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Customer Review

46 of 54 people found the following review helpful
1.0 out of 5 stars Outdated! No updates from the 2nd edition!, November 10, 2013
This review is from: Step-Up to Medicine (Step-Up Series)3rd EDITION (Paperback)
Apparently the publishers of this book took the previous edition (Step-Up to Medicine (Step-Up Series)) and slapped a shiny new cover on it. I don't think there are any actual updates, as this book is terribly outdated. Some examples:
- There is no mention of the interferon gamma release assays (IGRAs) used to test for TB. Although relatively new, they are widely used in clinical practice today, especially to confirm positive PPD results and to test for infection in individuals who have been vaccinated with the BCG vaccine. The authors state that a patient who has received the BCG vaccine for TB will have a positive PPD (true) but should be treated for TB like anyone else with a positive PPD (WRONG!). This may have been the standard of care 5 years ago but this would be malpractice now.
- The authors mention "Ultralente," a long-acting insulin preparation that was discontinued so long ago I had never heard of it! Meanwhile, there is no mention of insulin Detemir, one of the two long-acting insulins that every MS2 learns about.
- In its discussion of treatments for Multiple Sclerosis, the authors mention beta interferons and glatiramer acetate but admit that studies have only been in progress for 5 years. I looked back at the 2008 edition and it says the exact same thing. If it was 5 years in 2008, then it's 10 years in 2013! A lot happens in 5 years (these are now first-line agents for MS backed by very solid evidence).

My other gripes with this book: It isn't clear or detailed enough. I frequently have have to refer to my Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine (Pocket Notebook Series) (a splendid resource) for specific info when studying. It's sad that that that tiny pocket-size book has more depth and clarity than this 500+ page review book. Lastly, Step-Up is full of typos. You know the less-than (<) and greater-than (>) signs? They're backwards about 1/3 of the time. And there are entire tables so ill-formatted that they're incomprehensible. Garbage book. If you must buy it, save some money and get the previous edition.
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Showing 1-4 of 4 posts in this discussion
Initial post: Jul 6, 2014 10:25:19 AM PDT
ZK says:
I was debating if I should buy the 3rd edition of this book (already have 2nd edition) but after reading your review I don't think I need an upgrade. Thank you for writing an honest review & keeping me (and others) from wasting $50.

In reply to an earlier post on Jul 12, 2014 8:07:40 PM PDT
Last edited by the author on Jul 12, 2014 9:01:46 PM PDT
This is a great book. The guy who wrote these comments has no idea what he is talking about. Furthermore, the guidelines in this book are CORRECT for TB management in someone with BCG vaccine. Moreover, you do infact treat someone that had the BCG vaccine and a positive PPD with isoniazid for 9 months as this book clearly states. That is not malpractice, that is just incompetence on the guy who made this original post. You are spreading wrong information and people are being affected by your own incompetence. Step up to medicine is an EXCELLENT resource and highly recommended. Oh and in case you don't believe me about the TB test, check out http://www.cdc.gov/tb/publications/factsheets/prevention/bcg.htm :)

Posted on Jul 12, 2014 8:09:17 PM PDT
This is a great book. You have no idea what you are talking about clearly. There is a paragraph talking about interferon gamma release assay in the TB section. Furthermore, the guidelines in this book are CORRECT for TB management in someone with BCG vaccine. Moreover, you do infact treat someone that had the BCG vaccine and a positive PPD with isoniazid for 9 months as this book clearly states. That is not malpractice, that is just incompetence on the guy who made this original post. You are spreading wrong information and people are being affected by your own incompetence. Learn how to read. Step up to medicine is an EXCELLENT resource and highly recommended. Oh and in case you don't believe me about the TB test, check out http://www.cdc.gov/tb/publications/factsheets/prevention/bcg.htm :)

In reply to an earlier post on Jul 12, 2014 8:56:17 PM PDT
First, what page is that paragraph on? I can't find any mention of the interferon gamma release assays in Step-Up.

Second, the 2010 CDC guidelines state: "An IGRA is preferred for testing persons who have received BCG...Use of IGRAs in this population is expected to increase diagnostic specificity and improve acceptance of treatment for LTBI." OK so I'll admit treating a high-risk patient with prior BCG vaccination and a positive PPD isn't malpractice, but in an average-risk patient it's foolish not to use the more specific test (IGRA) when available.
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