Comparison of Advanced Imaging Resources, Radiology Workforce, and Payment Methodologies between the United States and Canada.

The purpose of this Practice Perspectives was to review the United States and Canadian approaches to health care access and payment for advanced imaging. The historical background, governmental role, workforce, coding, payment, radiologic challenges, cost, resource intensity, and overall outcomes in longevity are reviewed.

Golf club holder for upper-extremity amputee golfers.

A device which permits an upper-extremity amputee person to play golf is described. The device is interchangeable with a hook or hand, fits into a standard prosthetic arm, and can be used by a right or left above-elbow amputee golf player. It is inexpensive, weights under a pound, and can be readily made in a machine shop.

Ptophobia. Phobic fear of falling and its clinical management.

We have seen six patients, over the past two years, who had developed intense fear of standing or walking as a result of accidental falls. None of these patients showed any evidence of neuromuscular impairment that might account for their inability to walk. However, the results of psychological evaluations of all these patients revealed high degrees of focal anxiety that was phobic in nature and related to standing or walking. Personality assessments of these patients showed little or no evidence of psychopathology of a generalized nature or of personality trait disturbance. The phobic reaction was the primary psychological disturbance underlying their fear to stand or walk. Each patient demonstrated evidence of both reduction of anxiety and functional improvement in walking following behavioral desensitization and physical therapy. We believe this disorder is a distinct psychological problem unrelated to agoraphobia, and we propose using the term "ptophobia" when describing this clinical entity.

Electrodiagnosis of ulnar nerve lesions at the elbow.

To determine electrical criteria which might be helpful in the diagnosis of ulnar nerve entrapment at the elbow, clinical and electrodiagnostic features in 78 patients with suspected ulnar nerve entrapment at the elbow are described and compared to the results of sensory and motor conduction in the ulnar nerve in a control group of normal persons. These criteria include (1) absent or abnormal evoked sensory nerve action potential in the little finger, (2) motor conduction velocity of less than 45.0 meters/sec in across elbow segment of the ulnar nerve with elbow flexed at 35 degrees, and (3) abnormal electromyographic findings including the presence of increased insertional activity or signs of denervation in the first dorsal interosseous, abductor digiti minimi, and/or flexor carpi ulnaris muscles. Electromyographic abnormality was seen in 77.5% of patients with ulnar motor conduction velocity of less than 45.0 meters/sec across the elbow. The first dorsal interosseous was the most commonly affected muscle. A study of certain important anatomic and histologic factors, such as the arrangement and relative concentration of the motor and sensory fibers at certain key points inthe course of the ulnar nerve trunk, is necessary to understand the correlation between the clinicopathologic and electrodiagnostic features in patients with ulnar nerve entrapment at the elbow.