Chronic Pain: Fundamental Scientific Considerations, Specifically for Legal Claims

Abstract Scientific findings have indicated that psychological and social factors are the driving forces behind most chronic benign pain presentations, especially in a claim context, and are relevant to at least three of the AMA Guides publications: AMA Guides to Evaluation of Disease and Injury Causation, AMA Guides to Work Ability and Return to Work, and AMA Guides to the Evaluation of Permanent Impairment. The author reviews and summarizes studies that have identified the dominant role of financial, psychological, and other non–general medicine factors in patients who report low back pain. For example, one meta-analysis found that compensation results in an increase in pain perception and a reduction in the ability to benefit from medical and psychological treatment. Other studies have found a correlation between the level of compensation and health outcomes (greater compensation is associated with worse outcomes), and legal systems that discourage compensation for pain produce better health outcomes. One study found that, among persons with carpal tunnel syndrome, claimants had worse outcomes than nonclaimants despite receiving more treatment; another examined the problematic relationship between complex regional pain syndrome (CRPS) and compensation and found that cases of CRPS are dominated by legal claims, a disparity that highlights the dominant role of compensation. Workers’ compensation claimants are almost never evaluated for personality disorders or mental illness. The article concludes with recommendations that evaluators can consider in individual cases.

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The role of mobile devices in doctor-patient communication: A systematic review and meta-analysis

Journal of Telemedicine and Telecare ◽

10.1177/1357633x16661604 ◽

2016 ◽

Vol 23 (8) ◽

pp. 693-700 ◽

Cited By ~ 17

Author(s):

Abdullah Kashgary ◽

Roaa Alsolaimani ◽

Mahmoud Mosli ◽

Samer Faraj

Keyword(s):

Medication Adherence ◽

Health Outcomes ◽

Disease Control ◽

Mobile Devices ◽

Mobile Device ◽

Meta Analysis ◽

Patient Communication ◽

Doctor Patient Communication ◽

Phone Calls

Introduction In the last few years, the use of telecommunication and mobile technology has grown significantly. This has led to a notable increase in the utilization of this telecommunication in healthcare, namely phone calls and text messaging (SMS). However, evaluating its global impact on improving healthcare processes and outcomes demands a more comprehensive assessment. In this study, we focused on the role of mobile devices via phone calls and SMS in patient–doctor communication, and aimed to assess its impact on various health outcomes. Methods Major databases, including MEDLINE, EMBASE, PsycINFO, Global Health, and Cochrane CENTRAL, were searched for clinical trials that investigated mobile-device technology in any facet of doctor–patient communication published between 1990 and April 2015. A meta-analysis was performed where appropriate. Results Sixty-two articles met our inclusion criteria. Of those, 23 articles investigated mobile appointment reminder technologies, 19 investigated medication adherence, 20 investigated disease-control interventions, and two investigated test-result reporting. Patients who received an appointment reminder were 10% less likely to miss an appointment (relative risk [RR] = 1.11, 95% confidence interval [CI] 1.08–1.15). Mobile interventions increased medication adherence by 22% (RR = 1.22, 95% CI 1.09–1.36). Ten of 20 studies examining disease control reported statistically significant reductions in clinically meaningful endpoints. The use of mobile-device interventions improved forced expiratory volume in one second and hemoglobin A1c percentage in meta-analyses. Conclusion The use of mobile-device technologies exerted modest improvements in communication and health outcomes. Further research is needed to determine the true effect of these technologies on doctor–patient communication.

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Potassium Transport in the Mammalian Collecting Duct

Physiological Reviews ◽

10.1152/physrev.2001.81.1.85 ◽

2001 ◽

Vol 81 (1) ◽

pp. 85-116 ◽

Cited By ~ 59

Author(s):

Shigeaki Muto

Keyword(s):

Driving Forces ◽

Collecting Duct ◽

Dominant Role ◽

Duct Cell ◽

Cell Types ◽

Cortical Collecting Duct ◽

Membrane Conductances ◽

Collecting Duct Cells

The mammalian collecting duct plays a dominant role in regulating K+ excretion by the nephron. The collecting duct exhibits axial and intrasegmental cell heterogeneity and is composed of at least two cell types: collecting duct cells (principal cells) and intercalated cells. Under normal circumstances, the collecting duct cell in the cortical collecting duct secretes K+, whereas under K+ depletion, the intercalated cell reabsorbs K+. Assessment of the electrochemical driving forces and of membrane conductances for transcellular and paracellular electrolyte movement, the characterization of several ATPases, patch-clamp investigation, and cloning of the K+ channel have provided important insights into the role of pumps and channels in those tubule cells that regulate K+ secretion and reabsorption. This review summarizes K+ transport properties in the mammalian collecting duct. Special emphasis is given to the mechanisms of how K+ transport is regulated in the collecting duct.

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