Algorithmic approach - NCBI

tions" from well-meaning physicians whose interests lie in other topics. A new point of view is required. A well-organized, adequate occupational health service oriented toward cost-effective prevention and toward minimizing time off work through fitness-to-work evaluations and early-return-to-work programs has the potential to save a major institution far more than it costs, to shield the institution from liability and to reduce feelings of dissatisfaction among employees that are often expressed through collective bargaining positions and in absenteeism rates. It is ironic that hospitals, the focal point of our health care system, have lagged so far behind other major industries. The correction, however, is not to divert scarce resources away from patient care or to bash administrators. Rather, what is needed is a change in policy and attitudes, under which occupational health services for employees would be perceived as supportive of the primary mission of the hospital rather than as a distraction. Denning's bibliography was not prepared for the purpose of documenting these issues but does illustrate them well. Tee L. Guidotti, MD, MPH, CCBOM Professor of occupational medicine Faculty of Medicine University of Alberta Edmonton, Alta.

Algorithmic approach to infection Infectious Diseases of Children and Adults. A Step-by-Step Approach to Diagnosis and Treatment. Larry K. Pickering and Herbert L. DuPont. 716 pp. Illust. Addison-Wesley Publishing Company, Inc., Menlo Park, California. 1986. $35 (US). ISBN 0-201-12820-9

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ive years ago there was a Hdearth of books for physicians seeking information

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on the treatment of infectious diseases, and those available were either encyclopedic or dealt mainly with basic microbiology. Currently, however, there are several books of moderate cost that try to approach infectious diseases in a practical way. Thus, only if one is exclusively reliant on the algorithmic approach might this book be a useful acquisition, as it carries the algorithmic approach to the extreme. Some of the diagrams are so complicated and confusing that I was thankful for the accompanying test explaining the syndromes and the approach to diagnosis and treatment. The scope of the information presented is suitable for medical students, postgraduate trainees and practising physicians, and the chapters on diagnostic virology and bacteriology laboratories will be particularly useful to clinicians. However, the book has major omissions, including chapters devoted to infections of the eye and common parasitic diseases, although some of the latter are mentioned in chapters dealing with specific syndromes. Despite its increasing importance, the acquired immune deficiency syndrome is accorded little space. In general, the text is well written and has few typographic errors. However, it is illustrated with black and white (rather than colour) photographs of patients and photomicrographs of stained specimens, which poorly represent the actual appearance of skin lesions and specimens. In addition, the interpretation of one particular photograph of a chest x-ray film caused me considerable constemation until I realized that the patient had dextrocardia and was standing on her head when the film was made. I usually request a more mundane, standard posteroanterior view of the chest, which does not require the patient, especially one with pneumonia, to have proficiency in gymnastics. Edward D. Ralph, MD, FRCPC Internal medicine/infectious diseases University Hospital London, Ont.

Browsings A Guide to Symptom Relief in Advanced Cancer. 2nd ed. Claude F.B. Regnard and Anne Davies. 64 pp. Illust. Haigh & Hochland Ltd., International University Booksellers, Manchester, England. 1986. £3.95. ISBN 1-869888-00-6 Many primary care physicians have limited training and experience in treating symptoms related to incurable cancer, which include pain, psychologic distress, lymphedema and problems related to particular organs, hydration and feeding. Inadequate control of the symptoms can lead to strained relations between patient, family and physician. This excellent, portable compendium provides easily accessible, wellorganized and detailed information on specific forms of therapy for specific problems. The principles behind these measures are discussed. Key words on the outside edge of each page are a source of quick reference. The appendices contain information on portable subcutaneous infusion pumps and pharmacologic basics. There is also information on therapeutically equivalent drugs available in the United States and Australia. I highly recommend the book to anyone who provides palliative care for patients with cancer. James J. Rusthoven, MD, FRCPC Toronto-Bayview Regional Cancer Centre Sunnybrook Medical Centre University of Toronto Toronto, Ont.

Medical Care Chartbook. 8th ed. Avedis Donabedian, Solomon J. Axelrod, Leon Wyszewianski and Richard L. Lichtenstein, in collaboration with Beverlee A. Myers. 483 pp. Illust. Health Administration Press, Ann Arbor, Michigan. 1986. $30 (US). ISBN 0-910701-1 7-2 This unusual book evolved from a set of lecture notes in the early 1960s. It consists of about 450