IU Indianapolis ScholarWorks :: Browsing by Subject "Recommendations"

Browsing by Subject "Recommendations"

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10 Tips for Maintaining a Healthy Lifestyle and Body Weight
(Fairbanks School of Public Health, 2020-03-18) Song, Yiqing; Epidemiology, School of Public Health
At this extreme moment, we began working from home, away from campus, and keeping social distance for as many people as possible. As we stay home and are stuck with the foods that have been in our fridge or pantry for a while, we are temporarily living a sedentary lifestyle with increased odds of physical inactivity, excessive eating and sitting, stress, anxiety, and depression. In particular, many of us will gain some weight during the pandemic and may keep the extra weight permanently, which may carry considerable health risks for type 2 diabetes, hypertension, heart attack, stroke, and other health problems. Here, I’d like to share some basic tips and resources for how to maintain your healthy lifestyle, body weight, and overall well-being while staying home and engaging in social distancing.
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.
American Neurogastroenterology and Motility Society (ANMS) Task Force Recommendations for Resumption of Motility Laboratory Operations During the COVID-19 Pandemic
(American Neurogastroenterology and Motility Society (ANMS), 2020-05-17) Baker, Jason R.; Moshiree, Baha; Rao, Satish; Neshatian, Leila; Nguyen, Linda; Chey, William D.; Saad, Richard; Garza, Jose; Waseem, Shamaila; Khan, Abraham R.; Pandolfino, John E.; Gyawali, C. Prakash; Department of Pediatrics, IU School of Medicine
The ANMS organized a Task Force for developing guidance strategies regarding re-opening of motility laboratories. This document describes how to stratify urgency of motility physiologic procedures, screen prior to the procedures, optimize personal protective equipment (PPE) utilization, clean and prepare the motility laboratory space during the COVID-19 pandemic.
Animal Models for COVID-19: More to the Picture Than ACE2, Rodents, Ferrets, and Non-human Primates. A Case for Porcine Respiratory Coronavirus and the Obese Ossabaw Pig
(Frontiers Media, 2020-09-25) Heegaard, Peter M. H.; Sturek, Michael; Alloosh, Mouhamad; Belsham, Graham J.; Anatomy and Cell Biology, School of Medicine
The ongoing COVID-19 pandemic caused by infection with SARS-CoV-2 has created an urgent need for animal models to enable study of basic infection and disease mechanisms and for development of vaccines, therapeutics, and diagnostics. Most research on animal models for COVID-19 has been directed toward rodents, transgenic rodents, and non-human primates. The primary focus has been on the angiotensin-converting enzyme 2 (ACE2), which is a host cell receptor for SARS-CoV-2. Among investigated species, irrespective of ACE2 spike protein binding, only mild (or no) disease has occurred following infection with SARS-CoV-2, suggesting that ACE2 may be necessary for infection but is not sufficient to determine the outcome of infection. The common trait of all species investigated as COVID models is their healthy status prior to virus challenge. In contrast, the vast majority of severe COVID-19 cases occur in people with chronic comorbidities such as diabetes, obesity, and/or cardiovascular disease. Healthy pigs express ACE2 protein that binds the viral spike protein but they are not susceptible to infection with SARS-CoV-2. However, certain pig breeds, such as the Ossabaw pig, can reproducibly be made obese and show most aspects of the metabolic syndrome, thus resembling the more than 80% of the critically ill COVID-19 patients admitted to hospitals. We urge considering infection with porcine respiratory coronavirus of metabolic syndrome pigs, such as the obese Ossabaw pig, as a highly relevant animal model of severe COVID-19.
Clinical management guidelines for Friedreich ataxia: best practice in rare diseases
(Springer Nature, 2022-11-12) Corben, Louise A.; Collins, Veronica; Milne, Sarah; Farmer, Jennifer; Musheno, Ann; Lynch, David; Subramony, Sub; Pandolfo, Massimo; Schulz, Jörg B.; Lin, Kim; Delatycki, Martin B.; Clinical Management Guidelines Writing Group; Medicine, School of Medicine
Background: Individuals with Friedreich ataxia (FRDA) can find it difficult to access specialized clinical care. To facilitate best practice in delivering healthcare for FRDA, clinical management guidelines (CMGs) were developed in 2014. However, the lack of high-certainty evidence and the inadequacy of accepted metrics to measure health status continues to present challenges in FRDA and other rare diseases. To overcome these challenges, the Grading of Recommendations Assessment and Evaluation (GRADE) framework for rare diseases developed by the RARE-Bestpractices Working Group was adopted to update the clinical guidelines for FRDA. This approach incorporates additional strategies to the GRADE framework to support the strength of recommendations, such as review of literature in similar conditions, the systematic collection of expert opinion and patient perceptions, and use of natural history data. Methods: A panel representing international clinical experts, stakeholders and consumer groups provided oversight to guideline development within the GRADE framework. Invited expert authors generated the Patient, Intervention, Comparison, Outcome (PICO) questions to guide the literature search (2014 to June 2020). Evidence profiles in tandem with feedback from individuals living with FRDA, natural history registry data and expert clinical observations contributed to the final recommendations. Authors also developed best practice statements for clinical care points that were considered self-evident or were not amenable to the GRADE process. Results: Seventy clinical experts contributed to fifteen topic-specific chapters with clinical recommendations and/or best practice statements. New topics since 2014 include emergency medicine, digital and assistive technologies and a stand-alone section on mental health. Evidence was evaluated according to GRADE criteria and 130 new recommendations and 95 best practice statements were generated. Discussion and conclusion: Evidence-based CMGs are required to ensure the best clinical care for people with FRDA. Adopting the GRADE rare-disease framework enabled the development of higher quality CMGs for FRDA and allows individual topics to be updated as new evidence emerges. While the primary goal of these guidelines is better outcomes for people living with FRDA, the process of developing the guidelines may also help inform the development of clinical guidelines in other rare diseases.
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.
COVID-19s Impact on the Hispanic Community: How Understanding Culture Can Improve Outcomes
(Indiana Medical Student Program for Research and Scholarship (IMPRS), 2020-12-15) Guerra Rodriguez, Yamilet; Hudson, Brenda L.; IU School of Medicine
Background: A disproportionate burden of SARS-Cov-2 infection, or coronavirus disease 2019 (Covid-19), and death are highest among racial and ethnic minority groups. Based on data available on June 12, 2020, Hispanic people are more likely to acquire COVID-19 and have higher incidence of hospitalization and death compared to their white, non-Hispanic counterparts. While this issue is complex, many have hypothesized that the difference is due to societal factors and communication methods. The aim of this project was to evaluate information related to how the Hispanic population is affected by COVID-19 and how communications about the disease should be designed based on past research, physician input, and cultural sensitivities. Methods: We conducted a thorough literature search on COVID-19 articles, both peer reviewed and grey literature, evaluating race and ethnic differences in disease prevalence and severity. Additionally, we conducted interviews with a small number of Indiana doctors who treat Hispanic patients to obtain a doctor’s perspective on the Hispanic community’s needs during the pandemic and ways to help reduce prevalence. Results: Physicians in Indiana believe the main approach to help the Hispanic community is by utilizing trusted community resources to communicate information and build relationships with patients over time. It is recommended to develop new methods to deliver essential information about COVID-19 through multiple mediums, in a clear way, and in Spanish with focus on the collective good of the family. In addition, it is important not to just translate resources from English to Spanish but to design materials addressing barriers specific to the Hispanic community. Conclusion: More culturally tailored information should be released to educate the Hispanic community about COVID-19. This information will assist in the design of materials and initiatives for the Hispanic community that we hope will improve methods of communication and care delivery related to COVID-19.
Delaying Cancer Cases in Urology during COVID-19: Review of the Literature
(Wolters Kluwer, 2020-05-28) Tachibana, Isamu; Ferguson, Ethan L.; Mahenthiran, Ashorne; Natarajan, Jay P.; Masterson, Timothy A.; Bahler, Clinton D.; Sundaram, Chandru P.; Urology, School of Medicine
Purpose: Coronavirus Disease 2019 (COVID-19) is a global pandemic affecting hospital systems and the availability of resources for surgical procedures. Our aim is to provide guidance for urologists to help prioritize urologic cancer surgeries. Material and Methods: We reviewed published literature on bladder cancer, upper tract urothelial carcinoma (UTUC), penile cancer, testis cancer, prostate cancer, renal cancer, and adrenal cancer. Results: For muscle invasive bladder cancer (MIBC), delays should be less than roughly 10 weeks and neoadjuvant chemotherapy should be considered. For non-MIBC, patients should be counseled appropriately based on risk and intravesical therapies can continue. UTUC should also be treated with minimal delays for high risk patients, especially with ureteral tumors. Surgery for T1 renal cancers when indicated can be delayed until adequate resources are available. Patients with T2 renal cancer should be considered for early surgery if there are unfavorable pre-operative characteristics. Higher stage renal tumors should be considered for early surgery. Early multi-disciplinary approach is recommended for metastatic renal cancers. High risk prostate cancer may need preferential treatment and consideration of neoadjuvant hormonal therapy. Penile cancer can have worse sexual or oncologic outcome with prolonged surgical delay. Likewise, adrenal cancer is aggressive and needs early surgical treatment. Testicular cancer should be treated in a timely manner with surgery or chemotherapy, as indicated. Conclusions: This review should further assist urologists in recognizing patients with potentially aggressive tumor biology that warrant early treatment.
Emerging from the Pandemic: AAIM Recommendations for Internal Medicine Residency and Fellowship Interview Standards
(Elsevier, 2022) Luther, Vera P.; Wininger, David A.; Lai, Cindy J.; Dao, Anthony; Garcia, Maria M.; Harper, Whitney; Chow, Timothy M.; Correa, Ricardo; Gay, Lindsey J.; Fettig, Lyle; Dalal, Bhavin; Vassallo, Patricia; Barczi, Steven; Sweet, Michelle; Medicine, School of Medicine
Perspectives Viewpoints: •New standards are needed moving forward to guide residency and fellowship interviews in response to Coalition for Physician Accountability recommendations and dramatic changes in the interview landscape over the past 2 years. •Processes should be based on principles of equity for applicants and programs while taking into consideration personal and public health and safety. •Ongoing evaluation of advantages and disadvantages of interview practices should continue with iterative adjustments in guidance based on available data.
Genetic Risk Assessment for Hereditary Renal Cell Carcinoma: Clinical Consensus Statement
(Wiley, 2021) Bratslavsky, Gennady; Mendhiratta, Neil; Daneshvar, Michael; Brugarolas, James; Ball, Mark W.; Metwalli, Adam; Nathanson, Katherine L.; Pierorazio, Phillip M.; Boris, Ronald S.; Singer, Eric A.; Carlo, Maria I.; Daly, Mary B.; Henske, Elizabeth P.; Hyatt, Colette; Middleton, Lindsay; Morris, Gloria; Jeong, Anhyo; Narayan, Vivek; Rathmell, W. Kimryn; Vaishampayan, Ulka; Lee, Bruce H.; Battle, Dena; Hall, Michael J.; Hafez, Khaled; Jewett, Michael A.S.; Karamboulas, Christina; Pal, Sumanta K.; Hakimi, A. Ari; Kutikov, Alexander; Iliopoulos, Othon; Linehan, W. Marston; Jonasch, Eric; Srinivasan, Ramaprasad; Shuch, Brian; Urology, School of Medicine
Background: Although renal cell carcinoma (RCC) is believed to have a strong hereditary component, there is a paucity of published guidelines for genetic risk assessment. A panel of experts was convened to gauge current opinions. Methods: A North American multidisciplinary panel with expertise in hereditary RCC, including urologists, medical oncologists, clinical geneticists, genetic counselors, and patient advocates, was convened. Before the summit, a modified Delphi methodology was used to generate, review, and curate a set of consensus questions regarding RCC genetic risk assessment. Uniform consensus was defined as ≥85% agreement on particular questions. Results: Thirty-three panelists, including urologists (n = 13), medical oncologists (n = 12), genetic counselors and clinical geneticists (n = 6), and patient advocates (n = 2), reviewed 53 curated consensus questions. Uniform consensus was achieved on 30 statements in specific areas that addressed for whom, what, when, and how genetic testing should be performed. Topics of consensus included the family history criteria, which should trigger further assessment, the need for risk assessment in those with bilateral or multifocal disease and/or specific histology, the utility of multigene panel testing, and acceptance of clinician-based counseling and testing by those who have experience with hereditary RCC. Conclusions: In the first ever consensus panel on RCC genetic risk assessment, 30 consensus statements were reached. Areas that require further research and discussion were also identified, with a second future meeting planned. This consensus statement may provide further guidance for clinicians when considering RCC genetic risk assessment. Lay summary: The contribution of germline genetics to the development of renal cell carcinoma (RCC) has long been recognized. However, there is a paucity of guidelines to define how and when genetic risk assessment should be performed for patients with known or suspected hereditary RCC. Without guidelines, clinicians struggle to define who requires further evaluation, when risk assessment or testing should be done, which genes should be considered, and how counseling and/or testing should be performed. To this end, a multidisciplinary panel of national experts was convened to gauge current opinion on genetic risk assessment in RCC and to enumerate a set of recommendations to guide clinicians when evaluating individuals with suspected hereditary kidney cancer.

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