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

{"title":"Financial Toxicity of Partial Versus Whole Breast Irradiation: A Systematic Review","authors":"Taema Brinjikji MD ,&nbsp;Kimberly S. Corbin MD ,&nbsp;Zhen Wang PhD ,&nbsp;M. Hassan Murad MD ,&nbsp;Dean A. Shumway MD","doi":"10.1016/j.mayocpiqo.2025.100632","DOIUrl":"10.1016/j.mayocpiqo.2025.100632","url":null,"abstract":"<div><h3>Objective</h3><div>To determine if accelerated partial breast irradiation (APBI) is associated with less financial toxicity (financial difficulties that patients experience due to treatment, such as out-of-pocket costs, transportation costs, and time away from work) than whole breast irradiation (WBI).</div></div><div><h3>Patients and Methods</h3><div>We searched bibliographic databases for studies published from database inception through April 2024. Eligible studies were randomized clinical trials and observational studies that evaluated financial toxicity of APBI or WBI treatments among adult women with early-stage breast cancer. Pairs of independent reviewers selected the studies.</div></div><div><h3>Results</h3><div>Nine studies met the inclusion criteria. One study using the comprehensive score for financial toxicity did not report a significant difference between APBI and WBI. Four studies using the European Organization for Research and Treatment of Cancer QLQ-C30 financial difficulties question reported greater financial difficulties with WBI when compared with APBI, with 2 studies reporting differences within 3 months of radiotherapy and 2 studies reporting differences at 1-2 years. Four studies evaluated the cost of travel and days away from work and reported less financial impact associated with APBI when compared with WBI.</div></div><div><h3>Conclusion</h3><div>APBI is associated with less financial toxicity than WBI, which may be dependent on the shorter duration of treatment.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100632"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144205104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital-at-Home Patient Fall Predictors","authors":"Cristian Madrid MD ,&nbsp;Karthik Gnanapandithan MD ,&nbsp;Michael G. Heckman MS ,&nbsp;Sophia G. Blumenfeld BS ,&nbsp;Rachel Gothot MHA ,&nbsp;Colt Cowdell MD ,&nbsp;Michael J. Maniaci MD ,&nbsp;Sally Anne Brown JD ,&nbsp;Jennifer B. Cowart MD ,&nbsp;Margaret Paulson DO ,&nbsp;Wendelyn Bosch MD","doi":"10.1016/j.mayocpiqo.2025.100633","DOIUrl":"10.1016/j.mayocpiqo.2025.100633","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate predictors of falls in the hospital-at-home (HaH) setting from a single institution in 3 US states.</div></div><div><h3>Patients and Methods</h3><div>In this retrospective study of HaH patients residing in Florida, Wisconsin, and Arizona, we identified 51 patients who fell and were matched to 153 patients without fall, between July 2020 and July 2023. Patient demographics and clinical characteristics were collected, including age, sex, race, Charlson Comorbidity Index, geographic location, body mass index, Hester Davis Scale, admission diagnosis, continuous intravenous infusion, polypharmacy, marital status/life partnership, area deprivation index, and use of supplemental oxygen. Association of patient characteristics were examined using unadjusted and multivariable logistic regression models (July 29, 2020 to July 5, 2023).</div></div><div><h3>Results</h3><div>The rate of falls was 6.8 per 1,000 patient bed-days. In multivariable analysis, we found that older age (odds ratio [OR; per each 10-year increase], 1.37; <em>P</em>=.043), higher Charlson Comorbidity Index (OR [per each 5-unit increase], 1.80; <em>P</em>=.012), and supplemental oxygen use (OR, 2.05; <em>P</em>=.045) were independent predictors of falls in the HaH setting. Although not statistically significant, an increased risk of falls was observed in patients with a diagnosis of respiratory disorder (OR, 2.07; <em>P</em>=.075).</div></div><div><h3>Conclusion</h3><div>In patients hospitalized at home, the risk of falls may increase with older age, higher Charlson Comorbidity Index, and supplemental oxygen use. Mitigation strategies to prevent falls in patients with these risk factors should be considered in the HaH setting.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100633"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144205105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Evaluation of Artificial Intelligence Imaging Support Software for Acute Ischemic Stroke in the Mayo Clinic Telestroke Network","authors":"Brett H. Smith MD ,&nbsp;Jackson G. Wolfe ,&nbsp;Alvina Karam MD ,&nbsp;Bart M. Demarkschalk MD ,&nbsp;Courtney M. Hrdlicka MD ,&nbsp;Deena M. Nasr DO ,&nbsp;Felix E. Chukwudelunzu MD ,&nbsp;Charisse A. Nord MA ,&nbsp;Emily A. Pahl BA ,&nbsp;Claire Fernandez PhD ,&nbsp;Sam Wood ,&nbsp;Zoe VJ. Woodhead PhD ,&nbsp;Davide Carone MD, DPhil ,&nbsp;George Harston MBBS, Dphil ,&nbsp;Stephen W. English MD, MBA","doi":"10.1016/j.mayocpiqo.2025.100631","DOIUrl":"10.1016/j.mayocpiqo.2025.100631","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the real-world impact of artificial intelligence-driven decision support imaging software for patients with acute ischemic stroke in a mature telestroke network in the United States.</div></div><div><h3>Patients and Methods</h3><div>We conducted a prospective evaluation of stroke imaging support software in a robust, predominantly rural telestroke network (17 sites in Minnesota and Wisconsin). Data was collected from all patients who underwent video telestroke evaluation in a 3-month preimplementation period before installation of the software (from February 10, 2024 to May 9, 2024) and a 3-month postimplementation period while the software was in use (from May 10, 2024 to August 9, 2024). The preimplementation and postimplementation cohorts were directly compared (no control group included). Primary outcome measures were treatment rates and time to treatment (both treatment decision and delivery) for intravenous thrombolysis (IVT) and endovascular therapy (EVT); secondary outcomes included transfer rates, transfer times, and end user survey results.</div></div><div><h3>Results</h3><div>Total of 444 telestroke cases were included in the preimplementation period, and 463 in the postimplementation period. Comparing preimplementation and postimplementation periods, the rate of IVT treatment delivery rose from 26.6% to 35.0% of potentially eligible patients (<em>P</em>=.24), whereas EVT treatment delivery remained at 31%. Time to IVT delivery reduced from 47 minutes to 41 minutes (<em>P</em>=.772), and time to EVT treatment rose from 156 minutes to 157 minutes (<em>P</em>=.771). Overall rates of treatment (IVT or EVT) rose from 23.1% to 23.9% of potentially eligible patients (<em>P</em>=.944). Although none of the clinical outcomes reached statistical significance, the survey results reported good user satisfaction with algorithm performance and image viewing.</div></div><div><h3>Conclusion</h3><div>This study reported a nonsignificant increase in treatment rates and a decrease in time to treatment decisions. Future trials with larger sample sizes are needed to validate the real-world benefits of decision support software for acute ischemic stroke in an established telestroke network.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100631"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing and Deploying a Hypertension Remote Patient Monitoring Program 101","authors":"Musab S. Hommos MBBS ,&nbsp;Praneetha Elugunti MHA, MBA ,&nbsp;Amanda M. Pullee DNP ,&nbsp;Clay W. Walker PA-C ,&nbsp;Karen S. Drechsel DNP ,&nbsp;Stephanie R. Pinello MSN ,&nbsp;Andrea Fillers MSN ,&nbsp;Nandita Khera MD, MPH ,&nbsp;Margaret M. Paul PhD, MS","doi":"10.1016/j.mayocpiqo.2025.100629","DOIUrl":"10.1016/j.mayocpiqo.2025.100629","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the development and deployment of a remote patient monitoring (RPM) program for hypertension and to share outcomes from an initial cohort of patients enrolled in this program.</div></div><div><h3>Patients and Methods</h3><div>The development of an RPM program for hypertension is described in detail. A sample of patients who were enrolled in RPM, participated for at least 2 weeks, and completed the program from January 1, 2023, to December 31, 2023, were included in the analysis. Clinical data were summarized using descriptive statistics. For comparing continuous variables, the independent samples <em>t</em> test was employed. For analyzing relationships between categorical variables, the χ² test was utilized.</div></div><div><h3>Results</h3><div>Total of 101 patients met the inclusion criteria. The median age was 69 years with a range from 22 to 95 years; 51 (51%) were men, 93 (92%) were White, and 6 (6%) identified as Hispanic. The median length of participation in the program was 38 days, with a range from 18 to 160 days. The average blood pressure decreased during program enrollment from 153/84 to 126/75 mm Hg (<em>P</em>&lt;.001), whereas heart rate decreased from 73 to 70 bpm (<em>P</em>=.03). On average, the number of antihypertensive drugs increased from 2.06 to 2.3 (<em>P</em>=.02). On average, clinicians received 1.1 messages per week per enrolled patient in RPM.</div></div><div><h3>Conclusion</h3><div>Developing and implementing an RPM program for hypertension is feasible with adequate resources, planning, and piloting. These programs are associated with clinically significant improvements in blood pressure control for patients with hypertension without considerably increasing calls and messages from patients beyond routine care.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100629"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the Process of Engagement With Digital Health Interventions: A Cross-Case Synthesis","authors":"Madison Milne-Ives PhD ,&nbsp;Sophie R. Homer PhD ,&nbsp;Jackie Andrade PhD ,&nbsp;Edward Meinert PhD","doi":"10.1016/j.mayocpiqo.2025.100625","DOIUrl":"10.1016/j.mayocpiqo.2025.100625","url":null,"abstract":"<div><h3>Objective</h3><div>To map the associations between affective, cognitive, and behavioral components of engagement with digital health interventions to provide a framework to improve intervention design, evaluation, and impact.</div></div><div><h3>Patients and Methods</h3><div>An exploratory multiple case study examined 3 studies evaluating a childhood obesity mobile application (NoObesity, data collection: from September 15, 2020 to June 23, 2021), a mental health conversational agent mobile application (Wysa, data collection: from December 13, 2022 to July 31, 2023), and a telephone-delivered conversational agent postsurgical assessment (Dora R1, data collection: from September 17, 2021 to January 31, 2022). Qualitative data from semi-structured interviews (NoObesity: n=15, Wysa: n=4, and Dora R1: n=20) was analyzed using a codebook thematic analysis approach to generate models mapping engagement. A cross-case analysis compared the 3 models with a hypothesized model.</div></div><div><h3>Results</h3><div>The case studies highlighted close associations between affective, cognitive, and behavioral components throughout the engagement process. Similar patterns of engagement were generated from the case studies, but these patterns differed from the literature-based hypothesized model in the order of influence of cognitive and affective engagement.</div></div><div><h3>Conclusion</h3><div>Understanding how different components of engagement interact is essential for designing interventions that mitigate barriers to engagement and maximize intervention impact. The framework provides a preliminary guide and recommendations for how to support particular components. Future research on the order of cognitive and affective components (or importance thereof) and testing the influence of particular features on engagement components could improve the framework and clinical impact.</div></div><div><h3>Trial Registration</h3><div><span><span>clinicaltrials.gov</span><svg><path></path></svg></span> Identifier: NoObesity: <span><span>NCT05261555</span><svg><path></path></svg></span>; Wysa: <span><span>NCT05533190</span><svg><path></path></svg></span>; Dora R1: <span><span>NCT05213390</span><svg><path></path></svg></span></div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 3","pages":"Article 100625"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144154895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Trial of At-Home COVID-19 Tests, Telemedicine, and Rapid Prescription Delivery for Immunocompromised Individuals","authors":"Julia Moore Vogel PhD ,&nbsp;Ting-Yang Hung BS ,&nbsp;Erin Coughlin BS ,&nbsp;Felipe Delgado BS ,&nbsp;Vik Kheterpal MD ,&nbsp;Giorgio Quer PhD ,&nbsp;Eric Topol MD","doi":"10.1016/j.mayocpiqo.2025.100627","DOIUrl":"10.1016/j.mayocpiqo.2025.100627","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether access to at-home COVID-19 tests, telemedicine, and same-day prescription delivery could reduce COVID cases, hospitalizations, and the cost of COVID care for the high-risk populations using a randomized controlled trial.</div></div><div><h3>Patients and Methods</h3><div>Individuals participated remotely between December 1, 2022, and May 16, 2024, with half (n=346, 51.5%) receiving the option to access 10 at-home COVID-19 tests per month for themselves and others in their household as well as telemedicine and same-day Paxlovid delivery, and half (n=325, 48.4%) following their standard testing and treatment practices. Outcome data were collected from surveys, electronic health records and claims.</div></div><div><h3>Results</h3><div>Intensive care unit admissions were significantly reduced for intervention participants vs control participants (0.3% vs 4.6%, n=1 vs 13; <em>P</em>&lt;.001). Reported COVID case incidence did not differ significantly (19.0% vs 20.4%, n=59 vs 58; <em>P</em>=.69), nor did hospitalizations (5.2% vs 7.7%, n=15 vs 22; <em>P</em>=.14). The intervention was estimated to result in a reduction of $3650 in the cost of COVID care per person. The specific intervention used is no longer available in the market and alternatives should be considered. Evolution of SARS-CoV-2 could change the effect observed. Survey completion was higher in the intervention group.</div></div><div><h3>Conclusion</h3><div>In immunocompromised individuals and those at least aged 65 years, access to at-home COVID tests, telemedicine, and rapid Paxlovid delivery reduced the severity of COVID-19 infections, as reflected by a reduced need for intensive care unit admissions; this has the potential to reduce the cost of COVID care.</div></div><div><h3>Trial Registration</h3><div><span><span>clinicaltrials.gov</span><svg><path></path></svg></span> Identifier: <span><span>NCT05655546</span><svg><path></path></svg></span></div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 3","pages":"Article 100627"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"10.1016/j.mayocpiqo.2025.100602","DOIUrl":"10.1016/j.mayocpiqo.2025.100602","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 3","pages":"Article 100602"},"PeriodicalIF":0.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144072665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Camaraderie: Profession-Specific Facilitated Small Groups to Improve Well-Being in Health Care","authors":"Megan Furnari MD ,&nbsp;Sean P.M. Rice PhD ,&nbsp;Alexis C. Jaggers BA ,&nbsp;Abigail Lenhart MD ,&nbsp;Marie V. Soller MD","doi":"10.1016/j.mayocpiqo.2025.100624","DOIUrl":"10.1016/j.mayocpiqo.2025.100624","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the impact of profession-specific small groups for physicians, nurses, advanced practice providers, and managers led by trained peer facilitators with the intention to improve aspects of well-being.</div></div><div><h3>Participants and Methods</h3><div>This is a single-center, pilot, nonrandomized control trial of the Camaraderie group intervention with employees at Oregon Health and Science University (N=151; intervention, n=89; control, n=62). The intervention condition included 8 groups of 10 to 12 participants and 2 facilitators. Groups met 6 times for a 1-hour virtual session during a 3-month period from March to May 2023. Each session had a theme and 2 prompts. Participants were surveyed prior to the first session, immediately after the 6 sessions, and then 3 months after the program concluded. Validated metrics assessed included burnout, belonging, job satisfaction, and perceived stress levels.</div></div><div><h3>Results</h3><div>After completing the 6 sessions, 72.5% of intervention participants reported attending 5 or 6 of the 6 sessions, and 86.0% rated the facilitation as above average or highest value. Belonging on a Likert scale from 1 to 5 (strong agreement) had a statistically significant increase of +0.45 (mean change or difference-in-difference; <em>P</em>=.03), from baseline to postsession relative to the control group. Stress (Likert 0-4 [very often]) and depersonalization (Likert 0-6 [every day]) had a statistically significant decreases from baseline to postsession (−0.21; <em>P</em>=.04, and −0.70; <em>P</em>=.02, respectively), relative to the control. There were no effects on job satisfaction or emotional exhaustion and no maintenance effects at the 3-month survey.</div></div><div><h3>Conclusion</h3><div>Profession-specific facilitated virtual small groups provide a high-impact experience with a minimal time commitment and support the well-being and belonging of the health care workforce.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 3","pages":"Article 100624"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144068573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longer Drug Retention of Interleukin-12/23 or Interleukin-17 Inhibitors Compared With TNF Inhibitors in Female Patients With TNF Inhibitor-Experienced Psoriatic Arthritis","authors":"Godehard A. Scholz MD, PhD ,&nbsp;Eleftherios Papagiannoulis MSc ,&nbsp;Christoph Blapp MSc ,&nbsp;Raphael Micheroli MD ,&nbsp;Adrian Ciurea MD ,&nbsp;Michael J. Nissen MD ,&nbsp;Nikhil Yawalkar MD ,&nbsp;Diana Dan MD ,&nbsp;Jennifer Amsler MD ,&nbsp;Almut Scherer PhD ,&nbsp;Burkhard Möller MD","doi":"10.1016/j.mayocpiqo.2025.100622","DOIUrl":"10.1016/j.mayocpiqo.2025.100622","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the effectiveness of Interleukin (IL)-12/23 or IL-17A inhibitors (summarized to inhibitors of the Th17 cell generation or function, Th17i) with tumor necrosis factor inhibitors (TNFi) in patients with TNFi-experienced psoriatic arthritis (PsA).</div></div><div><h3>Patients and Methods</h3><div>We conducted a comparative effectiveness study by taking advantage of prospectively collected patients with PsA data from the Swiss Clinical Quality Management in Rheumatic Diseases register, encompassing the interval from January 1, 2015 to August 1, 2021. Drug retention was the primary outcome in unadjusted and inverse propensity-weighted Cox regression models. Secondary outcomes were a static skin score for psoriasis, the American College of Rheumatology (ACR) 20, 50, and 70 response rates, and the disease activity in PsA score.</div></div><div><h3>Results</h3><div>At baseline, Th17i (n=341) were initiated in patients with more severe skin disease, but with comparable disease activity as TNFi (n=503) in all other disease domains. In the unadjusted analysis, Th17i were later discontinued than TNFi (median 828 vs 445 days, <em>P</em>&lt;.001), but the hazard ratio for discontinuation was significantly lower for Th17i than for TNFi only in women (0.57 [0.37-0.87], <em>P</em>=.01). Furthermore, differences in static skin scores between the groups at baseline were equalized at follow-up. However, improvements in the disease activity in PsA were similar in both groups, and ACR20 (33% [29%] vs 14% [13%]; <em>P</em>=.03) and ACR50 response rates (24% [21%] vs 7% [6%]; <em>P</em>=.02) were even higher for TNFi in unadjusted and (LUNDEX-adjusted) analyses.</div></div><div><h3>Conclusion</h3><div>After TNFi failure, more profound skin improvement and longer drug retention in women argue in favor of switching to Th17i in certain patient populations. However, TNFi may at least be equivalent in improving locomotor system manifestations and remain a viable option in the first and in the later treatment line of PsA.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 3","pages":"Article 100622"},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143935450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Setting Expectations When Prescribing Medication for the Treatment of Patients With Obesity","authors":"Angela Fitch MD","doi":"10.1016/j.mayocpiqo.2025.100621","DOIUrl":"10.1016/j.mayocpiqo.2025.100621","url":null,"abstract":"<div><div>The worldwide prevalence of obesity more than doubled between 1990 and 2022 (men, 4.8%-14.0%; women, 8.8%-18.5%), with similar trends observed for obesity-related diseases, including type 2 diabetes mellitus. Despite this increase in prevalence, many individuals with obesity remain untreated. There are several barriers limiting access to effective care, including the stigma and bias associated with obesity and lack of insurance coverage as a standard job benefit. Additionally, unrealistic expectations for rate of weight-loss and the weight-loss process as well as a lack of proper education on the weight-loss journey and treatment options can contribute to the inability to achieve weight-loss goals and a reluctance to try evidence-based approaches. Therefore, there is a need for effective management and education focusing on individualized treatment and setting viable expectations for the treatment of patients with obesity. Health care providers should compassionately discuss with their patients the importance of weight-loss, the long-term clinical benefits, and expectations for the weight-loss journey, including amount and timing of weight-loss, as well as the potential financial implications associated with obesity treatment. Health care providers should also be able to inform patients along the treatment journey, including about potential adverse events and how they can be managed. Importantly, treatments and decisions should be tailored to each patient using shared decision making with a focus on their characteristics, history, and goals. In this study, the expectations and current use of approved antiobesity medications in the United States are reviewed.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 3","pages":"Article 100621"},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143921573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}