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Can J Hosp Pharm. 2009 Sep-Oct; 62(5): 422.
PMCID: PMC2827008

ASHP’s Clinical Pearls

Reviewed by Michael Legal, ACPR, PharmD

B Canaday, editor. , editor.  American Society of Health-System Pharmacists,  Bethesda, Maryland,  2009. Softcover,  129 pages. ISBN  978-1-58528-218-0. 

The Clinical Pearls presentations at the ASHP Midyear Clinical Meeting are popular and typically well attended. This book represents an attempt to translate the success of this Midyear staple to the print medium. The editor asked 15 Clinical Pearls presenters “to capture the essence of their presentations” for inclusion in this book. The contributors were also asked to expand on their original content and provide more detail, the rationale being that the 5-minute oral presentations are often too brief to cover the topic appropriately.

The book is organized into 15 sections, one for each clinical pearl. The pearls do not appear in any obvious order. Rather, a diverse range of topics is covered, from migraine prophylaxis in adolescents to hyporesponse to erythropoiesis-stimulating agents.

The strengths of this book are that it is generally well written by people who seem to have a good grasp of their subject matter. In addition, a few of the sections come across as bona fide clinical “pearls”, for example, the sections on N-acetylcysteine in severe acetaminophen toxicity and use of succinylcholine in critically ill patients. These are brief and to the point, providing a reasonably succinct take-home message.

Unfortunately, in my opinion, one of the main premises of this book is off the mark: that is, the decision to expand on each topic and provide greater detail. Clinical pearls have been variously described as “short, straightforward pieces of clinical advice”1 and “not common knowledge . . . often anecdotal in nature . . . relevant to patient care”.2 A common theme in these definitions is brevity. Many of the “pearls” in this book are too long (up to 15 pages in length), tending to be especially heavy on background material. Ultimately, the “pearl” is obscured by a sea of information.

A second criticism is that rather than imparting wisdom that may be more anecdotal or derived from experience (as clinical pearls have historically tended to do), many of the sections simply summarize a topic (e.g., “Pharmacy Proofs: ClCR ≠ GFR” and “Celiac Disease: Dangers of Gluten in Medications”) or review the evidence (e.g., “Glycemic Control in the ICU: How Low Should We Go?”). Topic summaries would probably be more easily located in a recent review article or a textbook. Medical evidence becomes outdated quickly and is more logically obtained by searching electronic databases of the literature to answer specific clinical questions.

Finally, the target audience for the book is unclear. Presumably, the volume is intended for any clinical pharmacist, but most books that clinical pharmacists keep on their shelf are used for periodic reference. This book would not serve that purpose well, since it lacks a particular topic focus; other reference sources or databases would be more appropriate for this purpose. However, this book could conceivably serve as basic or companion reading material for a pharmacy resident or student.

In summary, ASHP’s Clinical Pearls contains a number of good summary-type sections on a diverse range of topics. However, it fails to deliver’s clinical “pearls” in the classic sense, most of the sections being too long and lacking a sense of the wisdom wrought from experience. Much of the information in this book could be more easily located elsewhere.


1. The free dictionary Huntingdon Valley (PA)Farlex; 2009. [cited 2009 May 11]. Available from: Search term: clinical+pearl.
2. Mangrulkar RS, Saint S, Chu S, Tierney LM. What is the role of the clinical “pearl”? Am J Med. 2002;113(7):617–624. [PubMed]

Articles from The Canadian Journal of Hospital Pharmacy are provided here courtesy of Canadian Society Of Hospital Pharmacists