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

Rethinking Risk in Hypertrophic Cardiomyopathy: Assessing the Role of Myocardial Fibrosis and Left Ventricular Hypertrophy in Sudden Cardiac Death 反思肥厚型心肌病的风险：评估心肌纤维化和左心室肥大在心脏性猝死中的作用

Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2024-10-10 DOI: 10.1016/j.mayocpiqo.2024.09.001

{"title":"Rethinking Risk in Hypertrophic Cardiomyopathy: Assessing the Role of Myocardial Fibrosis and Left Ventricular Hypertrophy in Sudden Cardiac Death","authors":"","doi":"10.1016/j.mayocpiqo.2024.09.001","DOIUrl":"10.1016/j.mayocpiqo.2024.09.001","url":null,"abstract":"<div><div>The American College of Cardiology/American Heart Association guidelines recommend implantable cardioverter-defibrillator (ICD) implantation for patients with hypertrophic cardiomyopathy (HCM) with a wall thickness of ≥30 mm (class IIA), whereas they give a class IIB recommendation for the implantation of an ICD on the basis of extensive late gadolinium enhancement alone. In this analysis, we show that in a high-risk population with ICD implanted for primary prevention of sudden cardiac death (SCD) in the setting of HCM, the presence of massive left ventricular hypertrophy predicts a higher incidence of ICD therapy than other traditional SCD risk factors. The presence of extensive myocardial fibrosis, however, identifies a subgroup of patients without massive left ventricular hypertrophy who have an equally high incidence of receiving appropriate device therapy. These findings suggest that the presence of extensive late gadolinium enhancement on cardiac magnetic resonance can be used as a risk modifier for traditional SCD risk factors in patients with HCM to better understand their overall risk of ventricular arrhythmias.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418680","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}

引用次数: 0

Development of a New Instrument to Measure Workplace Mental Health and Well-Being 开发测量工作场所心理健康和幸福感的新工具

Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2024-10-10 DOI: 10.1016/j.mayocpiqo.2024.09.002

{"title":"Development of a New Instrument to Measure Workplace Mental Health and Well-Being","authors":"","doi":"10.1016/j.mayocpiqo.2024.09.002","DOIUrl":"10.1016/j.mayocpiqo.2024.09.002","url":null,"abstract":"<div><h3>Objective</h3><div>To develop and pilot test a new instrument measuring workplace mental health and well-being among health professionals.</div></div><div><h3>Participants and Methods</h3><div>A new survey instrument (hereafter referred to as the <em>Augusta Scale</em>) was developed using Qualtrics on the basis of the 5 essentials in the Office of the Surgeon General’s (OSG) framework for workplace mental health and well-being (protection from harm, connection and community, work-life harmony, mattering at work, and opportunity for growth). The <em>Augusta Scale</em> contains 22 core questions (on a 1-5 Likert scale) and several demographic characteristic questions. We piloted the <em>Augusta Scale</em> from May 9, 2023, to June 5, 2023, with health professionals serving as preceptors for the Georgia Area Health Education Centers and assessed the instrument’s psychometric properties under the classical test theory paradigm.</div></div><div><h3>Results</h3><div>The survey’s response rate was 97.8% (583 responses out of 596 surveyed). Physicians comprised the largest health professional group surveyed (307, 52.7%), followed by advanced practice nurses (207, 35.5%), and physician assistants (69, 11.8%). The domain-specific Cronbach’s α ranged from 0.71 (0.67-0.75) to 0.90 (0.87-0.92), whereas the overall scale α was 0.94 (0.93-0.95), suggesting strong reliability. The Ω (high-order) score was 0.91, confirming that all items measured the latent construct. The convergent validity analysis confirmed the inverse relationship between total scale score and perception of burnout.</div></div><div><h3>Conclusion</h3><div>To our knowledge, the <em>Augusta Scale</em> is the first instrument to assess workplace mental health and well-being using the OSG’s framework. Findings from this pilot test of Georgia health professionals offer evidence to support its validity in certain domains.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418678","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}

引用次数: 0

Electronic Health Records, Health Outcomes, and Vital Statistics: Opportunities and Challenges 电子健康记录、健康结果和生命统计：机遇与挑战

Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2024-10-08 DOI: 10.1016/j.mayocpiqo.2024.08.005

引用次数: 0

Accuracy of Outcome Ascertainment in Long-Term Mortality After Coronary Artery Bypass Grafting 确定冠状动脉旁路移植术后长期死亡率的结果的准确性

Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2024-10-08 DOI: 10.1016/j.mayocpiqo.2024.08.006

{"title":"Accuracy of Outcome Ascertainment in Long-Term Mortality After Coronary Artery Bypass Grafting","authors":"","doi":"10.1016/j.mayocpiqo.2024.08.006","DOIUrl":"10.1016/j.mayocpiqo.2024.08.006","url":null,"abstract":"<div><div>Long-term outcome ascertainment can be affected by the follow-up performance and needs to use a different data source for more comprehensive data capture. However, a universal tracking system is absent in Japan, and long-term outcomes are often ascertained through electronic medical records (EMRs), the reliability of which is uncertain. In this study, we compared EMR-based and direct outreach–based collections on outcome ascertainment accuracy in 500 patients who underwent coronary artery bypass grafting. Mortality data for all patients were extracted from the EMR, as standard data collection. When patient death was not confirmed in the EMR, we enhanced to collect updated mortality information by direct outreach to patients, their family, or their physicians, as enhanced direct outreach data. As a result, the Kaplan-Meier curves found a notable separation between different data sources analyzed. Interestingly, mortality events in the latter half of the follow-up period (median, 6.5 years) were overestimated in the EMR-based data collection analysis because of the reduced number of actively tracked cases, highlighting a potential bias in the EMR-based data collection on long-term prognoses. Our findings suggest that an active follow-up strategy with better adherence will enhance the accuracy of long-term outcome ascertainment and be helpful to build more reliable real-world evidence.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418679","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}

引用次数: 0

Intracardiac Shunts Among Patients Undergoing Oil-Based Contrast Lymphangiography: Prevalence and Rate of Systemic Arterial Embolic Complications 接受油基对比淋巴管造影术患者的心内分流：全身动脉栓塞并发症的发生率和比率

Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2024-10-08 DOI: 10.1016/j.mayocpiqo.2024.08.003

{"title":"Intracardiac Shunts Among Patients Undergoing Oil-Based Contrast Lymphangiography: Prevalence and Rate of Systemic Arterial Embolic Complications","authors":"","doi":"10.1016/j.mayocpiqo.2024.08.003","DOIUrl":"10.1016/j.mayocpiqo.2024.08.003","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the prevalence of systemic embolic complications after oil-based contrast lymphangiography.</div></div><div><h3>Patients and Methods</h3><div>A retrospective medical record review of all patients undergoing oil-based lymphangiographic procedures from January 1, 2000, to December 31, 2021 was performed to identify the following: (a) the rate of systemic embolic complications after the procedure; (b) the presence of preprocedure echocardiographic assessment for right-to-left shunting; and (c) the presence of right-to-left shunting after a systemic embolic complication.</div></div><div><h3>Results</h3><div>A total of 350 patients (200 male, 57%) underwent 400 oil-based lymphangiographic procedures. A total of 2 systemic embolic complications occurred for a prevalence of 0.5% (2/400). Preprocedure echocardiography was performed in 226 patients (226/350, 65%). Identification of a right-to-left shunt was made in 25 patients (25/226, 11%, with the majority reporting shunting at rest (23/25, 92%). Of the patients with systemic embolic complications, one had multifocal systemic oil contrast emboli, and one had a large territorial cerebrovascular infarct without the presence of oil-based contrast noted. Both cases underwent preprocedure echocardiography reporting a structurally normal heart with no evidence of a shunt through color flow Doppler evaluation, but neither case had undergone a true shunt study. Both patients were identified to have a right-to-left shunt during the dedicated echocardiographic shunt study postprocedure.</div></div><div><h3>Conclusion</h3><div>Risk of a systemic embolic complication after oil-based contrast lymphangiography is rare but can be catastrophic. A standardized assessment for patients undergoing the procedure may be necessary to identify those at risk and to allow for appropriate preventive strategies to be employed.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418677","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}

引用次数: 0

Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2024-10-07 DOI: 10.1016/j.mayocpiqo.2024.08.004

引用次数: 0

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}

引用次数: 0

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

引用次数: 0

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

引用次数: 0

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}

引用次数: 0