Question and Answer

2004 ◽  
Vol 9 (4) ◽  
pp. 5-9
Keyword(s):  
Reproducibility Of Results ◽  
Medical Information ◽  
Repeated Measurements ◽  
Question And Answer ◽  
Impairment Ratings ◽  
Normal Fluctuations ◽  
Trained Observers ◽  
Single Set

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) aims to provide “consistent and reliable acquisition, analysis, communication, and utilization of medical information through a single set of standards. Two physicians, following the methods of the [AMA] Guides to evaluate the same patient, should report similar results and reach similar conclusions.” In addition, the AMA Guides emphasizes that “[c]onsistency tests are designed to ensure reproducibility and greater accuracy.” If findings are inconsistent, the examiner may choose not to base an impairment rating on them, but, as with any biological measurements, some variability and normal fluctuations are inherent in permanent impairment ratings. Specifically, two measurements by the same examiner on two separate occasions or by two trained observers using the AMA Guides are consistent if they fall within 10% of each other. Repeated measurements may decrease error, and examiners should observe for consistencies in both behavior and findings. The musculoskeletal chapters of the AMA Guides provide specific directions in terms of consistency of measurements (eg, the number of measurements that should be taken using each test), allowable variations in measurements taken at different times, reproducibility of results on different occasions or by two or more trained observers, and the validity of these measurements. Inconsistent findings cannot be used to rate impairment.

Fifth Edition: the New Standard

2000 ◽  
Vol 5 (6) ◽  
pp. 1-7
Author(s):  
Christopher R. Brigham ◽  
James B. Talmage ◽  
Leon H. Ensalada
Keyword(s):  
Musculoskeletal System ◽  
Medical Information ◽  
Objective Assessment ◽  
Scientific Data ◽  
Practical Application ◽  
Fourth Edition ◽  
Appropriate Use ◽  
Medical Evaluation ◽  
Single Set

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, is available and includes numerous changes that will affect both evaluators who and systems that use the AMA Guides. The Fifth Edition is nearly twice the size of its predecessor (613 pages vs 339 pages) and contains three additional chapters (the musculoskeletal system now is split into three chapters and the cardiovascular system into two). Table 1 shows how chapters in the Fifth Edition were reorganized from the Fourth Edition. In addition, each of the chapters is presented in a consistent format, as shown in Table 2. This article and subsequent issues of The Guides Newsletter will examine these changes, and the present discussion focuses on major revisions, particularly those in the first two chapters. (See Table 3 for a summary of the revisions to the musculoskeletal and pain chapters.) Chapter 1, Philosophy, Purpose, and Appropriate Use of the AMA Guides, emphasizes objective assessment necessitating a medical evaluation. Most impairment percentages in the Fifth Edition are unchanged from the Fourth because the majority of ratings currently are accepted, there is limited scientific data to support changes, and ratings should not be changed arbitrarily. Chapter 2, Practical Application of the AMA Guides, describes how to use the AMA Guides for consistent and reliable acquisition, analysis, communication, and utilization of medical information through a single set of standards.

Diabetes related disease and disorder in a Chinese Q&A website: Comparison on frequency and position (Preprint)

2020 ◽  
Author(s):  
Wei Feng ◽  
Ruocheng Huang ◽  
Shan Lu ◽  
Tao Shan ◽  
Hong Wang ◽  
...  
Keyword(s):  
Kidney Failure ◽  
Medical Information ◽  
Healthcare Management ◽  
Medical Community ◽  
Circulation System ◽  
Age Group ◽  
Disease Category ◽  
Old Patients ◽  
Gender And Age ◽  
Question And Answer

BACKGROUND With the development of the Internet, online medical community can help patient access to medical information and relevant decisions more conveniently, and meet the needs of patients for their own healthcare management. Mining these Q&A (Question and Answer) data, we can help doctors give more targeted feedback which improve the efficiency of question-and-answer, and patient satisfaction. OBJECTIVE This study aimed to (1) analysis frequency and position of diabetes related diseases or symptoms in Q&A website and (2) find out the differences of disease terms in gender and age using in the questions. METHODS We collected 5766 Q&A diabetes related data on the website of Chunyuyisheng from June 2012 to April 2020. In 38176 combined sentences, a vocabulary contains 3 categories of 3851 word and 2094 ICD (International Classification of Diseases) matching terms were obtained by calculating the similarity using word vectors. Proportion of the frequency of words and Mann-Whitney U test on word position were used to quantify the difference in patient’s gender and age group. RESULTS The vocabulary of the disease category accounts for 70%. We analyzed the word frequency and position in questions for different gender and age group. For gender, women participate in question answering more, accounting for 53% of total questions. They pay more attention to pregnancy, sleep and thyroid gland related vocabulary compared to men. Men focus more on circulation system, kidney failure related vocabulary. For different age group, pregnancy, glucose regulation, digestive and respiratory system related vocabulary have a higher proportion for patients under 40 years old. Patients over 40 years old pay more attention on kidney failure, cerebral ischaemia, infectious and circulation system. CONCLUSIONS This study provides a new insight into frequency and position of diabetes related diseases or symptoms in online medical services. It can show patients’ different attention by comparing disease or symptom categories for gender and age with ICD disease codes. The frequency and position of disease category words in patients’ conversation can be used for further risk evaluation for chronic diseases research.

Use of Drugline—A Question-and-Answer Database

1993 ◽  
Vol 27 (3) ◽  
pp. 278-284 ◽  
Author(s):  
Birgitta Öhman ◽  
Helena Lyrvall ◽  
Gunnar Alván
Keyword(s):  
Full Text ◽  
Information Needs ◽  
Medical Information ◽  
Drug Information ◽  
Drug Problem ◽  
Karolinska Institute ◽  
Information Centre ◽  
Question And Answer ◽  
Medical Libraries ◽  
Information Database

BACKGROUND: DRUGLINE is a full-text, question-and-answer database offering drug information that has been evaluated as a result of consultations in a drug information center. A problem-oriented database such as DRUGLINE can be an efficient way to meet the increasing need among healthcare professionals for timely and accurate drug information. OBJECTIVE: To investigate how DRUGLINE was used during the years 1988 and 1990 and to identify any changes in needs, expectations, satisfaction, and use that occurred during those two years. DESIGN: This study investigated the use of DRUGLINE during two separate years. Questionnaires relating to DRUGLINE use during 1988 and 1990 were sent on two occasions to all users having access to the database. The anonymous questionnaires contained 17 and 18 questions, respectively. SETTING: The setting included MEDLINE/DRUGLINE use in healthcare institutions, pharmacies, medical libraries, and the pharmaceutical industry. PARTICIPANTS: The questionnaires were sent to all customers of the database host Medical Information Centre at the Karolinska Institute Library and Information Centre having access to DRUGLINE during 1988 and 1990. MAIN OUTCOME MEASURES: The responses were organized into those from users and nonusers within the following professions: Physicians, pharmacists, librarians, and others. RESULTS: The response rates were 87 percent in 1989 and 89 percent in 1991. The professional distribution among the respondents in 1991 was physicians, 36 percent; pharmacists, 20 percent; medical librarians, 21 percent; and others, 23 percent. One-third of the respondents had searched DRUGLINE during 1988 and 1990. The number of users increased by 25 percent between 1988 and 1990; however, the percentage of users versus nonusers did not change. Pharmacists comprised the largest user group and experienced the greatest increase in users. Most users were satisfied with the result of their searches, usually because they were guided to solve a specific drug problem at a reasonable cost. CONCLUSIONS: A full-text, question-and-answer drug information database has great potential to help problem-solving in medical care. The technical versatility of the information system and its factual contents need to be continuously assured. Health professionals have to identify their information needs and develop efficient procedures to meet these needs.

Precision In X-Ray Data Computed By Monte Carlo Calculations

1999 ◽  
Vol 5 (S2) ◽  
pp. 86-87
Author(s):  
Eric Lifshin ◽  
Amy Linsebigler ◽  
Raynald Gauvin
Keyword(s):  
Electron Beam ◽  
Repeated Measurements ◽  
X Ray ◽  
Intensity Measurements ◽  
Beam Incidence ◽  
Excitation Volume ◽  
Counting Statistics ◽  
Normal Electron ◽  
Analytical Expressions ◽  
Single Set

The analytical expressions used in ZAF and ϕ(ρz) calculations give single values for the composition of each element for a single set of intensity measurements from samples and standards. Confidence intervals in composition are established by looking at the variability of repeated measurements. They are usually attributed to x-ray counting statistics or experimental reproducibility factors such as sample repositioning. Uncertainty in the equations themselves or the parameters that go into them are rarely considered. The derivations of ZAF and ϕ(ρz) equations are primarily based on the case where flat single-phase regions, relative to the x-ray excitation volume, are examined using normal electron beam incidence. Use of these equations has been extended to non-normal electron beam incidence as well as the quantitative analysis of layered structures, but usually with less theoretical justification. Finally, special experimental cases including porous structures, rough surfaces, vertical interfaces and small particles are very difficult or impossible to model by the single application of a set of analytical equations to convert measured x-ray intensities to elemental composition.

scholarly journals Measurement of pentose phosphate-pathway activity in a single incubation with [1,6-13C2,6,6-2H2]glucose

1994 ◽  
Vol 302 (1) ◽  
pp. 31-38 ◽  
Author(s):  
B D Ross ◽  
P B Kingsley ◽  
O Ben-Yoseph
Keyword(s):  
Pentose Phosphate Pathway ◽  
Cultured Cells ◽  
Krebs Cycle ◽  
Pentose Phosphate ◽  
Repeated Measurements ◽  
Co2 Production ◽  
Spectrometric Analysis ◽  
14Co2 Production ◽  
Single Set

The isotopically substituted molecule D-[1,6-13C2,6,6-2H2]glucose is introduced for measuring the relative activities of the pentose phosphate pathway (PPP) and glycolysis in a single incubation. PPP activity in cultured cells was determined by gas chromatography/mass spectrometric analysis of lactate produced by cells incubated with [1,6-13C2,6,6-2H2]glucose. Two other isotopes, [1,5,6-13C3]glucose and [6-13C,1,6,6-2H3]glucose, were not satisfactory for measurements of this activity. This method has four advantages over the traditional one in which 14CO2 production from [1-14C]glucose and [6-14C]glucose is compared: (1) repeated measurements can be made on a single set of cells, (2) only a single incubation is required, (3) extensive CO2 production by Krebs-cycle activity does not interfere with the measurements and (4) it is not necessary to measure the amount of glucose consumed in order to calculate relative activities of the PPP and glycolysis. Preliminary observation indicates that rat brain PPP activity may be measured in vivo with [1,6-13C2,6,6-2H2]glucose when combined with microdialysis techniques.

The AMA Guides in Pennsylvania “Post-Protz”: Act 111 and Case Law Update

2020 ◽  
Vol 25 (3) ◽  
pp. 12-19
Author(s):  
Justin D. Beck ◽  
Judge David B. Torrey
Keyword(s):  
Case Law ◽  
General Assembly ◽  
Disability Benefits ◽  
Permanent Disability ◽  
Sixth Edition ◽  
Legal Questions ◽  
The Supreme Court ◽  
Recent Edition ◽  
Impairment Ratings

Abstract Medical evaluators must understand the context for the impairment assessments they perform. This article exemplifies issues that arise based on the role of impairment ratings and what edition of the AMA Guides to the Impairment of Permanent Impairment (AMA Guides) is used. This discussion also raises interesting legal questions related to retroactivity, applicability of prior precedent, and delegation. On June 20, 2017, the Supreme Court of Pennsylvania handed down its decision, Protz v. WCAB (Derry Area Sch. Dist.), which disallows use of the “most recent edition” of the AMA Guides when determining partial disability entitlement under the Pennsylvania Workers’ Compensation Act. An attempted solution was passed by the Pennsylvania General Assembly and was signed into law Act 111 on October 24, 2018. Although it affirms that the AMA Guides, Sixth Edition, must be used for impairment ratings, the law reduces the threshold for total disability benefits from 50% to 35% impairment. This legislative adjustment benefited injured workers but sparked additional litigation about whether, when, and how the adjustment should be applied (excerpts from the laws and decisions discussed by the authors are included at the end of the article). In using impairment as a threshold for permanent disability benefits, evaluators must distinguish between impairment and disability and determine an appropriate threshold; they also must be aware of the compensation and adjudication process and of the jurisdictions in which they practice.

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.

Spine Impairment Evaluation: Sixth Edition Approaches

2009 ◽  
Vol 14 (1) ◽  
pp. 1-5
Author(s):  
Craig Uejo ◽  
Marjorie Eskay-Auerbach ◽  
Christopher R. Brigham
Keyword(s):  
Functional Status ◽  
Spinal Injury ◽  
Current Medical ◽  
Clinical Testing ◽  
Medical Evidence ◽  
Sixth Edition ◽  
Whole Person ◽  
Rating Process ◽  
Impairment Ratings ◽  
Class Assignment

Abstract Evaluators who use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, should understand the significant changes that have occurred (as well as the Clarifications and Corrections) in impairment ratings for disorders of the cervical spine, thoracic spine, lumbar spine, and pelvis. The new methodology is an expansion of the Diagnosis-related estimates (DRE) method used in the fifth edition, but the criteria for defining impairment are revised, and the impairment value within a class is refined by information related to functional status, physical examination findings, and the results of clinical testing. Because current medical evidence does not support range-of-motion (ROM) measurements of the spine as a reliable indicator of specific pathology or permanent functional status, ROM is no longer used as a basis for defining impairment. The DRE method should standardize and simplify the rating process, improve validity, and provide a more uniform methodology. Table 1 shows examples of spinal injury impairment rating (according to region of the spine and category, with comments about the diagnosis and the resulting class assignment); Table 2 shows examples of spine impairment by region of the spine, class, diagnosis, and associated whole person impairment ratings form the sixth and fifth editions of the AMA Guides.

Medical and Legal Issues Raised by the Protz Decision Issued by the Pennsylvania Supreme Court

2017 ◽  
Vol 22 (4) ◽  
pp. 12-13
Author(s):  
LuAnn Haley ◽  
Marjorie Eskay-Auerbach
Keyword(s):  
Supreme Court ◽  
Scientific Evidence ◽  
Workers Compensation ◽  
Sixth Edition ◽  
Complex Concept ◽  
The Supreme Court ◽  
Compensation Claims ◽  
Recent Edition ◽  
Impairment Ratings ◽  
Definition Of

Abstract Pennsylvania adopted the impairment rating provisions described in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) in 1996 as an exposure cap for employers seeking predictability and cost control in workers’ compensation claims. In 2017, the Supreme Court of Pennsylvania handed down the Protz decision, which held that requiring physicians to apply the methodology set forth in the most recent edition of the AMA Guides reflected an unconstitutional delegation of legislative power to the American Medical Association. The decision eliminates the impairment-rating evaluation (IRE) mechanism under which claimants were assigned an impairment rating under the most recent edition of the AMA Guides. The AMA Guides periodically are revised to include the most recent scientific evidence regarding impairment ratings, and the AMA Guides, Sixth Edition, acknowledges that impairment is a complex concept that is not yet defined in a way that readily permits an evidence-based definition of assessment. The AMA Guides should not be considered standards frozen in time simply to withstand future scrutiny by the courts; instead, workers’ compensation acts could state that when a new edition of the AMA Guides is published, the legislature shall review and consider adopting the new edition. It appears unlikely that the Protz decision will be followed in other jurisdictions: Challenges to using the AMA Guides in assessing workers’ compensation claims have been attempted in three states, and all attempts failed.

Errata

2008 ◽  
Vol 13 (2) ◽  
pp. 5-5
Keyword(s):  
Psychotic Disorders ◽  
Pain Syndrome ◽  
Vestibular Disorders ◽  
Loss Of Function ◽  
Sixth Edition ◽  
Neurologic Disorders ◽  
Upper And Lower Extremities ◽  
Impairment Ratings ◽  
Extensive List ◽  
Mental And Behavioral Disorders

Abstract Although most chapters in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, instruct evaluators to perform impairment ratings by first assigning a diagnosis-based class and then assigning a grade within that class, Chapter 13, The Central and Peripheral Nervous System, continues to use a methodology similar to that of the fifth edition. The latter was criticized for duplicating materials that were presented in other chapters and for producing different ratings, so the revision of Chapter 13 attempts to maintain consistency between this chapter and those that address mental and behavioral disorders, loss of function in upper and lower extremities, loss of bowel control, and bladder and sexual function. A table titled Summary of Chapters Used to Rate Various Neurologic Disorders directs physicians to the relevant chapters (ie, instead of Chapter 13) to consult in rating neurologic disorders; the extensive list of conditions that should be addressed in other chapters includes but is not limited to radiculopathy, plexus injuries and other plexopathies, focal neuropathy, complex regional pain syndrome, visual and vestibular disorders, and a range of primary mood, anxiety, and psychotic disorders. The article comments in detail on sections of this chapter, identifies changes in the sixth edition, and provide guidance regarding use of the new edition, resulting in less duplication and greater consistency.

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