Informed Consent: A Guide for Health Care Providers. Arnold J Rosoff. Aspen Systems Corp, 1600 Research Blvd, Rockville, Md 20850, 1981, 520 pp, $37.50 clothbound.

The issues surrounding the patient’s right to information and to make his own decisions regarding health care have gained increased attention. Unfortunately, numerous lawsuits and a full-fledged patient’s rights movement were the means to reestablish this basic right of personal autonomy. Informed consent is an ethical issue of great magnitude for every health care professional, with legal ramifica- tions that are sensitive and complex. Written primarily from a legal standpoint, this volume attempts to (1 ) set forth the law, (2) provide a philosophical framework, and (3) provide a foundation for researching questions of patient consent law.

The author accomplishes this through de- tailed chapters with cases that illustrate the need for patient consent; hospital responsibil- ity; dealings with minors, incompetents, and spouses; consent for special procedures; con- sent for medical experimentation and re- search; refusal of consent; and prbof of con- sent. There is state-by-state analysis of the legal requirements concerning disclosure of case and treatment information and the con- sent for treatment of minors. The book is well indexed by subject. Additionally, specific cases are indexed alphabetically and by pro- cedure, problem, or issue. This assists the reader wishing to refer to selected topics.

Approximately one-third of the book is de- voted to the report of a survey conducted by the author in 1976-1 977. The research project studied physicians’ attitudes and actions re- garding the disclosure of case and treatment

information to their patients and the reactions of patients to such disclosures. As is typical of survey research, the results of this study provide some baseline information. More im- portantly, it highlights a number of questions about informed consent that require further study by health care professionals.

Although costly, this book presents invalu- able information on asubject that is particularly relevant to operating room nurses. Nurses working on quality assurance committees, dealing with offices of advocacy, or involved with medical or nursing research will find this book a most useful resource.

Susan B Shipley, RN Editorial Board

Interpreting ECGs: An Advanced Self-test Guide. Ali Haddad, David C Dean, consulting editor. Medical Economics, Box 554, Oradell, NJ 07649, 1981, 149 pp.

The author has written this as a supplementary workbook to test knowledge gained from the book How to Read an ECG by Blowers and Smith (Oradell, NJ: Medical Economics, 1977). It is a useful guide for testing knowledge of ECGs gained from other sources as well. As the title indicates, users of this workbook must have already mastered the basics of arrythmia interpretation and be ready to apply the basics to interpreting more complex and less com- mon arrhythmias.

The material consists of 145 rhythm strips collected by the author in his cardiology prac- tice. The strips demonstrate atrial, junctional, and ventricular arrhythmias, AV blocks, and pacemaker rhythms. Each rhythm strip is clearly reproduced and is marked with the lead and appropriate comments needed for in-

514 AORN Journal, September 1981, Vol34, No 3

terpretation. Concise, easy to understand ex- planations are found on the reverse side of each strip. Because this is designed as a workbook, no instructional text is presented. Other ECG texts must be consulted for more in-depth explanations of interpretations.

The rhythm strips in this workbook are chal- lenging and must be systematically analyzed to arrive at the correct interpretation. This workbook would be an excellent practice tool for any nurse, medical student, or physician interested in further developing his ECG in- terpretation skills.

Elizabeth A Rimm, RN Washington, DC

Quality and Accountability: A New Era in American Hospitals. Stanley A Skillicorn. Editorial Consultants, Inc, 655 Sutter St, San Francisco, Calif 94102, 1980, 144 pp, $14.

This is a fascinating book for all concerned with the quality of patient care. It was written by the director of medical education at San Jose (Calif) Hospital. As at most hospitals, the ad- ministration of this 543-bed acute care facility was concerned about the quality of its care. When inadequacies of its quality control sys- tems were recognized, a quality control com- mittee was formed. The committee set out to end such problems as patient falls, preventa- ble postoperative complications, medication errors, unnecessary x-rays, incompetence, and inefficiency. The new program, which was instituted in 1977, corresponds closely to the Joint Commission on Accreditation of Hospi- tals’ (JCAH) 1980 quality assurance standard.

In telling the story of how the committee instituted its new program, the author neces- sarily had to tell us how things were before changes were made. It took courage to be so honest, and the reader will appreciate the ad- ministration’s frankness in permitting its story to be told. Although incidents of neglect, error, incompetence, and carelessness are de- scribed, it must be remembered that they rep- resent only a small amount of the patient care given.

The approach the hospital took was “to search out deficiencies in patient care, wher- ever they occur and whoever might be respon- sible for them, and then through a system of peer review to adopt measures necessary to

eliminate the problems.” The author clearly outlines how the committee and hospital staff did this and what they did with the information that was found.

Among the conclusions are that few errors are caused by a lack of knowledge by profes- sionals and that deficiencies in performance usually arise from adeficiency in some internal hospital system.

The examples and forms that are included would be helpful for those at other hospitals in developing quality assurance guidelines. The appendices contain the JCAH quality assur- ance standard, the San Jose Hospital’s quality assurance program, and its patient relations program. There is also a bibliography.

Sister Kane, RHSJ, RN Cornwall, Ontario

Allergies to paper may cause skin rash Are you buried in paperwork? It may be more aggravating than you think. That puzzling skin rash that won’t go away just might be caused by the paper you work with every day.

Skin specialists have known for years that some individuals are allergic to the ingredients in typing paper, carbon paper, paper used in duplicating machines, and just paper in general. One person has been found to be allergic to newspapers. The newest problem to be discovered is allergy to carbonless copy paper.

James G Marks, Jr, MD, dermatologist with the Milton S Hershey Medical Center of Pennsylvania State University College of Medicine, Hershey, reports in the June 12 Journal of the American Medical Association on a 21 -year-old clerk in a college registrar’s office who suffered skin rashes for more than a year before the cause was traced to the carbonless copy paper used for student registration. Avoiding the paper cured the rash.

Dr Marks also cites earlier reports of allergy to paper. A female office worker developed a rash on her hands from the typing paper she used. Papers used in photocopying machines cause problems for some workers.

AORN Journal, September 1981, Vol34, No 3 515