Consensus Paper Research Articles

Warming-up for the Latest on Diagnosing and Managing Tendinopathy.

SYNOPSIS:JOSPT is starting 2024 on a high, with a tendinopathy-focused edition that showcases more of the high-quality tendinopathy research you know and love in systematic reviews, original research articles, a consensus paper, and editorials. As any athlete knows, a good warm-up is crucial to performing well at the main event. Here, we help you warm up and prime your brain to take on all the content of this tendinopathy-focused issue of the Journal. J Orthop Sports Phys Ther 2024;54(1):1-2. Epub 5 December 2023. doi:10.2519/jospt.2023.12440.

Health Impact of Chemical Disinfectant Exposures: A Review

Chemical disinfectant, such as sodium hypochlorite, bleach and quaternary is crucial for infection prevention. This applies to healthcare settings as well as other settings where the transmission of pathogens can potentially endanger the health of humans and/or animals. Ongoing interdisciplinary research is needed to ensure the effectiveness of disinfectants, understand the process of disinfection, and determine the appropriate timing, methods, and locations for implementing disinfection precautions. To ensure the long-term benefits of disinfection, it is crucial to utilize active substances responsibly and assess their impact on target organisms and the environment through close evaluation and monitoring. Given the worldwide risk posed by communicable diseases, as well as the emergence and resurgence of pathogens that are resistant to multiple drugs, the importance of chemical disinfection is consistently growing. This consensus paper focuses on important factors related to chemical disinfection strategies in healthcare settings, specifically for vulnerable patients

Protecting the vulnerable during a crisis - TAVR during the COVID-19 pandemic

Abstract Introduction The coronavirus (COVID-19) pandemic has been challenging for healthcare systems globally. Patients with symptomatic severe aortic stenosis awaiting transcatheter aortic valve replacement (TAVR) are a vulnerable, elderly subset of patients often with multiple comorbidities. Untreated severe aortic stenosis (AS) is associated with a poor prognosis. It is uncertain if population-based strategies to mitigate COVID-19 spread such as delaying elective procedures and virtual consultations have resulted in increased morbidity or mortality in this subset of patients. Position statements guiding TAVR during the COVID-19 pandemic have suggested fewer and shorter hospital admissions. We evaluated the available literature and performed a systematic review and meta-analysis assessing the impact of the COVID-19 pandemic on referral times, hospital stays and mortality in patients awaiting TAVR. Methods This systematic review and meta-analysis (CRD42022379840) is reported according to PRISMA guidelines. A comprehensive search strategy with computer- based search was performed using PubMed, Ovid MEDLINE, EMBASE and Cochrane databases. No time limit to start date was applied, and the search was conducted up to 28 November 2022. Only studies with available comparative data to pre-COVID 19 cohorts were included. Results Eleven studies satisfied our inclusion criteria, with a pooled analysis of 79785 TAVR patients. Patients undergoing TAVR in the COVID-19 era were associated with a modest risk of all-cause mortality (unadjusted RR: 1.41, 95% CI 0.97-2.06) however this was not statistically significant (Figure 1) and substantial heterogeneity was observed (p<0.01 and i2 = 84%). Patients undergoing TAVR in the COVID-19 cohort trended towards shorter average lengths of stay and time from referral to procedure than TAVR patients prior to the pandemic (mean difference -0.37, 95% CI -0.93 – 0.19 and mean difference -25.43, 95% CI -52.31 to 1.44 respectively), however this was not significant. Conclusion This systematic review suggested a trend towards increased all-cause mortality in TAVR patients in the COVID-19 era. Furthermore, the available data trended towards shorter times from referral to TAVR and a shorter average length of stay, consistent with published recommendations from European and Asian expert consensus papers. Our data did not reach statistical significance and showed significant heterogeneity, likely reflecting widespread institutional variations during the pandemic. As the COVID-19 dynamic changes, further data is required to help characterise and optimise patient care in this vulnerable patient group.

Portuguese Consensus on Acute Porphyrias: Diagnosis, Treatment, Monitoring and Patient Referral.

Acute porphyrias are a group of rare genetic metabolic disorders, caused by a defect in one of the enzymes involved in the heme biosynthesis, which results in an abnormally high accumulation of toxic intermediates. Acute porphyrias are characterized by potentially life-threatening attacks and, for some patients, by chronic manifestations that negatively impact daily functioning and quality of life. Clinical manifestations include a nonspecific set of gastrointestinal, neuropsychiatric, and/or cutaneous symptoms. Effective diagnostic methods are widely available, but due to their clinical heterogeneity and non-specificity, many years often elapse from symptom onset to diagnosis of acute porphyrias, delaying the treatment and increasing morbidity. Therefore, increased awareness of acute porphyrias among healthcare professionals is paramount to reducing disease burden. Treatment of acute porphyrias is centered on eliminating the potential precipitants, symptomatic treatment, and suppressing the hepatic heme pathway, through the administration of hemin or givosiran. Moreover, properly monitoring patients with acute porphyrias and their relatives is fundamental to preventing acute attacks, hospitalization, and long-term complications. Considering this, a multidisciplinary panel elaborated a consensus paper, aiming to provide guidance for an efficient and timely diagnosis of acute porphyrias, and evidence-based recommendations for treating and monitoring patients and their families in Portugal. To this end, all authors exhaustively reviewed and discussed the current scientific evidence on acute porphyrias available in the literature, between November 2022 and May 2023.

Feasibility of His bundle pacing facilitated by EASI derived 12‑lead ECG

IntroductionHis bundle pacing (HBP) has become popular in recent years as a more physiological alternative to conventional right ventricular pacing. Implantation requires 12‑lead ECG during surgery, which is not readily available in a standard operating room. Often but not always HBP is performed in an electrophysiology lab. EASI is a reduced lead system which enables derived 12‑lead ECG. EASI derived 12‑lead ECGs on modern tablet computers offer a more mobile and lightweight ECG solution which does not obstruct fluoroscopy during implantation. This case series aims to compare standard 12‑lead ECG to EASI derived 12‑lead ECG in patients undergoing HBP implantation. Methods and resultsA total of 11 patients received permanent HBP guided only by fluoroscopy, a pacing system analyzer (Medtronic CareLink SmartSync Device Manager) and EASI derived 12‑lead ECG (CardioSecur Pro). During the first postoperative device interrogation HBP criteria, as defined in the EHRA consensus paper on conduction system pacing, were evaluated with the EASI derived system as well as a standard 12‑lead ECG and compared to each other. There was perfect agreement with regards to these criteria which lead to identical conclusions in all cases. ConclusionHBP implantation can be performed with EASI derived 12‑lead ECG instead of conventional 12‑lead ECG. Criteria for discriminating between selective His bundle, non-selective His bundle or myocardial capture alone are clearly visible in the EASI derived ECG leading to the same conclusion when compared to standard 12‑lead ECG. Compared to a conventional 12‑lead ECG the EASI system offers a leaner setup with less visual obstruction on fluoroscopy.

EXPERT GROUP CONSENSUS PAPER OF THE RUSSIAN SCIENTIFIC SOCIETY OF INTERVENTIONAL CARDIOANGIOLOGY. On the routine use of intravascular imaging modalities (IVUS, OCT) during endovascular interventions for certain types of coronary artery lesions in chronic coronary syndrome; and on the necessity to equip all national CathLabs with intravascular imaging systems

Two decades have passed since the introduction of intravascular imaging techniques into clinical practice. These techniques have taken their rightful place in the treatment toolset for coronary atherosclerosis and, without overstating, have completely transformed both the procedure configuration and the daily work in the CathLabs. In addition to the technological advances achieved, it should be noted that substantial amount of qualitative evidences have been accumulated during this time, suggesting the superiority of intravascular imaging techniques over conventional angiography in optimizing percutaneous coronary interventions. Based on the strong evidential base and extensive personal experience, the authors of this paper provide a rationale for the use of intravascular imaging techniques in routine clinical practice, evaluating their role in improving the results of percutaneous coronary interventions. In addition, we propose a three­level system to train specialists and promote intravascular imaging techniques in order to introduce them into the clinical routine of every CathLab in Russia. Keywords: intravascular imaging, percutaneous coronary interventions, IVUS, OCT, optimal stenting

The Role of Recreational Therapy in Equine-Assisted Services

Certified Therapeutic Recreational Specialists (CTRS®) have incorporated equines into their practice for many years. Though not common, it is growing in popularity as the demand for equine-assisted services (EAS) grows. Recent factors draw new attention and significance to the discussion, including the 2021 Optimal Terminology Consensus paper. This paper left out recreational therapy (RT) service provision. The American Therapeutic Recreation Association (ATRA) Board of Directors commissioned a task force to define the position of therapeutic recreation within the defined service provisions of EAS and the role of the CTRS® in the implementation. This paper examines RT within the newly defined EAS scope. As a result of this work, RT was accepted as a therapy service as defined by the parameters of the Optimal Terminology Consensus paper under “Therapy.” The role of the CTRS® in planning and implementing a RT session incorporating equines using the Assessment, Planning, Implementation, Evaluation (APIE) process is also discussed. The hope is to advocate for and bring awareness to the essential role of RT and the need for further development of professional competencies, training, protocols, and standards for CTRS®s who incorporate equines into their practice as an intervention or modality for their clients.

Overweight and obesity in adults: general principles of treatment and conservative management

The prevalence of overweight and obesity is steadily increasing in Austria as well as internationally. Obesity in particular is associated with multiple health risks, comorbidities, functional disability, and social stigma. Obesity is an independent, complex, chronic disease and should be treated as such by amultidisciplinary team of appropriately qualified personnel. In addition to recent international guidelines, this consensus paper outlines the overall principles of the management of overweight and obesity and provides guidance for the diagnosis and conservative treatment, focusing on lifestyle modifications and pharmacotherapy. Using the "5A" framework of behavioral health intervention, guidelines for astructured, pragmatic, and patient-centered medical care of adults with overweight or obesity are presented.

Ecological Meanings: A Consensus Paper on Individual Differences and Contextual Influences in Embodied Language.

Embodied theories of cognition consider many aspects of language and other cognitive domains as the result of sensory and motor processes. In this view, the appraisal and the use of concepts are based on mechanisms of simulation grounded on prior sensorimotor experiences. Even though these theories continue receiving attention and support, increasing evidence indicates the need to consider the flexible nature of the simulation process, and to accordingly refine embodied accounts. In this consensus paper, we discuss two potential sources of variability in experimental studies on embodiment of language: individual differences and context. Specifically, we show how factors contributing to individual differences may explain inconsistent findings in embodied language phenomena. These factors include sensorimotor or cultural experiences, imagery, context-related factors, and cognitive strategies. We also analyze the different contextual modulations, from single words to sentences and narratives, as well as the top-down and bottom-up influences. Similarly, we review recent efforts to include cultural and language diversity, aging, neurodegenerative diseases, and brain disorders, as well as bilingual evidence into the embodiment framework. We address the importance of considering individual differences and context in clinical studies to drive translational research more efficiently, and we indicate recommendations on how to correctly address these issues in future research. Systematically investigating individual differences and context may contribute to understanding the dynamic nature of simulation in language processes, refining embodied theories of cognition, and ultimately filling the gap between cognition in artificial experimental settings and cognition in the wild (i.e., in everyday life).

Brain Signatures of Embodied Semantics and Language: A Consensus Paper.

According to embodied theories (including embodied, embedded, extended, enacted, situated, and grounded approaches to cognition), language representation is intrinsically linked to our interactions with the world around us, which is reflected in specific brain signatures during language processing and learning. Moving on from the original rivalry of embodied vs. amodal theories, this consensus paper addresses a series of carefully selected questions that aim at determining when and how rather than whether motor and perceptual processes are involved in language processes. We cover a wide range of research areas, from the neurophysiological signatures of embodied semantics, e.g., event-related potentials and fields as well as neural oscillations, to semantic processing and semantic priming effects on concrete and abstract words, to first and second language learning and, finally, the use of virtual reality for examining embodied semantics. Our common aim is to better understand the role of motor and perceptual processes in language representation as indexed by language comprehension and learning. We come to the consensus that, based on seminal research conducted in the field, future directions now call for enhancing the external validity of findings by acknowledging the multimodality, multidimensionality, flexibility and idiosyncrasy of embodied and situated language and semantic processes.

Consensus Paper: Situated and Embodied Language Acquisition.

Theories of embodied cognition postulate that perceptual, sensorimotor, and affective properties of concepts support language learning and processing. In this paper, we argue that language acquisition, as well as processing, is situated in addition to being embodied. In particular, first, it is the situated nature of initial language development that affords for the developing system to become embodied. Second, the situated nature of language use changes across development and adulthood. We provide evidence from empirical studies for embodied effects of perception, action, and valence as they apply to both embodied cognition and situated cognition across developmental stages. Although the evidence is limited, we urge researchers to consider differentiating embodied cognition within situated context, in order to better understand how these separate mechanisms interact for learning to occur. This delineation also provides further clarity to the study of classroom-based applications and the role of embodied and situated cognition in the study of developmental disorders. We argue that theories of language acquisition need to address for the complex situated context of real-world learning by completing a "circular notion": observing experimental paradigms in real-world settings and taking these observations to later refine lab-based experiments.

Treatment of recurrent acute tonsillitis-a systematic review and clinical practice recommendations.

There is an ongoing debate on the indications for tonsil surgery in both children and adults with recurrent acute tonsillitis. The aim is to provide practical recommendations for diagnostics and treatment for recurrent acute tonsillitis including evidence-based decision making for tonsillectomy. A systematic literature search in PubMed, Embase, Web of Science, and ScienceDirect from 2014 until April 2023 resulted in 68 articles. These were the basis for the review and a comprehensive series of consensus statements on the most important diagnostics and indications for both non-surgical and surgical therapy. A consensus paper was circulated among the authors and members of the International Head and Neck Scientific Group until a final agreement was reached for all recommendations. The differentiation between sore throat and tonsillitis patient episodes is mostly not feasible and hence is not relevant for diagnostic decision making. Diagnostics of a tonsillitis/sore throat episode should always include a classification with a scoring system (Centor, McIssac, FeverPAIN score) to estimate the probability of a bacterial tonsillitis, mainly due to group A streptococcus (GAS). In ambiguous cases, a point-of-care test GAS swab test is helpful. Consecutive counting of the tonsillitis/sore throat episodes is important. In addition, a specific quality of life score (Tonsillectomy Outcome Inventory 14 or Tonsil and Adenoid Health Status Instrument) should be used for each episode. Conservative treatment includes a combination of paracetamol and/or non-steroidal anti-inflammatory drugs. In case of high probability of bacterial tonsillitis, and only in such cases, especially in patients at risk, standard antibiotic treatment is initiated directly or by delayed prescription. Tonsillectomy is indicated and is highly effective if the patient has had ≥7 adequately treated episodes in the preceding year, ≥5 such episodes in each of the preceding 2 years, or ≥3 such episodes in each of the preceding 3 years. An essential part of surgery is standardized pain management because severe postoperative pain can be expected in most patients. It is necessary to follow a stringent treatment algorithm for an optimal and evidence-based treatment for patients with recurrent acute tonsillitis. This will help decrease worldwide treatment variability, antibiotic overuse, and avoid ineffective tonsillectomy.

Consensus Paper: Current Perspectives on Abstract Concepts and Future Research Directions.

concepts are relevant to a wide range of disciplines, including cognitive science, linguistics, psychology, cognitive, social, and affective neuroscience, and philosophy. This consensus paper synthesizes the work and views of researchers in the field, discussing current perspectives on theoretical and methodological issues, and recommendations for future research. In this paper, we urge researchers to go beyond the traditional abstract-concrete dichotomy and consider the multiple dimensions that characterize concepts (e.g., sensorimotor experience, social interaction, conceptual metaphor), as well as the mediating influence of linguistic and cultural context on conceptual representations. We also promote the use of interactive methods to investigate both the comprehension and production of abstract concepts, while also focusing on individual differences in conceptual representations. Overall, we argue that abstract concepts should be studied in a more nuanced way that takes into account their complexity and diversity, which should permit us a fuller, more holistic understanding of abstract cognition.

Assessment and treatment of nonsurgical thumb carpometacarpal joint osteoarthritis: A modified Delphi-based consensus paper of the American Society of Hand Therapists

BackgroundWhile the literature is abundant on hand therapy assessment and treatment of nonsurgical thumb carpometacarpal (CMC) osteoarthritis (OA), clarity and uniformity are meager, making it a desirable diagnosis to establish expert consensus. PurposeThis study aimed to ascertain if consensus exists for the assessment and treatment of nonsurgical management of thumb CMC OA in the hand therapy clinical setting. Study DesignThis was a consensus paper via the modified Delphi approach. MethodsA modified Delphi method was used to determine consensus among an expert panel, including hand therapists and hand surgeons, via two online surveys. A consensus paper steering committee (from the American Society of Hand Therapist’s research division) designed the surveys and analyzed responses. Consensus was established as 75% agreement among the expert panel. Demographic information was collected from the expert panel. ResultsThe expert panel included 34 hand therapists and seven hand surgeons. The survey response rates were 93.6% for the first survey and 90.2% for the second survey. Consensus recommendations were classified according to the World Health Organization categorization. These included evaluating the body structures for clinical signs/clinical testing and body functions for pain, range of motion for palmar abduction, radial abduction, opposition, and thumb metacarpal phalangeal flexion/extension, and grip and tripod pinch strength. Further consensus recommendations were for the assessment of function using a region-specific, upper extremity patient-reported outcome measure (activity and participation), environmental factors, outcome expectation, and illness perception within the patient’s unique environmental and social contexts. Treatment recommendations included the use of an orthosis during painful activities, a dynamic stability program (stable C posture, release of tight adductors, and strengthening of stabilizers), patient education, joint protection techniques, adaptive equipment, and functional-based intervention. ConclusionsThe findings describe the consensus of a group of experts and provide a clinical reference tool on the hand therapy assessment and treatment of nonsurgical thumb CMC joint OA.

Infections of cardiac implantable electronic devices: epidemiology, mechanisms and preventive measures.

Cardiac implantable electronic devices (CIED) infections represent a complication associated with high morbidity and mortality. Despite enormous efforts to prevent them, the rates of infections continue to rise out of proportion to the reported increase in CIED implantation rates. Following extensive research of various prevention strategies and new technologies, several organizations have issued recommendations and consensus papers covering the topic. The aim of this narrative review is to provide a summary of the existing preventive strategies put forward by the European Heart Rhythm Association consensus document, and European Society of Cardiology guidelines and introduce the most recent developments in the field, including optimized surgical site management and appropriate periprocedural antithrombotic drugs use. It also provides an overview of epidemiology, mechanisms, risk factors, and risk stratification approaches. It focuses on the pre-, intra-, and postprocedural actions to be taken in order to mitigate CIED infection risks. Future directions in the prevention of CIED infections have also been addressed.

Reduction in Earning Capacity (MdE) Statutory Accident Insurance

Changes in the employment market and improvements in the current prosthetic treatment have encouraged German Statutory Health Insurance e. V. (DGUV) to re-examine the standard values for reduced earning capacity after work related accidents. The new standard values for reduced earning capacity came into force on 01.11.2019. The present article summarises the consensus paper of the group of independent experts.

Open RT Structures: A Solution for TG-263 Accessibility

BackgroundConsistency of nomenclature within radiation oncology is increasingly important as big data efforts and data sharing become more feasible. Automation of radiation oncology workflows depends on standardized contour nomenclature which enables toxicity and outcomes research, while also reducing medical errors and facilitating quality improvement activities. Recommendations for standardized nomenclature have been published in the American Association of Physicists in Medicine (AAPM) report from Task Group 263. Transitioning to TG-263 requires creation and management of structure template libraries and retraining of staff, which can be a considerable burden on clinical resources. Our aim is to develop a program that allows users to create TG-263 compliant structure templates in English, Spanish, or French to facilitate data sharing. Methods53 pre-made structure templates were arranged by treated organ based on an American Society for Radiation Oncology (ASTRO) consensus paper. Templates were further customized with common target structures, relevant OARs (e.g., Spleen for anatomically relevant sites such as gastroesophageal junction or stomach), sub-site specific templates (e.g. partial breast, whole breast, intact prostate, postoperative prostate, etc.) and brachytherapy templates. An informal consensus on OAR and target coloration was also achieved, though color selections are fully customizable within the program. ResultsThe resulting program is usable on any Windows system and generates template files in practice-specific DICOM or XML formats, extracting standardized structure nomenclature from an online database maintained by members of the TG-263U1 Task Group which ensures continuous access to up-to-date templates. ConclusionsWe have developed a tool to easily create and name DICOM-RT structures sets that are TG-263-compliant for all planning systems utilizing the DICOM standard. The program and source code are publicly available via GitHub, encouraging feedback from community users for improvement and guide further development.

Practical Considerations for Instrumental Acoustic and Aerodynamic Assessment of Voice: Discussion Points From an Open Forum of Clinicians

Purpose: The purpose of this clinical focus article is to summarize a community discussion about the practical implementation of recommended vocal function measures by practicing speech-language pathologists specializing in the treatment of voice and upper airway disorders, review common barriers and challenges to implementation, and suggest opportunities for further education and discussion. Method: An online discussion was held with members of American Speech-Language-Hearing Association Special Interest Group (SIG) 3 to facilitate discussion regarding participants' experiences implementing vocal function assessment (acoustic and aerodynamic assessment) in their practice settings. The discussion was based on the expert panel consensus paper by Patel et al. (2018), which provided recommendations for a minimum core set of vocal function measures. Results: Discussion topics included standardization methods, environmental factors, preferred hardware and software, tasks and measures, interpretation, and infection control. Participants reported that the recommendations of the consensus paper provide a useful guideline for obtaining a core set of reliable and valid measures. They also reported facing barriers in meeting these recommendations due to varying practice settings and resources. Conclusions: Variations in instrumental assessment may arise due to differences in clinic models, testing environments, accessible equipment, allotted time, and clinician opinion. During the discussion, participants emphasized the need for further education and discussion on the implementation of vocal function assessment, particularly regarding adaptations for different clinical models, low-cost and low-tech alternatives, synthesis of findings, and the relevance of additional or omitted measures in specific situations. To address these concerns, it is recommended that the SIG 3 community delve deeper into this topic, open additional discussion about various topics cited as barriers to vocal function assessment implementation, and create ongoing educational opportunities for clinicians, especially for those who lack access to a voice-specialized clinical fellowship program or mentorship by a specialized clinical expert.

Mobilizing nurses to address the opioid misuse epidemic

BackgroundThe opioid epidemic is a major health challenge in the United States. PurposeMembers from the American Academy of Nursing joined to write a consensus paper about nurses' role in the opioid epidemic. MethodsThe panel reviewed the history of the opioid epidemic and policies to care for patients with opioid use disorder (OUD) and how registered nurses (RNs) and advanced practice nurses (APRNs) could increase care for people with OUD. DiscussionRecommendations are presented to advance policies that empower RNs and APRNs to abate the opioid epidemic. ConclusionRecommendations include (a) advance legislation that supports RNs and APRNs full scope of practice and expands professional role in pain management and addiction prevention; (b) evaluate effective policies that promote RN and APRN care; support federal elimination of X-waiver with state law alignment; (c) sustain the use of nurses in telemedicine; (d) support nursing research on nurse involvement in all aspects of OUD.

Monitoring of emergency cardiovascular patients in the emergency department : Consensus paper of the DGK, DGINA and DGIIN

Patients with potential or proven cardiovascular diseases represent arelevant proportion of the total spectrum in the emergency department. Their monitoring for cardiovascular surveillance until the diagnostics and acute treatment are initiated, often poses an interdisciplinary and interprofessional challenge, because resources are limited, nevertheless ahigh level of patient safety has to be ensured and the correct procedure has a major prognostic significance. This consensus paper provides an overview of the practical implementation, the modalities of monitoring and the application in aselection of cardiovascular diagnoses. The article provides specific comments on the clinical presentations of acute coronary syndrome, acute heart failure, cardiogenic shock, hypertensive emergency events, syncope, acute pulmonary embolism and cardiac arrhythmia. The level of evidence is generally low as no randomized trials are available on this topic. The recommendations are intended to supplement or establish local standards and to assist all physicians, nursing personnel and the patients to be treated in making decisions about monitoring in the emergency department.