Browsing by Subject "Guidance"

Now showing 1 - 8 of 8
  • Thumbnail Image
    Item
    AGA Institute Quality Measure Development for the Diagnosis and Management of COVID-19
    (Elsevier, 2020-11-23) Leiman, David A.; Maratt, Jennifer K.; Ketwaroo, Gyanprakash A.; Medicine, School of Medicine
    This document presents the official recommendations of the American Gastroenterological Association (AGA) regarding quality measures related to the diagnosis and management of the novel coronavirus, SARS-CoV-2. The current report outlines the process by which the Quality Committee (QC) evaluates guidance statements published by the AGA’s Clinical Guidelines Committee (CGC) to inform measure development. The recommendations discussed in this report relate to what remains an unprecedented event in contemporary history with unique challenges for CGC guidance-related measure development. The following recommendations were developed by the QC in consultation with the CGC. Their development was fully funded by the AGA Institute, with no additional outside funding.
  • Thumbnail Image
    Item
    COVID-19 and Medical Education: A Four-Part Model to Assess Risks, Benefits, and Institutional Obligations During a Global Pandemic
    (Elsevier, 2020-10-23) Barach, Paul; Ahmed, Rami A.; Nadel, Eric S.; Hafferty, Frederic; Philibert, Ingrid; Emergency Medicine, School of Medicine
    The practice of medicine carries inherent risks, especially during outbreaks of highly contagious diseases like Ebola, H1N1, tuberculosis, and COVID-19. Exposure risks remain and extend to medical students and resident/fellows functioning in clinical settings and create ethical dilemmas around service vs. potential risks of illness. At the time of an unprecedented crisis in the US healthcare system, institutional leaders and medical educators are tasked with meeting patient care demands and ensuring the health and well-being of learners across the medical education continuum, while preventing stagnation in their education and promoting their professional growth. In this commentary, we offer a framework to guide medical schools and teaching hospitals leaders’ decisions around the deployment of these learners during the pandemic. To create the framework, we drew on information about minimizing the risks in inherently dangerous industries, practice during earlier outbreaks of dangerous infectious disease and guidance from ethics experts. We provide examples of how this risk framework can be applied to specific situations where medical students and residents/fellows function in a clinical context.
  • Thumbnail Image
    Item
    COVID-19: What do we know?
    (Elsevier, 2020-09-21) Marshall, Steve; Duryea, Michael; Huang, Greg; Kadioglu, Onur; Mah, James; Palomo, Juan Martin; Rossouw, Emile; Stappert, Dina; Stewart, Kelton; Tufekci, Eser; Orthodontics and Oral Facial Genetics, School of Dentistry
    Coronavirus disease 2019 (COVID-19) is a global pandemic caused by the pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1 Preliminary assessments suggest the virus is highly transmittable and infectious,2, 3, 4, 5, 6, 7 with similarities in nosocomial and super-spreading events seen with severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) in 2003.8 Patients infected with SARS-CoV-2 display a wide range of host responses including no symptoms, mild nonrespiratory symptoms, severe respiratory illness, or organ dysfunction and death.1,5 The American Association of Orthodontists Council on Scientific Affairs was charged with examining the literature to determine the best evidence for questions pertaining to COVID-19 and its impact on the practice of orthodontics.
  • Thumbnail Image
    Item
    Evidence-based Risk Stratification for Sport Medicine Procedures During the COVID-19 Pandemic
    (Wolters Kluwer, 2020-10) Hinckel, Betina B.; Baumann, Charles A.; Ejnisman, Leandro; Cavinatto, Leonardo M.; Martusiewicz, Alexander; Tanaka, Miho J.; Tompkins, Marc; Marc, Seth L.; Chahla, Jorge A.; Frank, Rachel; Yamamoto, Guilherme L.; Bicos, James; Arendt, Liza; Fithian, Donald; Farr, Jack; Orthopaedic Surgery, School of Medicine
    Orthopaedic practices have been markedly affected by the emergence of the COVID-19 pandemic. Despite the ban on elective procedures, it is impossible to define the medical urgency of a case solely on whether a case is on an elective surgery schedule. Orthopaedic surgical procedures should consider COVID-19-associated risks and an assimilation of all available disease dependent, disease independent, and logistical information that is tailored to each patient, institution, and region. Using an evidence-based risk stratification of clinical urgency, we provide a framework for prioritization of orthopaedic sport medicine procedures that encompasses such factors. This can be used to facilitate the risk-benefit assessment of the timing and setting of a procedure during the COVID-19 pandemic.
  • Thumbnail Image
    Item
    Protocol for the development of guidance for stakeholder engagement in health and healthcare guideline development and implementation
    (BMC, 2020-02-01) Petkovic, Jennifer; Riddle, Alison; Akl, Elie A.; Khabsa, Joanne; Lytvyn, Lyubov; Atwere, Pearl; Campbell, Pauline; Chalkidou, Kalipso; Chang, Stephanie M.; Crowe, Sally; Dans, Leonila; Jardali, Fadi El; Ghersi, Davina; Graham, Ian D.; Grant, Sean; Greer-Smith, Regina; Guise, Jeanne-Marie; Hazlewood, Glen; Janet, Janet; Katikireddi, S. Vittal; Langlois, Etienne V.; Lyddiatt, Anne; Maxwell, Lara; Morley, Richard; Mustafa, Reem A.; Nonino, Francesco; Pardo, Jordi Pardo; Pollock, Alex; Kevin, Kevin; Riva, John; Schünemann, Holger; Simeon, Rosiane; Smith, Maureen; Stein, Airton T.; Synnot, Anneliese; Tufte, Janice; White, Howard; Welch, Vivian; Concannon, Thomas W.; Tugwell, Peter; Social and Behavioral Sciences, School of Public Health
    Stakeholder engagement has become widely accepted as a necessary component of guideline development and implementation. While frameworks for developing guidelines express the need for those potentially affected by guideline recommendations to be involved in their development, there is a lack of consensus on how this should be done in practice. Further, there is a lack of guidance on how to equitably and meaningfully engage multiple stakeholders. We aim to develop guidance for the meaningful and equitable engagement of multiple stakeholders in guideline development and implementation. METHODS: This will be a multi-stage project. The first stage is to conduct a series of four systematic reviews. These will (1) describe existing guidance and methods for stakeholder engagement in guideline development and implementation, (2) characterize barriers and facilitators to stakeholder engagement in guideline development and implementation, (3) explore the impact of stakeholder engagement on guideline development and implementation, and (4) identify issues related to conflicts of interest when engaging multiple stakeholders in guideline development and implementation. DISCUSSION: We will collaborate with our multiple and diverse stakeholders to develop guidance for multi-stakeholder engagement in guideline development and implementation. We will use the results of the systematic reviews to develop a candidate list of draft guidance recommendations and will seek broad feedback on the draft guidance via an online survey of guideline developers and external stakeholders. An invited group of representatives from all stakeholder groups will discuss the results of the survey at a consensus meeting which will inform the development of the final guidance papers. Our overall goal is to improve the development of guidelines through meaningful and equitable multi-stakeholder engagement, and subsequently to improve health outcomes and reduce inequities in health.
  • Thumbnail Image
    Item
    Response to the COVID-19 Pandemic Among Posthospital Brain Injury Rehabilitation Providers
    (Elsevier, 2020-12-27) Malec, James F.; Salisbury, David B.; Anders, David; Dennis, Leanne; Groff, April R.; Johnson, Margaret; Murphy, Mary Pat; Smith, Gregory T.; Physical Medicine and Rehabilitation, School of Medicine
    Rehabilitation after significant acquired brain injury (ABI) to address complex independent activities of daily living and return to family and community life is offered primarily after initial hospitalization in outpatient day treatment, group home, skilled nursing, and residential settings and in the home and community of the person served. The coronavirus 2019 pandemic threatened access to care and the health and safety of staff, persons served, and families in these settings. This article describes steps taken to contain this threat by 7 leading posthospital ABI rehabilitation organizations. Outpatient and day treatment facilities were temporarily suspended. In other settings, procedures for isolation, transportation, cleaning, exposure control, infection control, and use of personal protective equipment (PPE) were reinforced with staff. Visitation and community activities were restricted. Staff and others required to enter facilities were screened with symptom checklists and temperature checks. Individuals showing symptoms of infection were quarantined and tested, as possible. New admissions were carefully screened for infection and often initially quarantined. Telehealth played a major role in reducing direct interpersonal contact while continuing to provide services both to outpatients and within facilities. Salary, benefits, training, and managerial support were enhanced for staff. Despite early outbreaks, these procedures were generally effective, with preliminary initial infections rates of only 1.1% for persons served and 2.1% for staff. Reductions in admissions, services, and unanticipated expenses (eg, PPE, more frequent and thorough cleaning) had a major negative financial effect. Providers continue to be challenged to adapt rehabilitative approaches and to reopen services.
  • Thumbnail Image
    Item
    SARS-CoV-2 Nasopharyngeal Swab Testing—False-Negative Results From a Pervasive Anatomical Misconception
    (American Medical Association, 2020-09-17) Higgins, Thomas S.; Wu, Arthur W.; Ting, Jonathan Y.; Otolaryngology -- Head and Neck Surgery, School of Medicine
    Given our subspecialty focus on nasal anatomy, we have been involved in training personnel at our respective institutions on the proper techniques for NPS collection for SARS-CoV-2 testing, and we have noticed pervasive misperception about the location of the nasopharynx. Although many sites around the world are likely providing proper training, we are concerned that inadequate NPS collection may continue to lead to false-negative results. The rate of false-negative results in reverse transcriptase polymerase chain reaction testing is a great concern because it underestimates the prevalence of SARS-CoV-2 infection, gives a false sense of security to patients and the health care workers caring for them, and limits public health efforts in identifying and tracing the spread of the virus. We hope highlighting that the nasopharynx is back, not up, can help limit false-negative results in testing for SARS-CoV-2 and other respiratory viruses.
  • Thumbnail Image
    Item
    Tele-Neuro-Ophthalmology During the Age of COVID-19
    (Wolters Kluwer, 2020-09) Lai, Kevin E.; Ko, Melissa W.; Rucker, Janet C.; Odel, Jeffrey G.; Sun, Linus D.; Winges, Kimberly M.; Ghosh, Arko; Bindiganavile, Shruthi Harish; Bhat, Nita; Wendt, Sydney P.; Scharf, Jackson M.; Dinkin, Marc J.; Rasool, Nailyn; Galetta, Steven L.; Lee, Andrew G.; Ophthalmology, School of Medicine
    In this article, we present possible “best practices” for neuro-ophthalmologists to design and implement tele-neuro-ophthalmology during and following this national and international crisis. We review the previsit, intravisit, and postvisit steps in a practical manner that we hope will be of value to practicing neuro-ophthalmologists. We include sections on how to appropriately implement telemedicine and patient selection, focusing on different types of visits, determining eligible patients, and triaging patients. In addition, we outline the software and hardware requirements for the electronic medical record (EMR), including Epic and non-Epic platforms. We also describe the nuts and bolts of how to get started, including descriptions of the multiple useful applications and software available. As with any medical encounter, privacy regulations, billing, and coding can be significant hurdles to implementation, and we discuss each in detail. We hope that this article will be of use for neuro-ophthalmologists, comprehensive ophthalmologists, and general neurologists because we deal with effects and aftereffects of this COVID-19 pandemic. We believe that this current disruptive innovation will drive the future of telemedicine in neuro-ophthalmology.