AMA Guides® Newsletter - Issue Archive

Articles

1. Natural Rubber Latex Allergy

   Jon Musmand, Christopher R. Brigham

   Pages 1–3

   DOI: 10.1001/amaguidesnewsletters.2002.SepOct01

   Abstract

   Natural rubber latex (NRL) allergy is discussed in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, in Section 8.5, Natural Rubber Latex Allergy, and refers to an IgE-mediated immediate hypersensitivity reaction to one or more protein allergens in latex devices, especially gloves. Among health care workers, NRL allergy is the most common cause of occupationally induced rhinoconjunctivitis and asthma, and clinical manifestations range from dermatitis and contact urticaria, allergic rhinoconjunctivitis, and asthma, to anaphylaxis. Evaluating physicians must be cognizant that a suggestive clinical history is necessary but not sufficient to diagnose NRL allergy, and FDA-approved NRL-specific IgE serum tests may have sensitivity as low as 75% and up to 27% false-positive results. No FDA-approved skin test reagent is available for testing. In evaluating impairment due to NRL allergy, evaluators should determine if the individual's problem can be resolved by avoidance of wearing latex gloves. Most patients who have asthma or air passage disruption impairment due to NRL have problems with bronchospasm only when they are exposed, and these patients may not necessarily have any ratable impairment due to NRL (but individuals who have atopic dermatitis may have ongoing symptoms due to pre-existing allergic rhinitis). Efforts to decrease the incidence of NRL allergy have been encouraging, and some patients diagnosed with NRL allergy may return to work in a latex-safe environment.
   Show more

2. Clinical Update: IME Report Standards: Independent Medical Evaluation Report Standards

   Christopher R. Brigham

   Pages 4–9

   DOI: 10.1001/amaguidesnewsletters.2002.SepOct02

   Abstract

   Independent medical examinations (IMEs) are performed by a physician or another health care provider who is not involved in the examinee's care and for the purpose of clarifying medical and case issues. Poor quality evaluations and reports are unfair to both the client and the examinee, and this article presents standards of a quality IME report. Evaluators should know the purpose of the IME so the length and detail of the examination are sufficient to address the questions posed with supportable conclusions. One table lists common issues in IMEs, another explains them, and a third divides the preparation of reports into three steps: clinical evaluation, calculation of the impairment rating, and discussion of how the impairment rating was calculated. A fourth table includes an extensive checklist that lists the components of most quality IME reports. The use of templates assists in ensuring a best-practices approach to the evaluation. Most experienced examiners use questionnaires, pain drawings, and inventories as an adjunct to the interview, and the process must be planned carefully to ensure all relevant history and subjective information are obtained. All reports should be completed as soon as possible following the evaluation to ensure efficiency and to generate a report of the highest quality.
   Show more

3. Impairment Tutorial: The Lower Extremities: Challenges with Chapter 17, The Lower Extremities

   Charles N. Brooks, James B. Talmage

   Pages 10–11

   DOI: 10.1001/amaguidesnewsletters.2002.SepOct03

   Abstract

   Like all multi-authored texts, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) presents some challenges and inconsistencies, and in March 2002 AMA published an errata. The latter has only one correction for Chapter 17, The Lower Extremities, and this article reviews some additional problems and inconsistencies in Chapter 17. For example, the AMA Guides, Fifth Edition, gives inconsistent instructions about measurements of muscle atrophy, and this article recommends simple, unambiguous directions such as measuring thigh and leg circumferences 15 cm superior and inferior to the medial joint line of the knee, respectively. One could argue that no goniometer should be included in Figure 17-1a, Using a Goniometer to Measure Flexion of the Right Hip; in Figure 17-1b, the goniometer should be placed with its axis at the center of rotation of the right hip. In Figure 17-1c, the limb of the goniometer overlying the left femur should instead be parallel to the tabletop. Additional sections of the article discuss joint ankylosis; peripheral nerve injuries; causalgia, complex regional pain syndrome, and reflex sympathetic dystrophy. A careful reading of Chapter 17 uncovers some problems, none of which is critical, but all should be noted by frequent users of the AMA Guides.
   Show more