Exam - Evidence Based Medicine on the Internet


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Course Title Evidence Based Medicine on the Internet
Date Of Activity
Length Of Activity 1:00 Hour
Time of Activity Available 24 Hours
Credits Allowed 1
Credit Allowed Legal Ethics 0
Credit Allowed Elimination of Bias: 0
Credits Allowed Substance Abuse: 0
Credits Allowed Emotional Distress: 0
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Evidence Based Medicine on the Internet

(1). First Published: June 5, 2005

Many states now require an Evidence Based Medicine standard be applied in evaluating treatment protocols and disability evaluations in the field of Workers' Compensation. The use of Evidence Based Medicine is also prevalent in medical malpractice cases and can be extremely helpful in proving or rebutting the necessity of medical treatment in personal injury cases as well. This course is designed to expose you to the numerous sources for information relative to the use of Evidence Based Medicine that are available on the Internet. Start with the LawWorm.com Index page. Click on “Workers’ Compensation,” click on “Evidence Based Medicine.” Click on “Evidence Based Medicine and the Law: The Courts Confront Clinical Practice Guidelines.” The article is probably the best on the subject matter to be found on the net. It should be read in its entirety by anyone interested in evidence based medicine. For purposes of this course click on “The Uses of Medical Evidence in the Courts.” Read this section. Return to the course.

Q. In quality of care cases, issues that are typically addressed through expert medical testimony are:

a. Applicable standard of care.
b. Medical cost effectiveness.
c. Medical prognosis.
d. B and C, but not A.
e. A and C, but not B.


REMINDER: Always use your task bar or the Alt-Tab funtion to alternate between the course and the website you are/were working on.


(2). Start with the LawWorm.com Index page, click on Workers’ Compensation, click on Evidence Based Medicine, click on “Evidence Based Medicine & California Workers’ Comp. System: A report to the industry. CWCI.” Click on “Evidence Based Medicine…etc.” Click on “Click here to download…etc.” This will bring up the California Workers’ Compensation Institutes’ extensive 61 page report in pdf format. It may take a little time. Again this is an exhaustive report that should be read in its entirety by those with interest in the subject matter. Consistent with our primary mission, we are advising you of its existence and how and where to find it. For purposes of this exercise, scroll down to page five and read the information under “Part I: What is Evidence Based Medicine?” Return to the course.

Q. Evidence Based Medicine uses analysis and summaries of scientific studies to:

a. Ensure the consistent use of proven medical practices.
b. Incorporate professional opinions.
c. Reduce unproven, ineffective care.
d. A and C, but not B.
e. B and C, but not A.


(3). Start with the LawWorm.com Index page. Click on Workers’ Compensation. Click on Evidence Based Medicine. Click on “Health Web: Evidence Based Medicine Health Care.” Click on Evidence Based Medicine: Finding The Best Clinical Literature. Read the information. Return to the course.

Q. The process of evidence based medicine involves:

a. Efficiently tracking down the best evidence to answer the question.
b. Efficiently tracking down the best evidence to answer the question.
c. Applying the results in clinical practice.
d. Evaluating performance of the evidence in clinical application.
e. All of the above.


(4). Start with the LawWorm.com Index page. Click on Workers’ Compensation. Click on “Evidence Based Medicine.” Click on “Center for Evidence Based Medicine.” Click on “EBM Toolbox.” Scroll down and review the information under "Specific Tools and Data." Review the written material. Return to the course.

Q. Some of the specific tools and data the EBM Toolbox offers are:

a. Pre-test probabilities, with definition, how to calculate, and an example.
b. Cost effective analysis of treatment guidelines.
c. Likelihood Ratios with an interactive calculator, and an interactive nomgram for LRs.
d. A and B, but not C.
e. A and C, but not B.


(5). Start with the LawWorm.com Index page. Click on Workers’ Compensation, click on Evidence Based Medicine. Click on “CatBank (CEMB).” Click on “What’s a CAT?” Read the introduction and the need for CATs. Return to the course.

Q. Clinicians generate how many knowledge “needs” for every in-patient encountered.

a. About three.
b. About five.
c. About seven.


(6). Start with the LawWorm.com Index page. Click on Workers’ Compensation. Click Evidence Based Medicine. Click “Netting the Evidence.” Click Library on the left side. This opens the page to the Netting the Evidence Virtual Library. One of the purposes of this exercise is to alert you to this library’s existence and show you how to find it. The Netting the Evidence Library has been put together by assembling links to full text documents on all aspects of Evidence Based Medicine. Here is where you can find foundational support for the methodology employed in obtaining the scientifically based medical evidence being presented to the trier of fact. Click on Appraising on the left of the page. Scroll down and under “Critical Appraisal Worksheets,” click on “Diagnostic Tests.” Review the worksheet, then click on the “x” in the upper right corner of your screen to close this pdf page, then return to the course.

Q. Some of the areas of concern when using an article about assessing diagnostic tests are:

a. Was there an independent, blind comparison with a reference standard.
b. Were the methods for performing the test described in sufficient detail to permit replication.
c. Was the article written within the last two years.
d. A and B, but not C.
e. A and C, but not B.


(7). Clinical Practice Guidelines based upon evidence based medicine, such as the ACOEM Guidelines as well as other recognized treatments guidelines can be rebutted with contradictory findings contained within other nationally recognized peer reviewed guidelines, articles, etc., also derived from evidence based medical findings. Here is a valuable website where such material may be found. Start with the LawWorm.com Index page. Click on Workers’ Compensation. Click on Evidence Based Medicine. Click on “New York Academy of Medicine EBM Resource Center.” Click on “Practicing,” on the left of the page, click on “Clinical Practice Guidelines.” Click on “National Guideline Clearing House (AHCPR).” Under Browse, click on “Guideline Index.” Scroll down and under “American Academy of Orthopedic Surgeons,” click on “AAOS Clinical Guideline on Shoulder Pain.” Read the “Complete Summary of Content.”

Q. Some of the areas this guideline addresses are:

a. Occupation of the patient.
b. Evidence Supporting Recommendations.
c. Contradictions.
d. A and B, but not C.
e. B and C, but not A.


(8). Another good source for drawing useable information relative to supporting or attacking evidence based medicine findings is the collection of tools for identifying, assessing and applying relevant evidence for decision making prepared by the Evidence Based Medicine Working Group and originally published in JAMA. Start with the LawWorm.com Index page, click on Workers’ Compensation, click on Evidence Based Medicine, click on “EBM Toolkit.” AT the top of the Toolkit page, place your pointer over “About EBM,” then click on “EBM Intro,” from the drop down menu. Read all the information.

Q. Some of the components the practice of Evidence Based Medicine can be divided into are as follows:

a. Asking a relevant, focused, clinically important question that is answerable.
b. Seeking additional professional opinions
c. Assessing the clinical importance of the evidence.
d. A and B, but not C.
e. A and C, but not B.


(9). The integrated case management project conducted by Georgetown University, in collaboration with the U.S. Department of Labor Office of Workers’ Compensation, contains a wealth of accessible links relative to medical case management in the field of Workers’ Compensation. Start with the LawWorm.com Index page. Click on Workers’ Compensation, click on Evidence Based Medicine, click on “Georgetown Integrated Case Management Project: Full Text.” Scroll down and under Manuals and Documents, click on the “Manuals,” link. Click on “ICM Provider Manual.” Click on Sec. 3, Managing Medical Care for Occupational Upper Extremity Disorders.” Scroll down and read the information under “Red Flags in ACOEM Guidelines,” then review the grid information for Dislocation.

Q. Red Flag indicators that may be present for dislocation are:

a. Swelling
b. Tenderness and instability with history of deformity with reduction.
c. Hemarthrosis.
d. Any of the above.


(10). Let’s look at one more article which is highly informative on the subject of EBM. Click on the LawWorm.com Index page. Click on Workers’ Compensation. Click on Evidence Based Medicine. Click on “Expertise in Law, Medicine and Health Care. Shuman.” Click on “The Gatekeeping Approach,” under contents. Read the material

Q. The considerations for assessing the reliability of Expert Medical Testimony under the Gatekeeping Approach are:

a. Whether a theory or technique has been subjected to peer review and publication.
b. The credibility of the patient.
c. Whether the technique has a high known or potential rate of error.
d. A and B, but not C.
e. A and C, but not B.