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Presently the calculation of the grade of invalidity of the temporomandibular joint due to trauma, according to Belgian law, poses a number of problems concerning applicability and differentiation. This article proposes a reviewed version of article 27 based on recent representative literature.
Presently the calculation of the grade of invalidity of the temporomandibular joint due to trauma, according to Belgian law, poses a number of problems concerning applicability and differentiation. This article proposes a reviewed version of article 27 based on recent representative literature.
This article provides an overview of impairment rating in the burn survivor. It is not intended to be a complete guide; each jurisdiction and each agency requires the physician to use the necessary required criteria. This article also emphasizes the significant rating differences between agencies and jurisdictions and in the latitude given the health professional in performing the rating.
An algorithm of verbal description of EEGs based on the method of quantitative assessment of the brain bioelectric activity is suggested. One should take into account the distribution, the pattern, the degree of the rhythm distortion by other signals, presence of generalized manifestations, local outbreaks and paroxysms. The algorithm includes description of the orientation reaction, responses to rhythmic and trigger photostimulation, hyperventilation and pharmacological loads. The algorithm suggested allows a more complete use of the information contained in the EEG and can be a good basis for composing a program for respective specialized computers.
Standardization and categorization are indispensable principles to be applied to patients' data already when data are investigated. Only through this every kind of data processing with computers gains any sense and helps to remove errors from data-transfer and removes mistakes from statistics. Transferring the contents of the investigation-sheets for joint-measures of the German insurance on environmental health to machine-readable encounter-sheets data collecting errors and data transfer errors could be minimized excellently. For the first time the standardization developed could be applied to joint measures of the spine in patients after spine injuries and compared with clinical- and X-ray-findings.
Impairment rating for the person with an amputation requires a total body assessment in addition to the amputated extremity. In particular, those systems essential for prosthetic wear and function, skin coverage, sensation and motor function, and proximal joint range of motion should be included. Spinal function, pain, and psychologic impairment are frequently involved as secondary issues related to the amputation. All of these systems must be assessed and a determination made whether permanent impairment is present. The final calculation of the impairment rating uses the appropriate body systems and worksheets. Most persons with an amputation will have some appropriate work restrictions applied and all will have future medical needs.
For the judgement of the function of heart and circulation in the expert's opinion concerning invalidity are significant; anamnestic data (dyspnoea, angina pectoris, giddiness, disturbances of consciousness); clinical findings (cyanosis, dyspnoea, stasis of the jugular vein, pulse, heart sounds and extrasounds, enlargement of the liver, oedemata); paraclinical findings (thorax-x-ray, ECG, ergometry). Already by a critically made anamnesis a classification according to clinical degrees of severity (NYHA) can be done. By synopsis of anamnesis, clinical and paraclinical findings apart from the establishment of a diagnosis an objective estimation of the disease-related restriction of the working capacity is possible. All data necessary for the judgement must be in the expert's opinion.
295 expert opinans of the NVA (National People's Army) in conditions after craniocerebral traumas for which an EEG findings was present were subjected to an retrospective analysis to determine the importance of EEG for export opinion. In 59.3% of cases EEG was significant for expert opinion, but was of prime importance only in 1.3%. In 161 expert opinions the total damage of the body was determined. This gave the possibility of a statistical correlation of individual EEG findings with the extent of the body damage. Mean percentage values of the individual degrees of severity of EEG changes could be calculated on the basis of these data. The great importance of EEG for military medical opinion could also be confirmed in comparison with 8 other clinical data and findings.
OBJECTIVES: Tinnitus handicap evaluation through Spanish validation of the Tinnitus Handicap Inventory. STUDY DESIGN: Spanish validation of the Tinnitus Handicap Inventory. PATIENTS: Eighty patients referred to our Tinnitus Unit in University Hospital, between September and December, 1999. OUTCOME MEASURES: The Spanish version of the THI was administered after translation and retrotranslation. Internal consistency and reliability were established. RESULTS: Spanish adaptation of the THI and its subscales (functional, emotional and catastrophic) showed a high reliability and internal consistency (Cronbach's alfa: 0.90). CONCLUSIONS: Spanish adaptation of the THI is valid, reliable and can be used in a clinical setting to quantify the impact of tinnitus on patient's quality of life.
The paper presents an analysis of the results of a comprehensive clinical and instrumental examination (poly- and apex-cardiography) of 156 patients with essential hypertension (Stages I, I-II and II, according to L.I. Fogelson's classification) and of 40 normal individuals, that was undertaken to study the functional state and the reserves of the left ventricular myocardium. The disorders in the functional state and the reduction of the reserve capacity were shown to progress along with the stage of the disease. The clinical and labour prognosis of the patients with essential hypertension depend on the character of its course, stage of the disease, degree of functional disorders and reserve capacity of the myocardium, as well as on the profession and labour conditions. The employment of a broad complex of cardiological diagnostic techniques at rest and following dosaged bicycle ergometric load helps to determine the clinical and labour prognosis with greater precision and more objectively, and to solve the problems of timely employment of hypertensive patients.
The author studied 78 patients (60 males and 18 females) aged 36 to 60 years (mean age 50 +/- 6 years). They all were diagnosed as having coronary heart disease (CHD) concurrent with arterial hypertension. Transesophageal atrial pacing test (TEACT) was positive in 68 (87.2%), and negative in 4 (5.1%) patients. It failed to reach diagnostic ECG criteria in 6 (7.7%) patients. A close relationship was found between the number of diseased coronary arteries and the sensitivity of TEACT. The TEACT parameters were found to be related to bicycle ergometric ones. The findings showed that the threshold rate of induced rhythm decreased when the patients increased their functional class of exercise-induced angina pectoris, the appearance of ST-segment depression being delayed and its disappearance increased. Thus, transesophageal atrial pacing allows the functional class to be defined in patients with CHD concurrent with arterial hypertension from the threshold rate of imposed rhythm and the time of ST-segment depression appearance and disappearance and can be useful both in the diagnosis and appraisal of the working capacity in patients with coronary heart disease concurrent with arterial hypertension.
In Public Health exists a growing tendency to evaluate the impact of health problems both on the quality of life of the persons involved as well as the use of health services. In this sense, the evaluation of incapacity is acquiring ever greater relevance. The Barthel Index is an instrument widely used to this end and measures the capacity of the person for the execution of ten basic activities in daily life, obtaining a quantitative estimation of the subject's level of dependency. The Barthel Index has been used, since its introduction in 1955, resulting in numerous versions, as well as serving as a standard of comparison with other scales. It is an easily applicable method, with a high level of reliability and validity, capable of detecting changes, easy to interpret and the application of which is not problematic. On the other hand, its adaptation to different cultural environments is almost immediate. Although it has a few limitations, the Barthel Index may be recommended as a selection method for measuring physical incapacity, both in clinical practice as well as in epidemiological investigation and Public Health.
As providers of medical information and testimony, clinicians have ultimate responsibility for ethical conduct as it relates to this information. The authors offer the following recommendations for enhancing ethical relationships between expert clinicians and the courts. 1. Avoid or resist attorney efforts at enticement into joining the attorney-client team. Such compromises of scientific boundaries and ethical principles exist on a continuum ranging from standard attorney-client advocacy at the beginning of the expert consultation phase (e.g., promotional information at the forefront of retaining an expert, with either provision of selective or incomplete records or less than enthusiastic efforts to produce all records) and extending to completion of evaluation, when requests for changes in reports and documentation might be made. 2. Respect role boundaries and do not mix conflicting roles. Remember that the treating doctor possesses a bond with the patient but does not as a rule obtain complete preinjury and postinjury information in the context of assessing causality and apportionment. In contrast, the expert witness must conduct a thorough and multifaceted case analysis sans the physician-patient relationship in order to facilitate objectivity and allow optimum diagnostic formulations. Finally, the trial consultant's function in this adversarial process is to assist with critically scrutinizing and attacking positions of experts for the opposing side. These roles all represent inherently different interests, and mixing them can only reduce objectivity. 3. Insist on adequate time for thorough record review, evaluation, and report generation. Also insist on sufficient time and preparation for deposition and court appearances. 4. Work at building a reputation for general objectivity, reliance on multiple data sources, reaching opinions only after reviewing complete information from both sides, and completing the evaluation. 5. Spend a good amount of time actually treating the patient population being examined or being offered testimony about. This treatment should be current and should be of a similar frequency to treating practitioner specialists. Be able to discuss relevant research and scientific methodology issues competently and without notes. 6. Arrive at opinions only after reviewing all of the evidence from both sides of the adversarial fence, employing multiple data sources, completing the evaluation, and interpreting data within the full context of comprehensive historical, behavioral observation, and contextual information. Being otherwise favorable to retaining attorney interests suggests endorsement of "opinion prostitute," "scientific perjurer," or "hired gun" status. The only way a practitioner can reduce the likelihood of facing an "opinion prostitute" on the opposing side in future cases is to insist on establishing and maintaining a reputation for scientific objectivity. 7. Balance cases from plaintiff and defense attorneys. Predilection for one side or the other suggests bias and sets up predisposition to nonobjectivity. For example, a preponderance of plaintiff work suggests an overdiagnosis or uncritical sympathy bias, whereas a ratio that favors hiring by the defense suggests an underdiagnosis or skepticism bias. Perhaps Brodsky's suggested cut-off ratio of .8 for favorability findings would represent an initial cutoff for defense versus plaintiff ratio. That is, experts should do at least 20% work for the opposite side of the current case being represented. Further, it might be a reasonable expectation that data on these ratios be collected as an important method for ensuring objective opinions. 8. Ensure against excessive favorability to the side of the retaining attorney or firm. Objectivity demands that scientific opinions not be influenced by the position of the legal advocate. Importantly, Brodsky recommends using a ratio of .8 as a cut-off for detecting excessive bias. That is, practitioners should possess prerequisite objectivity to disagree with the referring attorney at least 20% of the time. We suggest that a more useful cut-off would be .75, where experts are expected to generate findings that do not support the referring attorney's position at least 25% of the time. 9. Never arrive at opinions that are inconsistent with plaintiff records, examination data, test data, behavioral presentation, and so forth, especially when such opinions are favorable to the side of the retaining attorney firm. Instead, use the following recommendations. (ABSTRACT TRUNCATED)
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BACKGROUND: Sexual aggression by men with intellectual disability (ID) is a serious problem requiring attention from the relevant agencies. Training for staff working with this problem is often not given sufficient attention and is rarely evaluated. In the present study, an introductory workshop for direct care staff that aimed to increase knowledge and improve attitudes towards work with this client group was evaluated. METHOD: Sixty-six staff working in inpatient and community settings completed a 2.5-day workshop. Before training began, the participants completed a survey questionnaire concerning their experiences of work with this client group. An assessment of their knowledge and attitudes was carried out prior to and at the end of training in order to evaluate any changes. The participants also rated the effectiveness of the workshop and their level of satisfaction with the training at the end of the workshop. RESULTS: The participants' knowledge and attitudes improved significantly following the workshop. Staff with greater experience over time and those who had worked with fewer sex offender clients responded to different aspects of the training. The participants' ratings indicated that they were highly satisfied with the training and found it to be effective. CONCLUSIONS: Brief workshop training is acceptable to and can be effective in improving the knowledge, attitudes and confidence of direct care staff working with sex offenders with ID. However, because the results are based on participant self-report, caution should be exercised concerning their external validity.
OBJECTIVE: To evaluate the effectiveness of a staff sexuality training programme as a means of improving the rehabilitative management of client sexual health concerns after neurological disability. DESIGN: A prospective controlled pre- and posttest evaluation design with six-month follow-up. SUBJECTS: Seventy-four multidisciplinary rehabilitation and disability staff who attended a two-day workshop, and a control group of 25 staff members who did not receive the training. SETTING: Two workshops were held at major rehabilitation centres in the North and South Islands of New Zealand respectively. MAIN MEASURES: The Sex Attitude Scale, as well as three purpose-designed measures including an objective knowledge test, a self-rating inventory of skills and clinical activity, and a single-item measure of the degree of staff comfort. RESULTS: Workshop participants showed significant increases in knowledge, skills and comfort comparing pre-to post-workshop scores. A number of these gains were maintained at the six-month follow-up. There was an associated increase in the level of reported staff activity in addressing patient/client sexual health concerns in the six months to follow-up, compared to a similar time period preceding the workshop. In contrast, the control group had similar pre-workshop scores to the workshop participants, but recorded no increase on the measures, or in their level of reported activity, at the six-month follow-up. CONCLUSIONS: The programme showed initial promise as an effective intervention in upgrading the capacity of staff working in rehabilitation and disability agencies to address the sexual health concerns of their patients/clients.
The Macomb-Oakland Regional Center has been facilitating the movement of persons with developmental disabilities into the community for 27 years. To measure randomness of their home locations, we used a geographic-based spatial analytic approach. Involvement of allies in planning futures, number of people with disabilities residing in each home, proportion of earned income, level of disability, and level of mobility were used as explanatory variables. Monte Carlo procedures using Moran's I, a measure of spatial autocorrelation, did not reveal significant clustering of residences. Regression procedures, however, did reveal that earned income was the independent variable that most explained the degree to which people were physically included. People living in smaller homes were more randomly dispersed.
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