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For example, machine calibration may be different in the two settings, so that one machine may show results considerably higher than another. See Patient safety Speaking, 68 Sampling errors Specialized medical courts, 265 pap smears, 171 Speech Scars tempo of, 68 generating malpractice claims, Spin, 14–15 190–191 Spinal blocks, 130 Scheduling damages, 267 Squamous intraepithelial lesion Scientific evidence (SIL)/carcinoma, 168 relevant and reliable, 28 Stabilization, 106 Sclerosing adenosis Standards of care misdiagnosis, 162 consultants, 141 Scope, 267 defendant breaching, 16 Screening errors defined, 36 pap smears, 171–172 family physician risk manage- Security ment, 91 Internet-based care, 82–86 Internet-based care, 82–83 online communications, 83 from local to national, xii telephone-based care, 78 medical Self-funded reserves, 256 replaced by medical–legal Self-insurance arrangements standards of care, 217 institutional, 231 national, 28 Sensitive subject matter plastic surgery, 181–182 online communications, 84 professional guidelines, 140 Settlements telephone-based care, 77–78 medical malpractice, 211 Stare decisis, 22 nuisance, 211 State Severity, 205 Statutes, 22 Shareholders State constitutions, 23 ownership, 4 State Department of Insurance, 7 Shorter statute of limitations, 239t State medical boards, 82 Shoulder dystocia, 145 State statutes, 22 SIL, 168 Statute of limitations, 18–19 Silence, 68 shorter, 239t Sincerity Storytelling, 14–15 physician witness, 61 players importance in, 24–25 Sitting Subarachnoid hemorrhage physician witness, 60 emergency room, 110 Skin resurfacing Subjective, objective, assessment, generating malpractice claims, 194 and plan (SOAP), 98 Sliding contingency fee scale Subject matter plaintiff attorneys, 18 dismissing as uninteresting, 66 Smiles Subject to authority physician witness, 46 physician witness, 42 Index 299 Substantial evidence, 26 Tension headache Substantive liability rule of negli- emergency room, 110 gence, 15–17 Terminology MICRA, 18 physician witness, 61 Suction-assisted lipectomy Testimony generating malpractice claims, defendants 193–194 plaintiff summarizing, 56–57 Summary adjudication Texas time, 30–31 malpractice insurers decline, 212 Summary judgment Textbooks motion for, 30–31 anesthesiology, 136 time, 30–31 authoritative, 56 Surplus citing by physician witness, 43– medical practice insurance, 7–8 44 Sutures, 220 The Doctors Company (TDC) Sympathy breast cancer claims, 154–163 physician witness, 48 pap smear litigation, 167–179 System reform, 237t, 238–241 Thought-speech speed, 67 T Thromboembolic disease pregnancy, 148 TDC Tillinghast-Towers Perrin, 207 breast cancer claims, 154–160 Time pap smear litigation, 167–179 discovery process, 29–30 Telephone, 71–74 family physician risk manage- summary adjudication, 30–31 ment, 98 summary judgment, 30–31 poor communication Time bomb attorneys, 59 cases of, 72–74 Timing Telephone-based care, 76–79 litigation, 29–31 appropriateness, 76–77 To Err Is Human, 255 CPT, 79 Tone of voice, 68 patient expectations, 77 Tort and patient safety practical, technical, financial clash between, 235–236 considerations, 78–79 Tort crisis, 233–235 record keeping, 79 Tort law, 228 security and privacy, 78 defined, 202 standards of care, 77–78 expansion of, 202 Telephone tag, 81 influencing provider behavior, Temper 233 physician witness, 43 Tort reforms, 236–238 Template charts Agency for Healthcare Research documentation, 104 and Quality, 219–220 Templates, 87 conventional, 237t Temporary holding orders Tort reforms of 1970s and early ACEP, 106 1980s emergency medicine, 106–107 impact of, 239t 300 Index Tort system Verbal expression, 68–69 directing compensation to plain- Verbose explanations tiffs, 232 losing interest, 66 Tort tax, 202 Vicarious liability Total damages doctrine of, 90–91 flat caps on, 259 Voice Tradeoffs, 267 tone of, 68 Treatment Voir dire, 26 online vs fee-based online consul- Volunteer physicians tation eRisk guidelines, 86 community clinics, 221 Trust patient, 234 W Truth Warfarin physician witness, 45, 47, 48, 51 epidural hematomas with, 130 Two cultures problem, 235–236 Warranty U plastic and reconstructive sur- gery medical liability, 182 Unauthorized access Web, 87 online communications, 83 Web-based malpractice informa- Underwriting tion, 270 practice of medicine insurance, 5 Weiler, Paul, 232 Urologists Wellman, Francis L. Neuroglial cells, sometimes called glial cells, cell body, or perikaryon; (2) dendrites; and (3) an axon are about 5 times as abundant as neurons and have limited mi- (fig. The latter two have fewer central effects since domperidone does not cross the blood±brain barrier while metaclopromide has the additional peripheral effect of increasing gastric emptying possibly by stimulating 5-HT receptors buy generic levitra soft 20 mg. Osteoarthritis is a progressive disease in which the ar- sule and inserting a tubelike instrument called an arthroscope. Failed tracheal intubation in obstetrics: a 6-year review in the UK region. If there is increased excretion of phosphate, ketone body acids (as occurs in uncontrolled di- tion of Na reabsorption occurs via direct effects on the 2– tubules and collecting ducts and via hemodynamic effects abetes mellitus), HCO3 , or SO4 , more Na is also ex- (see Chapter 23). Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 294 Unit 4 Support and Movement Skeletal Muscle Fibers and Types of (d) The A bands stay the same length Naming of Muscles (pp. Winalski CS, Aliabadi P, Wright JR et al (1993) Enhancement of the femoral head in the newborns. Those nerves that release ACh are called cholinergic; those that release NE are called adrenergic. A further parallel with the GABAA receptor is that there could well be differences in subunit composition of 5-HT3 receptors such that different heteromeric complexes form receptors which are functionally distinct. The secondary oocyte is formed several hours after the Follicular atresia, the degeneration of follicles in the ovary, initiation of the LH surge but before ovulation. T2-weighted images can show hyperintensity of such as those seen in rheumatoid arthritis and tuberculo- the involved muscle. This was not due to any effect of curare on the nerve because when curare was added to the nerve rather than the muscle dish, stimulation of the nerve was still effective.

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Give an example of each type of synovial joint and de- Trauma to a synovial joint causes the excessive production of synovial fluid in an attempt to cushion and immobilize the joint. Chronic use of form of THC, is also smoked and has con- methamphetamine in any form can result siderably more potency than does cannabis. In contrast, these drugs promote the flight/fight response to aversive stimuli. As with agonists, these have the advantage that they can be designed to have a long half-life and act specifically on one type of receptor. Glucagon secretion is regulated by relationships of delta cells to alpha and beta cells further many of the factors that also regulate insulin secretion. This remarkable work basis for the classification of living organisms explains the process of genetic replication and Darwin generic 20 mg levitra soft mastercard, Charles. In D (T2-weighted), the unique in that it is the only cranial nerve to exit the posterior (dorsal) trochlear nerve is seen passing through the ambient cistern around the aspect of the brainstem and is the only cranial nerve motor nucleus to lateral aspect of the midbrain (compare with Fig. This potential for security breach, although rather obvious and theoretically simple to avoid, can become a practical challenge in the environment of a busy office setting. The lesser whose cells are derived from postganglionic sympathetic neurons. What do you see in the left stetrician to evaluate a newborn in respira- hemithorax? Treatment would be directed toward replacement of gluco- 648 PART IX ENDOCRINE PHYSIOLOGY corticoids and mineralocorticoids. It is incompre- hensible that one’s personality, thoughts, and aspirations result The central nervous system and the peripheral nervous system from the functioning of a body organ. Estimated Use Pregnancy Oral contraceptive steroids prevent ovulation by reduc- Method (%) in Year 1 (%) ing LH and FSH secretion through negative feedback.

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At lengths near the normal resting bridges at different sites along the thin filaments (Fig. Electron microscopy reveals numerous pits in the membranes which are thought to reflect the vesicle/axolemma fusion pore of vesicles in the process of exocytosis. In contrast, the solution’s tonicity is determined by the concentrations of only those solutes that do not enter (“penetrate”) the cell. Thus, the vasoconstriction produced by both sympathetic stimulation and exogenous noradrenaline is enhanced in the presence of NPY. It may be negligent to do a hysterectomy in a high-risk patient when an endometrial ablation procedure would have sufficed. Unfortunately the authors did not report sufficient data to reconstruct the necessary 2 2 tables. Thus, the genotype of a person who is homozygous for pressed only in the homozygous recessive (ee) condition. Although subsequently found to be an artefact of the extraction process, this compound turned out to be a ligand for the benzodiazepine receptor, nonetheless, and was the first inverse agonist to be identified. Nervous Tissue and the © The McGraw−Hill Anatomy, Sixth Edition Coordination Central Nervous System Companies, 2001 386 Unit 5 Integration and Coordination Posterior horn Posterior funiculus Posterior median Lateral funiculus sulcus Gray commissure Posterior root of spinal nerve Central canal Lateral horn Spinal ganglion Paras Anterior horn Anterior root Anterior median Anterior funiculus fissure Spinal nerve of spinal nerve (a) Posterior horn Central canal Anterior horn Spinal ganglion Spinal nerve (b) FIGURE 11. Pathway activity: ---- low; Ð normal; high Ð less effective in combination unless given in high doses that could be inappropriate clinically (Treseder, Jackson and Jenner 2000). A normal bone scan has a hip include communication with greater trochanteric bur- strong negative predictive value. Prompt treatment of a work together so that images from each corneal inflammation can prevent subse- eye can fuse into one single image. The establishment of sound principles of of the oath are difficult to conform to in 3. The tumor dysplasia order levitra soft 20mg online, chondroma, osteochondroma, simple bone appears hypointense on T1 weighted sequences, allow- cyst, and vertebral angioma, should be recognized on ing clear delineation between infiltrated marrow and normal bright fatty marrow. It is generally accepted that the improvement is very good in 35% of patients, good in 30% and moderate in 30% with some (55%) not really responding. For example, the gonads stop functioning and the per- bolic problems because the primary action of hormones is to son suffers from amenorrhea (lack of menstruation) or aspermia regulate metabolism.

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This system appears The brainstem contains the neural circuitry for initiating to be important for the production of movement, especially locomotion and for controlling posture. The parietal-temporal-occipital from the brainstem provide visceral and somatic sensory association cortex integrates neural information con- signals, including tactile, pressure, pain, and temperature tributed by visual, auditory, and somatic sensory experi- information from the skin and sexual organs and pain in- ences. They may have dif- During the time the continuous monitor- ficulty breathing or experience nausea, ing device is being used, individuals vomiting, and flushing of the skin, which continue to use standard methods of meas- remains dry. About midway through ventricular diastole, filling slows as ven- tricular and atrial pressures converge. All but the deepest layers are composed of of tissues that are structurally arranged to function together. Thenervesoftheuppergroup(T1–T6)run uptothesternumandsupplytheintercostal muscles (C7), the superior and inferior pos- terior serrate muscles, and the transverse thoracic muscle. Initial evaluation revealed a minute puncture wound superior to the left clavicle safe levitra soft 20mg, just lateral to the sternocleidomastoid muscle. Varying by the dashed lines, the hormone content in known concentrations of unlabeled hormone (the stan- unknown samples can be deduced from the standard curve. Subsequently, however, the ability to send data using electronic communication is used to support new forms of collaboration between healthcare professionals. Both cardiac and skeletal also found in the walls of arteries, the walls of respiratory pas- muscle fibers cannot replicate once tissue formation has been sages, and in the urinary and reproductive ducts. The fiber bundles of the hypoglossal middle cranial fossae; its depression con- nerve (A27) pass as a single nerve through tains the hypophysis (A5), which is attached the hypoglossal canal. Its fibers originate from the muscle (D16), those for the medial rector large, multipolar neurons of the nucleus of muscle (D17) ventrally, and those for the le- the trochlear nerve (BC6) (p. De- doses over a prolonged period, however, they can suppress spite the increased mobilization of lipid, there is also an ab- antibody formation and interfere with cell-mediated immu- normal deposition of fat in the abdominal region, between nity. Fortunately, H2CO3 produced from metabolic CO2 is only formed transiently in the transport of CO2 by the 6 blood and does not normally accumulate.

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