Mayo Clinic proceedings. Innovations, quality & outcomes最新文献

Prognostic Factors and Epidemiology of Amyotrophic Lateral Sclerosis in Southeastern United States 美国东南部肌萎缩侧索硬化症的预后因素和流行病学

Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2024-09-17 DOI: 10.1016/j.mayocpiqo.2024.07.008

{"title":"Prognostic Factors and Epidemiology of Amyotrophic Lateral Sclerosis in Southeastern United States","authors":"","doi":"10.1016/j.mayocpiqo.2024.07.008","DOIUrl":"10.1016/j.mayocpiqo.2024.07.008","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the performance of known survival predictors and evaluate their stratification capability in patients with amyotrophic lateral sclerosis (ALS).</p></div><div><h3>Patients and Methods</h3><p>We analyzed demographic and clinical variables collected at the Mayo Clinic, Florida ALS center during the first clinical visit of 1442 (100%) patients with ALS.</p></div><div><h3>Results</h3><p>Our cohort had a median (interquartile range [IQR]) age at diagnosis of 64.8 (57-72) years; 1350 (92%) were non-Hispanic White; and 771 (53.5%) were male. The median (IQR) diagnostic delay was 10.1 (6-18) months, body mass index was 25.4 (23-49), and forced vital capacity was 72% (52%-87%). Approximately 12% of patients tested carried a pathologic <em>C9orf72</em> hexanucleotide repeat expansion. Median (IQR) ALS functional rating scale-revised score was 35 (29-40) and ALS cognitive behavioral screen score was 15 (12-17). The median (IQR) survival after diagnosis was 17.2 (9-31) months, and survival from symptom onset was 30 (20-48) months. We found that older age decreased forced vital capacity, and fast-progressing ALS functional rating scale-revised scores significantly (<em>P</em><.0001) influence survival curves and associated hazard risk.</p></div><div><h3>Conclusion</h3><p>Although results obtained from our cohort are consistent with other reports (eg, men with spinal onset experience a longer survival than women with bulbar onset), they remind us of the complexity of the disease’s natural history and the limited prognostic power of the most common clinical predictors.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000523/pdfft?md5=a5e3c1695eb2a43f63cf5c69f1afb112&pid=1-s2.0-S2542454824000523-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142238887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2024-09-16 DOI: 10.1016/j.mayocpiqo.2024.08.002

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Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2024-09-11 DOI: 10.1016/j.mayocpiqo.2024.06.004

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Rethinking Measures and Mortality Attribution in Health Care: The Diabetes and Endocrinology Example 重新思考医疗保健中的措施和死亡率归因：糖尿病与内分泌学实例

Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2024-09-06 DOI: 10.1016/j.mayocpiqo.2024.08.001

{"title":"Rethinking Measures and Mortality Attribution in Health Care: The Diabetes and Endocrinology Example","authors":"","doi":"10.1016/j.mayocpiqo.2024.08.001","DOIUrl":"10.1016/j.mayocpiqo.2024.08.001","url":null,"abstract":"<div><p>This study investigated the accuracy of mortality attributions assigned by the US News and World Report (USNWR) to the diabetes and endocrinology specialty. We reviewed medical records of all consecutive Medicare fee-for-service inpatients at Mayo Clinic, Florida (Jacksonville, Florida) with a Medicare Severity Diagnosis Related Group included in the USNWR Diabetes & Endocrinology specialty cohort admitted from November 2018 to April 2022, with documented mortality in our institution’s electronic health record within 30 days of the index admission. A clinician adjudicated the primary cause of death, categorizing it as diabetes or endocrine, cancer, failure to thrive, or other. Among 49 deceased patients, only 7 (14.3%) had diabetes or an endocrine-related cause of death. Cancer (49.0%) and failure to thrive (30.6%) were the leading causes. This substantial discrepancy (86% misattribution) suggests USNWR’s methodology might not precisely reflect the quality of care, potentially misleading patients and impacting hospital rankings.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000535/pdfft?md5=13e13dc82a20e1c13a4b590ae2b0c6c8&pid=1-s2.0-S2542454824000535-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142151965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Lifestyle Medicine in Medical Education: Maximizing Impact 医学教育中的生活方式医学：最大化影响

Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2024-08-24 DOI: 10.1016/j.mayocpiqo.2024.07.003

{"title":"Lifestyle Medicine in Medical Education: Maximizing Impact","authors":"","doi":"10.1016/j.mayocpiqo.2024.07.003","DOIUrl":"10.1016/j.mayocpiqo.2024.07.003","url":null,"abstract":"<div><p>The relationship between lifestyle behaviors and common chronic conditions is well established. Lifestyle medicine (LM) interventions to modify health behaviors can dramatically improve the health of individuals and populations. There is an urgent need to meaningfully integrate LM into medical curricula horizontally across the medical domains and vertically in each year of school and training. Including LM content in medical and health professional curricula and training programs has been challenging. Barriers to LM integration include lack of awareness and prioritization of LM, limited time in the curricula, and too few LM-trained faculty to teach and role model the practice of LM. This limits the ability of health care professionals to provide effective LM and precludes the wide-reaching benefits of LM from being fully realized. Early innovators developed novel tools and resources aligned with current evidence for introducing LM into didactic and experiential learning. This review aimed to examine the educational efforts in each LM pillar for undergraduate and graduate medical education. A PubMed-based literature review was undertaken using the following search terms: <em>lifestyle medicine, education, medical school, residency, and healthcare professionals</em>. We map the LM competencies to the core competency domains of the Accreditation Council for Graduate Medical Education. We highlight opportunities to train faculty, residents, and students. Moreover, we identify available evidence-based resources. This article serves as a “call to action” to incorporate LM across the spectrum of medical education curricula and training.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000444/pdfft?md5=1a959f156528bc6f7c327b8f469a212c&pid=1-s2.0-S2542454824000444-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142050041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Building a Cancer Care Clinic for Transgender and Gender Diverse Individuals 为变性人和性别多元化人士建立癌症护理诊所

Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2024-08-22 DOI: 10.1016/j.mayocpiqo.2024.07.007

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Perioperative Mortality: A Retrospective Cohort Study of 75,446 Noncardiac Surgery Patients 围手术期死亡率：75 446 名非心脏手术患者的回顾性队列研究

Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2024-08-21 DOI: 10.1016/j.mayocpiqo.2024.07.002

{"title":"Perioperative Mortality: A Retrospective Cohort Study of 75,446 Noncardiac Surgery Patients","authors":"","doi":"10.1016/j.mayocpiqo.2024.07.002","DOIUrl":"10.1016/j.mayocpiqo.2024.07.002","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate whether major adverse cardiac events (MACE) continue to be a major causative factor for mortality after noncardiac surgery.</p></div><div><h3>Patients and Methods</h3><p>We performed retrospective study of 75,410 adult noncardiac surgery patients at Mayo Clinic Rochester, between January 1, 2016, and May 4, 2018. Electronic medical records were reviewed and data collected on all deaths within 30 days (n=692 patients) of surgery. The incidence of death due to MACE was calculated.</p></div><div><h3>Results</h3><p>Postoperative MACE occurred in 150 patients (21.4 events per 10,000 patients; 95% CI, 18.2-25.2 events per 10,000 patients) with most occurring within 3 days of surgery (n=113). Postoperative MACE events were associated with atrial fibrillation with rapid rate response in 25 patients (16.7%), sepsis in 15 patients (10%), and bleeding in 15 patients (10%). There were 12 intraoperative deaths of which 9 were due to exsanguination (75%) and the remaining 3 (25%) due to cardiac arrest. Of the 56 deaths on the first 24 hours after surgery, 7 were due to hemorrhage, 17 due to cardiovascular causes, 20 due to sepsis, and 7 due to neurologic disease. The leading cause of total death over 30 days postoperatively was sepsis (28%), followed by malignancy (27%), cardiovascular disease (12%) neurologic disease (12%), and hemorrhage (5%).</p></div><div><h3>Conclusion</h3><p>MACE was not the leading cause of death both intraoperatively and postoperatively.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000432/pdfft?md5=0098ca40105e5ac2d80dc6de8fa7b7d2&pid=1-s2.0-S2542454824000432-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142040887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Redesigning the Care of Musculoskeletal Conditions With Lifestyle Medicine 用生活方式医学重新设计肌肉骨骼疾病的治疗方法

Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2024-08-12 DOI: 10.1016/j.mayocpiqo.2024.07.001

{"title":"Redesigning the Care of Musculoskeletal Conditions With Lifestyle Medicine","authors":"","doi":"10.1016/j.mayocpiqo.2024.07.001","DOIUrl":"10.1016/j.mayocpiqo.2024.07.001","url":null,"abstract":"<div><p>Value-based health care has been accelerated by alternative payment models and has catalyzed the redesign of care delivery across the nation. Lifestyle medicine (LM) is one of the fastest growing medical specialties and has emerged as a high-value solution for root cause treatment of chronic disease. This review detailed a large integrated health care delivery system’s value transformation efforts in the nonoperative treatment of musculoskeletal (MSK) conditions by placing patient-centric, team-based, lifestyle-focused care at the foundation. With an economic and treatment imperative to reimagine care, recognizing more intervention is not always better, a collaborative approach was designed, which placed functional improvement of the patient at the center. This article described the process of implementing LM into an MSK model of care. The change management process impacted clinical, operational, and benefit plan design to facilitate an integrated care model. A new understanding of patients’ co-occurring physical impairments, medical comorbidities, and behavioral health needs was necessary for clinicians to make the shift from a pathoanatomic, transactional model of care to a biopsychosocial, longitudinal model of care. The authors explored the novel intersection of the implementation of a biopsychosocial model of care using LM principles to achieve greater value for the MSK patient population.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000420/pdfft?md5=f0fcd09920f1f12c0732340e2c1eed5b&pid=1-s2.0-S2542454824000420-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141979844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2024-08-11 DOI: 10.1016/j.mayocpiqo.2024.07.005

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Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2024-08-11 DOI: 10.1016/j.mayocpiqo.2024.07.004

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