bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impairment Assessment of Female Sexual Dysfunction
Authors: Brigham Christopher R. , Soo Hoo Randolph 
Published: December 2020

Abstract
Impairment assessment of female sexual dysfunction using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth or Sixth Edition, must be performed using appropriate evaluation and objective findings to support ratable sexual dysfunction. In both editions, sexual dysfunction is discussed in Chapter 7, The Urinary and Reproductive Systems, and Chapter 13, The Central and Peripheral Nervous System. In the fifth edition, the maximum impairment rating for female sexual functioning is 35% whole person impairment; in the sixth edition, the maximum is 20%. In terms of rating female reproductive organ impairment, the fifth edition gives consideration to the differences between premenopausal and postmenopausal women. Table 7-9, Criteria for Rating Permanent Impairment Due to Vulval and Vaginal Disease in the fifth edition is used to rate female sexual dysfunction; three classes are identified, and, although age is not a specific consideration, this edition discusses differences between premenopausal and postmenopausal women. In the AMA Guides, Sixth Edition, Table 7-10, Criteria for Rating Permanent Impairment Due to Vulval and Vaginal Disease, is used and provides four classes, two of which have severity grades. Each class addresses historical signs and symptoms of vulvar or vaginal diseases, vulval and vaginal physical alterations, and potential effect of altered vaginal anatomy for vaginal delivery (if premenopausal). Neurogenic sexual dysfunction is combined with other related impairments using the Combined Values Chart.
Putting Job Loss in the Spotlight as a Poor (and Often Preventable) Health Outcome
Authors: Christian Jennifer 
Published: December 2020

Abstract
The author considers the hypothetical case of a worker disabled by an accident and spine fusion surgery that did not relieve the pain; he is offered opioids and spends his time in a recliner grieving the loss of his self-respect as a good husband, provider, and father. This outcome need not have been a foregone conclusion. Research has shown that, for adults, worklessness is harmful to both physical and mental health, as well as to marital, family, social, and economic well-being. Gaps in social fabric are creating job loss and work disability because none of the professionals who typically respond to workers with job disruption due to illness or injury specifically feels responsible for avoiding job loss. Besides being a personal catastrophe, health-related withdrawal from work (work disability) negatively effects society; the lost productivity of workers in the local and national economy, which accounts for the majority of the approximately $400 billion that federal and state governments spend to support working-age people with disabilities. All Americans deserve timely assistance to maintain their economic independence and enjoy the dignity that comes with having a job. Improved public policy, governmental efforts, and support from the private sector is needed to prevent needless disability.
Life Care Plans
Authors: Katz Richard T. 
Published: December 2020

Abstract
In catastrophic injury cases, attorneys may request that a budget, often called a life care plan (LCP), be created to estimate expenses that a client will have in the future. The LCP is a budgeting process that requires a thorough understanding of a patient's condition, rehabilitation, and future needs to estimate what services and costs are likely to be needed in the future. The physician determines the extent and sequelae of the patient's physical and cognitive impairments; estimates a prognosis; estimates the need for and benefit of further medical and rehabilitative interventions; and then calculates the costs of future personal needs. Such a model first requires an accurate prognostication of the patient's life expectancy. Various costs projections are evaluated to estimate costs related to supplies, medications, physician and therapist services, and home and transportation modifications. Finally, such costs must be placed in an economic model in order to determine how the costs of inflation will modify the LCP. A competently formulated LCP can be a useful tool in estimating the future costs in catastrophic patient care. The article also presents a case example using a spinal cord injury to demonstrate how an LCP can be constructed.
Two Faulty Beliefs about Independent Medical Evaluators and Impartial Physicians
Authors: Christian Jennifer 
Published: December 2020

Abstract
Patients and their advocates tend to be skeptical about reports produced by independent medical evaluators (IMEs) and file reviewers. There are legitimate reasons for this skepticism, but the author points out two common but erroneous beliefs that create unnecessary distrust in disability benefits and workers’ compensation claim management systems. First, despite patients’ faith in their own doctors, treating physicians as a group are not a reliable source of accurate and unbiased information. Second, although justice attempts to be even-handed, impartial physicians should not find for both sides equally (ie, should not attempt to achieve parity in outcomes), particularly because any case sent for review has some feature that raised questions in the mind of an experienced observer. This experienced observer requires an impartial, expert physician advisor who can confirm that the treating physician is doing the right thing or validate the claims manager's concerns. When claims or case managers are doing a good job of selecting cases for referral, one should expect that most of their decisions will favor the insurer/defense. The more expert the claims/case managers are, the more likely the independent physicians will agree because the claims/case managers are accurately detecting real problems and concerns. In counseling their patients, physicians should not discredit the work of independent experts; doing so increases distrust, resentment, and anger and encourages passivity rather than problem-solving.
Flawed Approaches to Determining the “Most Accurate Impairment Rating”: The California Experience
Authors: Brigham Christopher R. , Talmage James B. , Eskay-Auerbach Marjorie 
Published: December 2020

Abstract
Socioeconomic factors influence all aspects of workers’ compensation, personal injury, and disability systems, but the best financial interest of certain stakeholders may not be aligned with the ultimate best interests of those who are injured or ill. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, was introduced in California in 2005 to improve the reliability of permanent disability award ratings, which previously were based primarily on subjective factors. The result was a reduction in the dollar value of disability rewards, and, in response, certain stakeholders took steps to reduce this impact, including instructing physicians to ignore instructions in the AMA Guides. The AMA Guides, Sixth Edition, addresses many of the potential misapplications of the criteria in the fifth edition. Despite efforts to improve the validity and reliability of impairment assessment, some stakeholders continue to resist use of the more current edition. In California, impairment currently is rated by agreed medical evaluators; this should be changed to ensure that evaluations are performed by unbiased physicians who are educated with respect to evidence-based medicine and causation. Injured workers must be fairly and appropriately compensated for losses associated with an injury, but not at the cost of inappropriate inflation of impairment and disability ratings because the latter contribute to needless disability and impede living a productive and joyous life.
Rating Cognitive Impairment, Part 2: Objective and Evidence-Based Integration of Neuropsychology Testing
Authors: Barth Robert J. , Meyers John E. 
Published: December 2020

Abstract
Hearing impairment rating determination is described in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, Section 11.2a, Criteria for Rating Impairment Due to Hearing Loss. A hearing impairment evaluation for adults who have acquired language skills is derived from a pure-tone audiogram and always is based on the functioning of both ears even though hearing loss may be present in only one ear. Audiometers should be properly calibrated, and technicians should be appropriately trained to obtain accurate measurements. Audiograms typically are obtained at four frequencies (test frequencies): 500, 1000, 2000, and 3000 Hz, which are considered to be representative of everyday auditory speech ranges. The evaluator tests the individual's right and left ears at the test frequencies and adds the decibel levels for each of these frequencies for each ear separately; consults Table 11-2, Computation of Binaural Hearing Impairment; and finally consults Table 11-3, Relationship of Binaural Hearing Impairment to Impairment of the Whole Person. Tinnitus can be rated if the individual experiences hearing loss in the ear and this loss affects speech discrimination; loss is limited to a maximum of 5% loss. The AMA Guides provides no correction in the hearing section for age-related loss of hearing, although the latter may be apportionable. A table presents a model hearing impairment report.
Commonly Misused Musculoskeletal and Medicolegal Terms
Authors: Brooks Charles N. 
Published: December 2020

Abstract
The misuse of medical and legal terminology can be confusing and frustrating and also introduces the potential for errors; this article focuses on some of the most often misused terms applicable to injury and illness. A common example of anatomical imprecision involves the shoulder, and patients who complain of “shoulder pain” sometimes localize their discomfort in the trapezius or scapula rather than on the shoulder per se. The distinction between shoulder and upper back or shoulder girdle pain is not merely terminological nitpicking but rather is of clinical significance. Similarly, no terms are more commonly misused than “arm” and “leg.” The most misused terms in musculoskeletal pathology are those related to disc lesions, and one commonly hears that a magnetic resonance image (MRI) scan was ordered “to rule out a disc,” but having a disc is neither an indication for MRI nor surgery. Further imprecise terminology leads to semantic imprecision when terminology is incorrectly used, including intervertebral disc, bulge, protrusion, extrusion, sequestered fragment, hernia, rupture, and even fracture. Physician evaluators and health care providers must understand that—by virtue of the authority vested in them and the weight given to their opinions by claims personnel, attorneys, judges, and others—errors and injustices may occur if they do not understand or correctly use medicolegal terms.
Central Nerve System Impairment, AMA Guides, Sixth Edition: An Overview
Authors: Talmage James B. , Blaisdell Jay 
Published: December 2020

Abstract
Injuries that affect the central nervous system (CNS) can be catastrophic because they involve the brain or spinal cord, and determining the underlying clinical cause of impairment is essential in using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), in part because the AMA Guides addresses neurological impairment in several chapters. Unlike the musculoskeletal chapters, Chapter 13, The Central and Peripheral Nervous System, does not use grades, grade modifiers, and a net adjustment formula; rather the chapter uses an approach that is similar to that in prior editions of the AMA Guides. The following steps can be used to perform a CNS rating: 1) evaluate all four major categories of cerebral impairment, and choose the one that is most severe; 2) rate the single most severe cerebral impairment of the four major categories; 3) rate all other impairments that are due to neurogenic problems; and 4) combine the rating of the single most severe category of cerebral impairment with the ratings of all other impairments. Because some neurological dysfunctions are rated elsewhere in the AMA Guides, Sixth Edition, the evaluator may consult Table 13-1 to verify the appropriate chapter to use.
Rating Knee Impairments
Authors: Blaisdell Jay , Talmage James 
Published: December 2020

Abstract
Workers who kneel for major portions of their workday (eg, floor and roof installers) may be prone to inflammation of the knee bursae and patellofemoral pain. In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), range-of-motion (ROM) and diagnosis-based impairment (DBI) are the two possible stand-alone methods for rating knee impairment. The ROM method was widely used in previous editions of the AMA Guides, but at present DBI is the method of choice for calculating impairment. To rate knee impairment using the DBI method, the physician first chooses the appropriate diagnosis from the Knee Regional Grid in the AMA Guides, Sixth Edition. Next, the physician chooses the appropriate impairment class for the diagnosis and then selects the appropriate grade modifiers. The physician applies the net adjustment formula to determine lower extremity impairment and finally converts the final lower extremity impairment to whole person impairment. Two or more conditions often are found in the knees and require causation analysis in which the physician should choose the single causally related diagnosis that will yield the highest impairment rating. Modifiers should be chosen based on reliable findings that have not been used previously to assign either the diagnosis or impairment class. The ROM method can be used to select the physical examination grade modifier or as a stand-alone rating if the physician offers a rationale that is supported by the AMA Guides.
The Intersection of Medicine and Disability
Authors: Iglesias Marcos 
Published: December 2020

Abstract
Many physicians were not formally trained in the evaluation and management of disability and must understand the language of disability, how disability is evaluated, what to expect from a medical evaluation, and how to communicate effectively to achieve the best outcomes. The very language of disability is complex and often is misunderstood. For example, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, defines impairment as “a significant deviation, loss, or loss of use of any body structure or body function in an individual with a health condition, disorder, or disease.” In contrast, disability is variously defined by the administrative or legal system with jurisdiction, and the AMA Guides broadly defines disability as “activity limitations and/or participation restrictions in an individual with a health condition, disorder, or disease.” Another useful concept is “needless disability” or days away from work that are not medically necessary; workless populations experience a two- to threefold increased risk of poor general health, including higher rates of cardiovascular disease, lung cancer, and respiratory infections, among other problems that contribute to an excess mortality of 20% among individuals in this group. Physicians help establish but are not the final arbiters of disability determinations; their role is to provide accurate, complete, and clear information that allows others to determine the presence, extent, and compensability of disability.
Pelvic Impairments
Authors: Talmage James , Blaisdell Jay 
Published: December 2020

Abstract
Pelvic fractures are relatively uncommon, and in workers’ compensation most pelvic fractures are the result of an acute, high-impact event such as a fall from a roof or an automobile collision. A person with osteoporosis may sustain a pelvic fracture from a lower-impact injury such as a minor fall. Further, major parts of the bladder, bowel, reproductive organs, nerves, and blood vessels pass through the pelvic ring, and traumatic pelvic fractures that result from a high-impact event often coincide with damaged organs, significant bleeding, and sensory and motor dysfunction. Following are the steps in the rating process: 1) assign the diagnosis and impairment class for the pelvis; 2) assign the functional history, physical examination, and clinical studies grade modifiers; and 3) apply the net adjustment formula. Because pelvic fractures are so uncommon, raters may be less familiar with the rating process for these types of injuries. The diagnosis-based methodology for rating pelvic fractures is consistent with the process used to rate other musculoskeletal impairments. Evaluators must base the rating on reliable data when the patient is at maximum medical impairment and must assess possible impairment from concomitant injuries.
Challenges in Rating Multiple Upper Extremity Conditions: A Case of Quadrilateral Space Syndrome and Medial Elbow Injury
Authors: Martin Douglas W. 
Published: December 2020

Abstract
Physicians sometimes are challenged with clinical presentations that do not fit perfectly within the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides); in such cases, the evaluator is instructed to apply clinical judgment and common sense when determining an impairment, with particular consideration of the effect of the medical condition on the individual's activities of daily living. In this case presentation, a 35-year-old male private security guard injured his right elbow performing a bench press while on assignment. After magnetic resonance imaging and electrodiagnostic evaluation, the patient underwent surgery that included a medial elbow Nirschl procedure and an ulnar nerve submuscular transposition. The patient underwent twelve months of rehabilitation, but he continues to experience a pins-and-needles sensation and perceives upper arm strength loss. Twenty-four months after surgery, the patient declines surgical treatment for quadrilateral space syndrome and presents for an impairment rating evaluation. Accepted medical conditions under the workers’ compensation program include quadrilateral space syndrome, medial epicondylopathy, and ulnar nerve entrapment at the elbow (cubital tunnel syndrome). The AMA Guides, Sixth Edition, does not include a listing for quadrilateral space syndrome, and the author discusses the challenges of teasing out functional limitations when multiple diagnoses are present within the same limb. Evaluators should note that the AMA Guides recommends using the impairment rating that most closely represents the actual functional loss.
Rating Physical Residuals of Breast Disfigurement
Authors: Demeter Stephen L. 
Published: December 2020

Abstract
A 48-year-old woman was working as a hostess in a lounge and was struck in the chest when a fight arose; afterwards, she noticed discomfort and a warm sensation in her left breast, which over the course of months remained smaller and also became distorted in comparison with her previous size, shape, contour, and comparison with her right breast. Ten years previously, she had received double lumen prostheses (saline on the outside and silicone gel on the inside). One year later she was found to be at maximum medical improvement (MMI) and described no signs or symptoms although her sexual life reportedly changed, with less frequency and satisfaction. Tables present the fifth edition criteria for rating permanent impairment due to skin disorders; fifth edition criteria for rating permanent impairment due to facial disorders and/or disfigurement; and sixth edition criteria for rating permanent impairment due to mammary disorders. Section 10.9 of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, mentions that coexisting psychiatric impairment would be rated using the mental and behavioral disorders chapter, which contains one reference to cosmetic abnormalities and requires a “severe cosmetic deformity with no ability to lactate.” Thus the only way to provide an impairment rating using the fifth edition for this individual is to perform a psychological evaluation; in the sixth edition, it is the only permissible rating.
Part II: Psychological Factors In Delayed And Failed Recovery and Unnecessary Disability
Authors: Caruso Garson , Kertay Les 
Published: December 2020

Abstract
Part two of this two-part article on psychological factors in delayed and failed recovery and resultant unnecessary work disability (DFRUD) considers both conceptual and practical interventions, including specific evaluation and treatment methods. The authors propose five categories of intervention for DERUD: 1) advance and operationalize our knowledge base; 2) make conceptual and practical shifts in our approaches; 3) place greater emphasis on prevention; 4) improve recognition of potentially difficult cases, and 5) apply specific management approaches and tools. Further, the authors propose conceptual and practical changes that should be made: Eliminate the dualistic separation of mind and body and the scientific reductionism that follows; change the focus from disability to capability; reduce improper workers’ compensation claims; improve the administrative and medical management of valid claims; enhance collegiality and communication among all stakeholders; and adopt a cost-utility vs absolute cost approach. The overarching goals of managing DFRUD include optimizing administrative and clinical treatment of the worker; protecting all stakeholders from excess; and overcoming barriers to intervention. To these ends, three activities can optimize the process: Intervene early; avoid iatrogenicity (ie, shorten claim durations and reduce costs); and stratify risk and employ stepped care. Barriers to meaningful intervention in DFRUD include questions of jurisdiction and responsibility for management (eg, does management of DFRUD fall to insurers or clinicians); who will pay; what are the maladaptive health cognitions and/or psychiatric comorbidities; and how can clinician behavior be altered to implement evidence-based practice?
Review of Symptoms and Signs for Working Adults with Median Nerve Entrapment
Authors: Melhorn J. Mark , Hegmann Kurt T. 
Published: December 2020

Abstract
Physicians often must evaluate patients who present with symptoms in a median nerve distribution and typically diagnose carpal tunnel syndrome (CTS), but an accurate diagnosis is critical to determine causation and to define possible impairment. CTS is a constellation of symptoms and signs that result from mononeuropathy of the median nerve in the carpal tunnel; symptoms typically include tingling and/or numbness, dysesthesias, and/or pain in the radial palm and palmar aspect of the thumb, index, middle, and perhaps ring fingers. The American Academy of Orthopaedic Surgeons suggests use of the CTS-6 scoring aid (shown in a table) as a clinical aid for diagnosing CTS. Electrodiagnostic testing, nerve conduction studies in particular, are considered the gold standard for diagnosis of CTS, but research suggests that the definitions of relevant sensory and assignment of CTS are sensitive to threshold changes from a latency of, eg, >4.4 msec vs >4.5 msec. Other factors to consider include whether there are effects from the known association between wrist ratio and CTS and assessing the benefits of neuromuscular ultrasound to diagnose CTS. Nocturnal paresthesias and paresthesias while holding onto an object were sensitive indicators of the presence of CTS but use of the Phalen and Hoffmann-Tinel signs has significant potential to be unreliable.