Recommendations For Clinical Practice Research Articles

Does new research address persistent questions since the publication of the CDC's 2018 pediatric mTBI guideline.

Due to the potential debilitating sequelae following pediatric mTBI, the CDC published the Guideline on the Diagnosis and Management of mTBI Among Children in 2018. However, the guideline identified several key gaps in our clinical knowledge to support several clinical recommendations. The objective of this review is to evaluate if subsequent research has addressed these gaps in clinical practice recommendations. A literature review was conducted in PubMed using keywords from the CDC guidelines for the years of July 2015-January 2021. Articles were screened by title and abstract so only studies with children < 18years of age and those focusing on mTBI were included. A total of 531 articles were identified after screening. Forty-three percent was prospective; 24% were case reports, literature reviews, comments, or protocols; 19% were retrospective, 7% were cross-sectional, 4% were RCTs, and 4% were systematic reviews/meta-analyses. Forty-nine percent focused on diagnosis, 17% on prognosis, and 34% on treatment. The four most published topics were neuropsychological tools (28%), risk factors for intracranial injury and computed tomography (11%), cognitive/physical rest (11%), and return to school (10%). Since the release of the 2018 CDC guidelines, the majority of publications addressing pediatric mTBI have been prospective studies evaluating the clinical application of neuropsychological tools in concussion management. While these studies do address several of the clinical gaps noted by the CDC regarding the diagnosis and prognosis of pediatric mTBI, there remains a lack of high-quality studies focused on improving pediatric concussion treatment and outcomes.

Timely identification and treatment of uterine artery pseudoaneurysm after hysteroscopic procedures

Uterine artery pseudoaneurysm (UAP) is a rare but potentially life-threatening complication that can occur following hysteroscopic surgery for endometrial polyp resection. This article discusses the case study by Kakinuma et al , which highlights the successful diagnosis and treatment of UAP in a 48-year-old primiparous woman. Utilizing advanced imaging techniques such as ultrasound and computed tomography (CT), the medical team was able to promptly identify the UAP and subsequently perform a uterine artery embolization to treat the condition. The study underscores the critical need for rapid diagnosis and intervention to prevent severe outcomes and provides practical clinical recommendations for managing similar cases. This article aims to expand on the study’s findings, discuss the clinical implications, and suggest future research directions to optimize the management of UAP post-hysteroscopic surgery.

1. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes-2025.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

3. Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes-2025.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2025.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Care in Diabetes-2025.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

14. Children and Adolescents: Standards of Care in Diabetes-2025.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes-2025.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2025.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2025.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes-2025.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2025.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2025.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

16. Diabetes Care in the Hospital: Standards of Care in Diabetes-2025.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

17. Diabetes Advocacy: Standards of Care in Diabetes-2025.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

7. Diabetes Technology: Standards of Care in Diabetes-2025.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Importance of timely diagnosis and intervention in uterine artery pseudoaneurysm caused by hysteroscopic surgery.

This manuscript explores the case on the occurrence of uterine artery pseudoaneurysm (UAP) during hysteroscopy endometrial polypectomy and the subsequent successful treatment via uterine artery embolization (UAE). Moreover, we focus on the management and treatment options for UAP in patients of advanced maternal age. A pseudoaneurysm is an extraluminal blood collection with a disrupted flow that communicates with the parent vessel via a defect in the arterial wall. The reported case involved a 48-year-old primiparous woman who developed a UAP after uterine polyp removal. The study enhances the understanding of UAP, a rare but potentially life-threatening condition, by providing a detailed and well-documented account of the comprehensive case presentation, effective use of medical imaging techniques for diagnosis, successful postoperative patient management following UAE, and practical clinical recommendations for clinicians managing similar cases. Overall, this study highlights the importance of considering UAP as a differential diagnosis in patients with abnormal vaginal bleeding following hysteroscopic surgery. Additionally, this manuscript recommends that clinicians with a high index of suspicion for UAP promptly request ultrasonography and computed tomography to facilitate early diagnosis. UAE is suggested as a primary treatment due to its effectiveness and safety, particularly in facilities capable of avoiding hysterectomy.

Evidence-Based Clinical Utility of Heart Rate Variability Across Populations, Including Long COVID

Purpose: Heart rate variability (HRV) has been used for decades as a tool for measuring systemic health through the autonomic nervous system (ANS). The purpose of this paper was to examine the literature on HRV and to investigate its use in the long COVID (LC) population. Summary of Key Points: Measurement devices vary significantly in their validity and reliability when compared with the gold standard of electrocardiogram (ECG). Wrist and hand devices typically demonstrate diminished validity for capturing HRV signal, while chest strap devices often exhibit high reliability and validity. Lack of transparency in third-party software used to clean and analyze HRV data makes assessment for accuracy problematic. This is of particular concern when single beat miscalculations can result in significantly dissimilar output. The conditions under which HRV data are collected, such as natural or paced breathing, activity intensity, and patient position, can dramatically affect HRV readings. While some individual HRV metrics have consistently been shown to reflect certain components of the ANS, such as high-frequency power as a measure of parasympathetic function, the meaning of other metrics is less clear. Recommendations for Clinical Practice: Heart rate variability can be an extraordinarily valuable tool to measure systemic function. However, it is recommended that clinicians be judicious in the interpretation of HRV, considering inconsistencies in presentation. This is particularly true in LC, where individual HRV varies greatly. In all populations, clinicians should consider using valid devices to assess trends in HRV values over time, along with consideration of unique physical conditions.

Clinical management of patients with cavernous malformations of the central nervous system: an update and recommendations for clinical practice

Cerebral cavernous malformations are benign vascular anomalies of the central nervous system (CNS). The clinical presentation of a cavernoma depends on its location. The majority of patients with cavernomas are asymptomatic. The most common symptoms include epileptic seizures, focal neurological deficits and/or headaches. The clinical management of cavernomas is challenging because numerous factors influence decision-making. These factors include the risk stratification of cavernoma-related hemorrhage, weighing the risks of surgical intervention against the natural course of the cavernoma and the clinical presentation. This article presents current guidelines and recommendations for clinical practice, based on the latest research findings and expert opinions. The article focuses on diagnostic approaches, risk stratification, therapeutic management and follow-up strategies.

Orthosis Management in Knee Osteoarthritis: Evaluating Existing Recommendations and Achieving Consensus on Implementation Through the Delphi Method.

The available evidence on orthosis management in the knee osteoarthritis (KOA) remains questionable. This study aims to evaluate existing recommendations and achieve consensus on their implementation through the modified Delphi method. Experienced experts in orthosis management for KOA patients participated in three Delphi rounds. Each round involved addressing various questions related to recommended orthosis type such as insole, knee brace, footwear, indications and contraindications, dosage of orthosis usage, follow-up period, long-term side effects, fitting, and weaning procedure. Consensus was defined as ≥70% agreement with a question. Consensus was achieved for all questions. Experts frequently recommended custom-made insoles, neoprene knee braces, and appropriate footwear. The recommended duration of insole and knee brace usage averaged 3-6months. Insole usage was advised during all weight-bearing activities, while knee braces were suggested for 4-6h per day. Experts recommended orthosis follow-up for an average of 4-6months. Reduced compliance with orthoses was highlighted by experts as the most significant long-term side effect. The fitting of orthoses is typically evaluated through gait analyses, assessment of symptoms and comfort, and observation of the corrective effects on impaired biomechanics in the clinical setting. Besides, experts commonly recommend a gradual weaning process from orthoses. This study addresses the existing lack of consensus on orthosis management in KOA and provides essential clinical practice recommendations from multidisciplinary experts.