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Critical Diagnostic Thinking in Respiratory Care: A Case-Based Approach FREE TO VIEW

Gary J. Hospodar, MAOM, RRT, RCP
Author and Funding Information

St. Vincent Hospital, Santa Fe, NM

Chest. 2002;122(2):757. doi:10.1378/chest.122.2.757
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By James K. Stoller, Eric D. Bakow, and David L. Longworth. Philadelphia, PA: W.B. Saunders, 2002; 398 pp; $34.95

Part I of Critical Diagnostic Thinking in Respiratory Care: A Case-Based Approach begins with a description of the principles underlying clinical diagnostic teaching and problem-based learning for respiratory care practitioners. It cites evidence-based medicine (EBM) as a preferred learning approach and stresses the importance of using “best practices” established by randomized clinical trials in daily clinical practice. By using this approach, emphasis is placed on data collection tools that have been established as reliable and valid. Throughout, this book is organized not as a definitive textbook, but as a method to enhance the understanding of the EBM model, with sections devoted to separate disease processes, specific types of diagnostic and therapeutic modalities available in clinical practice, and common pitfalls in assessing and treating various diagnoses.

Part I also stresses the importance of performing a detailed evaluation of medical history, physical assessment, and laboratory testing in a manner that is patient and family centered, and explores other resources available to collect and compile data. The text describes how to establish a diagnosis or differential diagnoses from the assessment data, and teaches the need to systematically compare and contrast assessment findings. The authors underscore the importance of periodic reevaluation when additional assessment data become available. However, while detailed and thorough, the information in part I can be overwhelming to the novice. Part I provides fair warning that the rest of the book is pitched at the level of the experienced respiratory care practitioner or the advanced house staff member. The use of an algorithmic methodology would have enhanced the understanding of the EBM model for all readers, both beginner and veteran.

Throughout the remainder of the text, the authors provide a concise and timely review of common and uncommon clinical scenarios throughout the spectrum of pulmonary medicine. Part II explores “Common Presentations in the Outpatient Setting.” Part III describes “Common Problems in the NonICU Patient,” while part IV evaluates the “Common Problems in the ICU Adult.” Though most chapters vary slightly in presentation style, they all contain similar elements and format so as to enhance the EBM model. At the beginning of each chapter, a different clinical problem is presented, pertinent to the subject at hand. Following the vignette, the authors provide a pathophysiologic explanation; assessment data appropriate to making a differential diagnosis; clinical features that suggest a specific diagnosis; invasive and noninvasive diagnostic testing opportunities; tables that include helpful information for interpreting signs and symptoms; and clinical pitfalls and common mistakes in the assessment and treatment of the diagnosis. In addition, most chapters include appropriate supportive information such as tables, graphics (eg, spirometric tracings, sleep study data, ventilator waveforms), or flow charts and radiologic information that all assist in understanding the formulation of a diagnosis and implementation of treatment, all conforming to EBM methodology.

Throughout the text, sections are well organized around abundant and useful clinical vignettes and accompanied by key references. Stoller and colleagues have succeeded in providing the most current medical information regarding patient management, thus allowing the reader to achieve best practice status. The target audience would likely to be respiratory care practitioners, but may include medical students and house officers, although anyone participating in the assessment and care of pulmonary patients could find it useful, including nurses and even seasoned attending physicians. While this type of resource is not designed to replace more comprehensive references, Clinical Diagnostic Thinking in Respiratory Care: A Case Based Approach succeeds in quickly and efficiently introducing its readers to the EBM model and the methodology used to attack a wide array of respiratory care issues in a variety of settings.




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