Institutionalising the Medical Evaluation of CAM: Dietary and Herbal Supplements as a Peculiar Example of (Differential) Legitimisations of CAM in the USA

Pellagra in the USA: unusual manifestations of a rare entity

BMJ Case Reports ◽

10.1136/bcr-2019-230972 ◽

2019 ◽

Vol 12 (9) ◽

pp. e230972 ◽

Cited By ~ 1

Author(s):

Ana Rivadeneira ◽

Patricia Moyer ◽

Justin D Salciccioli

Keyword(s):

Adrenal Insufficiency ◽

Clinical Syndrome ◽

Vitamin Supplementation ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Medical Evaluation ◽

Severe Deficiency ◽

The Usa ◽

History Of ◽

Function Testing

The case involves a 62-year-old female native of the USA with a history of bipolar disorder and chronic obstructive pulmonary disease who presented with intractable diarrhoea. Prior to the index admission, she was admitted to the intensive care unit and required pericardiocentesis for an idiopathic pericardial effusion with tamponade physiology. Following discharge, she suffered intractable diarrhoea and represented for medical evaluation. She had a painful, swollen tongue as well as persistent hypoglycaemia and required glucose infusions. She had adrenal function testing which revealed adrenal insufficiency. Vitamin testing revealed normal B12 and folate levels but undetectable levels of thiamine, riboflavin and niacin. Her symptoms and signs resolved entirely with appropriate vitamin supplementation. Niacin (vitamin B3) is essential for multiple metabolic pathways, and severe deficiency may cause clinical syndrome of pellagra which is most commonly associated with diarrhoea, delirium and dermatitis. Additional physiological derangements may include adrenal insufficiency, insulin hypersensitivity and pericarditis.

Download Full-text

The influence of game scheduling on medical encounters at the USA Cup soccer tournament

British Journal of Sports Medicine ◽

10.1136/bjsm.2010.077198 ◽

2011 ◽

Vol 46 (6) ◽

pp. 424-429

Author(s):

Nathan G Waibel ◽

William O Roberts ◽

Scott Lunos

Keyword(s):

Survey Study ◽

Injury Incidence ◽

Medical Facility ◽

Additional Risk ◽

Medical Encounter ◽

Encounter Rates ◽

Youth Soccer ◽

Medical Evaluation ◽

Significant Difference ◽

The Usa

ObjectiveTo investigate the influence of playing multiple games on multiple days on youth soccer medical encounter rates.DesignProspective cohort survey study.SettingMedical facility at the 2008 Schwan's USA Cup soccer tournament.ParticipantsPlayers presenting to the medical facility for game-related medical evaluation.Assessment of risk factorsDate, game and half of game for each medical encounter.Main outcome measuresGame play-related medical encounters per 1000 match hours (MH).Results211 players surveyed with 195 eligible and completed questionnaires. There were 4.06, 5.14 and 3.92 medical encounters/1000 MH on 11, 12 and 13 July, respectively, with no significant difference in injury incidence. There was no difference in medical encounter rates of second games compared with first games of the day (p=0.126). Daily medical encounter rates were 5.65, 8.95, 7.83, 6.94 and 4.62/1000 MH on 15, 16, 17, 18 and 19 July, respectively, with statistically significant differences on 16 July (p<0.001) and 17 July (p=0.022) compared with 15 July. Encounter rates of second games compared with first games of the day showed no difference (p=0.385). A linear test for trend from 15 to 19 July was not significant (p=0.092).ConclusionsThe USA Cup format did not show either increased medical encounter rates from the cumulative total of games played or a consistently increased rate in the second game of the day compared with the first. Players, coaches, parents and administrators can feel confident that this tournament format does not pose an additional risk of injury.

Download Full-text

Impairment Tutorial: Spinal Cord Stimulation and Intraspinal Opioids:Impairment Rating Issues

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2000.sepoct04 ◽

2000 ◽

Vol 5 (5) ◽

pp. 4-5

Author(s):

James B. Talmage ◽

Leon H. Ensalada

Keyword(s):

Medical Records ◽

Evaluation Process ◽

Current Approach ◽

Satisfaction Survey ◽

Start Time ◽

Medical Evaluation ◽

Independent Medical Evaluation ◽

Other Information ◽

Physician Reviews ◽

Written Informed Consent

Abstract Evaluators must understand the complex overall process that makes up an independent medical evaluation (IME), whether the purpose of the evaluation is to assess impairment or other care issues. Part 1 of this article provides an overview of the process, and Part 2 [in this issue] reviews the pre-evaluation process in detail. The IME process comprises three phases: pre-evaluation, evaluation, and postevaluation. Pre-evaluation begins when a client requests an IME and provides the physician with medical records and other information. The following steps occur at the time of an evaluation: 1) patient is greeted; arrival time is noted; 2) identity of the examinee is verified; 3) the evaluation process is explained and written informed consent is obtained; 4) questions or inventories are completed; 5) physician reviews radiographs or diagnostic studies; 6) physician records start time and interviews examinee; 7) physician may dictate the history in the presence of the examinee; 8) physician examines examinee with staff member in attendance, documenting negative, physical, and nonphysiologic findings; 9) physician concludes evaluation, records end time, and provides a satisfaction survey to examinee; 10) examinee returns satisfaction survey before departure. Postevaluation work includes preparing the IME report, which is best done immediately after the evaluation. To perfect the IME process, examiners can assess their current approach to IMEs, identify strengths and weaknesses, and consider what can be done to improve efficiency and quality.

Download Full-text

Fifth Edition: the New Standard

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2000.novdec01 ◽

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.

Download Full-text

Clinical Update: Assessing Maximum Medical Improvement in Carpal Tunnel Syndrome

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2003.julaug02 ◽

2003 ◽

Vol 8 (4) ◽

pp. 4-5

Author(s):

Christopher R. Brigham ◽

James B. Talmage

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Proper Time ◽

Carpal Tunnel Release ◽

Hand Function ◽

Factors Affecting ◽

Early Results ◽

Medical Evaluation ◽

Nerve Recovery ◽

Tunnel Syndrome

Abstract Permanent impairment cannot be assessed until the patient is at maximum medical improvement (MMI), but the proper time to test following carpal tunnel release often is not clear. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states: “Factors affecting nerve recovery in compression lesions include nerve fiber pathology, level of injury, duration of injury, and status of end organs,” but age is not prognostic. The AMA Guides clarifies: “High axonotmesis lesions may take 1 to 2 years for maximum recovery, whereas even lesions at the wrist may take 6 to 9 months for maximal recovery of nerve function.” The authors review 3 studies that followed patients’ long-term recovery of hand function after open carpal tunnel release surgery and found that estimates of MMI ranged from 25 weeks to 24 months (for “significant improvement”) to 18 to 24 months. The authors suggest that if the early results of surgery suggest a patient's improvement in the activities of daily living (ADL) and an examination shows few or no symptoms, the result can be assessed early. If major symptoms and ADL problems persist, the examiner should wait at least 6 to 12 months, until symptoms appear to stop improving. A patient with carpal tunnel syndrome who declines a release can be rated for impairment, and, as appropriate, the physician may wish to make a written note of this in the medical evaluation report.

Download Full-text