8. Use of pertinent treatment guidelines 2

Question 1

What does section 9792.23 state regarding medical treatment guidelines?

Answer 1

Section 9792.23 states that the Administrative Director is responsible for adopting and incorporating by reference medical treatment guidelines commencing with section 9792.23.1.

Question 2

What does section 9792.21d1 of the MTUS guidelines indicate about treatment for conditions not addressed in the MTUS?

Answer 2

For conditions or injuries not addressed in the MTUS treatment guidelines authorized treatment and diagnostic services shall adhere to other scientifically and evidence-based medical treatment guidelines recognized nationally by the medical community.

Question 3

How are the MTUS guidelines organized in terms of their effective dates?

Answer 3

The MTUS guidelines are organized chronologically by their effective dates: 1. Prevention (May 1 2011) 2. General Approach to Initial Assessment and Documentation (July 25 2016) 3. Initial Approaches to Treatment (October 22 2021) 4. Work Disability Prevention and Management (April 11 2022).

Question 4

What is the significance of evidence-based medical treatment guidelines as per the MTUS?

Answer 4

Evidence-based medical treatment guidelines are critical for ensuring that all treatment and diagnostic services provided for work-related injuries are scientifically supported and aligned with best practices recognized by the medical community.

Question 5

What chapter addresses work disability prevention and management in the ACOEM guidelines?

Answer 5

Chapter 4 addresses Work Disability Prevention and Management which was effective as of April 11 2022.

Question 6

What is the role of the Administrative Director in relation to the MTUS guidelines?

Answer 6

The Administrative Director adopts medical treatment guidelines and incorporates them into the MTUS ensuring that these guidelines are followed for occupational medicine practices.

Question 7

What is the meaning of ‘Presumption of Correctness’ in the context of the MTUS guidelines?

Answer 7

The ‘Presumption of Correctness’ refers to the principle that decisions made by the Administrative Director regarding the treatment guidelines are assumed to be correct unless proven otherwise.

Question 8

What burdens of proof are specified in relation to the treatment guidelines under MTUS?

Answer 8

The specific burdens of proof related to the treatment guidelines require that any contestation of treatment recommendations based on the guidelines must provide substantial evidence to override the presumption of correctness.

Question 9

What is the ‘Appraisal of Guidelines for Research Evaluation II (AGREE II) Instrument’?

Answer 9

The AGREE II Instrument is a tool designed to help guideline developers and users assess the methodological rigor and transparency in which a guideline is developed.

Question 10

When was the AGREE II Instrument adopted into the MTUS?

Answer 10

The AGREE II Instrument was adopted and incorporated by reference in May 2009.

Question 11

Where can the AGREE II Instrument be accessed?

Answer 11

The AGREE II Instrument can be accessed from www.agreetrust.org or obtained from the Medical Unit Division of Workers’ Compensation P.O. Box 71010 Oakland CA 94612-1486 or on the DWC website at http://www.dwc.ca.gov.

Question 12

What is the definition of ‘Bias’ in the context of research evaluation?

Answer 12

Bias refers to any tendency to influence the results of a trial or its interpretation other than the experimental intervention. Biases can stem from various factors including vested interests.

Question 13

List examples of biases that can affect research results.

Answer 13

Examples of biases include selection bias performance bias detection bias reporting bias and publication bias.

Question 14

What are the potential consequences of bias in clinical trials?

Answer 14

Bias can lead to inaccurate results and conclusions jeopardizing the reliability and validity of clinical guidelines and recommendations.

Question 15

Explain the importance of methodological rigor in developing clinical guidelines.

Answer 15

Methodological rigor ensures that clinical guidelines are based on sound evidence reducing the risk of bias and enhancing the trustworthiness of the guidelines for decision-making.

Question 16

What role does transparency play in guideline development?

Answer 16

Transparency allows stakeholders to understand the processes and decisions involved in guideline development which enhances accountability and trust in the recommendations made.

Question 17

What sections of law or regulation are relevant to the definitions provided about evidence strength?

Answer 17

Sections 9792.25-9792.26 are relevant to the definitions provided concerning evidence strength.

Question 18

What are confounding variables in research?

Answer 18

Confounding variables are external influences that can affect the outcome of a study potentially leading to incorrect conclusions. They can include factors such as financial interests academic interests and industry influence.

Question 19

What does ‘inadequate generation of the randomization sequence’ refer to in clinical trials?

Answer 19

This refers to a failure in the process of creating a random sequence to assign participants to different groups in a study which can lead to biased results.

Question 20

Why is inadequate concealment of allocation a problem in clinical trials?

Answer 20

Inadequate concealment of allocation means that researchers or participants may know which group they are assigned to introducing bias in treatment effects and potentially skewing the results.

Question 21

What is the significance of selection bias in research studies?

Answer 21

Selection bias occurs when the participants included in a study are not representative of the larger population which can distort the results and limit the generalizability of the findings.

Question 22

What does ‘lack of blinding’ mean and why is it important?

Answer 22

Lack of blinding refers to the absence of measures to prevent participants and researchers from knowing which interventions have been administered. This can introduce bias as expectations may influence outcomes.

Question 23

What is selective outcome reporting?

Answer 23

Selective outcome reporting involves only publishing certain results from a study based on the significance or the favorability of those results which can lead to a biased representation of the intervention’s effectiveness.

Question 24

What is meant by ‘failure to do intention-to-treat analysis’?

Answer 24

Failure to perform intention-to-treat analysis means not including all randomized participants in the groups they were assigned to regardless of whether they completed the intervention which can lead to biased outcomes.

Question 25

Why is early stopping of a trial considered problematic?

Answer 25

Early stopping of a trial can introduce bias and affect the validity of the results particularly if the decision to stop is based on interim results that may not accurately reflect the long-term effects.

Question 26

What implications does publication bias have for clinical research?

Answer 26

Publication bias occurs when studies with positive or significant results are more likely to be published than those with negative or inconclusive results skewing the available evidence on an intervention.

Question 27

What does 'biologic plausibility' signify in research studies?

Answer 27

Biologic plausibility refers to the degree to which existing biological medical and toxicological knowledge supports the reasonableness of the observed effect of an intervention.

Question 28

Define 'blinding' in the context of research studies.

Answer 28

Blinding is a technique used to prevent bias by keeping participants clinicians and other interpreters unaware of which intervention the participants are receiving ensuring objective results.

Question 29

What is a 'case-control study'?

Answer 29

A case-control study is a retrospective observational study that compares individuals with the disease (cases) to individuals without the disease (controls) to investigate associations with risk factors.

Question 30

What is a 'case report' in medical literature?

Answer 30

A case report is a detailed documentation of a single patient's medical history symptoms treatment outcomes and other relevant clinical data often used to highlight unusual or novel occurrences.

Question 31

What is a case report in clinical studies?

Answer 31

A case report is a detailed description of the symptoms signs diagnosis treatment and follow-up of an individual patient. It is often used to document unusual or novel occurrences in clinical practice.

Question 32

What is the purpose of a case series?

Answer 32

A case series presents a group of case reports that involve patients who received similar treatment. It provides detailed information about each individual patient including demographics diagnosis treatment response to treatment and follow-up.

Question 33

What demographic information is typically included in case series reports?

Answer 33

Demographic information in case series reports usually includes age gender ethnic origin and other relevant factors regarding the individual patients.

Question 34

What are the two types of approaches for collecting data in case series reports?

Answer 34

Data for case series reports can be collected prospectively (looking forward) or retrospectively (looking back at existing data).

Question 35

Define cohort study.

Answer 35

A cohort study also known as a follow-up study or prospective study is an epidemiologic study that compares two or more groups of people who are free of disease but differ in their exposure to a potential cause of the disease examining the incidence of the disease in each group.

Question 36

What are the key features of cohort studies?

Answer 36

Key features of cohort studies include following individuals over time to observe disease development comparing treated vs. non-treated groups and establishing an association between exposure and disease outcomes.

Question 37

How does a cohort study differ from case reports and case series?

Answer 37

Cohort studies involve larger groups of participants compare groups based on exposure to risk factors and assess outcomes over time whereas case reports and case series focus on individual patient experiences without comparative analysis.

Question 38

What is the importance of follow-up in case series and cohort studies?

Answer 38

Follow-up is essential to assess the effectiveness of treatment monitor patient progress identify long-term effects or outcomes and gather comprehensive data for analysis.

Question 39

Can cohort studies be conducted retrospectively?

Answer 39

Yes cohort studies can be conducted both prospectively or retrospectively depending on whether researchers analyze existing data or collect new data moving forward.

Question 40

What is a retrospective cohort study?

Answer 40

A retrospective cohort study examines a group of individuals from past records identifying exposures and outcomes that have already occurred thus allowing researchers to analyze data without waiting for future events.