bluuebunny/crossref_metadata_2025_split huggingface dataset:
To Combine or Not to Combine
Authors: Ranavaya Mohammed I , Rondinelli Robert 
Published: December 2020

Abstract
Physicians must account for the effects of multiple impairments using a summary value. Sometimes, when dealing with multiple impairments in a single case, the evaluating physician may be confused about whether specific impairments are added or combined, particularly during the assessment of hand or limb injuries. Combining is accomplished by using the Combined Values Chart presented in the Appendix of each edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). With a few exceptions, the general rule is that all impairments should be combined. The combining must occur at the same hierarchal level (eg, upper extremity impairment can be combined only with another upper extremity impairment from the same limb), and whole person impairment (WPI) can be combined only with another WPI impairment. In case of impairments from a different limb (either from both upper or lower limbs) even though they may be expressed at the same hierarchal limb (eg, upper extremity or lower extremity), they should be combined at the WPI level only after the individual limb is fully rated and the final impairment for that limb is expressed at the WPI level. Evaluators should remember that impairing factors (sensory, motor, vascular, and so on) are combined at the smallest common unit (ie, digit < hand < upper extremity < whole person).
Evidence-Based Medicine: Determining Quality of Randomized Controlled Trials
Authors: Cheng Melissa 
Published: December 2020

Abstract
Evidence-based medicine is based on evidence gathered by randomized controlled trials (RCTs), which are considered the “gold standard” of research studies. Users of the medial literature must be able to read critically and evaluate RCTs. The present article uses the standards of the American College of Occupational and Environmental Medicine (ACOEM) practice guidelines in evaluating RCTs according to 11 criteria; these criteria follow those used by the Cochrane Collaboration in their evidence-based reviews. Well-written articles present their randomization schemes to create comparable groups, and studies must be controlled for co-interventions; in a double-blind trial, the co-interventions would be used equally in both groups, and treatment allocations should be concealed. Readers should ask if the study had acceptable compliance; that is, were patients doing what they were asked, and was the dropout rate acceptable (typically, less than 20%)? RCTs should be analyzed by an intention-to-treat analysis that includes all study subjects who were randomized, not just those who completed the study. Having high internal validity ensures a more accurate study that can be reproduced by others, so readers may ask if results are likely to be affected by observational bias, confounding, or chance variation. Readers can determine external validity by assessing study participants according to inclusion and exclusion criteria and baseline characteristics.
Cardiopulmonary Exercise Stress Testing – an Update
Authors: Demeter Stephen L. 
Published: December 2020

Abstract
This article updates one published in The Guides Newsletter in January/February 1998 and reflects changing legislation in the workers’ compensation area and also in motor accident compensation. In the various Australian state and federal jurisdictions, impairment rating has become an important component of independent medical examinations, and in many areas, impairment guides have been adopted as a mandatory tool for assessing permanent impairment. For example, in the mid-1990s the state of Victoria established use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, as the sole tool for evaluating impairment and continues to use this edition to the present time. Despite the publication of the AMA Guides, Fifth Edition, in 2000, the Motor Accidents Authority in New South Wales (NSW) continues to use the fourth edition, supplemented with the NSW Motor Accidents Authority Guidelines. In November 2001, Tasmania adopted the same guidelines that were being used by the NSW Motor Accidents Authority. Despite publication of the AMA Guides, Sixth Edition, in 2007, there has remained a general reticence in Australia to progress to use of this latest edition either as stand-alone impairment rating tools or an underpinning of the purpose-developed impairment guidelines already in place. A large number of Australian medical assessors have become used to the model based on the NSW WorkCover Guides for the Evaluation of Permanent Impairment, which interprets the AMA Guides, Fifth Edition.
Impairment Rating for Non-Specific Back Pain Under the AMA Guides, Sixth Edition: Medical Perspective
Authors: Talmage James B. , Blaisdell Jay , Eskay-Auerbach Marjorie , Brigham Christopher R. 
Published: December 2020

Abstract
Low back pain and disability are common and evaluating a patient with non-specific spinal pain may be challenging, including determining impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, provides ratable impairment for the diagnosis of “non-specific chronic, or chronic recurrent low back pain (also known as chronic sprain/strain, symptomatic degenerative disc disease, facet joint pain,” and others. The evaluator should consider the diagnosis of non-specific chronic back pain only when no category of specific diagnosis fits the case (eg, no fracture, no spinal stenosis) or when “no reliable physical examination or imaging findings” but the patient's history of pain is felt to be reliable. According to the AMA Guides, primary determinant between a class 0 and class 1 rating for non-specific chronic back pain is whether the evaluator gives credibility to the patient's subjective reports of pain and interference with activities of daily living (ADLs). An evaluator may choose to use the Pain Disability Questionnaire (reproduced in the article) and Table 17-6, Functional History Adjustment, Spine, to determine the Functional History Grade Modifier (GMFH). The diagnosis of non-specific chronic or chronic recurrent low back pain yields a positive impairment only when the evaluator feels the patient's pain, as quantified by the GMFH, is reliably reported. Because there are no diagnostic objective findings on physical examination or clinical studies, these modifiers are excluded.
Electrodiagnosis of the Peripheral Nervous System: An Introduction
Authors: Katz Richard T. 
Published: December 2020

Abstract
This article is an introduction to electrodiagnosis of the peripheral nervous system, including electromyography, electroneurography (nerve conduction studies), and somatosensory evoked potentials. Electromyography involves the introduction of a special recording needle into a muscle body in search of spontaneous activity (electrical potentials that occur while the muscle is at rest). Three types of spontaneous activity are of greatest relevance: positive sharp waves, fibrillation potentials, and fasciculations. Electromyography can help assess the status of nerve fibers indirectly, but the integrity of large myelinated sensory and motor neurons can be evaluated directly by nerve conduction studies (NCS), also known as electroneurography. NCS involves the introduction of an electrical stimulus, either by surface electrode or needle, and recording an evoked response. NCS can assess motor neurons, sensory neurons, or mixed nerve trunks, depending on the strategy employed. Somatosensory evoked potentials (SSEP) sometimes are useful as an adjunct to EMG and NCS in the diagnosis of peripheral nervous system pathology and are obtained by stimulating a peripheral mixed nerve at a frequency of approximately 2-5 Hz. Several manufacturers have created automated, hand-held units for performing nerve conduction studies, and neuromuscular ultrasound is noninvasive and painless, and ultrasound of nerve entrapment has identified nerve enlargement just proximal to the site of entrapment. Physicians should know or learn the qualifications of the physician to whom they refer their patients for electrodiagnostic assessment.
Two-Point Discrimination in the Use of Upper Extremity Nerve Function in the AMA Guides
Authors: Katz Richard 
Published: December 2020

Abstract
This article presents a case report regarding a 34-year-old obese male who works as a chipper and grinder at a steel manufacturing mill and uses high-frequency vibratory power tools. He presents with typical complaints of carpal tunnel syndrome, including numbness in all five digits, wrist pain, nocturnal awakening/numbness, and others. Two-point discrimination (2PD) using a caliper was tested in the digits of the upper extremities and was 5 mm throughout. 2PD first appeared in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, and the Sixth Edition states, “sensory deficits can be challenging to grade, since the clinical examination is based on subjective reports by the patient. Grading is based on the results of sensibility testing and two-point discrimination, to improve inter-rater reliability.” The discussion of “sensibility” involves a concept of sensory perception that is more appropriate in surgery literature than neurological literature, and the discussion of the case report in this article reflects the recent literature regarding 2PD as a measure of sensibility. The authors report that sensibility is not a simple recovery of sensory function following nerve injury but rather is a complex interaction between nerve recovery and modulation of central nervous system function in spinal cord, subcortical, and cortical structures. The authors ask if the value of 2PD in the clinical assessment of impairment has been overrated within the AMA Guides, as was range of motion in the assessment of spine impairment.
Apportionment of Medical Illness
Authors: Demeter Stephen L. , Hoo E. Randolph Soo 
Published: December 2020

Abstract
Apportionment sometimes is necessary when a person had a prior injury that affected the same organ system or when there was evidence of a pre-existing disorder that was similar to the injury that will be rated. The past three editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) include subtle differences in the way that apportionment is defined. In addition to the information provided in the appropriate edition, certain philosophical and mechanistic considerations should be assessed before any apportionment and then should be used consistently in any subsequent cases that require apportionment. The first step in apportionment is a scientifically based causation analysis. Evaluators must avoid arbitrary, opinion-based unscientific apportionment estimates that are little more than speculations. In a situation that involves multiple injuries, if the impairment assessment has reached a defensible position with respect to causation then the rating for the first injury is determined using the edition of the AMA Guides that was used to rate the second injury. For example, if the rating for a second injury will be determined using the sixth edition, then the data for the first injury should be reworked using the sixth edition rules, irrespective of the rating for the first injury and the edition that was used.
Range of Motion: AMA Guides, Sixth Edition
Authors: Talmage James B. , Blaisdell Jay 
Published: December 2020

Abstract
In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, range of motion (ROM) is used to calculate the physical examination modifier when the diagnosis-based impairment (DBI) method is used, ie, Table 15-8, Physical Examination Adjustment: Upper Extremities, and Table 16-7, Physical Examination Adjustment: Lower Extremities. The DBI method is preferable for calculating upper and lower extremity ratings, but in instances specified by the regional grid, the evaluator may choose to use the ROM method, typically because it yields a higher impairment rating. The article outlines the steps for measuring ROM. Invalid results on the day of testing are declared after three consecutive efforts if the three measurements for a given plane of motion vary by more than 10 degrees from the average (mean) of these three measurements. The process can be tried again another day, or the DBI method can be used. All ROM measurements should be rounded to the nearest number ending in zero, and a figure provides examples of suitable annotations. Adjustments for functional history can be made if ROM is the only method used for rating, if results are deemed reliable and consistent with results from an activities of daily living questionnaire or other valid functional report, and if the current ROM impairment does not adequately capture the full impairment.
Social Security Disability and the AMA Guides
Authors: Hoo E. Randolph Soo 
Published: December 2020

Abstract
Two disability programs are administered by the US Social Security Administration (SSA): Disability under Title II of the Social Security Act is referred to as SDI, which is funded via contributions made by the individual worker, and disability under Title XVI of the Act commonly is referred to as SSI, which is funded through general funds from the US Treasury. Both SDI and SSI disability adjudication use the same five-step sequential evaluation process to determine if a claimant fulfills SSA's disability definition. The foundation for determining disability under SSA is medical evidence that establishes a medically determinable impairment based on defined evidentiary criteria. SSA determines disability, does not rate disability, and awards disability benefits only for total disability. Unlike SSA, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) does not determine (or rate) disability. The AMA Guides, Sixth Edition, emphasizes the use of evidence-based diagnosis for determining whole person impairments and contrasts with SSA disability for which a diagnosis is not a requirement and the focus is placed on determining «impairment» based on symptoms, clinical signs, and laboratory/diagnostic findings. SSA determines disability, does not rate disability, and awards disability benefits only for total disability. An impairment rating using the AMA Guides should not be equated to an SSA disability determination.
Cardiovascular Impairment Evaluation: Sixth Edition
Authors: Talmage James B. , Blaisdell Jay 
Published: December 2020

Abstract
To assess medical impairments, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) divides cardiovascular diseases into the following eight groups, each of which has its own grid: valvular heart disease; coronary artery disease; cardiomyopathies, pericardial heart disease, dysrhythmias, hypertensive cardiovascular disease, vascular diseases affecting the extremities, and diseases of the pulmonary artery. An accompanying table shows the criteria for rating permanent impairment due to valvular heart disease. Within the grids, the rows are divided into three main impairment variables: history, physical findings, and objective test results. The latter are essential in assigning cardiovascular impairment ratings. The AMA Guides names the objective test results variable as the key factor to underscore its role in assigning the impairment class in the cardiovascular chapter. For cardiovascular impairments, objective test results are always used to place the injury in its impairment class; therefore, objective test results are never used to modify the rating once the evaluator chooses the impairment class. Not all internal medicine chapters designate objective test results as the key factor, but all use one key factor that is clearly indicated in a footnote and one or two non-key factors. This rating scheme emphasizes objective test results, history, and physical findings and avoids incorporating variables twice.
Sex-Specific Conditions, Gender, and Evaluation Using the AMA Guides
Authors: Cocchiarella Linda , Mueller Kathryn 
Published: December 2020

Abstract
Concerns about potential sex and gender bias during impairment and disability evaluations have been raised; this article reviews ways in which sex and gender contribute to the unique presentation, manifestations, treatment, and functional outcome of medical conditions and how these differences can be appropriately addressed using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. Sex differences are objective and are based on biochemical and biological factors; gender refers to cultural attitudes that are learned and vary by culture, history, and ethnicity. The AMA Guides acknowledges individual variations and advocates a flexible approach: Physicians can choose among sections of the AMA Guides those best suited to account for individual and sex differences. The AMA Guides does not advocate different evaluation of medical conditions based on sex, except for sex-specific disorders (eg, unique male or female reproductive organs). The health care system is striving to eliminate gender and sex bias, and impairment and disability are following by attempting to eliminate bias by offering individualized assessments of how impairment affects the injured organ, use of unique rating methods to fully characterize the impairment, use of rating ranges to account for individual variability and sex, and by ascribing equal values to gender-ascribed activities of daily living.
Impairment Assessment of Male Sexual Dysfunction
Authors: Brigham Christopher R. , Soo Hoo Randy 
Published: December 2020

Abstract
Impairment assessment of male sexual dysfunction using both the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth and Sixth Editions, must be done with appropriate evaluation and objective findings in order to support ratable sexual dysfunction. The fifth edition specified that the absence of sexual functioning results in a maximum rating of 20% whole person impairment (WPI); in the sixth edition, the maximum is 15%. In the AMA Guides, Fifth and Sixth Editions, sexual dysfunction is discussed in Chapter 7, The Urinary and Reproductive Systems, and in Chapter 13, The Central and Peripheral Nervous System. In the fifth edition, Section 7.7, Male Reproductive Organs, provides guidance for impairment percentages for male reproductive organs for men aged 40–65 years; age adjustment is made for males younger than 40 (WPI is increased 50%) and older than 65 (WPI is decreased 50%). Section 13.7d, Sexual System Neurologic Impairments, in the fifth edition of the AMA Guides directs evaluators to use Table 13-21, Criteria for Rating Neurologic Sexual Impairments. In the sixth edition, Section 7.7 similarly offers guidance for impairment percentages for male reproductive organs for men aged 40–65 years but, unlike the fifth edition, allows a 10% upward or downward adjustment at the evaluator's discretion based on the individual's age and level of premorbid sexual functioning. In the sixth edition, Table 7-6, Criteria for Rating Permanent Impairment Due to Penile Disease, presents four classes and three grades.
Case Study: Use of Electrodiagnostic Evaluation to Assess Lumbar Radiculopathy
Authors: Dagher Edward , Talmage James B. , Direnfeld Lorne , Brigham Christopher R. 
Published: December 2020

Abstract
The electrodiagnostic examination is an important diagnostic tool that defines the location, pathophysiology, severity, and chronicity of a wide array of neuromuscular disorders. The test comprises two parts, a nerve conduction study (NCS) and needle electromyography (EMG), and is an extension of the neuromuscular portion of the physical examination. Together, NCS and EMG provide complementary information about the integrity of the peripheral nervous system. The article presents a case example that is evaluated using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. The case describes a 52-year-old woman who had a back injury that was managed conservatively for fifteen months and then underwent a three-level lumbosacral instrumented posterolateral fusion (the rationale is unclear from the records). Her pain persisted and treatment has included chronic narcotics; she reported multiple physical and psychological complaints and difficulties, and illness behavior and unreliable self-reports failed to corroborate her reports. Needle EMG must be performed on the patient's paraspinal muscles for proper evaluation of radiculopathy, and in this case there was no evidence of involvement of any ventral ramus and thus no evidence was documented of nerve root abnormality involving two or more limb muscles that receive innervation from the same nerve root. For this individual, the changes seen in paraspinal EMGs were unlikely to be due to a true lumbar radiculopathy, which was not convincingly established.
Assessing Sexual Dysfunction Part 2: Female Sexual Dysfunction
Authors: Cohen Seth D. , Mandel Steven , Samadi David B. 
Published: December 2020

Abstract
Sexual dysfunction is more common in women (43%) than men (31%), and the evaluating physician must consider the individual's chronological and physiologic age, personal and interpersonal sexual experiences, life events, and relationship issues that may have an effect on female sexual health. The medical history should include focused questions about medical and/or surgical illnesses, use of medications, and urogynecological history. Validated, reliable, standardized questionnaires are useful to identify the presence or absence of various domains of female sexuality such as sexual desire, sexual arousal, orgasm, and/or sexual pain (eg, the Female Sexual Function Index). Serum hormone testing should be dictated by clinical suspicion, and the physician also may assess multiple androgen and estrogen values, as well as pituitary function and levels of thyroid stimulating hormone. Systemic androgens (eg, systemic dehydroepiandrosterone and/or systemic testosterone) may improve mood, energy, stimulation, sensation, arousal, and orgasm in women with sexual health concerns. Combining a biomedical and psychosocial approach to any kind of sexual dysfunction helps to optimize patient outcomes. In the case of hypoactive sexual desire disorder (HSDD), individual or couples-based therapy with a sexual health therapist should be part of the consultation. If the biologic basis of the sexual health concern can be diagnosed by history, physical examination, laboratory testing, and directed imaging studies, then management can be directed to evidence-based management strategies.