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Core paediatrics: a problem-solving approach
  1. L J Phillips

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    Steven Ryan, Jackie Gregg, Leena Patel. London: Arnold, 2003, £24.99, pp 428. ISBN 0-34080971-X

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    In contrast to a decade ago, there appears to be numerous paediatric “textbooks” on the market today, aimed primarily at medical students. The choice must appear somewhat overwhelming! Core paediatrics adds itself to this ever-growing list. As the title suggests however, it does attempt to approach the subject from a different angle.

    The book is set out in 40 distinct chapters. Each chapter approaches a familiar topic in a refreshing manner—likely to appeal to a student and in a way in which they can place it in context. For instance, rather than a chapter on “Upper airway obstruction”, Core paediatrics presents this as “A boy with a croupy cough and breathlessness”. Other examples are “A child with a black eye”, “A tired teenager”, and so on…

    The authors present each chapter in a systematic manner. A clinical case is presented—many of which the typical student is likely to encounter on any paediatric attachment. Realistic differential diagnoses are then presented, the same way in which a junior doctor may formulate impressions after clerking such a child. The authors then go on to consider each of the differential diagnoses at length, taking into account aetiology, pathology, investigations, and management. Frequently, the text pauses to present the reader with “Self-tests”. These questions are relevant to the clinical case and many are typical dilemmas that doctors face in planning management for unwell children. Some are presented as extended matching multiple choice type questions.

    The authors stress the importance throughout, of history and examination, and guide the reader in eliciting key facts in the clinical cases. Throughout the book, information is presented in easy to read tables and diagrams, which appeal and break up the text. Relevant investigations are discussed at length, often with illustrations. Dilemmas are often centred around such investigations—for instance, how should a urine sample be obtained from young children when investigating for UTI? Further questions relate to interpretation of such investigations—ensuring a clinically relevant approach. Throughout the text, misleading “normal” test results are discussed as well as obvious positive test results. Management of various conditions is presented in a structured way, incorporating both immediate and long term issues. When relevant, drug doses are included—useful for junior doctors, as well as other tips such as writing child protection medical reports. The book centres discussion of management around clinical cases, presenting likely progress that a child may make while in hospital and any complications or side effects one may encounter. Finally each chapter ends with further sources of information, including other textbooks and relevant articles, although pleasingly not an exhaustive list of documents!

    Core paediatrics therefore is primarily aimed at medical students. It approaches paediatrics in a manner that a student is likely to understand well and encounter on an attachment. It moves away from a traditional system based approach, towards a clinical presentation based approach, while integrating basic science and pathology of each disease well. The text is also likely to appeal to junior doctors embarking on a paediatric career who require refreshment of how children present when ill. The 40 presentations of unwell children that the book describes are likely to incorporate many such patients who will present to a department.

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