AMA Guides® Newsletter - Issue Archive

Articles

1. Sexual Dysfunction Impairment

   Irvin H. Hirsch, Steven Mandel, Christopher R. Brigham

   Pages 1–4, 11

   DOI: 10.1001/amaguidesnewsletters.2001.SepOct01

   Abstract

   Male sexual dysfunction (MSD) and female sexual dysfunction (FSD) may be of multifactorial etiology; rating these disorders heretofore has been based on subjective, patient-reported criteria. This article discusses the process of determining sexual disability by incorporating objective, laboratory-based data in order to render more reliable and valid determinations, including whether the patient has received appropriate treatment and is at maximum medical improvement. MSD is of organic, psychogenic, mixed, or indeterminate cause, and identification of specific MSD etiology can be made via a thorough sexual and medical history, physical examination, and tailored laboratory testing. Routine laboratory studies should include complete blood count, serum chemistry, lipid profile, and serum free/total testosterone and prolactin levels. Using the history and physical examination and laboratory studies, evaluators can differentially diagnose more than 80% of patients as having either organic or psychogenic MSD. Objective laboratory studies for MSD include nocturnal penile tumescence, duplex Doppler ultrasound, and neurosensory testing. FSD is a prevalent, age-related women's health issue that reportedly affects up to half of women older than 50. FSD evaluation requires a comprehensive sexual and medical history as well as physical examination, pelvic examination, hormonal profile, and an evaluation by a sex therapist. Laboratory testing is not yet fully defined but may include measurements of genital blood flow, vaginal pH and compliance, and genital vibratory sensory threshold determination.
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2. Vision Impairment Rating and the Fifth Edition: A New Approach Based on Activities of Daily Living

   Bernard R. Blais

   Pages 5–7, 10

   DOI: 10.1001/amaguidesnewsletters.2001.SepOct02

   Abstract

   The assessment of visual impairment has been significantly revised from the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition. The Fifth Edition, Chapter 12, The Visual System, bases ratings on an estimate of the severity of the effects of certain types of visual loss on the ability to perform activities of daily living (ADLs). Permanent visual impairment is defined as a permanent loss of vision that remains after a patient reaches maximal medical improvement in the underlying medical condition. To assess vision loss, physicians must conduct a visual assessment, including the cause, severity, and prognosis of the underlying disorder and the expected or documented effects of the vision loss on the patient's ability to perform ADLs. Tables in Chapter 12 guide the assessment of visual impairment and consider the results of visual acuity testing, acuity-related impairment rating, and associated classifications. Table 12-10, Classification of Impairment of the Visual System and of the Whole Person, uses clinical data to classify the individual in one of six classes associated with a range of whole person impairment. According to the Fifth Edition of the AMA Guides, examining ophthalmologists or optometrists are required to have new visual acuity charts, appropriate visual field testing equipment, and other equipment for testing contrast sensitivity and glare tests as needed.
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3. Impairment Tutorial: Impairment Evaluations Standards: A Checklist

   Christopher R. Brigham

   Pages 8–10

   DOI: 10.1001/amaguidesnewsletters.2001.SepOct03