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Diagnostic imaging in paraneoplastic autoimmune multiorgan syndrome: retrospective single site study and literature review of 225 patients. Clinical validity of a negative computed tomography scan in patients with suspected pulmonary embolism. Thoracic outlet syndrome Thymoma evaluation or history of myasthenia gravis Note: Approximately 15% of patients with myasthenia gravis will have a thymoma. Billing 77058 two times for the same date of service or separately over subsequent days in order to describe a bilateral procedure fragments the service into its component parts and is not allowed. The European Society of Breast Cancer Specialists recommendations for the management of young women with breast cancer. The effect of study design biases on the diagnostic accuracy of magnetic resonance imaging for detecting silicone breast implant ruptures: a meta-analysis. Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by frst pass or gated technique, additional quantifcation, when performed); single study, at rest or stress (exercise or pharmacologic) 78454. Thus, patients who are obese may beneft from 2 day imaging protocols and/or prolonged image acquisition times. Similarly, imaging in the prone position may improve accuracy in patients who are obese and women with high likelihood of breast attenuation artifact. If imaging studies using other radioactive tracers have been recently performed, adequate time must elapse to allow for clearance of activity from the heart and surrounding regions. Gated equilibrium; planar, multiple studies, wall motion study plus ejection fraction 78481. First pass technique; multiple studies, wall motion study plus ejection fraction 78494. Commonly Used Radiopharmaceuticals Technetium-99m Imaging Considerations Primarily used to evaluate global and regional ventricular function and to determine ejection fraction(s) May be used in the evaluation of intracardiac shunting or diastolic function First-pass studies display initial transit of the radiotracer bolus passing through the cardiopulmonary and central systemic circulations. Due to regional variation in technical expertise and interpretive profciency, the clinician should use the diagnostic imaging modality that has been proven most accurate in his/her practices. While it is possible to acquire images during exercise in patients undergoing bicycle exercise testing, image quality during treadmill exercise is suboptimal. Image quality is frequently suboptimal in morbidly obese patients and in those with advanced lung disease. If image quality at rest is inadequate, the test should be canceled and consideration given to an alternative imaging modality. Image acquisition, interpretation and report only (congenital cardiac anomalies) 93320. Transthoracic echocardiography or congenital cardiac anomalies; follow-up or limited study 93306. Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color fow Doppler echocardiography 93307. Transthoracic echocardiography; complete, without spectral Doppler echocardiography, or color fow Doppler echocardiography 93308.

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The page layout software that had been my workhorse for over 10 years was no longer supported, and the developers of the reference manager I utilized had changed their focu s an d t h e p r od u ct w as n ow com p at ib le p rim ar ily w it h w or d p r oce ssor s (w h ich w e re p oor ly suited for complex multi-chapter books like this one). I never imagined that desktop publishing was going to atrophy and fall victim to the same fate that would later come to claim print newspapers. With the availability of the world wide web, the inter net was quickly becoming the chief means of accessing information on demand. Thanks to the people at Thieme, the material was painstakingly converted from the defunct software platform to a contemporary format that will facilitate continued updates and availability in digital media. This time-consuming and labor-intensive process included porting thousands of cross references, index entries, and literature citations. In t e re st in gly, t h e object ives of t h e h an d b ook h ave also gon e t h rough a t ran sfor m at ion. It is ch al lenging to distill w hat all of those objectives are, but I believe that it is im portant to present m aterial in a fram ework that can serve as a foundation for studying the field of neurosurgery. This book is intended to be a place that brings together the im portant inform ation that is increasingly scattered across the literature and the web (for instance, practice guidelines for disparate subjects like spinal cord injury, stroke, aneurysm s) that might not necessarily be encountered unless one is actively seeking it out. My goal with the book has always been to present information succinctly and clearly. To that end, this edition is a completely restructured version of the Handbook of Neurosurgery, presen t in g th e entire content in a collection of more than 100 well-ordered chapters of comparable length and for mat while retaining the wealth of crosslinks and references the book is known for. With its new structure and format, as well as revised and updated content, I hope I have provided th readers with an even more valuable resource in this 8 edition of the Handbook of Neurosurger y. Th an ks t o t h e many contributors who helped with the material, and the people known and not known to me at Th ie m e Me d ica l Pu b lish e r s. To Br ia n Sca n la n, Pr e sid e n t o f Th ie m e Me d ica l Pu b lish e r s, for m a kin g the resources available to save the book from disappearing entirely. Th a n k s a lso t o m y co lle agu e s a n d t h e r e sid e n t s in t h e n e u r o su r ge r y p r o gr a m a t t h e Un ive r sit y o f Sou t h Flor id a fr om w h om I le ar n e ve r y d ay. Har r y van Love re n, for h is advice, calm lead ersh ip an d for in sp ir in g e xcellen ce in n eu rosu rger y. Nu m b e r s fo llow in g entries below indicate the page number for the relevant section.

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Patients are instructed to daily indicate on a form the intensity, duration and frequency of their pain complaints. Parker (1978) used a patient report headache diary of severity, duration and frequency and a disability score calculated from it. Plain diaries may also be very useful for single-case time-series research designs (Keating, 1985). It has been used in back pain treatment research and to describe chiropractic patients (Nyiendo, 1990). The McGill Questionnaire consists of twenty categories of words that describe qualities of pain. While relatively well-studied in terms of validity and reliability (McDowell, 1987), it may present some practical difficulties in clinical practice because it should be administered by an interviewer. For example, Coyer and Curwen (1955) used an outcome of "well" defined by lack of signs and symptoms of low back pain presumably judged by the practitioner in consultation with the patient. Edwards (1969) assessed care on a five point scale of signs and symptoms judged by the doctor. Patient Satisfaction: Patient satisfaction is an important perception having not only to do with the actual effectiveness of care, but also the setting and the process of receiving care (Donabedian, 1980). Patient satisfaction may be an important marker of quality of care (Cleary, 1988), and it is increasingly evident that patient satisfaction is a consumer marketing target for managed care organizations. Patient satisfaction outcomes have been studied by Ware and others (Ware, 1978; Lochman, 1983). They include: interpersonal manner, technical quality, efficacy/outcomes, accessibility/convenience, finances, continuity, physical environment, and availability. The Patient Satisfaction Questionnaire measures all eight dimensions (Ware, 1983). According to Cherkin (1990), the Visit-Specific Satisfaction Questionnaire (Ware, 1988) is probably very appropriate for chiropractic outcomes. Deyo (1986) developed a patient satisfaction scale specifically for patients with low-back pain. Recently, Cherkin (in press) developed and validated a back pain patient questionnaire that addressed three key dimensions of satisfaction: caring, information, and effectiveness. One of the valuable aspects of assessing patient satisfaction is its global nature. Works by Sawyer (1991), Cherkin (1989), and Kane (1974) have suggested high levels of satisfaction with chiropractic care.



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