Association Position Statement Research Articles

A Saudi Heart Association Position Statement on Obesity and Cardiovascular Disease.

The obesity pandemic is a major public health concern in Saudi Arabia, with significant impact on cardiovascular disease (CVD). This position statement aims to provide an overview of available evidence as well as the recommendations of the Saudi Heart Association on the management of obesity associated with CVD. Under the auspices of the Saudi Heart Association, a multidisciplinary expert panel comprised of cardiologists and endocrinologists discussed available evidence and provided recommendations on the management of obesity in CVD. The expert panel discussions occurred between September of 2023 and May of 2024 and also took into consideration local expertise in addition to published data in the management of obesity and CVD in the Kingdom of Saudi Arabia. The expert panel explored studies on obesity and its implication on CVD assessment modalities, while also examining the efficacy and cardiovascular safety of available interventions for weight reduction. The association between obesity and CVD is undeniable. The treatment of obesity, be it through lifestyle changes, pharmacological therapy or surgery, is an effective strategy for both weight loss as well as the primary and secondary prevention of CVD. The Saudi Heart Association position statement thus provides guidance and recommendations for the management of obesity/overweight and CVD in Saudi Arabia. This position statement is expected to contribute towards obesity and CVD prevention efforts in Saudi Arabia by promoting adequate and time-appropriate treatment of these conditions.

Frequently asked questions to the 2023 Obesity Medicine Association Position Statement on Compounded Peptides: A call for action

BackgroundIn 2023, the Obesity Medicine Association (OMA) published “Compounded peptides: An Obesity Medicine Association Position Statement.” Since this publication, the use of compounded peptides for the treatment of obesity has continued to evolve, leading to additional confusion and questions from obesity medicine clinicians and their patients. MethodsThis frequently asked questions (FAQ) document and “Call for Action” commentary is based upon the existing evidence and practical clinical experiences of the authors. ResultsThis FAQ is intended to provide insights beyond the original 2023 OMA Position Statement regarding the use of “compounded peptides” for treating obesity. Three obstacles impair patient access to highly effective peptide anti-obesity medications: insufficient production especially during times of high demand, high costs, and lack of clarity surrounding the role of compounded peptides. Solutions to enhance patient access to these medications lie within the existing legal and regulatory framework and Food and Drug Administration policies. Implementing these solutions necessitates dispelling misinformation and providing clear guidance on the appropriate prescribing and administration of compounded peptides, particularly during times of acknowledged shortage. ConclusionAmong stakeholders with aligned priorities, challenges can often be overcome by collaboration and communication. Towards the goal of providing patient-centered care, the OMA calls on applicable stakeholders (e.g., pharmaceutical companies, compounding pharmacy organizations, health insurance companies, and the Food and Drug Administration) to work collaboratively to achieve a consensus that improves patient access to safe anti-obesity medications. The purpose of this “Call to Action” is to ask stakeholders to provide clinicians and their patients clarity regarding the role of compounded peptide anti-obesity medications during times of FDA-acknowledged shortages. Finally, this FAQ review provides clinicians with a simple and practical checklist respective to the potential use of compounded peptides.

Optimizing diuretic management in acute decompensated heart failure: the impact of diuretic algorithm in real-world setting

Abstract Background/Introduction Achieving euvolaemia is an important prognostic factor in acutely decompensated heart failure (ADHF). The European Society of Cardiology (ESC) guidelines suggest that a stepwise diuretic treatment algorithm based on regular reassessment of urinary output and natriuresis may be superior compared to current standard of care. We studied the implementation and effectiveness of such a pre-specified algorithm in a real-word cohort for realizing euvolaemia. Methods In 2020 we implemented the stepped diuretic strategy from the Heart Failure Association position statement, now stated in the 2021 ESC guidelines, in a peripheral hospital. Afterwards we conducted a retrospective cohort study, including patients with ADHF (with hospitalization duration > 3 days for decongestive treatment). Patients admitted between 10-Jan-2021 and 04-Dec-2021, who were treated according to the diuretic algorithm (protocol cohort), were compared to patients who were treated between 04-Jan-2018 and 19-jan-2019 (before implementation of this algorithm). Our primary outcomes were length of hospital stay (days), complications during hospitalization, such as electrolyte disturbance, kidney function, arrhythmias, infections and mortality during hospitalization. Results The study comprised 221 patients, with 107 in the pre-protocol cohort and 114 in the protocol cohort. Baseline characteristics were similar between the cohorts, expect for the kidney function and NT-proBNP levels at admission. Mean eGFR was slightly better in the protocol cohort (53 [36-71] vs 43 [29-63] ml/min/1.73m2, p .016), were as NT-proBNP was higher in the pre-protocol cohort (990 vs 480 pmol/l) (Table 1). The mean length of stay was shorter in the protocol cohort (7.0 [5.1-10.3] vs 7.5 [5.9-10.9] days). The incidence of complications, such as electrolyte disturbances and arrhythmias, were comparable. Notably, the mean eGFR on third day of hospitalization was higher in the protocol cohort (50 ± 21 vs. 42 ± 19 ml/min/1.73m2). There was a difference in the median weight lost during the admission between the two cohorts (Figure 1). Conclusion Our data suggest that a pre-specified stepwise diuretic treatment algorithm, based on urinary output is feasible and effective in achieving euvolaemia in a real-world cohort. Furthermore, it reduces length of hospital stay without increasing the risk of complications.

National Athletic Trainers' Association Position Statement: Emergency Action Plan Development and Implementation in Sport.

An emergency action plan (EAP) is a written document detailing the preparations and on-site emergency response of health care professionals and other stakeholders to medical emergencies in the prehospital setting. The EAP is developed to address any type of catastrophic injury response and should not be condition specific. The objective of this National Athletic Trainers' Association position statement is to provide evidence-based and consensus-based recommendations for developing and implementing an EAP for sports settings. These recommendations were developed by a multidisciplinary expert panel that performed (1) a comprehensive review of existing EAP evidence, (2) a modified Delphi process to define consensus recommendations, and (3) a strength of recommendation taxonomy determination for each recommendation. An EAP is an essential tool designed to facilitate emergency preparedness and an efficient, coordinated emergency response during an athletic event. A comprehensive EAP should consider modes to optimize patient outcomes, the various stakeholders needed to develop the plan, the factors influencing effective implementation of the EAP, and the roles and responsibilities to ensure a structured response to a catastrophic injury. These evidence-informed recommendations outline the necessary steps for emergency planning and provide considerations for the immediate management of patients with catastrophic injuries. Increasing knowledge and implementation of the EAP to manage patients with catastrophic injuries improves the overall response and decreases errors during an emergency.

Development of an International Qualification Framework for the Strength and Conditioning Profession: International Universities Strength and Conditioning Association Position Statement

In the profession of strength and conditioning (S&C), there is a need for a standardised, comprehensive framework that can allow for the alignment of international certifications, qualifications, and standards. This need stems from the lack of clarity surrounding the awarding levels of different governing bodies and organisations worldwide, as well as the increased connectedness of international sport and physical activity. Central to such a framework is understanding the current issues affecting S&C coaches,1 current professional standards and guidelines,2 and remuneration structures.3,4 As the sole dedicated international accreditation body, the International Universities Strength and Conditioning Association (IUSCA)5 carried out market research analysis and stakeholder engagement with regional and international educational authorities (Ofqual, European Commission, UNESCO, USDE, CHEA, TEQSA, ASQA) to develop a global framework for the rating and awarding of S&C courses, certifications, and qualifications.

White Paper: American Gastroenterological Association Position Statement: The Future of IBD Care in the United States–Removing Barriers and Embracing Opportunities

Despite incredible growth in systems of care and rapidly expanding therapeutic options for people with inflammatory bowel disease, there are significant barriers that prevent patients from benefiting from these advances. These barriers include restrictions in the form of prior authorization, step therapy, and prescription drug coverage. Furthermore, inadequate use of multidisciplinary care and inflammatory bowel disease specialists limits patient access to high-quality care, particularly for medically vulnerable populations. However, there are opportunities to improve access to high-quality, patient-centered care. This position statement outlines the policy and advocacy goals that the American Gastroenterological Association will prioritize for collaborative efforts with patients, providers, and payors.

World Psychiatric Association position statement on mental health and the death penalty

World Psychiatric Association position statement on mental health and the death penalty

Single-Legged Triple-Hop Propulsion Strategies in Females With and Those Without a History of Anterior Cruciate Ligament Reconstruction.

The single-legged triple hop is a commonly used functional task after anterior cruciate ligament reconstruction (ACLR). Recently, researchers have suggested that individuals may use a compensatory propulsion strategy to mask underlying quadriceps dysfunction and achieve symmetric hop performance. To evaluate the performance and propulsion strategies used by females with and those without ACLR during a single-legged triple hop. Cross-sectional study. Laboratory. A total of 38 females, 19 with ACLR (age = 19.21 ± 1.81 years, height = 1.64 ± 0.70 m, mass = 63.79 ± 7.59 kg) and 19 without ACLR (control group; age = 21.11 ± 3.28 years, height = 1.67 ± 0.73 m, mass = 67.28 ± 9.25 kg). Hop distance and limb symmetry index (LSI) were assessed during a single-legged triple hop for distance. Propulsion strategies were evaluated during the first and second hops of the single-legged triple hop. Separate 2-way analysis-of-variance models were used to examine the influence of ACLR, joint, and their interaction on mechanical joint work, moment impulse, and the relative joint contributions to total work and moment impulse in females with and those without a history of ACLR. Despite achieving a mean LSI of approximately 96%, the ACLR group produced less total work in the reconstructed than the uninvolved limb during single-legged triple-hop propulsion (first hop: t18 = -3.73, P = .002; second hop: t18 = -2.55, P = .02). During the first and second hops, the reconstructed knee generated 19.3% (t18 = -2.33, P = .03) and 27.3% (t18 = -4.47, P < .001) less work than the uninvolved knee. No differences were identified between the involved and uninvolved limbs of the ACLR group in moment impulse (first hop: t18 = -0.44, P = .67; second hop: t18 = -0.32; P = .76). Irrespective of limb or group, the ankle was the largest contributor to both work and moment during both the first and second hops (P < .001). Clinicians should exercise caution when using a single-legged triple hop as a surrogate for restored lower extremity function in females post-ACLR. This recommendation is driven by the compelling findings that knee-joint deficits persisted in the reconstructed limb despite an LSI of approximately 96% and, regardless of previous injury status, single-legged triple-hop propulsion was predominantly driven by the ankle.

Spinal Cord Injury Management Policies in High School Sports as Reported by Athletic Administrators

ABSTRACT Introduction/Purpose Athletic administrators (AA) in U.S. high schools are uniquely positioned to provide guidance and endorsement for the prevention and management of common sport-related catastrophic injuries, such as the development of a spinal cord injury management (SCIM) policy. The purpose of this project was to evaluate AA’s knowledge of comprehensive SCIM policies in U.S. high schools. Secondarily, we aimed to investigate the factors, facilitators, and barriers to the development and adoption of comprehensive policies. Methods An online questionnaire was distributed to 6423 AA working in U.S.-based high school athletics, with 366 included in the final data analysis. The questionnaire evaluated AA’s knowledge of comprehensive SCIM policies addressing components of adoption, documentation, and communication. The questionnaire was developed based on the 2002 “National Athletic Trainers’ Association Position Statement: Acute Management of the Cervical Spine-Injured Athlete.” The questionnaire also inquired about facilitators and barriers to developing and adopting comprehensive policies. Proportions were calculated for policy adoption, and independent-samples t-tests evaluated the influence of athletic training services on comprehensive SCIM policies. Results About half of AA (49.2%, n = 180/366) reported having all recommended components of a written SCIM policy. AA who had access to an athletic trainer (yes = 62.9%, no = 18.1%, unknown = 19%) were more likely to have a comprehensive SCIM policy compared with those without access (80.6% vs 19.4%, χ 2 1 = 7.091, P = 0.008, prevalence ratio = 1.24, 95% confidence interval = 1.03–1.50). The most commonly reported facilitator (49.9%) was “having a medical professional at the school,” and the main barrier (30.2%) was “my school would need more information, resources, assistance, etc.” Conclusions The findings identify areas for improvement in supporting the health and safety of children in high school participating in interscholastic athletics. Future dissemination and implementation research should develop strategies tailored to individual school community and need to improve SCIM policy adoption and implementation.

Comprehensive care for patients with obesity: An Obesity Medicine Association Position Statement

Comprehensive care for patients with obesity: An Obesity Medicine Association Position Statement

National Strength and Conditioning Association Position Statement on Weightlifting for Sports Performance.

Comfort, P, Haff, GG, Suchomel, TJ, Soriano, MA, Pierce, KC, Hornsby, WG, Haff, EE, Sommerfield, LM, Chavda, S, Morris, SJ, Fry, AC, and Stone, MH. National Strength and Conditioning Association position statement on weightlifting for sports performance. J Strength Cond Res 37(6): 1163-1190, 2023-The origins of weightlifting and feats of strength span back to ancient Egypt, China, and Greece, with the introduction of weightlifting into the Olympic Games in 1896. However, it was not until the 1950s that training based on weightlifting was adopted by strength coaches working with team sports and athletics, with weightlifting research in peer-reviewed journals becoming prominent since the 1970s. Over the past few decades, researchers have focused on the use of weightlifting-based training to enhance performance in nonweightlifters because of the biomechanical similarities (e.g., rapid forceful extension of the hips, knees, and ankles) associated with the second pull phase of the clean and snatch, the drive/thrust phase of the jerk and athletic tasks such as jumping and sprinting. The highest force, rate of force development, and power outputs have been reported during such movements, highlighting the potential for such tasks to enhance these key physical qualities in athletes. In addition, the ability to manipulate barbell load across the extensive range of weightlifting exercises and their derivatives permits the strength and conditioning coach the opportunity to emphasize the development of strength-speed and speed-strength, as required for the individual athlete. As such, the results of numerous longitudinal studies and subsequent meta-analyses demonstrate the inclusion of weightlifting exercises into strength and conditioning programs results in greater improvements in force-production characteristics and performance in athletic tasks than general resistance training or plyometric training alone. However, it is essential that such exercises are appropriately programmed adopting a sequential approach across training blocks (including exercise variation, loads, and volumes) to ensure the desired adaptations, whereas strength and conditioning coaches emphasize appropriate technique and skill development of athletes performing such exercises.

The Asia Pacific Pediatric Association (APPA) position statement on the MAFLD definition of fatty liver disease

The Asia Pacific Pediatric Association (APPA) position statement on the MAFLD definition of fatty liver disease

International Pediatric Transplant Association (IPTA) position statement supporting prioritizing pediatric recipients for deceased donor organ allocation.

A position statement of the International Pediatric Transplant Association endorsing prioritizing pediatric recipients for deceased donor organ allocation, examining the key ethical arguments that serve as the foundation for that position, and making specific policy recommendations to support prioritizing pediatric recipients for deceased donor organ allocation globally.

Saudi Heart Association Position Statement on the Use of Biomarkers for the Management of Heart Failure and Acute Coronary Syndrome.

BackgroundThe burden of acute coronary syndrome (ACS) and heart failure (HF) remains high in Saudi Arabia. Biomarkers can greatly improve the management and outcomes of these conditions, but no official guidance is available on their use in Saudi Arabia.Consensus panelAn expert panel of cardiologists, interventional cardiologists and cardiac surgeon reviewed available evidence and formulated recommendations relevant to clinical practice in Saudi Arabia.Consensus findingshigh-sensitivity cardiac troponins play a major role in the diagnosis of ACS and the exclusion of myocardial infarction in patients with HF. Natriuretic Peptides are recommended to determine the likelihood of a diagnosis of HF in a chronic setting and rapidly exclude HF in an acute setting. High-sensitivity cardiac troponins and NT-proBNP have good prognostic ability in ACS and HF. These biomarkers could also facilitate discharge planning and reduce unnecessary hospital admissions and resource wastage. The use of biomarkers should not be excessive and should abide by appropriateness criteria. High-sensitivity assays and NT-proBNP measurements are preferred.ConclusionBy outlining expert recommendations on the best practices in the use of biomarkers, the panel hopes to contribute towards a recognized updated guidance for all healthcare providers in Saudi Arabia on the evidence-based management of HF and ACS.

The American Broncho-Esophagological Association Position Statement on Swallowing Fluoroscopy.

To develop an expert consensus statement on the clinical use of swallowing fluoroscopy in adults that reduces practice variation and identifies opportunities for quality improvement in the care of patients suffering from swallowing impairment. A search strategist reviewed data sources (PubMed, Embase, Cochrane, Web of Science, Scopus) to use as evidence for an expert development group to compose statements focusing on areas of controversy regarding swallowing fluoroscopy. Candidate statements underwent two iterations of a modified Delphi protocol to reach consensus. A total of 2184 publications were identified for title and abstract review with 211 publications meeting the criteria for full text review. Of these, 148 articles were included for review. An additional 116 publications were also included after reviewing the references of the full text publications from the initial search. These 264 references guided the authors to develop 41 candidate statements in various categories. Forty statements encompassing patient selection, fluoroscopic study choice, radiation safety, clinical team dynamics, training requirements, videofluoroscopic swallow study and esophagram techniques, and interpretation of swallowing fluoroscopy met criteria for consensus. One statement on esophagram technique reached near-consensus. These 40 statements pertaining to the comprehensive use of swallowing fluoroscopy in adults can guide the development of best practices, improve quality and safety of care, and influence policy in both the outpatient and inpatient settings. The lack of consensus on some aspects of esophagram technique likely reflects gaps in knowledge and clinical practice variation and should be a target for future research. Laryngoscope, 133:255-268, 2023.

Addendum.

Swartz EE, Register-Mihalik JK, Broglio SP, et al. National Athletic Trainers' Association Position Statement: Reducing Intentional Head-First Contact Behavior in American Football Players. J Athl Train. 2022;57(2):113–124. doi: https://doi.org/10.4085/1062-6050-0062.21Please see the authors' disclosures below.Erik E. Swartz, PhD, ATC, has received grants from the GOG Hawaii Foundation and the Nine Sigma Head Health Challenge and trademark registration for HUTT. Johna K. Register-Mihalik, PhD, LAT, ATC, has received grants from the National Operating Committee on Standards for Athletic Equipment, Department of Defense (DOD), Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control, National Athletic Trainers' Association (NATA) Foundation, National Football League (NFL), and National Collegiate Athletic Association (NCAA)–DOD Mind Matters Research Challenge Award; she is a member of USA Football's Football Development Council. Steven P. Broglio, PhD, ATC, has received funding from the National Institutes of Health, CDC, DOD-USA Medical Research Acquisition Activity, NCAA, NATA Foundation, NFL, Under Armour/GE, Simbex, and ElmindA. He has consulted for the NCAA (travel expenses only), US Soccer, US Cycling (unpaid), and medicolegal litigation and received speaker honoraria and travel reimbursements for talks given. He is on the University of Calgary SHRed Concussions external advisory board (unpaid). Jason P. Mihalik, PhD, CAT(C), ATC, has received grants from the National Institutes of Health, NFL, CDC, and DOD. Kevin M. Guskiewicz, PhD, ATC, has received grants from the NFL (subaward from Boston Children's Hospital) and NCAA and nonfinancial support from the NCAA Scientific Committee. Julian Bailes, MD, is Chairman of the Medical Advisory Committee for Pop Warner Football. Jay L. Myers, PhD, reported no disclosures. Merrill Hoge, BA, has received royalties from Mascot Books for a football-related publication.

Prioritizing the Vitality of the Athletic Training Profession.

Exploring concepts and constructs related to the work-life balance of athletic trainers has been a priority of ours for years, and it has been an honor to serve as guest editors for this special issue of the Journal of Athletic Training. In 2019, the Strategic Alliance released its prioritized research agenda for the athletic training profession and included the exploration of solutions to improve work-life balance.1 The prioritized research agenda came on the heels of the National Athletic Trainers' Association position statement on facilitating work-life balance for the athletic trainer,2 a statement that not only advocated for improved quality of life but also recognized the need for more research in work-life balance. Work-life balance is one possible individual outcome of the work-life interface, or the overlap between work and personal roles.3 It has always been our belief that in order to suggest and implement solutions to address concerns related to the work-life interface, we need a better understanding of what those concerns are, which is what prompted us to advocate for and create this special issue.The athletic training literature related to the work-life interface is robust and has roots dating back to the late 1980s, before athletic training was recognized as an allied health profession by the American Medical Association in 1990. We acknowledge that work-life balance is not unique to athletic trainers and our profession; however, the nature of our job does result in some unique causative factors. In 1986, Capel4 found that role conflict, role ambiguity, locus of control, number of hours in direct contact with patients, and number of patients in the athletic trainer's direct care were significantly related to burnout, an antecedent contributing to career departure.5,6 In recent years, the multifactorial nature of the work-life interface has been explored in the literature,3,7 and the effects of societal (gender ideology, cultural norms), organizational (work hours, organizational culture), and individual (sex, personality) factors on numerous individual- and organizational-level outcomes, including work-life balance, turnover, and job performance, have been studied.Over the last decade, we have learned that every athletic trainer, at some point in his or her career, likely faces challenges with work-life balance, regardless of sex or marital or family status. In a recent systematic review,8 burnout was observed in all subsets of the athletic training population, including students, graduate assistants, staff, and faculty. We do, however, know that different causative factors may be responsible for the challenges, which can include various personality traits, societal norms, and the ideologies associated with gender roles (pressure for men to be the breadwinner or women feeling guilty about not being at home). Athletic trainers work in a variety of settings, yet work-life balance challenges occur. Although the factors contributing to the challenges may be setting dependent, conflicts result.The need for more research stems from potential negative outcomes such as job burnout, job dissatisfaction, and turnover, as they are likely to have indirect effects on patient care. Moreover, athletic trainers' inability to find balance has implications for their personal lives, as they experience guilt for not being able to give as much to their nonwork roles, especially parenting. As investigators, we have only scratched the surface of the work-life interface phenomenon and recognize that there is more to learn and understand. A special issue dedicated to this research is a testament to the importance of the topic.

National Athletic Trainers' Association Position Statement: Reducing Intentional Head-First Contact Behavior in American Football Players.

To provide evidence-based recommendations for reducing the prevalence of head-first contact behavior in American football players with the aim of reducing the risk of head and neck injuries. In American football, using the head as the point of contact is a persistent, well-documented, and direct cause of catastrophic head and cervical spine injury. Equally concerning is that repeated head-impact exposures are likely to result from head-first contact behavior and may be associated with long-term neurocognitive conditions such as dementia, depression, and chronic traumatic encephalopathy. The National Athletic Trainers' Association proposes 14 recommendations to help the certified athletic trainer, allied health care provider, coach, player, parent, and broader community implement strategies for reducing the prevalence of head-first contact in American football.

P-value and the probability of direction of effect

The p-value has been widely criticized in the scientific literature for its naive use in classifying results as 'significant' and 'non significant'. Much has been written about it; for example, see the American Statistical Association position statement of march 2016. To date, few alternative measures have been suggested and few changes were observed in the scientific practice regarding the use of p-value despite general agreement on the critics raised on it. In this paper, we use an alternative measure to p-value. It consists in the probability of the direction of the effect, that is the strength of empirical evidence in favour of the alternative directional hypothesis. In the context of scientific research, reporting the probability of the direction of the effect is easier to understand. Moreover, it focuses on the effect in the study rather than on the value under the null hypothesis, which sometimes has little meaning or has been used opportunistically. The proposal is not intended as an alternative to using the confidence interval, but as a probabilistic metric to be used instead of the p-value when we refer to particular hypotheses to be tested.

Rapid Atrial Fibrillation in the Emergency Department.

Atrial fibrillation (AF) is the most common rhythm disorder seen in doctors' offices and emergency departments (EDs). In both settings, an AF holistic pathway including anticoagulation or stroke avoidance, better symptom management, and cardiovascular and comorbidity optimization should be followed. However, other considerations need to be assessed in the ED, such as haemodynamic instability, the onset of AF, the presence of acute heart failure and pre-excitation. Although the Advanced Cardiovascular Life Support guidelines (European Society of Cardiology guidelines, Acute Cardiac Care Association/European Heart Rhythm Association position statements) and several recent AF publications have greatly assisted physicians in treating AF with rapid ventricular response in the ED, further practical clinical guidance is required to improve physicians' skill and knowledge in providing the best treatment for patients. Herein, we combine multiple strategies with supporting evidence-based treatment and experiences encountered in clinical practice into practical stepwise approaches. We hope that the stepwise algorithm may assist residents and physicians in managing AF in the ED.