Alan L. Silver

Reviews and Notes: Health Promotion and Disease Prevention in Clinical Practice

SH Woolf, S Jonas, and RS Lawrence; eds. 618 pages. Baltimore: Williams & Wilkins; 1996.

Development of faculty consultants in a problem-based third year community medicine clerkship

35.00. ISBN 0-683-09270-7. Order phone 800-638-0672. Clinical preventive services, that is, preventive medicine as it is applied to individual patients, has increased in prominence in medical care. Recommendations about aspects of screening, counseling, immunization, and chemoprophylaxis for individual patients have been made by various professional organizations, most notably the U.S. Preventive Services Task Force. The report from the Task Force supplies evidence-based assessments of the clinical efficacy of various preventive services. The Task Force provides great detail on what should be offered to individual patients and when. What has been lacking is a comprehensive yet practical work on how to provide clinical preventive services, from techniques for the history and physical examination to techniques for counseling and practice organization. Health Promotion and Disease Prevention in Clinical Practice was written to fill this void. The book is organized around the tenets that risk factors should be identified in asymptomatic patients and that this risk assessment should be used to tailor health maintenance plans to individual patients. After briefly summarizing basic epidemiologic and population-based principles (such as absolute versus relative risk reduction and test sensitivity and specificity versus positive and negative predictive values), the book walks the clinician through the elements of the usual patient encounter, providing clear and frequently detailed information on pertinent aspects of the history, physical examination, and laboratory-based tests to determine patient risk factors. The major portion of the book examines approximately 17 health maintenance topics, such as tobacco use and immunizations. Chapters provide specific suggestions about testing or counseling. Individual screening assessment tools are presented for such factors as nutritional status, depression, and alcoholism. These tools are supplemented by citations of recent work in the medical literature and the presentation of sources of educational materials for both patients and professionals. Behavioral counseling techniques are described in detail. The various authors give specific instructions in communication skills for everything from history taking to discussing lifestyle modification. The final part of the book discusses practice organization for the implementation of preventive services. Useful information is presented on developing health maintenance protocols in various practice settings. Also included are chapters on reimbursement and on how to link billing information to computerized tracking systems. The book even lists the pertinent CPT and ICD-9-CM codes. The books shortcomings are few and far between. Some topics, such as chemoprophylaxis, are presented only briefly. There is the occasional typographical error. While reading a given chapter, the reader must frequently refer to tables and summaries presented in other chapters. Williams & Wilkins would do the medical community a great service if it would publish this work in combination with the Task Force report in a computer-readable format with hypertext capability. This book admirably fulfills its goal of providing information that clinicians can incorporate into day-to-day practice. One can look up specific information quickly during a busy office session or use it to plan a monitoring system for a large group practice. This book belongs in the office of every practitioner who provides preventive services.

Preventive Treatment for Tuberculosis in Elderly Persons

This paper describes the development of consultancy groups in behavioral science, epidemiology and biostatistics, and information science in a required community medicine rotation with a twenty year history. The addition of consultants to individual student tutors and field preceptors has led to a structure which promotes student-project flexibility, development of critical assessment skills and independent learning while maximizing faculty expertise and effectiveness.

The Age Threshold for Isoniazid Chemotherapy-Reply

Excerpt To the editor: Stead and colleagues (1) have provided valuable evidence documenting the incidence of isoniazid-induced hepatitis and the effectiveness of isoniazid chemoprophylaxis in elder...

Community-oriented health services education: a strategy for international cooperation.

In Reply.— We appreciate the comments of Dr Reichman supporting the conclusions of our article. If prevention of tuberculosis with isoniazid becomes accepted practice again, clinicians will face additional questions: Who should be screened with tuberculin tests? How often? Using which methods? We are currently carrying out further research in these areas and encourage others to do the same.

The age threshold for isoniazid chemoprophylaxis. A decision analysis for low-risk tuberculin reactors

This paper describes the approach of the Department of Community Medicine of the Mount Sinai School of Medicine in the education of local and foreign physicians and their participation in the development of community oriented health care systems. It also presents the first steps taken by this medical school to create an international program whose aims are to develop long-term partnership agreements with foreign universities by bringing together and integrating medical education with the development of community-oriented health care services.