bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating Causation for the Opposite Upper Limb
Authors: Melhorn J. Mark , Talmage James B. , Brooks Charles N. , Brigham Christopher R. 
Published: December 2020

Abstract
Workers’ compensation and personal injury claims often become embroiled in debates about the cause of the clinical presentation. When the primary claim involves an extremity, affected individuals sometimes report subsequent symptoms in the contralateral, previously “normal” limb and often attribute its onset to overuse while favoring the initially involved extremity; such an overuse hypothesis seems plausible, and perhaps intuitively obvious, to some. The concept that favoring one upper limb can result in injury to or illness in the other is not based on scientific evidence and instead is an unsupportable myth. Determining relationships between risk factors or exposures and medical conditions is a complex process that is outlined in the Guides to the Evaluation of Disease and Injury Causation (Causation). A search on PubMed and MEDLARS using the key phrases “opposite uninjured arm” and “uninjured arm” returned only six relevant articles, and the authors report that claims of serious or persisting painful syndromes in the arm or hand opposite the injured one are seldom adequately supported by clinical evidence. Similarly, the literature does not support “favoring” as a reasonable cause for development of symptoms in the contralateral shoulder or elbow. Epidemiological studies can provide general information regarding risk; this information must be filtered by specific steps to assess causal association for a disorder and determine if the injury is work related. Findings then can be applied to the specific individual.
Determining Injury-Relatedness, Work-Relatedness, and Claim-Relatedness
Authors: Barth Robert J 
Published: December 2020

Abstract
The American Medical Association's Guides to the Evaluation of Disease and Injury Causation (Causation) is an important component of the AMA Guides library and delineates a type of evaluation that is distinctly different from a diagnostic evaluation, a treatment planning evaluation, a prognosis evaluation, or an impairment evaluation. Causation provides a protocol for determining whether a clinical presentation, in the context of a legal or administrative claim, may be credibly attributed to a claimed cause. This article presents the evaluation protocol from Causation, provides self-assessment questions (so users can check how well they complied with the protocol), highlights the protocol's value as a model for scientifically credible practice in general, and clarifies that the protocol is relevant to claims that involve issues related to forensic causation. Courts and administrative systems have an extremely unfortunate emphasis on opinions from experts rather than on facts. The protocol from Causation is a good example of how clinicians can focus on facts and avoid surrendering to the court or administrative system's emphasis on opinions. The protocol is standardized, objective, fact-based, and scientifically credible and involves the following: establish a diagnosis; apply relevant findings; obtain and assess evidence of exposure; consider other relevant factors; scrutinize the validity of the evidence; and evaluate results and generate conclusions.
AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition: A Response to the NCCI Study
Authors: Rondinelli Robert D. , Eskay-Auerbach Marjorie , Ranavaya Mohammed I. , Brigham Christopher R. 
Published: December 2020

Abstract
The AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Sixth Edition, is the recognized international standard for assessing impairment. The National Council on Compensation Insurance (NCCI) conducted a comparative study to examine the effects on impairment ratings in three states that have switched from the fifth to the sixth edition. The purpose and objectives of this article are as follows: 1) to provide a brief review of the conceptual framework and terminology of disablement and of the current model of disability in the AMA Guides and also to underscore the importance of the construct of medical impairment to compensation schemes within workers' compensation and other disability systems; 2) to examine the AMA Guides in terms of its origin, purpose, distribution, applications, and misapplications; 3) to examine the changes in the sixth edition in terms of efforts to direct change and improve upon the AMA Guides; 4) to examine the merits and shortcomings of the NCCI study and its conclusions within a broader context of inherent sources of variance in impairment ratings, as well as the content validity, reliability, and reproducibility of the ratings themselves; 5) to provide recommendations regarding the implications of this study for the use of the sixth and earlier editions of the AMA Guides, and to suggest new directions for much needed critical research.
Question and Answer
Authors: Brigham Christopher R. , Melhorn J. Mark , Talmage James B. 
Published: December 2020

Abstract
Following successful surgical treatment of an inguinal hernia (ie, preparing the defect), there should be no ratable impairment unless there is clearly recognized nerve injury or a complication such as infection. The AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fifth and Sixth Editions, provide guides to the rating of permanent impairment for hernias. Both stress that impairment evaluation is predicated on the existence of a causal relationship between the individual's condition and an event or exposure. If a patient has an appropriate repair, then the defect should be resolved; that is, there should be no physical examination findings of a palpable deficit nor of a protrusion. If a palpable defect is present and the hernia is causally related to an injury, then the hernia is ratable. As with all ratings, the underlying basis must be reliable; that is, the history, including reported activities of daily living (ADL), must be supportable. In the AMA Guides, Fifth Edition, three examples show ratings, all of which depend on objective findings of palpable defects (protrusions). The sixth edition outlines the assignment of one of four classes of findings and interferences with ADLs. Impairment is based on objective findings when the individual is at maximum medical improvement.
A Trial Consultant's View of the Medical Expert Witness
Authors: Rutt Deborah , Mueller Kathyrn 
Published: December 2020

Abstract
Physicians who use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) often serve as medical expert witnesses. In workers’ compensation cases, the expert may appear in front of a judge or hearing officer; in personal injury and other cases, the physician may testify by deposition or in court before a judge with or without a jury. This article discusses why medical expert witnesses are needed, what they do, and how they can help or hurt a case. Whether it is rendered by a judge or jury, the final opinions rely on laypersons’ understanding of medical issues. Medical expert testimony extracts from the intricacies of the medical literature those facts the trier of fact needs to understand; highlights the medical facts pertinent to decision making; and explains both these in terms that are understandable to a layperson, thereby enabling the judge or jury to render well-informed opinions. For expert witnesses, communication is everything, including nonverbal communication that critically determines if judges and, particularly, jurors believe a witness. To these ends, an expert medical witnesses should know the case; be objective; be a good teacher; state opinions clearly; testify with appropriate professional demeanor; communicate well, both verbally and nonverbally; in verbal communications, explain medical terms and procedures so listeners can understand the case; and avoid medical jargon, finding fault or blaming, becoming argumentative, or appearing arrogant.
Impairment Related to Diseases of the Aorta
Authors: Demeter Stephen L. 
Published: December 2020

Abstract
Aneurysms may result in ratable permanent impairment, and this article provides a basic understanding of aneurysms and how to rate them using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. An aneurysm is a bulge in a blood vessel, commonly in the arterial circulation and in the cerebral and renal vasculature or in the aorta. Because ruptured aneurysms frequently are lethal, generally they are treated prophylactically once they have reached a certain size. Endovascular repair is associated with an increased risk of all-cause mortality and abdominal aortic aneurysm mortality. The AMA Guides, Fifth Edition, rated aneurysms solely on the risk of rupture (ie, a future impairment, one of the few exceptions to their general proscription in the AMA Guides), and the impairment percentages can be quite large. These impairments are rated using the rating systems for the affected organ system when the individual is at maximum medical improvement (MMI). In addition, the risk of future impairment should be assessed when the individual is at MMI, and that rating should be combined with the rating for organ system vascular compromise. The justification for rating the risk of future events should be clarified in the report, which should cite the method reported in the present article because the AMA Guides, Sixth Edition, does not provide a methodology for rating this disease process.
Apportionment of Impairment from Meniscal Tears and Knee Arthritis
Authors: Brooks Charles N. , Talmage James B. 
Published: December 2020

Abstract
Meniscal tears and osteoarthritis (osteoarthrosis, degenerative arthritis, or degenerative joint disease) are two of the most common conditions involving the knee. This article includes definitions of apportionment and causes; presents a case report of initial and recurrent tears of the medial meniscus plus osteoarthritis (OA) in the medial compartment of the knee; and addresses questions regarding apportionment. The authors, experienced impairment raters who are knowledgeable regarding the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), show that, when instructions on impairment rating are incomplete, unclear, or inconsistent, interrater reliability diminishes (different physicians may derive different impairment estimates). Accurate apportionment of impairment is a demanding task that requires detailed knowledge of causation for the conditions in question; the mechanisms of injury or extent of exposures; prior and current symptoms, functional status, physical findings, and clinical study results; and use of the appropriate edition of the AMA Guides. Sometimes the available data are incomplete, requiring the rating physician to make assumptions. However, if those assumptions are reasonable and consistent with the medical literature and facts of the case, if the causation analysis is plausible, and if the examiner follows impairment rating instructions in the AMA Guides (or at least uses a rational and hence defensible method when instructions are suboptimal), the resulting apportionment should be credible.
Do Rear-End Motor Vehicle Collisions Cause Rotator Cuff Tears?
Authors: Brooks Charles N. , Funk James R. , Mark Melhorn J. , Talmage James B. , Brigham Christopher R. 
Published: December 2020

Abstract
The rotator cuff comprises four muscles and their tendons, the supraspinatus, infraspinatus, teres minor, and subscapularis. Rotator cuff tears (RCTs) are common and most frequently involve the supraspinatus, and usually occur through tendon rather than muscle. Clinical manifestations vary depending on the size and age of the tear, the individual's physical demands, psychosocial factors, and other variables; tears may range from the asymptomatic to large, full-thickness, and retracted tears that cause pain, weakness, and at least partial disability. Individuals involved in rear-end motor vehicle collisions (MVCs) may complain of “shoulder” pain, and magnetic resonance imaging may reveal the presence of shoulder cuff tears, high-energy trauma can cause rotator cuff tears, but the tensile forces encountered in rear-end MVCs almost certainly do not cause rotator cuff tears de novo. Because rear-end collisions and RCTs are common and often involve claims or lawsuits, physicians may be asked to assess the causation of the RCTs. Treatment should be based on clinical findings and not the results of imaging; the same applies to causation analysis: Involvement in a rear-end MVC does not establish causality for a rotator cuff tear. The medical literature is devoid of evidence indicating that rear-end collisions cause RCTs, but compelling evidence in the biomechanical literature shows that low-speed rear-end MVCs do not cause RCTs.
Clinical Assessment of Cervical Myelopathy
Authors: Eskay-Auerbach Marjorie , Brooks Charles N. 
Published: December 2020

Abstract
Myelopathy literally indicates any pathology of the spinal cord, but the term most commonly is used when the cord pathology results from degenerative disease. Specific names usually are used if the disorder is traumatic (spinal cord injury), infectious (myelitis), or neoplastic (the name of the tumor is used). Cervical myelopathy (CM) may result in symptoms such as clumsiness, loss of dexterity, imbalance or poor coordination; muscle weakness; pain; and, in severe cases, bowel, bladder, or sexual dysfunction. When impairment is rated, if the evaluator finds objective evidence of myelopathy when the individual is at maximum medical improvement, neurological impairment is combined with that for the spine. A detailed and thorough neurologic examination is the current standard for the diagnosis of CM, but diagnosis is challenging in the early stages. Correlation of patient symptoms and imaging studies, both plain radiographs and magnetic resonance imaging scans, is essential for correct diagnosis. When imaging studies are equivocal or insensitive, other studies such as electrodiagnostic testing and cerebrospinal fluid analysis may be considered. When CM is defined as the presence of more than one long-tract sign, spinal cord compression in isolation did not cause myelopathy, and up to 20% of those with cord compression did not exhibit CM.
Evidence-Based Medicine, Treatment Guidelines, and Literature Search Web Resources
Authors: Brigham Christopher R. 
Published: December 2020

Abstract
Cardiopulmonary exercise stress testing (CPET) provides objective data to assess cardiac and pulmonary impairment. This article discusses changes in the CPET section of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). The explanation of CPET in the AMA Guides, Sixth Edition, adds a single word, “static,” that significantly effects how this test should be conducted. Routine pulmonary function tests (PFTs) provide information about a person's ability to breathe, eg chronic obstructive pulmonary disease or asthma can stratify the severity of these diseases; they do not measure the ability of the lungs or heart to provide adequate oxygenation to metabolizing tissues. Static tests of lung function are the norm when diagnosing asbestosis, and the typical abnormalities seen are restriction, some airflow obstruction, and a diminished diffusing capacity. These abnormalities correlate linearly with the degree of abnormality found radiographically. In individuals with unexplained shortness of breath with exertion or fatigue that is not easily explained in the medical records, a CPET will allow secure diagnosis of causation. Thus CPET is a powerful tool to explain shortness of breath with exertion or fatigue, and CPET has a role in the impairment rating process of all individuals with interstitial lung diseases and in selected individuals with unexplained symptoms.
Sacroiliac Joint Pain: Clinical and Impairment Rating Issues
Authors: Eskay-Auerbach Marjorie , Talmage James B. 
Published: December 2020

Abstract
The sacroiliac joint (SIJ) is an accepted source of pain in patients with ankylosing spondylitis and other spondyloarthropathies, osteoarthritis, infections, and tumors, but the occurrence of isolated SIJ pain in the absence of such diseases is controversial. The term, sacroiliac joint dysfunction, which is used widely, describes pain from an SIJ that has no identifiable lesion but is presumed to have some mechanical etiology. Practitioners currently have no universally accepted gold standard for identifying a disc, facet joint, of SIJ as the pain generator. Treatment options for SIJ pain include medications, physical therapy, bracing, manual therapy, injections, radiofrequency neurotomy, and arthrodesis. Optimal management of patients with SIJ pain remains controversial. In the AMA Guides, Sixth Edition, a clinically established and causally related diagnosis of SIJ dysfunction is rated using the first row in Table 17-4. Surgery does not change the diagnosis or rating: The SIJ is not a motion segment of the lumbar spine, and SIJ fusion is not an alteration of motion segment integrity. Clinically, pain presumed to be from SIJ dysfunction is low back pain, so if this is the clinical diagnosis, the spine chapter in the AMA Guides, Fifth Edition, should be used. In such cases, the first step is to determine whether to use the diagnosis-related estimate or the range-of-motion method, and the article provides guidance about situations in which the use of each is appropriate.
Fit Vs Faint: Assessing Work Causation in “Idiopathic Fall” Cases
Authors: Direnfeld Lorne , Torrey David B. , Black Jim , Haley LuAnn , Brigham Christopher R. 
Published: December 2020

Abstract
When an individual falls due to a nonwork-related episode of dizziness, hits their head and sustains injury, do workers’ compensation laws consider such injuries to be compensable? Bearing in mind that each state makes its own laws, the answer depends on what caused the loss of consciousness, and the second asks specifically what happened in the fall that caused the injury? The first question speaks to medical causation, which applies scientific analysis to determine the cause of the problem. The second question addresses legal causation: Under what factual circumstances are injuries of this type potentially covered under the law? Much nuance attends this analysis. The authors discuss idiopathic falls, which in this context means “unique to the individual” as opposed to “of unknown cause,” which is the familiar medical terminology. The article presents three detailed case studies that describe falls that had their genesis in episodes of loss of consciousness, followed by analyses by lawyer or judge authors who address the issue of compensability, including three scenarios from Arizona, California, and Pennsylvania. A medical (scientific) analysis must be thorough and must determine the facts regarding the fall and what occurred: Was the fall due to a fit (eg, a seizure with loss of consciousness attributable to anormal brain electrical activity) or a faint (eg, loss of consciousness attributable to a decrease in blood flow to the brain? The evaluator should be able to fully explain the basis for the conclusions, including references to current science.
Peripheral Nerve Entrapment Impairments Revisited: Part I
Authors: Melhorn J. Mark , Talmage James B. , Brooks Charles N. 
Published: December 2020

Abstract
The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, introduced the concept of diagnosis-based impairments (DBI), and a modified version of this method can be used in rating peripheral nerve injury in general (Section 5.4) and upper limb entrapment syndromes (Section 15.4f). The first portion of this article reviews the evaluation of upper extremity nerve impairment and summarizes inclusion criteria and causation correlation for carpal tunnel syndrome, Guyon's canal syndrome, cubital tunnel syndrome, anterior interosseous, Wartenberg's syndrome, and radial tunnel syndrome. Very mild nerve entrapments do exist and may fail to meet the AMA Guides criteria for impairment related to a diagnosis of nerve entrapment. Electrodiagnostic examination includes nerve conduction studies that assess the largest, most heavily myelinated axons, and needle electromyelography, which detects muscle membrane instability but not the sensory function of nerves. A case example from the AMA Guides, Sixth Edition, shows the process of permanent impairment rating in a case of carpal tunnel syndrome. Determination of impairment for peripheral nerve entrapments can be easily accomplished once one understands how to determine if the nerve under consideration from the electrodiagnostic evaluation demonstrates a conduction delay, a conduction block, or an axon loss. This establishes the test findings that usually are the only objective findings present.
International Classification of Functioning, Disability, and Health: A Contemporary Model of Disablement
Authors: Bond Malcolm 
Published: December 2020

Abstract
This article begins with a consult of a patient using the International Classification of Functioning, Disability, and Health (ICF), published by the World Health Organization in 2001. The ICF framework serves as the conceptual model for the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. In contrast to the issues of morbidity-centric documentation schemas, the ICF platform provides a standardized nomenclature to chart functioning, specifically an integrative biopsychosocial model of functioning that defines the components of functioning. The ICF qualifier serves as the titratable dimension of function; the qualifier not only satisfies the need for charting progress but also, when aggregated, provides the possibility of identifying the quantitative metrics of a cohort (eg, service needs, length of hospitalization, level of care, functional outcomes, and return-to-work potential). Implementing ICF into routine documentation moves practitioners toward the concept of functioning not as a consequence of disease but rather toward the real-life dynamics among health condition, body function, body structure, and environmental factors that determine functioning. ICF will be an essential basis for the standardization of data concerning all aspects of human functioning and disability around the world. ICF will be useful for persons with all forms of disabilities, not only for identifying health care and rehabilitative needs but also in identifying and measuring the effect of the physical and social environments.
Practical Individual Resilience: A Neuroplastic Approach
Authors: Aurbach Robert 
Published: December 2020

Abstract
Resilience has been a disappointment in the context of understanding why some people bounce back from injury, illness, or other challenges, but others do not. Researchers have identified characteristics that are found in people they deem to be resilient, but these characteristics are too general to be used effectively and do not demonstrate how to build or reinforce resilience. Humans form habits of thought, feelings associated with particular stimuli, and behaviors in response to stimuli, a process known as neuroplasticity. Injured or ill individuals often are presented with additional stimuli that maintain the associations and expand the scope of illness. In the privacy of their own minds, individuals may repeat self-negating thoughts about economic pressure, loss of work identity, psychosocial issues, and others that lead to anger, frustration, worry, catastrophic thinking, and grief—creating a web of disability. In this context, resilience can be reframed as the ability of a person to change, quiet, or moderate self-talk in order to minimize their long-term reaction to stressors. To foster resilience, individual interventions can be undertaken as general life training, specific inoculation against anticipated situations, or in a remedial role to help those whose experience of challenges has been exacerbated by an inner voice that is out of control. Workplaces that enhance rather than diminish individual resilience allow productivity and wellness to coexist and reinforce one another.