Comparative Analysis of Visual System Disability Evaluation Criteria between China and the United States / 法医学杂志

Gradation of Disability in Human Body Injuries （hereinafter referred to as Gradation） has been released and used since January 2017, and has become the most widely used standard in forensic science practice. This paper calculates and rates the visual system evaluation provisions of the current domestic disability evaluation criteria represented by the Gradation which used the methods of Guides to the Evaluation of Permanent Impairment （hereinafter referred to as GEPI） issued by American Medical Association （AMA）. Through comparing, a good correlation between the provisions in Gradation and whole person impairment rating index in GEPI was shown. On the basis of this, suggestions are put forward to amend some provisions of Gradation, in order to provide reference for the revision and further improvement of domestic standards and provisions.

Comment on the two randomized clinical trials on acupuncture from / 中国针灸

In June 27, 2017, there were two acupuncture clinical trials published in (). The conclusions were that electroacupuncture could relieve the leakage of urine of female stress urinary incontinence and that acupuncture with clomiphene or not could not improve the live birth rate of female with polycystic ovarian syndrome, compared with shallow insertion at non-acupoint combined with clomiphene placebo. The Youth Committee of the China Association of Acupuncture-Moxibustion held an academic salon about the above two trials on September 7, 2017. It is considered that rigorous design is key to clinical acupuncture-moxibustion trial, that acupuncture-moxibustion therapy is with psychosomatic medicine theory. The clinical acupuncture-moxibustion research method was discussed, including study group selection, acupuncture control, the primary outcome, the interpretation of result, etc.

Comments on " " from / 中国针灸

In recent years, acupuncture has been used widely as an adjuvant treatment for the in vitro fertilization (IVF). " " published in on May 15, 2018, the research findings do not support the use of acupuncture to improve the rate of live births among the women undergoing IVF. In order to avoid the misunderstanding of the scholars at home and abroad for the clinical effects of acupuncture on IVF assistance, the authors put forward the doubts after the analysis from the following 3 aspects, including the acupuncture scheme, outcomes and result explanation. Additionally, the thinking and suggestions are proposed for the future development of the clinical trials of acupuncture IVF assistance in terms of selecting the proper participants, being abided by the standards of the evidence-based medicine, designing multi-acupuncture schemes and setting up the rational control, as well as conducting the overall analysis of the trial data.

Empowerment of Korean Medical Association with KMA Policy system developing

Recently, the Korean Medical Association (KMA) launched the KMA Policy system based upon the American Medical Association (AMA) Policy system. The KMA's official positions on health issues and medical ethics, as well as its constitution, bylaws, and directives, will be included in the KMA Policy system. The AMA's organizational structure and decision making process provided essential information for developing the KMA Policy system. Through the KMA Policy system, hereafter, the KMA should introduce a procedure not only to decide upon positions on various health issues but also a means to open them to the public. In addition, the KMA can expect the continuity and transparency of work, enhanced benefits to members, public credibility, and growth of its social reputation by means of KMA Policy. Furthermore, the system would be beneficial for both KMA members and the public, as they can easily access KMA Policy, and, in turn, access the healthcare systems of Korea and its medical knowledge. To achieve a successful KMA Policy system, the definite authority and responsibility should be granted to the organizational bodies of the KMA, for example, the House of Delegates and Board of Trustees, and the regional societies and other sections. These various groups must then efficiently divide up their work and cooperate systematically. Moreover, it is crucial that each individual member of the KMA pay much more attention to health issues and participate in the decision making process on KMA Policy.

The Quality of Health Information on Allergic Rhinitis, Rhinitis, and Sinusitis Available on the Internet

PURPOSE: The internet has become one of the most important media outlets used to obtain health information. Therefore, the quality of health information available on the internet is very important. We evaluated the quality of internet-derived health information on allergic rhinitis, rhinitis and sinusitis and compared these results to those of previous studies performed five years ago. METHODS: The terms "allergic rhinitis (AR)", "rhinitis" and "sinusitis" were searched among the four most commonly used search engines in South Korea. These websites were evaluated according to the author, the Journal of the American Medical Association (JAMA) benchmarks, the DISCERN questionnaire and the Allergic rhinitis and its Impact on Asthma (ARIA) 2008 Update. RESULTS: A total of 120 websites were obtained and analyzed. For all diseases, "Oriental physician" had the largest portion (almost half of all websites), followed by "Western physician". Based on analyses using the JAMA benchmark, "Attribution" and "Disclosure" were ignored in almost all surveyed websites. According to the scores of the DISCERN question, the majority of websites did not supply appropriate references for their health information, and information on the negative aspects of treatment such as risks and uncertainty was not provided in several websites. In an analysis based on the ARIA 2008 Update concepts, 65% of websites pertaining to health information on AR contained unreliable information. CONCLUSIONS: The quality of health information on the internet was not acceptable. Thus, governmental regulation or control to improve the quality of health information is required.

Hearing Injury Evaluation: Current Status and Medicolegal Considerations / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In disability rating of hearing injury, there are some medicolegal considerations, such as discrepancy in estimating values between McBride system and the American Medical Association system, and difficulties in judging the hearing level in boundary cases. We have therefore felt the need of complementary hearing disability evaluation methods that reflect reality. As a first step, we have pointed out current situation and problems in legal advisory cases of hearing injury. SUBJECTS AND METHOD: For the past 14 years, we have provided legal advisory on hearing injury for 121 cases for courts (group A) or insurance companies (group B). Eleven cases of 'aggravation of disability' were excluded. Data were summarized and tested statistically. We have used unpaired t-test for continuous variables such as age, hearing, hearing disability, disability rating, Fisher's exact test for dichotomous variable such as gender, group (A/B), and Pearson's correlation test for correlation coefficients between continuous variables. RESULTS: Subjects were more frequently males (3:1) and in the fifth decade of life. The averages of audiometry were around 40 dB. There were significant differences in hearing and disability rating between younger and older group. Group B is significantly older than group A. The type of disability or accident did not influence hearing and disability rating. CONCLUSION: This paper could help figure out the current situation with respect to medicolegal considerations of hearing injury discrepancies in disability rating and could also serve well to recognize the necessity for a complementary hearing disability evaluation method, especially for borderline hearing level.

Comparative Analysis of the Humphrey Static Perimetry and the Goldmann Kinetic Perimetry: Application of the Humphrey Static Perimetry to Visual Disability Evaluation

PURPOSE: In the evaluation of visual field defect, Goldmann kinetic perimetry is the preferred method. However, in many cases, Humphrey static perimetry is performed for visual disability evaluation in Korea. In the present study we investigated the correlation between Goldmann kinetic perimetry and Humphrey static perimetry for disability evaluation using visual field score (VFS). METHODS: This study included 126 eyes, classified into the following groups: 60 eyes, normal group; 11 eyes, contraction of central visual field group; 42 eyes, irregular visual field group; 13 eyes, hemianopsia group. All subjects were examined with Goldmann kinetic perimetry and Humphrey static perimetry. We studied the correlation of the VFS between Goldmann kinetic perimetry and Humphrey static perimetry according to the Korean Academy of Medical Science Guides for Impairment Evaluation (KAMS Guides) and American Medical Association Guides for the Evaluation of Permanent Impairment (AMA Guides). RESULTS: Regarding contraction of central visual field group, Goldmann VFS, Humphrey VFS and extended Humphery VFS showed no statistical significance (AMA: p = 0.50, p = 0.30, KMAS: p = 0.36, p = 0.18. respectively). In the irregular visual field and hemianopsia groups, Goldmann VFS and Humphrey VFS showed statistical significance (AMA: p = 0.00, p = 0.00, KMAS: p = 0.00, p = 0.00. respectively). Goldmann VFS and extended Humphrey VFS showed no statistical significance (AMA: p = 0.13, p = 0.12, KMAS: p = 0.08, p = 0.99. respectively). CONCLUSIONS: The contraction of central visual field based on Humphrey static perimetry can be applied to visual disability evaluation. However, in the majority of cases, there is a difference between the two tests and Goldmann kinetic perimetry should be used first in the evaluation of visual field disability evaluation.

New Guides to the Evaluation of Korean Hearing Impairment in 2012 / 대한이비인후과학회지

The incidence of hearing impairment is increasing due to growth of the population of the elderly, industrialization and noise exposure. Evaluation of hearing impairment are frequently made in purpose of compensation, indemnification or welfare policy of the disabled. Evaluation of hearing impairment is a process to diagnose and to evaluate the disability under objective criteria. Several domestic and international standards have been proposed including legal acts such as the disable welfare law, industrial accident compensation insurance and the national pensions act. There are also medical counsel standards such as Korean academy of medical sciences disability evaluation standards, disability standards of American medical association and disability evaluation of McBride. In order to assess the hearing impairment fairly, thorough understanding about the difference of the purposes and standards of each guideline of hearing impairment is needed. Therefore in this article, the domestic and the international standards for the evaluation method of hearing impairment which was revised recently and their differences are discussed.

Quality of Cohort Studies Reporting Post the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement / 한국역학회지

The quality of reporting of cohort studies published in the most prestigious scientific medical journals was investigated to indicate to what extent the items in the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist are addressed. Six top scientific medical journals with high impact factor were selected including New England Journal of Medicine, Journal of the American Medical Association, Lancet, British Medical Journal, Archive of Internal Medicine, and Canadian Medical Association Journal. Ten cohort studies published in 2010 were selected randomly from each journal. The percentage of items in the STROBE checklist that were addressed in each study was investigated. The total percentage of items addressed by these studies was 69.3 (95% confidence interval: 59.6 to 79.0). We concluded that reporting of cohort studies published in the most prestigious scientific medical journals is not clear enough yet. The reporting of other types of observational studies such as case-control and cross-sectional studies particularly those being published in less prestigious journals expected to be much more imprecise.

Assessment of Allergic Rhinitis Websites in Korea

OBJECTIVES: The internet has become an important source of medical information and a great amount of information related to allergic rhinitis (AR) is available on the internet. However, the quality of this information is still a matter of debate. Therefore, this study was conducted to assess the AR-related information on Korean websites. METHODS: The key word "allergic rhinitis" was entered into 4 popular search engines, and this led to identifying 40 websites. After being categorized according to authorship, the informational value of these websites was evaluated using 4 different assessment tools such as the Journal of the American Medical Association (JAMA) benchmarks, the DISCERN questionnaire, the Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update and the Health On the Net (HON) code. RESULTS: The 40 websites containing AR-related information were categorized according to their authorship as Western physician: 20, Oriental physician: 14, commercial: 1, and others: 5. The mean citation frequencies of the JAMA benchmarks and the ARIA 2008 Update concepts was 1.23 out of 4 and 4.33 out of 8, respectively, while the mean DISCERN score was 1.92 out of 5. When the websites were evaluated based on the type of authorship, the mean citation frequencies of the ARIA 2008 Update concepts were Western physician: 5.35, Oriental physician: 2.64. Additionally, three websites authored by Western physicians and 13 authored by Oriental physicians contained unreliable information. Among these 16 websites, only 3 websites met the requirements for the HON code "Justification". CONCLUSION: AR-related information available on Korean websites is of variable quality and not all of the information provided is justifiable. Thus, performing surveillance of the medical information on these websites is necessary. Furthermore, common criteria that can be used to evaluate the websites created by both Western and Oriental physicians are also needed.

A Review of the AMA Guides to the Evaluation of Permanent Impairment

The American Medical Association's Guides to the Evaluation of Permanent Impairment (Guides) has provided an useful guideline in interpreting information on permanent impairment based on the in-depth knowledge and experience in impairment ratings accumulated for a long period of time. Since its first publication by American Medical Association (1958), as A Guide to the Evaluation of Permanent Impairment of the Extremities and Back', 12 additional guides' has been published by the JAMA over the next 12 years. All the guides were consolidated to become the first official edition of the Guides' in 1971. The 'Guides' has been updated periodically to reflect current scientific clinical knowledge and judgment methods. It has become the best system available to evaluate permanent impairments across many disciplines. The latest sixth edition created a "paradigm shift" in the area of the impairment assessment by introducing a contemporary model of disablement. The standardized methods elaborated in the sixth edition clearly enhances the relevancy of impairment ratings, improves internal consistency of the methods and renders the application of the rating process easier. It adopts the terminology and conceptual framework from the International Classification of Functioning, Disability and Health in order to generate five impairment classes. A diagnosis-based grid has been developed for each organ system. Functional history, physical findings and objective clinical test results are integrated to determine the grade within the impairment class. The Guides' is the most widely used source for assessing and rating permanent impairments in the United States and can be considered as the best available method for the assessment of permanent impairment.

Assessment of Functional Vision Score and Vision-Specific Quality of Life in Individuals With Retinitis Pigmentosa

PURPOSE: To determine the relationship between the American Medical Association's (AMA) functional vision score (FVS) and vision-specific quality of life in retinitis pigmentosa (RP) patients using the National Eye Institute's Visual Functioning Questionnaire (NEI-VFQ 25). METHODS: One hundred eight patients with RP participated in the study. We measured best-corrected visual acuity, conducted Goldmann perimetry, and collected the self-reported NEI-VFQ 25. The FVS was calculated using the functional field score (FFS) and the functional acuity score (FAS). The correlations of the VFQ composite scores to the FVS, FFS, and FAS were determined using correlation and regression analyses. RESULTS: FVS was highly correlated to the BCVA (r=0.69, p<0.001), the FFS (r=0.86, p<0.001) and the FAS (r=0.73, p<0.001). Significant correlations of the VFQ composite score to the BCVA (r=0.60, p<0.001), FFS (r=0.44, p<0.001), FAS (r=0.60, p<0.001), FVS (r=0.58, p<0.001) were also found. However, the correlation strengths of BCVA, FVS, FAS, and FFS to NEI-FVQ were not different. CONCLUSIONS: In RP patients, the vision-specific quality of life was correlated with the AMA guidelines' FVS, FFS, and FAS. Their correlation degrees to NEI-FVQ were not different. This result suggests that vision-specific quality of life can be explained by both visual acuity and visual field in RP patients.

Disability Evaluation of the Pain : The Present and Prospect in Korea

OBJECTIVE: Pain has long been regarded as a subjective symptom. Recently, however, some regard a type of intractable chronic pain as a disease. Furthermore, chronic persistent pain becomes a cause of permanent impairment (PI). In 6th edition, the American Medical Association (AMA) Guides has rated the pain as a PI. In Korea, pain has been already been rated as a PI. Here, we examined the present status and the prospect of disability evaluation for the pain in Korea. METHODS: Pain can be rated as a PI by the Workmen's Compensation Insurance Act (WCIA) and Patriots and Veterans Welfare Corporation Act (PVWCA) in Korea. We examined the definition, diagnostic criteria and grades of the pain related disability (PRD) in these two acts. We also examined legal judgments, which were made in 2005 for patients with severe pain. We also compared the acts and the judgments to the criteria of the 6th AMA Guides. RESULTS: The PRD can be rated as one of the 4 grades according to the WCIA. The provisions of the law do not limit the pain only for the complex regional pain syndrome (CRPS). The PRD can be rated as one of the 3 grades by the PVWCA. If there were objective signs such as osteoporosis, joint contracture and muscle atrophy corresponding to the CRPS, the grade is rated as 6. When the pain always interferes with one's job except easy work, the grade is rated as high as 5. In Korea, judicial precedents dealt the pain as a permanent disability in 2005. CONCLUSION: Although there were no objective criteria for evaluation of the PRD, pain has been already rated as a PI by the laws or judicial precedents, in Korea. Thus, we should regulate the Korean criteria of PRD like the AMA 6th edition. We also should develop the objective tools for evaluation of the PRD near in future.

Impairment Rating Ambiguity in the United States: The Utah Impairment Guides for Calculating Workers' Compensation Impairments

Since the implementation of workers' compensation, accurately and consistently rating impairment has been a concern for the employee and employer, as well as rating physicians. In an attempt to standardize and classify impairments, the American Medical Association (AMA) publishes the AMA Guides ("Guides"), and recently published its 6th edition of the AMA Guides. Common critiques of the AMA Guides 6th edition are that they are too complex, lacking in evidence-based methods, and rarely yield consistent ratings. Many states mandate use of some edition of the AMA Guides, but few states are adopting the current edition due to the increasing difficulty and frustration with their implementation. A clearer, simpler approach is needed. Some states have begun to develop their own supplemental guides to combat problems in complexity and validity. Likewise studies in Korea show that past methods for rating impairment are outdated and inconsistent, and call for measures to adapt current methods to Korea's specific needs. The Utah Supplemental Guides to the AMA Guides have been effective in increasing consistency in rating impairment. It is estimated that litigation of permanent impairment has fallen below 1% and Utah is now one of the least costly states for obtaining workers' compensation insurance, while maintaining a medical fee schedule above the national average. Utah's guides serve as a model for national or international impairment guides.

A Review of the Classification of the Practice Characteristics and the Physicians' Work in Vascular Surgery

PURPOSE: Since the medical insurance system was started in Korea, there has been an imbalance in the medical charges among the procedural items of special departments. For correcting this problem, the Resource-based Relative Value Scale (RBRVS) was introduced to determine the relative values of physician services and practices. The RBRVS is the prevailing model used today to describe, quantify and reimburse physicians for their services. In this study we attempted to clarify the relative values of the practice characteristics in vascular surgery and evaluate the propriety compared with the relative value unit (RVU) of the American Medical Association (AMA). METHOD: The classification of practice characteristics in vascular surgery was compared with that of the AMA. The propriety of physicians' work was measured according to the Korean and American physicians' work. The rate more than 70, between 50 to 69, and less than 49 were used to decide over-, proper- or under-estimation, respectively. RESULT: The ratio of the number of practice characteristics in Korean and American vascular surgery was 1:3.31 (97:321). The over-, proper- or under-estimated physicians' work among the identical American practice characteristics was 8/46 (17.4%), 19/46 (41.3%) and 19/46 (41.3%) respectively. CONCLUSION: Our results demonstrated that the practice characteristics of Korean vascular surgery are not sorted by detail and a large percentage of physicians' work (41.3%) is under-estimated. Therefore, reasonable payment for physician services or practices can not be determined for Korean vascular surgery.

A Study for the Assessment of Disability and Compensation in Patients with Hearing Impairment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Disability in hearing impairment represents not only an increase in hearing threshold level, but also unmeasurable subjective discomfort to patients. Until now, several guidelines for quantitative assessment of disability of hearing impairment have been offered. In Korea, laws for industrial accident compensation insurance (IACI) and disabled persons welfare (DPW), and guidelines proposed by American Medical Association (AMA) were frequently used to assess the degree of disability in hearing impaired patients, but there were some discrepancies in the methods and criterions of assessment among the different guidelines and laws. The purposes of this study were to compare these guidelines and look for the problems and to suggest a plan for the improvement in the objective assessment of disability in hearing impaired patients. MATERIALS AND METHOD: The grades of Korean laws for IACI and DPW were converted into the impairment percentage rates used in the AMA guideline. We compared inter-guideline and inter-grade differences in impairment percentage rates. RESULTS: We found several problematic areas in the grades of IACI and there were some differences in the understanding of the degree of disability in hearing impairment between guideline of the Korean laws and foreign guidelines. CONCLUSION: Some changes are needed to be made in the guidelines for disability assessment in the Korean laws for IACI and DPW. Modification of the current grading system into the percentage rating system that is suited to the Korean sociocultural situation would be beneficial in the objective and balanced assessment of the disability of hearing impaired patients.

Comparison of the Two Impairment Classes Publicized by the American Medical Association in Complex Regional Pain Syndrome Patients / 대한통증학회지

BACKGROUND: Complex regional pain syndrome (CRPS) is not regarded as an impairment in Korea. Guidelines for rating this impairment are under development by the Korean Academy of Medical Science based on that of the American Medical Association (AMA). However, no studies have been done on the validity of these guidelines in Korea. We therefore evaluated the validity of these guidelines using the criteria from the chapter on the central and peripheral nervous system (CNS-PNS class) and the worksheet for calculating total pain-related impairment score (TPRIS class). METHODS: TPRIS and CNS-PNS classes were calculated through interviews of 28 CRPS patients. The correlation between the two classes was calculated. RESULTS: TPRIS class and CNS-PNS class were well correlated (r = 0.593, P < 0.05). CONCLUSIONS: Both TPRIS or CNS-PNS classes were well correlated and could be used for evaluation of impairment. However, the CNS-PNS class is simpler and quicker to complete.

Evaluation of Bilateral Visual Function after Vitrectomy for Complications of Proliferative Diabetic Retinopathy

PURPOSE: The author evaluated the impact of vitreoretinal surgery for proliferative diabetic retinopathy (PDR) on bilateral visual function. METHODS: Anatomic and visual acuity outcomes were reviewed by author for patients who underwent bilateral surgery for PDR. Bilateral visual function was evaluated using the American Medical Association (AMA) Guidelines for Disability scale to quantitate the impact of surgery on visual system disability. RESULTS: There were 18 patients (36 eyes) who underwent vitrectomy for complications of PDR, and the overall anatomic success rate was 100%. Mean visual impairment of the study eyes and visual system according to AMA Guidelines for Disability decreased postoperatively by 22.4% points, and 25.7% points, respectively. A higher functional level of the bilateral visual system resulted postoperatively in 83.2% of all patients, according to eyes with better visual acuity. CONCLUSIONS: Vitreoretinal surgery was associated with a reduction in bilateral visual disability and improved bilateral visual function in patients with PDR.