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Item Adherence to Surveillance Guidelines in Nondysplastic Barrett’s Esophagus(Wolters Kluwer, 2016) Dalal, Kunal S.; Coffing, Jessica; Imperiale, Thomas F.; Department of Medicine, School of MedicineIntroduction: Surveillance patterns in Barrett's esophagus (BE) are not well characterized. Guidelines published between 2002 and 2008 recommended surveillance esophagogastroduodenoscopy (sEGD) at 3-year intervals for nondysplastic BE (NDBE). We assessed guideline adherence in incident NDBE in a Veterans Affairs (VA)-based study. Methods: At a single VA center, we identified incident cases of biopsy-confirmed NDBE between January, 2006 and December, 2008. We excluded patients aged 76 years and above and those who developed BE-associated dysplasia or cancer during follow-up. All sEGDs through October, 2014 were documented. Our primary criteria classified cases as guideline adherent if a sEGD was performed within 6 months of each expected 3-year surveillance interval; in cases with >=2 sEGDs, 1 sEGD >6 months, and <=1 year outside an interval was allowed if the average interval was between 2.5 and 3.5 years. Comorbidity, primary care encounters, presence of long-segment BE (LSBE), endoscopist recommendations, and Charlson comorbidity index (CCI) were assessed. Results: We identified 110 patients (96.4% male, 93.6% white) with mean age 58.9+/-8.5 years at index EGD. Median follow-up was 6.7 years (range, 3.7 to 8.6). Thirty-three (30.0%) cases were guideline adherent; 77 (70.0%) cases were nonadherent, including 52 (47.3%) with irregular surveillance and 25 (22.7%) with no surveillance. Forty cases (14 adherent) had 1 sEGD, 36 (18 adherent) had 2, 8 (1 adherent) had 3, and 1 nonadherent case had 4. Adherent cases were significantly older (61.5 vs. 57.9 y, P=0.04), and tended to have more LSBE (33.3% vs. 20.8%, P=0.16). There were no differences between adherent and nonadherent cases in annual primary care encounters (72.7% vs. 66.2%, P=0.66), CCI>=4 (15.2% vs. 15.6%, P=0.95), biopsy-positive sEGDs (75.8% vs. 76.6%, P=0.92), and any recommendation for subsequent surveillance (81.8% vs. 77.9%, P=0.65). A logistic regression model using age, CCI, and LSBE showed an independent association between adherence and older age (P=0.03). Conclusions: In a single-center VA cohort, sEGD of NDBE was mostly nonadherent to guidelines. Adherent cases were older at baseline with a trend toward more LSBE. A larger study is needed to identify medical and social factors associated with adherence or nonadherence to surveillance.Item Developing a Best Practices Plan for Tutorials in a Multi-Library System(Taylor and Francis, 2014-07-14) Blevins, Amy E.; Deberg, Jennifer; Childs, ChrisIn 2010, the University of Iowa's library system administration created a task force to conduct a reevaluation of tools and spaces used for video tutorial creation across a multi-library system. Following this effort, a working group was charged with improving documentation and staff awareness of resources for developing video tutorials. The group observed that librarians were often independently creating videos that were variable in quality, lacked consistent branding, and were not often shared with others. This article will describe experiences at the Hardin Library for the Health Sciences at the University of Iowa in selecting video tutorial software, and striving to establish a more structured process, including team-developed guidelines, for tutorial creation in a multi-library system. Project limitations and areas for future work will also be presented.Item The Diagnosis and Management of Nonalcoholic Fatty Liver Disease: Practice Guidance from the American Association for the Study of Liver Diseases(Wiley, 2017) Chalasani, Naga; Younossi, Zobair; Lavine, Joel E.; Charlton, Michael; Cusi, Kenneth; Rinella, Mary; Harrison, Stephen A.; Brunt, Elizabeth M.; Sanyal, Arun J.; Department of Medicine, School of MedicineThis guidance provides a data-supported approach to the diagnostic, therapeutic, and preventive aspects of NAFLD care. A “Guidance” document is different from a “Guideline.” Guidelines are developed by a multidisciplinary panel of experts and rate the quality (level) of the evidence and the strength of each recommendation using the Grading of Recommendations, Assessment Development, and Evaluation (GRADE) system. A guidance document is developed by a panel of experts in the topic, and guidance statements, not recommendations, are put forward to help clinicians understand and implement the most recent evidence.Item Implementing clinical practice guidelines for chronic obstructive pulmonary disease in an EHR system(IEEE, 2017-11) Walker, Marisa; Ge, WeiWei; Gichoya, Judy W.; Purkayastha, Saptarshi; BioHealth Informatics, School of Informatics and ComputingThe use of clinical practice guidelines to improve quality of care has been a vividly discussed topic. Clinical practice guidelines (CPG) aim to improve the health of patients by guiding individual care in clinical settings. CPGs bring potential benefits for patients by improving clinical decision making, improving efficiency and enhancing patient care, while essentially optimizing financial value. Chronic conditions like heart disease, stroke, and chronic obstructive pulmonary disease (COPD), plague the US healthcare system causing several million dollars in healthcare related cost. This paper demonstrates the development of a CPG into an open-source EHR system to effectively manage COPD patients. The CPG is incorporated using the open web app standard, which allows it to be used with any web browser based EHR system, once data from the EHR system can be fed into the app. As a result, the CPG helps create a more effective and efficient decision-making process.Item Report From the International Society of Urological Pathology (ISUP) Consultation Conference on Molecular Pathology of Urogenital Cancers: IV: Current and Future Utilization of Molecular-Genetic Tests for Testicular Germ Cell Tumors(Wolters Kluwer, 2020-03-20) Looijenga, Leendert H. J.; Van der Kwast, Theodorus H.; Grignon, David; Egevad, Lars; Kristiansen, Glen; Kao, Chia-Sui; Idrees, Muhammad T.; Pathology and Laboratory Medicine, School of MedicineThe International Society of Urological Pathology (ISUP) organized a Consultation Conference in March 2019 dealing with applications of molecular pathology in Urogenital Pathology, including testicular tumors (with a focus on germ cell tumors [GCTs]), preceded by a survey among its members to get insight into current practices in testicular germ cell tumor (TGCT) diagnostics and adoption of the ISUP immunohistochemical guidelines published in 2014. On the basis of the premeeting survey, the most commonly used immunomarker panel includes OCT3/4, placental alkaline phosphate, D2-40, SALL4, CD117, and CD30 for GCTs and the documentation of germ cell neoplasia in situ (GCNIS). Molecular testing, specifically 12p copy gain, is informative to distinguish non-GCNIS versus GCNIS related GCTs, and establishing germ cell origin of tumors both in the context of primary and metastatic lesions. Other molecular methodologies currently available but not widely utilized for TGCTs include genome-wide and targeted approaches for specific genetic anomalies, P53 mutations, genomic MDM2 amplification, and detection of the p53 inactivating miR-371a-3p. The latter also holds promise as a serum marker for malignant TGCTs. This manuscript provides an update on the classification of TGCTs, and describes the current and future role of molecular-genetic testing. The following recommendations are made: (1) Presence of GCNIS should be documented in all cases along with extent of spermatogenesis; (2) Immunohistochemical staining is optional in the following scenarios: identification of GCNIS, distinguishing embryonal carcinoma from seminoma, confirming presence of yolk sac tumor and/or choriocarcinoma, and differentiating spermatocytic tumor from potential mimics; (3) Detection of gain of the short arm of chromosome 12 is diagnostic to differentiate between non-GCNIS versus GCNIS related GCTs and supportive to the germ cell origin of both primary and metastatic tumors.Item Role of Bone-Modifying Agents in Multiple Myeloma: American Society of Clinical Oncology Clinical Practice Guideline Update(American Society of Clinical Oncology, 2018) Anderson, Kenneth; Ismaila, Nofisat; Flynn, Patrick J.; Halabi, Susan; Jagannath, Sundar; Ogaily, Mohammed S.; Omel, Jim; Raje, Noopur; Roodman, G. David; Yee, Gary C.; Kyle, Robert A.; Medicine, School of MedicinePurpose To update guideline recommendations on the role of bone-modifying agents in multiple myeloma. Methods An update panel conducted a targeted systematic literature review by searching PubMed and the Cochrane Library for randomized controlled trials, systematic reviews, meta-analyses, clinical practice guidelines, and observational studies. Results Thirty-five relevant studies were identified, and updated evidence supports the current recommendations. Recommendations For patients with active symptomatic multiple myeloma that requires systemic therapy with or without evidence of lytic destruction of bone or compression fracture of the spine from osteopenia on plain radiograph(s) or other imaging studies, intravenous administration of pamidronate 90 mg over at least 2 hours or zoledronic acid 4 mg over at least 15 minutes every 3 to 4 weeks is recommended. Denosumab has shown to be noninferior to zoledronic acid for the prevention of skeletal-related events and provides an alternative. Fewer adverse events related to renal toxicity have been noted with denosumab compared with zoledronic acid and may be preferred in this setting. The update panel recommends that clinicians consider reducing the initial pamidronate dose in patients with preexisting renal impairment. Zoledronic acid has not been studied in patients with severe renal impairment and is not recommended in this setting. The update panel suggests that bone-modifying treatment continue for up to 2 years. Less frequent dosing has been evaluated and should be considered in patients with responsive or stable disease. Continuous use is at the discretion of the treating physician and the risk of ongoing skeletal morbidity. Retreatment should be initiated at the time of disease relapse. The update panel discusses measures regarding osteonecrosis of the jaw.Item Testicular-sparing surgery in the pediatric population: Multicenter review of practice with review of the literature(Wolters Kluwer, 2019-09) Radford, Anna; Peycelon, Matthieu; Haid, Bernhard; Powis, Mark; Lakshminarayanan, Bhanu; Surgery, School of MedicinePurpose of review Pediatric testicular tumors have predominantly favorable histology, which may permit testicular sparing surgery (TSS). Limited guidance exists for TSS in adults and is absent in pediatric practice. The international survey and retrospective case series evaluated the current use of TSS in pediatric testicular tumors. Alongside the complementary literature review, the aim of this work was to provide evidence that could be used to produce a guideline document. Recent findings Published evidence advocates small mass size as an indicator for TSS, this was not supported in the pediatric literature. Frozen section examination at TSS was not always performed by surgeons and yet the literature reports close to 100% specificity. Tumor markers and ultrasound findings are also used as indicators for TSS, a finding reflected in our survey results. Summary Multiple case series are reported but no large data series exists, which will require international collaboration rather than a drive to publish the results of individual centers. Common indicators for TSS use; such as tumor markers and imaging are known but further work needs to evaluate the role of on-table histology and the risks of this not being available.Item Unlocking the Interlibrary Loan Code for the United States(2016-06-09) Miller, Brian; Baich, TinaThe ALA RUSA STARS Codes, Guidelines, and Technical Standards Committee recently undertook a revision of the Interlibrary Loan Code for the United States and its Explanatory Supplement. The Committee wishes to encourage awareness and application of the Code in the interlibrary loan community. This session will explore the newly revised ILL Code and Supplement and share an overview of the feedback received during the public comment period.Item Unlocking the Interlibrary Loan Code for the United States(Taylor & Francis, 2016-12-20) Baich, Tina; Dethloff, Nora; Miller, BrianA newly revised Interlibrary Loan Code for the United States was approved in 2016, the 100th anniversary of its first appearance. This article outlines the two-year, iterative revision process undertaken by the ALA RUSA STARS Codes, Guidelines, and Technical Standards Committee, including the results of two public surveys and significant changes to the Interlibrary Loan Code for the United States. The authors hope to provide a template for future revisions and share the process with the entire interlibrary loan community.