American College Of Occupational And Environmental Medicine Research Articles

A Comprehensive Obesity Benefit as a Guide for Employers on the Core Components of Obesity Care: Guidance From the American College of Occupational and Environmental Medicine (ACOEM) Roundtable on Obesity.

The need to confront the obesity epidemic and its impact on employers requires a serious look at how we address the treatment of obesity. This article focuses on the core components of obesity care and the need for employers to offer a comprehensive obesity benefit (COB) as part of employee insurance coverage. In May 2022, the American College of Occupational and Environmental Medicine convened a roundtable meeting, which brought together five corporate medical directors and representatives from aerospace/defense and energy industries to learn about the disease of obesity and provide clinical insights regarding health and safety in their respective industries. The goals of the program were to provide awareness of benefits for the treatment of obesity and identify the feasibility for employers of implementing a COB for their employees. Participants learned how a comprehensive approach to covering obesity treatments is necessary, and what benefits should be offered to employees. Participants were invited to review the insurance benefits they currently offer to employees and compare them to the COB. Outcomes were limited by a lack of participation by the employers invited to participate. Participants identified actions that need to be addressed for employers to develop a more comprehensive approach to obesity care. Implementing a COB can help employers increase access and utilization of comprehensive obesity care by employees.

The Role and Value of Corporate Medical Directors in Employer Benefits Management: Current Perceptions of Corporate Medical Directors and Benefits Professionals.

Knowledge of health-related employer benefits is considered a core competency by the American College of Occupational and Environmental Medicine. This study seeks to understand how this translates into practice. An electronic survey was e-mailed to members of American College of Occupational and Environmental Medicine Corporate Medicine and Health and Human Performance Sections; Integrated Benefits Institute; and Employer Health Innovation Roundtable. One hundred nineteen responses were received, including 54 from corporate medical directors (CMDs) and 43 from employee benefits professionals, from a variety of industries. Fifty percent of CMDs reported expertise in designing benefits, but only 25% are engaged with health benefits. The majority of CMDs thought that their involvement was important, while the majority of benefits professionals thought that it was not important. Many CMDs report having benefits expertise but being underutilized while others report not having expertise.

Caring for Miners During the Coronavirus Disease-2019 (COVID-19) Pandemic.

Caring for Miners During the Coronavirus Disease-2019 (COVID-19) Pandemic.

Utilization Review in Workers' Compensation: Review of Current Status and Recommendations for Future Improvement.

: Utilization review (UR) is a process that assesses aspects of a treating provider's care plans and then provides recommendations to payors/insurance carriers, third party administrators, etc, concerning the appropriateness of the proposed care. UR has become an integral part of medical practice and has influenced medical care within the workers' compensation (WC) system and is mandated in several states and jurisdictions. This guidance statement from the American College of Occupational and Environmental Medicine (ACOEM) reviews structural elements of UR programs and proposes a possible template for operational standards. UR has a unique role in protecting patients and educating providers on evidence-based guidelines, new research, and best practices.

Use of BIM and Smart Monitoring for buildings’ Indoor Comfort Control

Building information modeling (BIM) is the geometric way to present a life cycle construction project including geographic information. Recently, the Internet of Things (IoT) has been progressively used smart buildings in order to enhance living comfort, work productivity and entertainment. However, studies addressing the combination of these two technologies (BIM and IoT) focused on the automatic diffusion of data through sensors to BIM models [1]. Based on American College of Occupational and Environmental Medicine (ACOEM) a great portion of our time is spend inside buildings, in our offices, homes, schools, health care facilities, or in other private or public buildings. Hence the necessity to improve the basic human right to live in a healthy, safe and comfort environment is vital. This paper presents the use of BIM to support complex decisions concerning comfort conditions in buildings. This use is illustrated through a case study concerning a building of the AUST campus in Beirut.

Fitness-for-Duty Assessments of Industrial Firefighters: Guidance for Occupational Medicine Physicians.

: Industrial firefighters share many characteristics with municipal firefighters; however, employers frequently have not addressed or characterized the unique job duties, hazards, and specific physical/mental demands associated with industrial firefighting. In addition, gaps exist in the medical literature with regard to industrial firefighter demographics, behavioral risk factors, and chronic diseases. Finally, the proper methodologies for fitness-for-duty assessment of employees acting in this capacity are lacking. To address these gaps, the American College of Occupational and Environmental Medicine (ACOEM) convened a Task Force in 2014, to develop fitness-for-duty guidance for industrial firefighters. This document highlights these gaps and suggests research opportunities to enhance the health and safety of this population. While an extensive literature review found a lack of studies for this population-thus excluding the development of an evidence-based document-sufficient materials were available from which to draw preliminary conclusions, considerations for best practices, and recommendations for future studies.

Reducing Disability Durations and Medical Costs for Patients With a Carpal Tunnel Release Surgery Through the Use of Opioid Prescribing Guidelines.

Objective:The impacts of compliance with opioid prescribing guidelines on disability durations and medical costs for carpal tunnel release (CTR) were examined.Methods:Using a dataset of insured US employees, opioid prescriptions for 7840 short-term disability cases with a CTR procedure were identified. Opioids prescriptions were compared with the American College of Occupational and Environmental Medicine (ACOEM)'s opioid prescribing guidelines for postoperative, acute pain, which recommends no more than a 5-day supply, a maximum morphine equivalent dose of 50 mg/day, and only short-acting opioids.Results:Most cases (70%) were prescribed an opioid and 29% were prescribed an opioid contrary to ACOEM's guidelines. Cases prescribed an opioid contrary to guidelines had disability durations 1.9 days longer and medical costs $422 higher than cases prescribed an opioid according to guidelines.Conclusions:The use of opioid prescribing guidelines may reduce CTR disability durations and medical costs.

Genetic screening in the workplace.

Genetic screening in the workplace.

Evidence-Based Medicine: Determining Quality of Randomized Controlled Trials

Abstract Evidence-based medicine is based on evidence gathered by randomized controlled trials (RCTs), which are considered the “gold standard” of research studies. Users of the medial literature must be able to read critically and evaluate RCTs. The present article uses the standards of the American College of Occupational and Environmental Medicine (ACOEM) practice guidelines in evaluating RCTs according to 11 criteria; these criteria follow those used by the Cochrane Collaboration in their evidence-based reviews. Well-written articles present their randomization schemes to create comparable groups, and studies must be controlled for co-interventions; in a double-blind trial, the co-interventions would be used equally in both groups, and treatment allocations should be concealed. Readers should ask if the study had acceptable compliance; that is, were patients doing what they were asked, and was the dropout rate acceptable (typically, less than 20%)? RCTs should be analyzed by an intention-to-treat analysis that includes all study subjects who were randomized, not just those who completed the study. Having high internal validity ensures a more accurate study that can be reproduced by others, so readers may ask if results are likely to be affected by observational bias, confounding, or chance variation. Readers can determine external validity by assessing study participants according to inclusion and exclusion criteria and baseline characteristics.

American College of Occupational and Environmental Medicine's Occupational and Environmental Medicine Competencies-2014: ACOEM OEM Competencies Task Force*.

The preventive medicine foundation of occupational medicine impacts all the different practice areas of OEM, whether it involves preventing illness related to a hazardous exposure, treating injury due to an employee health condition, or addressing unnecessary work disability after an occupational injury. The OEM physicians are required to effectivelyinteractwithawiderangeofother professionals and provide guidance not only to patients but also to other clinicians and occupational health nurses, employers, safety and industrial hygiene professionals, human resource managers, attorneys, labor unions, and public health care professionals. In these interactions,OEMphysiciansshouldfollowa strict code of ethics related to matters of confidentiality and potential conflicts of interest. Detailed guidance in this area is provided in ACOEM Code of Ethics. 16 Effective communication in OEM includes risk communication, patient education, workforce education, development of policy and guidance documents, and medical/legal document preparation. Physicians practicing OEM typically

Pertussis Vaccination of Health Care Workers

Pertussis Vaccination of Health Care Workers

Pandemic Influenza Guidance for Corporations

The purpose of this guidance document is to assist members of the American College of Occupational and Environmental Medicine (ACOEM), and the organizations for which they work, in managing the impact of a pandemic of influenza or other contagious respiratory disease on patients, employees, and business. This guidance document outlines actions to take before and during an influenza pandemic on the basis of two main strategies: (1) reducing the spread of the virus within facilities; and (2) providing medical care and medical surveillance to client/patient populations. Facilities in which ACOEM members serve include government agencies and the military, universities, and corporations, which generally have multiple locations/sites and their own medical staff, with members responsible for medical care and disease control. This guidance is for organizations with outpatient occupational medicine services, to be used as appropriate. Medical centers should also use guidance that addresses additional employee and external patient care needs.1–3 The ACOEM fully supports implementation of occupational influenza programs that conform with guidance from the Centers for Disease Control and Prevention (CDC), with other guidance from the US Department of Health and Human Services (DHHS), and Occupational Safety and Health Administration (OSHA) regulations and guidance.

Nanotechnology and Health

There has been a considerable scientific, governmental, and public interest in potential adverse health effects associated with exposure to engineered or synthesized nanomaterials. Although such effects have not been reported in humans, there is accumulating evidence from animal studies that exposure to some nanomaterials may be harmful. There is sparse knowledge as to the likelihood, frequency, and intensity of exposures experienced by those working around engineered nanoparticles. Similarly, there is little knowledge regarding the potential existence, type, and dose dependence of adverse health effects, which might result from workplace exposures to engineered nanoparticles. This uncertainty, reflecting a relative lack of research, makes it difficult at present (and probably for the near future) to fully rely upon firm scientific evidence for the development of rational, preventive, and screening measures to protect against such potential effects. Recognizing this predicament, the American College of Occupational and Environmental Medicine (ACOEM) has developed this guidance document for occupational medicine physicians and their colleagues. The purpose of the document is to offer current prudent preventive recommendations on the topics of exposure monitoring, exposure controls, and medical surveillance. This document will not attempt to review the rapidly evolving animal toxicology literature in detail, as any review would be quickly outdated, but general areas of concern will be discussed.

Obstructive Sleep Apnea Screening During Commercial Driver Medical Examinations: A Survey of ACOEM Members

To survey American College of Occupational and Environmental Medicine (ACOEM) members regarding recent consensus guidelines for screening commercial drivers for Obstructive Sleep Apnea (OSA). A brief survey instrument was distributed electronically by the American College of Occupational and Environmental Medicine to its members during February 2008 to April 2008. Most (92%) of the 552 examiners opined that screening commercial drivers for OSA was important. Nevertheless, only 42% reported screening using consensus guidelines or another specific protocol. Common reasons for not applying the guidelines included unaware (36%), too complicated (12%), client retention (10%), and driver inconvenience (10%). Most would consider using the guidelines going forward but 39% wanted additional evidence and another 21% only if they became the "community standard." More education regarding OSA and drivers is needed. A Federal mandate and eliminating "doctor shopping" would likely increase examiners' compliance with screening.

Occupational Medicine Practice Guidelines, 2nd Edition: Evaluation and Management of Common Health Problems and Functional Recovery in Workers, 2008 Revision

The American College of Occupational and Environmental Medicine (ACOEM) first published its Occupational Medicine Practice Guidelines (ACOEM Practice Guidelines or Guidelines) in 1997 to identify effective treatment strategies for injured workers. The ACOEM Practice Guidelines are evidence-based guidelines that focus on returning acutely injured employees to work within 90 days of injury. Given the rising societal expectations for quality of care in addition to the increasing utilization of standardized medical guidelines by state workers’ compensation systems across the nation, ACOEM has committed itself to updating individual chapters on a 3-year rotating basis. This version of the second edition of the Guidelines includes revisions to the chapters on Elbow Disorders, Low Back Disorders, and Chronic Pain. ACOEM also performs an annual review of the literature to identify recently published studies that would significantly impact clinical practice and necessitate earlier revisions to the book to ensure their recommendations remain state-of-the-art. The textbook is divided into two major sections. Section one reviews the foundations of occupational medicine practice and includes chapters on prevention, initial assessment and documentation, initial treatment strategies, causation and work-relatedness, disability prevention, chronic pain, and independent medical examinations. The chronic pain guidelines are noteworthy in that they include a detailed review of more than 20 medications commonly used to treat patients with chronic pain, recommendations regarding the use of appliances and alternative therapies, and efficacy outcomes regarding various injection therapies. Although expertly written and informative, it is unclear why several chapters in this section of the book fail to include in-text citations for material that corresponds to the reference list at the end of the chapter. The second section of the Guidelines focuses on disorders with the chapters organized by body part, e.g. neck and upper back, lower back, shoulder, elbow and other physical disorders. This section also includes a chapter on stressrelated disorders. Most of the chapters follow the same general format in terms of content, i.e. general approach and basic principles, initial assessment, medical history, physical examination, special studies and diagnostic considerations, work-relatedness, initial care, activity modification, work activities, follow-up visits, medications and surgical considerations, referral to other healthcare professionals, rehabilitation, algorithms, and references. This format allows for easy access of desired information. The ACOEM Practice Guidelines are well written and organized, but not without its short-comings and controversies. It is interesting that the Guidelines are marketed as an authoritative evidence-based document; however, close scrutiny of the book’s analytic methodology suggests that the final product is ultimately that of a consensus document. Not unexpectedly, the ACOEM Practice Guidelines have been scrutinized by several professional organizations. A joint position statement published by the American Academy of Pain Medicine, American Society of Interventional Pain Physicians, International Spine Intervention Society, Neuromodulation Therapy Access Coalition, and North American Neuromodulation cited several serious flaws in the ACOEM Practice Guidelines such as limited expert review of pain-related tests, therapies and interventions, incomplete and outdated evidence, inconsistencies in the application of ACOEM’s evidence-ranking B. A. Barron (&) Division of Occupational and Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA e-mail: bruce_barron@urmc.rochester.edu

A Critique of the ACOEM Statement on Mold: Undisclosed Conflicts of Interest in the Creation of an “Evidence-Based” Statement

In 2003, the American College of Occupational and Environmental Medicine (ACOEM) published its evidence-based statement, "Adverse Human Health Effects Associated with Molds in the Indoor Environment," in its Journal of Occupational and Environmental Medicine (JOEM). ACOEM's author selection, development, peer review, and publication of its mold position paper involved a series of seemingly biased and ethically dubious decisions and ad hoc methods. The resulting position paper resembled a litigation "defense report" which omitted or inadequately acknowledged research validating the association between mold and building-related symptoms. ACOEM nonetheless released the paper as an "evidence-based" statement and then published it in JOEM without any further changes or conflict disclosure. The Mold Statement has been relied upon by attorneys and expert witnesses representing defendants in mold litigation to disclaim and invalidate individuals', families', and workers' claims of building-related health effects from indoor mold exposure.

“Guidotti Fails to Convince” on Two Issues

This is a response to Tee Guidotti's defense of the American College of Occupational and Environmental Medicine (ACOEM) as an ally for workers struggling for safer and healthier work. Guidotti fails to convince on two central issues: a blindness to the powerful impact of corporate power on professional thought and behavior; and a lack of evidence that ACOEM has ever been inclined to collaborate with workers. In addition, Guidotti relies upon his own review of ACOEM's historical archive to support his argument. Unfortunately, access to this archive is limited to those deemed reliable by Guidotti, giving the appearance of an attempt to control both information and interpretation, and calling Guidotti's own "objectivity" into question.

Occupational Medicine and the Construction of “Difficult Reputations”

The creation of "difficult reputations" is a collective act of disparagement often undertaken to diminish the influence of the target individual or group for political reasons. This process can be observed in efforts to discredit the field of occupational medicine and the American College of Occupational and Environmental Medicine (ACOEM) by revising its history. Examples are given from Draper's 'The Company Doctor: Risk, Responsibility, and Corporate Professionalism' and LaDou, in which new sources of historical information do not support the allegations or impressions conveyed. This tendency is inimical to progress in occupational health in general and may be highly destructive to the field if not recognized and discouraged.

Reassessment of Evidence Synthesis of Occupational Medicine Practice Guidelines for Interventional Pain Management

Background: Appropriately developed practice guidelines present statements of best practice based on a thorough evaluation of the evidence from published studies on the outcomes of treatments, which include the application of multiple methods for collecting and evaluating evidence for a wide range of clinical interventions and disciplines. However, the guidelines are neither infallible, nor a substitute for clinical judgment. While the guideline development process is a complex phenomenon, conflict of interest in guideline development and inappropriate methodologies must be avoided. It has been alleged that the guidelines by the American College of Occupational and Environmental Medicine (ACOEM) prevent injured workers from receiving the majority of medically necessary and appropriate interventional pain management services. An independent critical appraisal of both chapters of the ACOEM guidelines showed startling findings with a conclusion that these guidelines may not be applied in patient care as they scored below 30% in the majority of evaluations utilizing multiple standardized criteria. Objective: To reassess the evidence synthesis for the ACOEM guidelines for the low back pain and chronic pain chapters utilizing an expanded methodology, which includes the criteria included in the ACOEM guidelines with the addition of omitted literature and application of appropriate criteria. Methods: For reassessment, randomized trials were utilized as it was in the preparation of the guidelines. In this process, quality of evidence was assessed and recommendations were made based on grading recommendations of Guyatt et al. The level of evidence was determined utilizing the quality of evidence criteria developed by the U.S. Preventive Services Task Force (USPSTF), as well as the outdated quality of evidence criteria utilized by ACOEM in the guideline preparation. Methodologic quality of each individual article was assessed utilizing the Agency for Healthcare Research and Quality (AHRQ) methodologic assessment criteria for diagnostic interventions and Cochrane methodologic quality assessment criteria for therapeutic interventions. Results: The results of reassessment are vastly different from the conclusions derived by the ACOEM guidelines. The differences in strength of rating for the diagnosis of discogenic pain by provocation discography and facet joint pain by diagnostic facet joint nerve blocks is established with strong evidence. Therapeutic cervical and lumbar medial branch blocks and radiofrequency neurolysis, therapeutic thoracic medial branch blocks, cervical interlaminar epidural steroid injections, caudal epidural steroid injections, lumbar transforaminal epidural injections, percutaneous and endoscopic adhesiolysis, and spinal cord stimulation qualified for moderate to strong evidence. Additional insight is also provided for evidence rating for intradiscal electrothermal therapy (IDET), automated percutaneous disc decompression, and intrathecal implantables. Conclusion: The reassessment and reevaluation of the low back and chronic pain chapters of the ACOEM guidelines present results that are vastly different from the published and proposed guidelines. Contrary to ACOEM’s conclusions of insufficient evidence for most interventional techniques, the results illustrate moderate to strong evidence for most diagnostic and therapeutic interventional techniques. Key words: Guidelines, evidence-based medicine, systematic reviews, ACOEM, interventional pain management, interventional techniques, guideline development, workers’ compensation, chronic pain guidelines, low back pain guidelines

Review of Occupational Medicine Practice Guidelines for Interventional Pain Management and Potential Implications

In the modern day environment, workers’ compensation costs continue to be a challenge, with a need to balance costs, benefits, and quality of medical care. The cost of workers’ compensation care affects all stakeholders including workers, employers, providers, regulators, legislators, and insurers. Consequently, a continued commitment to quality, accessibility to care, and cost containment will help ensure that workers are afforded accessible, high quality, and cost-effective care. In 2004, workers’ compensation programs in all 50 states, the District of Columbia, and federal programs in the United States combined received an income of $87.4 billion while paying out only $56 billion in medical and cash benefits with $31.4 billion or 37% in administrative expenses and profit. Occupational diseases represented only 8% of the workers’ compensation claims and 29% of the cost. The American College of Occupational and Environmental Medicine (ACOEM) has published several guidelines; though widely adopted by WCPs, these guidelines evaluate the practice of medicine of multiple specialties without adequate expertise and expert input from the concerned specialties, including interventional pain management. An assessment of the ACOEM guidelines utilizing Appraisal of Guidelines for Research and Evaluation (AGREE) criteria, the criteria developed by the American Medical Association (AMA), the Institute of Medicine (IOM), and other significantly accepted criteria, consistently showed very low scores (< 30%) in most aspects of the these guidelines. The ACOEM recommendations do not appear to have been based on a careful review of the literature, overall quality of evidence, standard of care, or expert consensus. Based on the evaluation utilizing appropriate and current evidence-based medicine (EBM) principles, the evidence ratings for diagnostic techniques of lumbar discography; cervical, thoracic, and lumbar facet joint nerve blocks and sacroiliac joint nerve blocks; therapeutic cervical and lumbar medial branch blocks and radiofrequency neurolysis; cervical interlaminar epidural steroid injections, caudal epidural steroid injections, and lumbar transforaminal epidural injections; caudal percutaneous adhesiolysis; abd spinal cord stimulation were found to be moderate with strong recommendation applying for most patients in most circumstances. The evidence ratings for intradiscal electrothermal therapy (IDET), an automated percutaneous disc decompression and also deserve further scrutiny and analysis. In conclusion, these ACOEM guidelines for interventional pain management have no applicability in modern patient care due to lack of expertise by the developing organization (ACOEM), lack of utilization of appropriate and current EBM principles, and lack of significant involvement of experts in these techniques resulting in a lack of clinical relevance. Thus, they may result in reduced medical quality of care; may severely hinder access to appropriate, medically needed and essential medical care; and finally, they may increase costs for injured workers, third party payors, and the government by transferring the injured worker into a non-productive disability system. Key words: Guidelines, ACOEM, ASIPP, interventional pain management, interventional techniques, evidence-based medicine, systematic reviews, guideline development, AHCPR, AHRQ, IOM, AMA, AGREE, workers’ compensation, chronic pain guidelines, low back pain guidelines