British Journal of Anaesthesia 108 (3): 535–6 (2012)
BOOK REVIEWS TEE Pocket Manual, revised reprint. L. Groban and J. F. Butterworth (editors). Published by Elsevier Saunders, Philadelphia, PA, USA. Pp. 185; indexed; illustrated. Price £45.99. ISBN 978-1-4557-0588-7. TEE Pocket Manual started life as a set of revision notes written while one of the authors was preparing for the North American Perioperative Transesophageal Echocardiography Certification Examination. The first edition of this book was published in 2007 with the intention of providing clinicians with a portable reference source for use in the operating theatre and after operation on the cardiac intensive care unit. The first edition was also available in electronic format for the personal digital assistant. This present incarnation is described as a revised reprint rather than a second edition. The principle revisions seem to be the addition of a short section on the three-dimensional (3D) assessment of the mitral valve and the production of a separate laminated quick reference card. The book is definitely pocket sized. It is light weight and seems to be well made with a spiral ring binder and waterresistant paper. It survived several weeks in the pockets of our theatre greens without suffering any obvious signs of damage. It is certainly packed with information and there is liberal use made of figures and tables. The layout is logical and individual sections are clearly identified with tabs, making it easy to quickly find the topic one is looking for. Some of the print is on the small side and one of the reviewers, who had recently purchased varifocal spectacles, found the laminated reference card very hard to read. Half of the figures in this book are reproduced from the first edition of the excellent Practical Perioperative Transoesophageal Echocardiography book by Sidebotham and colleagues (which has recently appeared as a fully revised second edition). The majority of the remainder come from other acknowledged original sources. Comparatively, few illustrations are originals specifically produced for this publication. The book contains a number of annoying errors and omissions that one would have thought should have been addressed in a revised edition. For instance, Vena Contracta measurement, a technique which is used to assess the severity of valvular regurgitation using colour Doppler, is incorrectly described as the smallest regurgitant jet area rather than the minimum jet width. Of greater concern, the table on normal mitral prosthetic gradients actually quotes values for normally functioning aortic prosthetic valves which are significantly higher. This might lead to an inexperienced practitioner accepting as normal a mitral prosthesis with an unacceptably high gradient, with potentially grave consequences for the patient. The section on the tricuspid valve includes figures showing four standard views with which to
assess the tricuspid valve but only identifies the individual leaflets in one figure, leaving the reader to guess which leaflet is which in the other three figures. The chapter on 3D echo has up-to-date references, but there does not appear to have been any significant updating of other sections. This is disappointing given that there have been quite a few important new guideline statements published by specialist societies in recent years. For instance, outmoded terminology is used to describe left ventricular wall segments with the authors still using the term posterior rather than inferolateral. There are also some important inconsistencies; severe aortic stenosis is variously defined correctly as a valve area of less than 1 cm2 but also incorrectly as a valve area of less than 0.75 cm2. There is no mention of a number of important emerging areas of practice. The use of echocardiography to guide interventional cardiology procedures receives no coverage. Neither does the echocardiographic assessment required to facilitate ventricular assist device placement. There is also no coverage of the use of chest ultrasound on the intensive care unit. Can we recommend purchase of this book which is in competition with a number of alternative texts that are currently available? The concept is a good one and the format and portable nature of the book is excellent. Unfortunately, the content lets the book down badly. It still has the feel of a set of revision notes rather than an authoritative pocket reference. It does not fully reflect the current practice guidelines and contains too many errors. A´. Marko´ and N. Morgan-Hughes Sheffield, UK E-mail:
[email protected] doi:10.1093/bja/aer508
Single Best Answer MCQs in Anaesthesia: Volume II Basic Sciences. C. Mendonca, M. Chaudhari and A. Pitchiah (editors). Published by Tfm publishing Ltd, Shrewsbury, UK. Pp. 200. Price £30.00. ISBN 978-1-903378-83-0. At the last sitting of the Part 1 FRCA, approximately one-third of the MCQ paper consisted of ‘single best answer’ (SBA) questions. This change has been introduced following advice from the Postgraduate Medical Education and Training Board (PMETB), who believe that such questions more fairly test candidates’ understanding of topics when compared with the more familiar ‘True/False’ variety. While this may be true of questions relating to clinical situations, it remains to be seen if such an approach is appropriate for testing knowledge in the basic sciences relating to anaesthesia and intensive care. The
& The Author [2012]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email:
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BJA SBA format can at first seem to test less breadth of knowledge, since a single question will only have one correct answer that should be chosen, whereas a five-stem ‘True/ False’ question could ask about five distinctly different pieces of information relating to the common stem. It therefore seems unlikely that SBA will ever fully replace ‘True/False’ questions. The very recent introduction of SBA questions into the Part 1 FRCA exam inevitably means that there is a shortage of preparatory material for those sitting the exam, although some example questions are available from the RCOA. Books such as this one have therefore been eagerly awaited. The questions have all been researched and written by consultants and senior trainees from the UK, mainly based in the Midlands. The content sets out to emphasize the understanding and application of basic science knowledge which underpins the whole FRCA examination system. The book is a soft cover and is small enough to carry around and dip into during short breaks. It consists of six papers with 30 questions in each. The related answers follow on after each paper accompanied by a short explanation or justification for the correct answer, including appropriate references and further reading. The skill in writing good quality, unambiguous SBA questions in pharmacology, physiology, and physics is not to be
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underestimated. The authors of this collection should be applauded for their efforts which on the whole are very good, although there are some answers that are guaranteed to generate healthy debate! As this style of MCQ becomes more established, the quality of questions will undoubtedly improve. For example, a stem ending in ‘what device would you chose?’ would always have the correct answer, even if the examinee chose something completely inappropriate! Candidates preparing for the exam need to be aware that they might find the questions in the actual exam a little more challenging than those in this book. That said, answering this format of MCQ needs practice, and by working through this book, trainees will learn to avoid some of the potential pitfalls that lie in wait on the day. I would recommend this book to all exam candidates preparing for Part 1 FRCA. I also think that it will be of value to those who passed the exam years ago, since it provides a wonderful way of brushing the cobwebs away from basic science knowledge that, as practicing clinicians, we still require in our daily work. J. Andrzejowski Sheffield, UK E-mail:
[email protected] doi:10.1093/bja/aer507
