Recommendations to guide revision of the Guides to the Evaluation of Permanent Impairment. American Medical Association.

The American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition, is the most commonly used tool in the United States for rating permanent impairments for disability systems. The Guides, currently undergoing revision, has been the focus of considerable controversy. Criticisms have focused on 2 areas: internal deficiencies, including the lack of a comprehensive, valid, reliable, unbiased, and evidence-based system for rating impairments; and the way in which workers' compensation systems use the ratings, resulting in inappropriate compensation. We focus on the internal deficiencies and recommend that the Guides remains a tool for evaluation of permanent impairment, not disability. To maintain wide acceptance of the Guides, its authors need to improve the validity, internal consistency, and comprehensiveness of the ratings; document reliability and reproducibility of the results; and make the Guides easily comprehensible and accessible to physicians.

Why is the treatment of work-related injuries so costly? New evidence from California.

There is growing evidence that workers' compensation insurers are charged substantially more than health insurers for the treatment of similar injuries. The first study of the problem, conducted in Minnesota in 1987, found that both overutilization of services and price discrimination contributed to the charge differential. This article applies the Minnesota model to 1991-1993 data on health care charges and payments from California. Approximately 13,000 persons with work-related injuries are compared to approximately 3,600 persons with similar injuries that occurred off the job. Despite important differences in the populations and workers' compensation laws in California and Minnesota, workers' compensation insurers are charged more than health insurers for the treatment of similar injuries in both states. The difference in California's payments is attributable to using more health care providers and services to treat workers' compensation patients. The results do not support the hypothesis that work-related injuries cost more to treat because they are more severe than similar injuries occurring off the job.

Why does workers' compensation pay more for health care?

An analysis shows that health care providers charged substantially larger amounts for treatment of workers' compensation cases than for the treatment of similar patients insured by Blue Cross.

Eyeglasses to maintain flexibility of vision for the older dentist: the Otago dental lookover.

Presbyopia is inability of the eye to accommodate and provide clear images of near objects. It affects all dentists in middle age, when "near point," the nearest point at which the eye can focus accurately, exceeds ideal working distance. Dentistry has unique visual demands and many older dentists have been shown to be working with less-than-optimal visual efficiency and comfort. This paper discusses methods for improving vision in the dental operatory and details a new design for eyeglasses suitable for the presbyopic dentist.

Presbyopia and the dentist: the effect of age on clinical vision.

Vision is extremely important in dentistry where many clinical tasks requiring fine discrimination are performed. Presbyopia, an inability to focus sharply on near objects, affects all dentists in the later years of their practising lives and may have adverse effects on the practice of dentistry. This study examined the visual acuity of 172 practising dentists using a reduced Snellen chart imaged at 25 cm and 33 cm. Twenty-seven per cent failed the near vision test, having acuity of less than 6/9 at 25 cm, while 18 per cent had acuity of less than 6/7.5 at 33 cm; 96 per cent of those who failed at 25 cm and 93.5 per cent of those who failed at 35 cm were 45 years of age or more. Working distance (operating distance) was found to be significantly greater in dentists over the age of 45 than in a group of undergraduate dental students. No statistically significant relationship between visual acuity and working distance could be demonstrated. Regular examinations by qualified personnel are essential for dentists who should have their eyes checked every 2 years after the age of 40. Dentists should discuss their specific requirements for the practice of dentistry with their eye-care specialist. A suggested minimum standard of visual acuity for practising dentists is 6/7.5 at 33 cm.

Eye protection in dental practice.

A survey of Southland dental practices showed that eye protection for dentists, dental surgery assistants, and patients did not generally meet currently recommended standards. The prevalence of eye injuries was low but, because of the random nature of many eye injuries, all practitioners should maintain proper protective procedures.

The effects of disposable and custom-made impression trays on the accuracy of impressions.

This study indicates that some non-rigid impression trays, including disposable plastic trays and custom-made acrylic resin trays, may produce unreliable results when used with some medium-bodied elastomers. The study does not question the well-documented clinical accuracy of these elastomers when they are used with rigid trays. Disposable plastic trays are found to be acceptable when used with a combination of reversible and non-reversible hydrocolloid impression materials.

Dental damage during anaesthesia and surgery.

A review of the Accident Compensation Corporation (ACC) files on dental damage following anaesthesia or surgery was undertaken along with a survey of New Zealand anaesthetists asking about their practice with respect to protection of teeth during anaesthesia. These results confirm that damage is relatively common and that the majority of damaged teeth (62%) were known to have been previously restored, or weakened through periodontal disease prior to the damage occurring. The anaesthetists surveyed thought that dental damage was even more common than shown from the ACC records, and yet the vast majority of them did not routinely use specific protective guards and 45% of them did not ever use protective guards of any type.

Workers' compensation insurance: recent trends in employer costs.

Costs of insuring against work-related injuries and diseases have escalated rapidly since 1972; growing variation in premiums among States over the same period may indicate unequal rates of improvement in workers' compensation laws.