Idea Transcript
and laboratory tests necessary for the diagnosis of senile dementia are outlined. The importance of recognizing acute and chronic mental changes in the elderly, which may be reversible, is pointed out. A new technique for the evaluation of mental status, FROMAJE, is outlined. Each letter represents an aspect of mental function. The test has advantages over other tests of mental function, for it takes into consideration such factors as reasoning, judgement and emotional status. According to one of the authors, the care of the elderly patient with multiple problems falls mainly to the family physician, who should be able to treat and give appropriate advice and assistance to the elderly patient whether the complaint be physical, somatic, psychosomatic or behavioural. Various resources are available to the physician dealing with comprehensive medical problems should the need arise. In part III, papers are presented on the comprehensive care of the cognitively impaired elderly individual, the nursing care associated with this group of patients, the use of medication to prevent the need for custodial care, and the pharmacokinetics of psychotherapeutic agents for the elderly. This book is highly recommended for workers in the geriatric field. J.E. GIBSON, MD
Department of geriatric and continuing care medicine St. Mary's of the Lake Hospital Kingston, Ont.
Emergency Care Handbook. How
able to describe his or her symptoms in a more helpful way. He also shows how one should immediately address the problem of defusing a hostile situation; the kind of situation that, if inexpertly handled, explodes into one of anger, frustration, ill-will and bitterness. The book is written in simple and clear language, and includes chapters such as "The view from the Guerney" and "Reality shocks: handling patient disorientation to reality". The author persistently expresses the concept of "gently, yet firmly and compassionately" from the beginning of any exchange, tuning in on the patient's wavelength. Most of what he says will ring true to persons who have worked in an emergency department for any length of time and who have kept their senses open as to what patients are trying to tell them. It is only in one chapter that Ciancutti has stretched the limits of simplicity by suggesting that the amount of pain can be assessed by measuring it in volume, colour and shape (for example, a conical blue 1 0O-g object). Pain is often best quantified by how much it intrudes upon one's daily activities. However, this is my only criticism of a book that should be mandatory reading for anyone working in an emergency department, be they ward clerk, receptionist, physician, nurses' aide, orderly or porter, as well as for ambulance attendants, police officers and firefighters. A.F. HENRY, MD, CCFP
Chief, emergency department Ottawa Civic Hospital Ottawa, Ont.
to Deal with People in Emergen- Grant's Atlas of Anatomy. 7th ed. cies. Arthur R. Ciancutti. 100 pp. Edited by James E. Anderson, Technomic Publishing Co., Inc., 500 pp. approx. Illust. The WilWestport, Connecticut; Natural hams & Wilkins Company, BaltiLearning Center, San Anselmo, more, Maryland; Burns & MacCalifornia, 1977. Price not stated. Eachern, Don Mills, Ont., 1978. ISBN 7762-242-6 $34.95. ISBN 0-683-00209-0 This book, which contains a series This seventh edition of "Grant's Atof essays on different aspects of las of Anatomy" includes much of patient-physician encounters, most the material of previous editions. successfully explores areas of patient- However, colour has been incorphysician relations that are not taught porated in several previously black in medical school. A few interns and and white illustrations. The sections residents are intuitively aware of have been rearranged so that they what the author is describing, but now correspond to the order in most are ignorant in this regard. "Grant's Dissector". Ciancutti repeatedly gives examples The volume begins with a discusof situations in which only minor sion of the thorax rather than the variations in the professional tech- upper limb. Whatever the reason, this nique of interviewing can make the is a more logical arrangement for a patient feel much more at ease and student learning anatomy. It is better 1284 CMA JOURNAL/DECEMBER 9, 1978/VOL. 119
DERMOVATE
(clobetasol propionate 0.05%) TOPICAL CORTICOSTEROID
Rapid relief can mean an early return to normal living. INDICATIONS ¶Ibpical therapy of recalcitrant corticosteroidresponsive derrnatoses, including severe cases of psoriasis and eczematous dermatitis. CONTRAINDICATIONS Infected skin lesions if no anti-infective agent is used simultaneously: fungal and viral infections of the skin, including herpes simplex. vaccinia and varicella; pregnancy and lactation; hypersensitivity to any of the ingredients. ¶Ibpical corticosteroids are also contralndicated in tuberculous lesions of the skin. WARNINGS Dermovate should not he used in the eye. When used over extensive areas for prolonged periods, it is possible that sufficient absorption may take place to give rise to systemic effects. It is advisable, therefore, to use Dermovate for brief periods only, and to discontinue its use as soon as the lesion has cleared up. Do not use more than fifty grams of Dermovate per week. Patients should be advised to inform subsequent physicians of the prior use of corticosteroids. PRECAUTIONS 'Ibpical corticosteroids should be used with caution on lesions close to the eye. Posterior subcapsular cataracts have been reported following systemic use of corticosteroids. Although hypersensitivity reactions are rare with topically applied steroids, the drug should be discontinued and appropriate therapy initiated if there are signs of hypersensitivity. In cases of bacterial infections of the skin, appropriate antibacterial agents should be used as primary therapy. If it is considered necessary, the topical corticosteroid may be used as an adjunct to control inflammation, erythema and itching. Ifs symptomatic response is not noted within a few days to a week, the local application of corticosteroid should be discontinued until the infection is brought under controL Significant systemic absorption may occur when steroids are applied over large areas of the body, especially under occlusive dressings. Because the degree of absorption of clobetasol 17-propionate when applied under occlusive dressing has not been measured, its use in this fashion is not recommended. Because the safety and effectiveness of Dermovate has been established in children, its use in children is not recommended. ADVERSE REACTIONS Local burning, irritation, itching, skin atrophy, striae, change in pigmentation, secondary ininfection, hypertrichosis and adrenal suppression have been observed following topical corticosteroid therapy. DOSAGE AND ADMINISTRATION Dermovate Cream and Dermovate Ointment are applied thinly to cover the affected area, and gently rubbed into the skin. Frequency of application is two to three times dally, according to the severity of the condition. The total dose of Dermovate applied weekly should not exceed fifty grams. Therapy should be discontinued if no response is noted after a week or as soon as the lesion heals. It is advisable to use Dermovate for brief periods only. Note: If malntenance therapy is required, a lower strength topical steroid, such as Betnovate, is indicated. DOSAGE FORMS Dermovate Cream and Dermovate Ointment are available in 15 and 60 g tubes, and in 100 gjars. Product monograph available on request REFERENCE: 1. Floden, C.H. et al., Current Med. Research and Opinion, 3:875-877,1975.
\Gt/Glaxo Labomtories
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