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Authors have historically chosen many diverse formats in their quest to teach, including exhaustive compendia, physiologic approaches, and heavily footnoted referential texts, to name a few. It is more unusual to emulate the classic teaching method of mentoring younger physicians in part with material gleaned from clinical experiences. The Oxford Case Histories series presents cases in a most refreshing manner, using the Aristotelian concept of practical knowledge learned through experience and conveyed to those in search of knowledge. We heartily endorse this approach. These cases are chosen by clinicians from the files of Churchill Hospital in Britain, and are real-world cases with good teaching potential.
Oxford Case Histories in Respiratory Medicine has 44 short cases that cover many interesting topics in pulmonary and sleep medicine. It is not a cookbook or heavily referenced text, but it encompasses a wide breadth of topics. It is neither too superficial nor too deep, and it is both a delight and a challenge to read. The stated purpose of this assemblage is to demonstrate cases as they present to the respiratory/sleep physician and include common diseases that present in uncommon ways and vice versa. They range from the routine, such as asthma, to the more arcane, such as upper airway obstruction from Wegener granulomatosis. There are challenging sleep cases as well. The cases are presented as unknowns and a brief clinical history is provided. They are accompanied by relevant laboratory, pulmonary function, and imaging data. A series of questions and brief discussion follows. The flow of information to the reader often occurs in a fashion similar to that in clinical experience.
Although seemingly targeted to the senior British registrar or physician early in practice, this book should be appealing even to the most seasoned clinicians as well. The general medicine physician and respiratory therapists will likewise find it useful and fun. For all those being challenged, this review is a seeming departure from the more “structured learning” or the current fashion of “evidence-based” approaches. Oxford Case Histories in Respiratory Medicine accomplishes its goal of teaching with a non-evidence-based approach and relies more on the experiential aspects of acquired clinical knowledge. We heartily endorse this approach too. Those who have puzzled over the value of many clinical practice guidelines, and have realized that recent reviews, ranging from cardiology to infectious disease, have indicated that only 10–12% of clinical practice guidelines' recommendations are based on level 1 evidence, will also realize that there is a strong value in cases presented by an experienced physician.
The cases in this book include a wide variety of topics and are indexed by both diagnoses and “aetiology,” which is useful. There are many graphics and tabled data. Many cases include key references.
Although we felt the book achieves its goals to educate with the case method and was challenging and fun to read, there were some distractions for non-United-Kingdom readers. A little more editing of the cases could have considerably improved the presentations. The graphics are suboptimal and the key points in many of the figures are difficult or impossible to see, and often we simply skipped the graphics and went to the “answer.” As an example, the high-resolution computed tomogram that is Figure 4.1 is said to show tree-in-bud changes, but lacks any detail. On a follow-up image the changes can be seen. Images for cases 2 and 3 preclude interpretation, and there are other inadequate figures as well.
The occasional presentation of weights in “stones” and the liberal use of international units present obstacles for those not used to those units. There are unexplained abbreviations, such as CETTE (contrast enhanced-transthoracic echogram) and DVLA (driver vehicle licensing authority), as well. That being said, there is a table of abbreviations and normal laboratory values to aid the reader through these annoyances.
There is liberal use of pulmonary function data. Unfortunately, the data tables are not uniform from case to case. Often data are listed as “Measured” and “% Measured” but sometimes no percent value is listed, but a single predicted value is. Diffusion (transfer) capacities are listed as TLco (mmol/min/kPa), which is not familiar to American audiences. Data presentation would have benefited from uniform presentation.
These distractions are offset by the number of outstanding and challenging case discussions, including case 9, which involves cystic and bullous lung disease, and case 2, which provides a good discussion on orthodeoxia. Case 21 presents the challenge of dealing with an airline pilot with sleep apnea. While many of the cases do not have a single correct answer and there is room for further discussion, the reader will be challenged.
In summary, we endorse the purchase and study of this volume and consider it a worthwhile addition to one's library.
- Copyright © 2011 by Daedalus Enterprises Inc.