393 Book reviews Photographic Manual of Regional Orthopaedic and Neurological Tests Williams and Wilkins, Baltimore 1997, 3rd edition (ISBN 0683 18100 9) lllus 446 Daaes by Joseph J Cipriano DC f60 This tliird edition of the above text is an exciting book which, on initial brief review. reveals a manual which is easy to use, with an c xce I 1 v n t i ndexing system and layou t . ‘I- h e i 11 us t rat ions throughout are superb and the accompanying photographs ensuw, in most cases, good understanding of test instructions. The text for each ‘test’ is divided into procedure and rationale. The book is divided anatomically, with a separate section for miscellaneous tests, cranial nerves and rellexes. Preceding most cliaptcirs is a flow chart which indicatrs thc appropriate routes to test eachjoint. The hook appears to he written with the orthopedic inedic/registrar in mind, to he used as a reference text. The manual boasts 35 new tests in this new edition; however, the term seems to be used in its broadest sense, often it seems including simple observations to ‘make up’ the numbers. With few exceptions the examples given are unsophisticated and too generalised to be of any use, the impact of each chapter bcing lost to a maze of bizarrely named procedures each supposed to Promoting Cont nence Clinical audit scheme for the management of urinary and faecal i ncon t i nence Royal College of Physicians, 11 St Andrews Place, Regent‘s Park, London N W I 4LE 1998 (ISBN 1 86016 053 0) 40 Daaes by John Brocklehurst FRCP Including postage, f15 UK, f 17 overseas point to the same condition, via varying rationale. Being an American text, I was chastened to find one particular procedure, ‘Spurling’s test’ directing the practitioner to ‘deliver a vertical blow to the uppermost portion of the patient’s head’ if the preceding instructions, to flex the head laterally and gradually apply strong downward pressure, did not elicit pain. The rationale given for this is: ‘Localised pain may indicate facet joint involvement either from the strong downward pressure placed on the head or from the vertical blow to the head. Radicular pain may indicate foramina1 encroachment, degenerating cervical intervertebral disc, or disc defect with nerve root pressure. This test may also indicate a lateral disc defect.’ In all I was disappoiiitecl by what appeared to he ;I very well illustrated and useful manual. Most of the chapters supported some worth-while and interesting ideas, but the iise of over- simplistic procedures, with minimal relerencing more recent than 1994 (the majority being cited from texts and articles written over a decade ago), meant that I would have strong reservations in advising non-experienced orthopaedic physiotherapists to use this hook. If the manual is already in your medical library, the illustrations are very clear and worth viewing, but before you try out a iicw test, make sure it is one that you can usefully clinically rcason and can justify. Maria Andrew BSc MCSP To improve the general level of care given to the 10%. olincn and 20% of women .who suffer from incontinence, these guidelines have been produced to enable doctors and others to nicasiire their treatment against national standards. They includr thr-ee different types of audit questionnaires: Singk palimt nurli/ - suitable for a detailed review of one or two patients. /tlt~/rz~~/r.~~n,iunt aiiilil- a shorter review of many patients to provide an overview of how far standards are being achieved. Fk(,iZity mulit - coyer-ing policy, procedures, and staff education. The audits are complementary and units can carry out all of them. Physiotherapists and other healthcare professionals arc expected to be able to use the guidelines to measure how well paticnts are cared for within units.

Promoting Continence Clinical audit scheme for the management of urinary and faecal incontinence

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393

Book reviews

Photographic Manual of Regional Orthopaedic and Neurological Tests

Williams and Wilkins, Baltimore 1997, 3rd edition (ISBN 0683 18100 9) lllus 446 Daaes

by Joseph J Cipriano DC f60 This tliird edition of the above text is an exciting book which, on initial brief review. reveals a manual which is easy to use, with an c xce I 1 v n t i ndexing sys tem and la you t . ‘I- h e i 11 u s t rat ions throughout are superb and the accompanying photographs ensuw, in most cases, good understanding of test instructions. The text for each ‘test’ is divided into procedure and rationale. The book is divided anatomically, with a separate section for miscellaneous tests, cranial nerves and rellexes. Preceding most cliaptcirs is a flow chart which indicatrs thc appropriate routes to test eachjoint.

The hook appears to he written with the o r thoped ic inedic/registrar i n mind, to he used as a reference text. The manual boasts 35 new tests in this new edition; however, the term seems to be used in its broadest sense, often it seems including simple observations to ‘make up’ the numbers. With few exceptions the examples given are unsophisticated and too generalised to be of any use, the impact of each chapter bcing lost to a maze of bizarrely named procedures each supposed to

Promoting Cont nence Clinical audit scheme for the management of urinary and faecal i ncon t i nence

Royal College of Physicians, 11 S t Andrews Place, Regent‘s Park, London NWI 4LE

1998 (ISBN 1 86016 053 0) 40 Daaes

by John Brocklehurst FRCP Including postage, f15 UK, f 17 overseas

point to the same condition, via varying rationale. Being an American text, I was chastened to find one particular

procedure, ‘Spurling’s test’ directing the practitioner to ‘deliver a vertical blow to the uppermost portion of the patient’s head’ if the preceding instructions, to flex the head laterally and gradually apply strong downward pressure, did not elicit pain. The rationale given for this is: ‘Localised pain may indicate facet joint involvement either from the strong downward pressure placed on the head or from the vertical blow to the head. Radicular pain may indicate foramina1 encroachment, degenerating cervical intervertebral disc, or disc defect with nerve root pressure. This test may also indicate a lateral disc defect.’

I n all I was disappoiiitecl by what appeared to he ;I very well illustrated and useful manual. Most of the chapters supported some worth-while and interesting ideas, but the iise of over- simplistic procedures, with minimal relerencing more recent than 1994 (the majority being cited from texts and articles written over a decade ago), meant that I would have strong reservations in advising non-experienced orthopaedic physiotherapists t o use this hook.

If the manual is already i n your medical library, the illustrations are very clear and worth viewing, but before y o u try out a iicw test, make sure it is one that you can usefully clinically rcason and can justify.

Maria Andrew BSc MCSP

To improve the general level of care given to the 10%. olincn and 20% of women .who suffer from incontinence, these guidelines have been produced to enable doctors and others to nicasiire their treatment against national standards. They includr thr-ee

different types of audit questionnaires:

Singk palimt nurli/ - suitable for a detailed review of one or two patients.

/ t l t ~ / r z ~ ~ / r . ~ ~ n , i u n t aiiilil- a shorter review of many patients to provide an overview of how far standards are being achieved.

Fk(,iZity mulit - coyer-ing policy, procedures, and staff education.

The audits are complementary and units can carry out all of them. Physiotherapists and other healthcare professionals arc expected to be able to use the guidelines to measure how well paticnts are cared for within units.