L7;
Telephone (613) 746-5280
2000/158 pp/$25; no charge to family caregivers in Alberta

OVERALL RATING Excellent
STRENGTHS Highly practical, well organized, simply written, good index, comprehensive, well illustrated
WEAKNESSES None
AUDIENCE Non-professional caregivers of dying patients

Successful care of dying patients at home depends heavily on non­professional teams of family, friends, and (frequently) untrained or minimally trained aides. Usually family members have no experience of bedside care of very ill patients and require education during the course of the disease. This book will educate caregivers to make them more effective members of the team. It will also increase the satisfaction and sense of accomplishment they experience as they care for their loved ones.

The authors begin with useful advice on coping with the diagnosis and on self-care for caregivers. This is followed by basic instructions on bedside nursing skills and on dealing with common symptoms of cancer. Recognition and home management of serious complications (eg, spinal cord compression) and when to call the doctor are also covered.

This book has been written by nurses, in non-technical language. Coverage of important issues is thorough, and clear strategies are offered for any event. Important points are highlighted in colour boxes. The advice given is sound. Even the most difficult complications (eg, seizures, hemorrhage) are portrayed as manageable in confident and reassuring language.

Literate caregivers who read this book will be reassured that they can handle the care required to help a dying person stay at home for as long as possible and even until the time of death, if that is the goal.

—David P. Ouchterlony, MD, CCFP, FCFP

Dr Ouchterlony is a palliative care consultant with The Temmy Latner Centre for Palliative Care in Toronto, Ont.

Making clinical decisions with patients

EVIDENCE-BASED PATIENT CHOICE. INEVITABLE OR IMPOSSIBLE?

Editors: Adrian Edwards, Glyn Elwyn
Oxford University Press, 70 Wynford Dr, Don Mills, ON M3C 1J9;
Telephone (416) 441-2941; fax (416) 444-0427; website www.oupcan.com
2001/352 pp/$52.95

OVERALL RATING Good
STRENGTHS A good overview of the current state of knowledge on decision making in clinical encounters
WEAKNESSES Occasionally reads more like a religious text with “thou shalts”; few contributors are practising physicians, and those who are practise part time, so the scenarios seem simplistic and unrealistic
AUDIENCE Academics with an interest in patient-physician communication or decision making in clinical encounters

Just when you thought you had the patient-centred clinical method down and knew how to do literature searches to practise evidence-based medicine effectively, you now must add evidence-based patient choice (EBPC) to your professional repertoire. You might think you already involve your patients in the decision-making process, but according to studies quoted in this book, you probably do not.

I had never heard of EBPC before reading this book. I thought, obviously naïvely, that it was incorporated in “reaching common ground” of the patient-centred method. Boy, was I wrong.

Evidence-based patient choice involves a full and frank discussion with your patients regarding all the available treatments and their risks (happy faces interspersed with sad ones pictorially demonstrate those risks). Decision trees, videos, and handouts can all be used to accomplish this task.

One of the contributors acknowledges that EBPC would be part of a utopian health care system. The contributors, who do not actually practise EBPC themselves, are content to state that doctors who do not practise this method are deficient. Nobody seems quite sure, however, who is going to pay for the extra time and materials needed to practise EBPC.

Apart from the occasional stumble into “academe,” this book is well written and represents knowledge as it currently stands in the field. It will make readers question the way they practise, but its suggestions strike me as unrealistic in the present health system. The book will interest academics in the field. I doubt it will interest practising clinicians, although it might tweak some of their communication styles in clinical encounters.

—W.E. Osmun, MD, MCLSC, CCFP

Dr Osmun is an Associate Professor in the Department of Family Medicine at the University of Western Ontario in London. He practises medicine in Mount Brydges, Ont, and at Strathroy Middlesex General Hospital.