Quick Consult: Quick Consult: Acromioplasty

2002 ◽  
Vol 7 (3) ◽  
pp. 4-5
Keyword(s):  
Glasgow Coma Scale ◽  
Outcome Assessment ◽  
High Probability ◽  
Vegetative State ◽  
Behavioral Impairment ◽  
Whole Person ◽  
Ordinal Scales ◽  
Probability Of Death ◽  
The Individual ◽  
Assessment Scales

Abstract Different jurisdictions use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) for different purposes, and this article reviews a specific jurisdictional definition in the Province of Ontario of catastrophic impairment that incorporates the AMA Guides. In Ontario, a whole person impairment (WPI) exceeding 54% or a mental or behavioral impairment of Class 4 or 5 qualifies the individual for catastrophic benefits, and individuals who do not meet the test receive a lesser benefit. By inference, this establishes a parity threshold among dissimilar injuries and dissimilar outcome assessment scales for benefits. In Ontario, the Glasgow Coma Scale (GCS) identifies patients who have a high probability of death or of severely disabled survival. The GCS recognizes gradations of vegetative state and disability, but translating the gradations for rating individual impairment on ordinal scales into a method of assessing percentage impairments cannot be done reliably, as explained in the AMA Guides, Fifth Edition. The AMA Guides also notes that mental and behavioral impairment in Class 4 (marked impairment) or 5 (extreme impairment) indicates “catastrophic impairment” by significantly impeding useful functioning (Class 4) or significantly impeding useful functioning and implying complete dependency on another person for care (Class 5). Translating the AMA Guides guidelines into ordinal scales cannot be done reliably.

Combining Values

2002 ◽  
Vol 7 (2) ◽  
pp. 1-4, 12 ◽  
Author(s):  
Christopher R. Brigham
Keyword(s):  
Lower Extremity ◽  
Upper Extremity ◽  
Evaluation Method ◽  
Proximal Phalanx ◽  
Common Error ◽  
The Third ◽  
Whole Person ◽  
Impairment Ratings ◽  
Upper Extremity Impairment ◽  
The Individual

Abstract To account for the effects of multiple impairments, evaluating physicians must provide a summary value that combines multiple impairments so the whole person impairment is equal to or less than the sum of all the individual impairment values. A common error is to add values that should be combined and typically results in an inflated rating. The Combined Values Chart in the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, includes instructions that guide physicians about combining impairment ratings. For example, impairment values within a region generally are combined and converted to a whole person permanent impairment before combination with the results from other regions (exceptions include certain impairments of the spine and extremities). When they combine three or more values, physicians should select and combine the two lowest values; this value is combined with the third value to yield the total value. Upper extremity impairment ratings are combined based on the principle that a second and each succeeding impairment applies not to the whole unit (eg, whole finger) but only to the part that remains (eg, proximal phalanx). Physicians who combine lower extremity impairments usually use only one evaluation method, but, if more than one method is used, the physician should use the Combined Values Chart.

Nonspecific Chronic Back Pain: Sixth Edition Approaches

2019 ◽  
Vol 24 (5) ◽  
pp. 14-15
Author(s):  
Jay Blaisdell ◽  
James B. Talmage
Keyword(s):  
Back Pain ◽  
Chronic Back Pain ◽  
Intervertebral Disk ◽  
Key Factors ◽  
Sixth Edition ◽  
Whole Person ◽  
Class 1 ◽  
A Cell ◽  
Intervertebral Disk Herniation ◽  
The Individual

Abstract Ratings for “non-specific chronic, or chronic reoccurring, back pain” are based on the diagnosis-based impairment method whereby an impairment class, usually representing a range of impairment values within a cell of a grid, is selected by diagnosis and “specific criteria” (key factors). Within the impairment class, the default impairment value then can be modified using non-key factors or “grade modifiers” such as functional history, physical examination, and clinical studies using the net adjustment formula. The diagnosis of “nonspecific chronic, or chronic reoccurring, back pain” can be rated in class 0 and 1; the former has a default value of 0%, and the latter has a default value of 2% before any modifications. The key concept here is that the physician believes that the patient is experiencing pain, yet there are no related objective findings, most notably radiculopathy as distinguished from “nonverifiable radicular complaints.” If the individual is found not to have radiculopathy and the medical record shows that the patient has never had clinically verifiable radiculopathy, then the diagnosis of “intervertebral disk herniation and/or AOMSI [alteration of motion segment integrity] cannot be used.” If the patient is asymptomatic at maximum medical improvement, then impairment Class 0 should be chosen, not Class 1; a final whole person impairment rating of 1% indicates incorrect use of the methodology.

Impairment Tutorial: Functionally Limiting Upper Extremity Pain: Controversies in Impairment Rating

2003 ◽  
Vol 8 (5) ◽  
pp. 4-12
Author(s):  
Lorne Direnfeld ◽  
James Talmage ◽  
Christopher Brigham
Keyword(s):  
Upper Extremity ◽  
Radicular Pain ◽  
Illness Behavior ◽  
Orthopedic Surgeon ◽  
First Case ◽  
Clinical Presentations ◽  
Whole Person ◽  
Physical Examinations ◽  
Upper Extremity Impairment ◽  
The Individual

Abstract This article was prompted by the submission of two challenging cases that exemplify the decision processes involved in using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). In both cases, the physical examinations were normal with no evidence of illness behavior, but, based on their histories and clinical presentations, the patients reported credible symptoms attributable to specific significant injuries. The dilemma for evaluators was whether to adhere to the AMA Guides, as written, or to attempt to rate impairment in these rare cases. In the first case, the evaluating neurologist used alternative approaches to define impairment based on the presence of thoracic outlet syndrome and upper extremity pain, as if there were a nerve injury. An orthopedic surgeon who evaluated the case did not base impairment on pain and used the upper extremity chapters in the AMA Guides. The impairment ratings determined using either the nervous system or upper extremity chapters of the AMA Guides resulted in almost the same rating (9% vs 8% upper extremity impairment), and either value converted to 5% whole person permanent impairment. In the second case, the neurologist evaluated the individual for neuropathic pain (9% WPI), and the orthopedic surgeon rated the patient as Diagnosis-related estimates Cervical Category II for nonverifiable radicular pain (5% to 8% WPI).

Nature, Nurture, and ’Ndividuality

2021 ◽  
pp. 329-350
Author(s):  
Jack Bauer
Keyword(s):  
Free Will ◽  
Personal Growth ◽  
Causal Role ◽  
Individual Person ◽  
System A ◽  
Whole Person ◽  
Nature And Nurture ◽  
The Individual ◽  
Self Organizing

The field of psychology is under a spell of believing that the person is merely a product of nature and nurture. This belief holds that the individual person plays no causal role in their own development. This belief assumes that epiphenomena (like persons, which originate from nature and nurture) lack real agency and cannot be a cause of themselves at a later time, so personal growth and the transformative self are illusions. This chapter explains the faulty logic in such beliefs and presents the nature, nurture, and ‘ndividuality model of personhood, which holds that the individuality of the whole person influences that person’s own development in ways not explained by nature, nurture, or their interaction. This model relies not on notions of free will or even intentionality but rather on another model of the person as a self-organizing system—a dynamic, organismic system within a pluralistic ecology of systems.

The Gentle Loving Rehab of Yoga,with Ayurveda

2002 ◽  
Vol 12 (1) ◽  
pp. 39-43
Author(s):  
Patricia Hansen ◽  
Hansa Knox
Keyword(s):  
The Body ◽  
Human Beings ◽  
Therapeutic Application ◽  
Yoga Therapy ◽  
Vast Array ◽  
Structural Problems ◽  
Whole Person ◽  
Therapeutic Assistance ◽  
The Individual

People seek the benefits of private Yoga sessions for many reasons, including structural problems, stress,mental, emotional, and spiritual concerns, or a preference for one-on-one instruction. Others seek to deepen their Yoga experience because something has awakened during a yogâsana class. This is a natural unfoldment of the individual in the context of the classical darshana(system) of Yoga. Yoga is an ancient tradition that has been used by human beings for centuries to experience wholeness and health on every level of their being, and these individuals are seeking therapeutic assistance from Yoga, also known as yoga-cikitsâ, or Yoga therapy. The intention of this paper is to present an overview of the vast array of tools available through the traditions of Yoga and Ayurveda to support the individual therapeutic application of Yoga. Yoga-cikitsâ encompasses every level of the body-mind, and we feel that Yoga teachers and therapists need to integrate all of the available tools to best work with the whole person.

scholarly journals Honey bee workers reared in a neonicotinoid contaminated in-hive environment

2018 ◽  
Author(s):  
Richard Odemer ◽  
Franziska Odemer
Keyword(s):  
Risk Assessment ◽  
Honey Bee ◽  
Plant Protection ◽  
Plant Protection Products ◽  
List Type ◽  
Case Scenario ◽  
Behavioral Impairment ◽  
Worst Case ◽  
Simple Substitution ◽  
The Individual

ABSTRACTWith the currently updated risk assessment of three neonicotinoid pesticides, the European Food Safety Authority has confirmed that different applications of these substances represent a risk to wild and managed bees and their use was therefore severely restricted. However, to close further gaps in knowledge, this experiment covers exposure of honey bee worker brood reared in a neonicotinoid contaminated in-hive environment with focus on the individual. In a worst case scenario, mini-hives were fed chronically with a sublethal concentration of clothianidin (15 µg/kg), which is highly toxic to bees already in small amounts. Freshly hatched workers from these colonies were subsequently marked and introduced into non-contaminated colonies, where their lifespan and behavior was monitored. Nineteen days after exposure, clothianidin treated bees had no reduced lifespan or showed any signs of behavioral impairment when compared to the control, demonstrating that social buffering is not a simple substitution of dead bees by rearing more brood. Our results suggest that the social environment plays a crucial role for the individual in terms of “superorganism resilience”. These findings are discussed in context with the current use of lower tier test systems in risk assessment and contrary results obtained from laboratory experiments.HIGHLIGHTSSublethal clothianidin treatment did not affect lifespan nor behavior of workers.Effects on individual bees reared within a mini-hive are translatable to full-sized colonies.“Superorganism resilience” is not a simple substitution of dead bees by rearing more brood.Laboratory testing in the risk assessment of plant protection products bears severe weaknesses.

scholarly journals PSYCHOLOGICAL FACTORS OF FORMATION OF SECURITY CONCEPTS IN MILITARY HIGH SCHOOL CADETS

2017 ◽  
pp. 141-150
Author(s):  
A. G. Kostousov ◽  
M. S. Ivanov
Keyword(s):  
Psychological Factors ◽  
National Guard ◽  
Value Orientations ◽  
Educational Process ◽  
Character Traits ◽  
Whole Person ◽  
The Individual ◽  
Military Institute ◽  
The Mind ◽  
Relationship Of

The article presents the results of studies on the relationship of formation of security concepts and individual psychological characteristics, such as intelligence, character traits, internality of person, value-semantic sphere of the person described as psychological factors of representations. The subjects were students of Military Institute of the Russian Federation of the National Guard troops, whose training involves the formation of military-professional competences directly related to security. Representations about security are considered as a complex semantic construct in the minds of students, is one of the basic elements of professional representations system. According to the results of statistical data, we found significant correlations between the characteristics of security concepts and the level of intelligence, lack of cusps  of  character  traits,  a  meaningful  life,  internality  personality,  maturity of the system of value orientations. It is suggested that security representations is a complex construct in the mind, which is closely integrated in the individual relations, emerging in connection with the development of the whole person. It is concluded that the educational process should be improved in respect of the formation of the security concepts in military education. 

scholarly journals PERSON-CENTERED INTEGRATIVE DIAGNOSIS: CONCEPTS AND PROCEDURES

2020 ◽  
Author(s):  
Ihsan M Salloum ◽  
Juan E. Mezzich
Keyword(s):  
Health Status ◽  
Paradigm Shift ◽  
Clinical Care ◽  
Well Being ◽  
Component Model ◽  
The Third ◽  
Whole Person ◽  
The Individual ◽  
Novel Model ◽  
Major Domain

The person-centered integrative diagnosis (PID) is a model that aims at putting into practice the vision of person-centered medicine affirming the whole person of the patient in context as the center of clinical care and health promotion at the individual and community levels. The PID is a novel model of conceptualizing the process and formulation of clinical diagnosis. The PID presents a paradigm shift with a broader and deeper notion of diagnosis, beyond the restricted concept of nosological diagnoses. It involves a multilevel formulation of health status (both ill and positive aspects of health) through interactive participation and engagement of clinicians, patients, and families using all relevant descriptive tools (categorization, dimensions, and narratives). The current organizational schema of the PID comprises a multilevel standardized component model integrating three main domains. Each level or major domain addresses both ill health and positive aspects of health. The first level is the assessment of health status (ill health and positive aspects of health or well-being). The second level includes contributors to health, both risk factors and protective factors. The third major level includes health experience and values. Experience with the PID through a practical guide in Latin America supported the usefulness and adequacy of the PID model.

scholarly journals Correlation of risk factors with Glasgow coma scale to predict the severity and outcome of children with non-traumatic coma

2019 ◽  
Vol 6 (4) ◽  
pp. 1524
Author(s):  
A. Manikanteswara Reddy ◽  
G. Sreedhar ◽  
Gangadhar B. Belavadi
Keyword(s):  
Glasgow Coma Scale ◽  
Hospital Admissions ◽  
Good Prognosis ◽  
Cns Infection ◽  
Coma Scale ◽  
The Family ◽  
Probability Of Death ◽  
Traumatic Coma ◽  
Gcs Score

Background: Non-traumatic coma is the problem of pediatric group, accounts 10-15% in hospital admissions. Assessment of the severity of coma is useful to speculate the survival. The aim was to assess outcome in pediatric non-traumatic coma with role of Glasgow coma scale and modified Glasgow coma scale.Methods: Total of 80 cases of non-traumatic coma between 1 month to 12 years, coma severity was assessed by using Glasgow coma scale. A score of less than 8 and more than 8 were used for analysis of outcome.Results: The maximum number of patents with non-traumatic coma were in the age group of 1 month-5 years, 40 children (50%). On neurological examination 42 (52.5%) children has GCS score of >8, 38 cases (47.5%) has GCS <8, 20 children had meningeal signs, 7 children had cranial nerve deficit (7th nerve), 9 children had decebrate posture. Out of 80 cases, 8 cases expired (10%), 4 cases were discharged against medical advice (4%), 68 cases were improved and discharged (85%), among these, 8 cases were discharged with complication (11.7%). Overall mortality was (10%) (8/80), males outnumbered females in frequency with ratio of 1.28:1. CNS infection accounted for almost about 66%.Conclusions: Children with GCS and MGCS scores of less than 8 have poor prognosis and a very high probability of death. Those with GCS score of more than 8 have good prognosis. Identification of these cases at the outset can help prepare the treating physician to plan critical care referral and to give a preliminary assessment of outcome to the family.

Combining Values Chart

2012 ◽  
Vol 17 (2) ◽  
pp. 7-9
Author(s):  
Christopher R. Brigham
Keyword(s):  
Lower Extremity ◽  
Upper Extremity ◽  
Sixth Edition ◽  
Whole Person ◽  
The Individual

Abstract Evaluating physicians may need to account for the effects of multiple impairments using a summary value. In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, the Combined Values Chart provides a method to combine two or more impairment percentages based on the formula A + B(1 – A) = the combined value of A and B. Using the Combined Values Chart and this formula, physicians can combine multiple impairments so that the whole person impairment is equal to or less than the sum of all the individual impairment values. The AMA Guides, Sixth Edition, specifies that “impairments are successively combined by first combining the largest number with the next largest remaining number, and then further combining it with the next largest remaining number … until all given impairment numbers are combined.” Impairment values within a region generally are combined and converted to whole person permanent impairment before being combined with values from other regions. The article reviews the AMA Guides, Sixth Edition, approach to combining upper extremity impairments, lower extremity impairments, and combining spinal impairments.

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