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

{"title":"Comparing Clinical Outcomes and Health Care Utilization: Telehealth Versus Traditional Care at US Rural Hemodialysis Units","authors":"Mariam Charkviani MD ,&nbsp;Lagu A. Androga MD ,&nbsp;Arvind K. Garg MD ,&nbsp;Priya Ramar MPH ,&nbsp;Rachel H. Amundson MHA ,&nbsp;Lisa E. Vaughan MS ,&nbsp;Ziad Zoghby MD ,&nbsp;Robert C. Albright Jr. DO","doi":"10.1016/j.mayocpiqo.2025.100645","DOIUrl":"10.1016/j.mayocpiqo.2025.100645","url":null,"abstract":"<div><h3>Objective</h3><div>To determine whether novel dialysis delivery models, such as telehealth visits combined with face-to-face visits in a hybrid model (telehealth hybrid model), positively influence clinical outcomes and healthcare utilization.</div></div><div><h3>Patients and Methods</h3><div>This retrospective cohort study compares the rates of emergency department visits, hospitalizations, and Medicare established hemodialysis quality metrics before and after implementation of a telehealth hybrid model focused among rural populations in regions served by the Mayo Clinic dialysis system between January 1, 2020, to December 31, 2020, versus face-to-face visits alone before implementation of the program from January 1, 2019, to December 31, 2019. In addition, we used a standardized anonymous survey to examine patient perspectives toward the implementation of telehealth at the dialysis units.</div></div><div><h3>Results</h3><div>No significant differences in health care utilization outcomes (emergency department visits: Incidence rate ratios, 95% CI, 0.87 (0.62-1.22); <em>P</em>=.41; hospitalizations: Incidence rate ratios, 95% CI, 0.92 (0.63-1.35); <em>P</em>=.68) or clinical outcomes (abnormal laboratory measures) between the telehealth and standard care groups were observed. Patient satisfaction with telehealth was high, with 90% reporting successful video visits.</div></div><div><h3>Conclusion</h3><div>Our study provides evidence suggesting that the telehealth hybrid model can deliver nephrology care comparable to traditional care models in in-center dialysis without negatively impacting clinical outcomes, health care utilization, or patient satisfaction. Further research is necessary to confirm these results in other settings and to explore the long-term impacts of such hybrid care models.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100645"},"PeriodicalIF":0.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144713436","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":"Nonsurgical Management of Abdominal Compartment Syndrome Using Transarterial Embolization and Percutaneous Catheter Drainage: A Case Report","authors":"Subhash Chander MBBS, MPH ,&nbsp;Marco A. Bracamonte MD ,&nbsp;Newton B. Neidert MD ,&nbsp;Samuel I. Garcia MD","doi":"10.1016/j.mayocpiqo.2025.100644","DOIUrl":"10.1016/j.mayocpiqo.2025.100644","url":null,"abstract":"<div><div>Abdominal compartment syndrome (ACS) is a critical condition characterized by increased intra-abdominal pressure and, if left untreated, can cause organ dysfunction and multiorgan failure. We present a case of an elderly man who developed ACS secondary to hemoperitoneum from a splenic artery laceration after multiple falls. Despite successful arterial embolization, the patients’ ACS worsened considerably. Given his high surgical risk and advanced age, percutaneous catheter drainage was performed. The procedure was uneventful and led to the resolution of the ACS. This case highlights the importance of early recognition and close monitoring of intra-abdominal pressure and the utility of minimally invasive strategies for managing ACS in patients with high-surgical risk.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100644"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670842","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":"Point-of-Care Testing and Treatment of Hepatitis C Virus in Prisons: The SINTESI Project in Sicily","authors":"Lorenza Di Marco MD, PhD ,&nbsp;Fabio Cartabellotta MD ,&nbsp;Fabio Santangelo MD ,&nbsp;Fabrizio Scalici MD ,&nbsp;Rosario Insinna RN ,&nbsp;Tullio Prestileo MD ,&nbsp;Maria Giovanna Minissale MD ,&nbsp;Francesca Pasca PA ,&nbsp;Vincenza Calvaruso MD, AP ,&nbsp;Antonio Craxi MD, FP ,&nbsp;Vito Di Marco MD, FP","doi":"10.1016/j.mayocpiqo.2025.100643","DOIUrl":"10.1016/j.mayocpiqo.2025.100643","url":null,"abstract":"<div><h3>Objective</h3><div>To eradicate hepatitis C virus (HCV) infection among prisoners using specific models of screening and linkage to care.</div></div><div><h3>Patients and Methods</h3><div>The Sicilian Network for Therapy, Epidemiology and Screening in Hepatology (SINTESI) runs an HCV point-of-care project in all 23 prisons in Sicily. All prisoners received information on HCV screening and the possibility of receiving treatment with direct-acting antiviral (DAA) therapy during imprisonment. HCV status was assessed by rapid oral test and immediate reflex testing for HCV-RNA by Xpert HCV Viral Load. HCV-RNA–positive subjects received DAA therapy within 72 hours of screening.</div></div><div><h3>Results</h3><div>The project was conducted from October 18, 2021, through March 24, 2023. Among 5912 prisoners (98% of the entire prison population) informed of the screening project, 5050 (85.4%) accepted HCV testing. The mean age was 41.8 years (range, 18-86 years), and 4843 (95.9%) were males. Overall, 245 subjects (4.8%) tested positive for anti-HCV. Among 245 anti-HCV-positive prisoners, 20 (8.1%) refused the HCV-RNA test; 100 (40.9%) tested negative (80 had a previous DAA treatment) and 125 (51.1%) tested positive for HCV-RNA. Twelve (4.9%) of the latter refused treatment, whereas 113 (46.2%) started a cycle of DAA drugs during imprisonment. Of these, 99 (87.9%) completed DAA therapy, and 98 (86.7%) obtained HCV clearance.</div></div><div><h3>Conclusion</h3><div>The findings highlight the importance of tailored interventions for high-risk populations, and the model is replicable in other regions and contexts.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100643"},"PeriodicalIF":0.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663343","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":"Immunogenicity and Safety of ChAdOx1 nCoV-19 (AZD1222) as a Homologous Fourth-Dose Booster: A Substudy of the Phase 3 COV003 Trial in Brazil","authors":"Sue Ann Costa Clemens MD, PhD ,&nbsp;Sagida Bibi PhD ,&nbsp;Natalie G. Marchevsky MSc ,&nbsp;Parvinder K. Aley PhD ,&nbsp;Federica Cappuccini PhD ,&nbsp;Sophie A. Davies BSc ,&nbsp;Isabela Gonzalez PhD ,&nbsp;Sarah C. Kelly MSc ,&nbsp;Yama F. Mujadidi MSc ,&nbsp;Eveline Pipolo Milan MD, PhD ,&nbsp;Alexandre V. Schwarzbold PhD ,&nbsp;Eduardo Sprinz MD, DSc ,&nbsp;Merryn Voysey DPhil ,&nbsp;Lily Y. Weckx MD, PhD ,&nbsp;Daniel Wright DPhil ,&nbsp;Himanshu Bansal MS ,&nbsp;Maria A.S. Bergagård MSc ,&nbsp;Abby J. Isaacs MS ,&nbsp;Elizabeth J. Kelly PhD ,&nbsp;Dongmei Lan MS ,&nbsp;Andrew J. Pollard FMedSci","doi":"10.1016/j.mayocpiqo.2025.100642","DOIUrl":"10.1016/j.mayocpiqo.2025.100642","url":null,"abstract":"<div><h3>Objective</h3><div>To address that, despite widespread use of ChAdOx1 nCoV-19 (AZD1222) as a COVID-2019 booster, fourth-dose clinical outcomes data are limited. We report immunogenicity and safety for ChAdOx1 nCoV-19 as a homologous fourth-dose booster.</div></div><div><h3>Participants and Methods</h3><div>Participants (aged ≥18 years) who had received 2 doses of ChAdOx1 nCoV-19 in phase 3 COV003 trial in Brazil were offered a third dose after a planned dose interval from 11 to 13 months and a fourth dose after a planned interval from 6 to 15 months (both 5 × 10¹⁰ viral particles). All fourth doses were administered to substudy participants between August 18 and October 28, 2022. The data cutoff was December 9, 2022. The primary immunogenicity outcome was noninferiority of ancestral severe acute respiratory syndrome coronavirus (SARS-CoV)-2–neutralizing antibody responses 28 days after dose 4 versus dose 3. Solicited and unsolicited adverse events were recorded 7 and 28 days postdose 4, respectively.</div></div><div><h3>Results</h3><div>172 participants received a fourth dose (median interval postthird dose, 10.7 months). Ancestral SARS-CoV-2–neutralizing antibody titers postdose 4 were noninferior to those postdose 3; geometric mean fold rise was 1.9 (95% CI, 1.6-2.4; n=112). Immunogenicity results were consistent across all variants analyzed. Local and systemic solicited adverse events were reported in 60.3% (n=35/58) and 43.1% (n=25/58) of participants, respectively.</div></div><div><h3>Conclusion</h3><div>Immune responses after a fourth dose of ChAdOx1 nCoV-19 were noninferior to those after a third dose across SARS-CoV-2 variants. The fourth dose was well tolerated with no emergent safety concerns, supporting the continued development of the ChAdOx1 platform in preparation for future pandemics.</div></div><div><h3>Trial Registration</h3><div><span><span>clinicaltrials.gov</span><svg><path></path></svg></span> Identifier: <span><span>NCT04536051</span><svg><path></path></svg></span></div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100642"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605570","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":"Minibeam Radiation Therapy for Recurrent Mucosal Melanoma: An Eye-Opening Response","authors":"Maddi A. Jacobson MPAS, PA-C ,&nbsp;Yasamin Sharifzadeh MD ,&nbsp;Arkadiusz Z. Dudek MD, PhD ,&nbsp;Svetomir N. Markovic MD, PhD ,&nbsp;Jeffrey E. Johnson MD ,&nbsp;Jonathan M. Morris MD ,&nbsp;Scott C. Lester MD ,&nbsp;Robert W. Mutter MD ,&nbsp;Michael P. Grams PhD ,&nbsp;Sean S. Park MD, PhD","doi":"10.1016/j.mayocpiqo.2025.100640","DOIUrl":"10.1016/j.mayocpiqo.2025.100640","url":null,"abstract":"<div><div>We report a case of novel radiation treatment referred to as minibeam radiation therapy (MBRT) that was used to treat recurrent mucosal melanoma. The patient’s disease recurred after surgery, conventional radiation therapy, and 4 lines of systemic therapy, and then, the patient was referred to our clinic. Despite substantial disease progression after multiple prior therapies, a complete metabolic and clinical response, along with an improved quality of life and performance status, was achieved after 2 treatments of MBRT. Additionally, disease response was noted in an unirradiated abdominal metastasis. The MBRT treatments were well-tolerated, with minimal toxicity reported more than 6 months posttreatment. This case highlights the potential of MBRT as a completely novel form of radiation therapy that warrants further study.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100640"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517639","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":"Epidemiological Study of Childhood Idiopathic Epilepsy from 1990 to 2021 at Global, Regional, and National Scales","authors":"Li Wang MM ,&nbsp;Lei Tang MM ,&nbsp;Ji Zhang MM ,&nbsp;Ye Li MM ,&nbsp;Feng Zhang MD ,&nbsp;Qiaoling Tang MB ,&nbsp;Siyuan Ma MB ,&nbsp;Ran Liu MB ,&nbsp;Xiangbin Zhang MM ,&nbsp;Sai Wang MD ,&nbsp;Yupeng Zhang MM ,&nbsp;Lei Chen MM ,&nbsp;Junyi Ma MM ,&nbsp;Xuelun Zou MM ,&nbsp;Tianxing Yao MM ,&nbsp;Rongmei Tang MM ,&nbsp;Yexiang Yi MB ,&nbsp;Yi Zeng PhD ,&nbsp;Duolao Wang PhD ,&nbsp;Le Zhang MD","doi":"10.1016/j.mayocpiqo.2025.100641","DOIUrl":"10.1016/j.mayocpiqo.2025.100641","url":null,"abstract":"<div><h3>Objective</h3><div>To address the long-term impact of childhood idiopathic epilepsy on health and families, and to provide epidemiological evidence for developing effective prevention and treatment strategies, this study aimed to explore the trends in incidence, deaths, and disability-adjusted life years (DALYs) of childhood idiopathic epilepsy globally and across regions from 1990 to 2021.</div></div><div><h3>Patients and Methods</h3><div>This cross-sectional analysis utilized data from the 2021 Global Burden of Disease database, covering idiopathic epilepsy cases among children aged 0-14 years across 204 countries and regions. The study period was from September 15, 2024, to October 31, 2024. Key indicators included incidence, deaths (all-cause and specific), and DALYs, with trend analysis conducted using the exponential annual percentage change (EAPC). All analyses were stratified by region, country, gender, and sociodemographic index (SDI).</div></div><div><h3>Results</h3><div>In 2021, there were 1,227,191 new cases of childhood idiopathic epilepsy globally (95% uncertainty interval [UI], 786,363-1,734,488). From 1990 to 2021, the total number of cases increased by 26.3% (95% UI, 6.8%-51.2%), with the incidence rising from 55.85 per 100,000 population to 60.998, and an EAPC of 0.2% (95% CI, 0.17-0.23). Deaths decreased by 29.5%, from 25,768 to 18,171, with the death rate dropping from 1.482 per 100,000 to 0.903 and an EAPC of −1.39% (95% CI, −1.48 to −1.3). DALYs decreased by 14.90%, reaching 3,564,497 in 2021 (95% UI, 2,700,944-4,753,410), with an EAPC of −0.94% (95% CI, −1.0 to −0.89). Low SDI regions bore the highest burden, with the highest death rate (1.459 per 100,000 in 2021). Regionally, tropical Latin America saw the fastest growth in incidence (EAPC 0.29), whereas Tajikistan had the highest death rate (2.766 per 100,000), and Taiwan Province of China had the highest DALY rate (99.718 per 100,000).</div></div><div><h3>Conclusion</h3><div>Childhood idiopathic epilepsy remains a significant global health challenge, with an increasing incidence. Despite a decline in global deaths and DALYs, the disease burden in low SDI regions remains substantial. Understanding the epidemiological characteristics of childhood idiopathic epilepsy is critical for developing effective prevention and management strategies. The findings highlight the importance of targeted interventions in resource-limited settings to bridge the gap in treatment outcomes for childhood epilepsy globally.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100641"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480191","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":"Nailfold Video Capillaroscopy in Acute and Chronic Skin Graft Versus Host Disease","authors":"Sehreen Mumtaz MBBS ,&nbsp;Florentina Berianu MD ,&nbsp;Puneet Bhullar MD, MS ,&nbsp;Jordan Phillipps MD ,&nbsp;Madiha Iqbal MBBS ,&nbsp;David Hodge MS ,&nbsp;Breanna Cane MPH ,&nbsp;Olayemi Sokumbi MD","doi":"10.1016/j.mayocpiqo.2025.100635","DOIUrl":"10.1016/j.mayocpiqo.2025.100635","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the utility of nailfold video capillaroscopy (NVC) in patients diagnosed with acute and chronic graft versus host disease (GVHD) of the skin.</div></div><div><h3>Patients and Methods</h3><div>Patients diagnosed with acute and chronic skin GVHD (n=11) and those without the diagnosis of GVHD (controls) (n=21) underwent NVC to assess capillary density, morphology, and hemorrhage. Statistical comparisons were made using Fisher’s exact test. The study was performed from March 1, 2024, to August 1, 2024.</div></div><div><h3>Results</h3><div>Patients diagnosed with acute and chronic GVHD were observed to have considerably more microhemorrhages, ramifications, and disorganized capillaries when compared with patients without a diagnosis of acute or chronic GVHD.</div></div><div><h3>Conclusion</h3><div>This study reveals significant NVC abnormalities in patients with GVHD, suggesting distinct microvascular features that imply potential diagnostic value. The NVC may be a valuable tool for diagnosing and monitoring GVHD and warrants further investigation in larger cohorts.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100635"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271897","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":"Patient Experiences of and Priorities for Traumatic Brain Injury Health Care in a US Level 1 Trauma Center: A Qualitative Study","authors":"Lindsay D. Nelson PhD ,&nbsp;Samuel Gray BA ,&nbsp;Courtney O. Barry PsyD ,&nbsp;Staci A. Young PhD","doi":"10.1016/j.mayocpiqo.2025.100630","DOIUrl":"10.1016/j.mayocpiqo.2025.100630","url":null,"abstract":"<div><h3>Objective</h3><div>To learn patient perspectives about health care in a level I trauma center for traumatic brain injury (TBI) that inform the design of better TBI systems of care.</div></div><div><h3>Patients and Methods</h3><div>This was a community-engaged qualitative study that enrolled 42 individuals who had been either treated and discharged home from a level I trauma center emergency department (n=21, 50%) or who were admitted to the trauma center inpatient units (n=21, 50%). Interviews, conducted from August 12, 2022, to September 22, 2023, inquired about injury, post-acute and after post-acute care, clinical and community supports received, unexpected experiences, and things that helped or hurt access to care and outcome. Thematic analyses were completed in October 2024.</div></div><div><h3>Results</h3><div>Four themes emerged. Participants conveyed a desire to be informed and engaged in their health and health care, reporting deficiencies, for example, in health care providers’ explanation of their TBI diagnosis, communication about in-hospital care, and discharge instructions. They reported varied difficulties navigating the health care system after discharge, resulting in no or insufficient TBI follow-up care. Third, responses illuminated the importance of social risk and resilience factors, with particularly important roles of financial strain and social support. Fourth, participants conveyed unique feelings of vulnerability and uncertainty about TBI resulting from its variable, uncertain course.</div></div><div><h3>Conclusion</h3><div>The findings align with and expand on findings from quantitative studies of common gaps in TBI care, whereas illuminating distinct targets for ongoing national and international efforts to develop more coordinated, patient-centered systems of care.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100630"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279281","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":"Exercise Testing Characteristics, Safety, and Quality in Patients with Cancer: A Systematic Review","authors":"Elisabeth Edvardsen PhD ,&nbsp;Tormod Skogstad Nilsen PhD ,&nbsp;Robert Novo BA ,&nbsp;Michael Curry BS ,&nbsp;Scott C. Adams PhD ,&nbsp;Konstantina Matsoukas MLIS ,&nbsp;Justin Huang BA ,&nbsp;Jasme Lee MS ,&nbsp;Chaya Moskowitz PhD ,&nbsp;Lee W. Jones PhD ,&nbsp;Jessica M. Scott PhD","doi":"10.1016/j.mayocpiqo.2025.100628","DOIUrl":"10.1016/j.mayocpiqo.2025.100628","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate exercise testing (ExT) characteristics, safety, and methodological quality in oncology settings.</div></div><div><h3>Patients and Methods</h3><div>In this systematic review, we searched electronic databases (PubMed, Embase, CINAHL, and Cochrane Library) from inception to March 2024. Studies using ExT to evaluate cardiorespiratory fitness or functional capacity in adults with a history of cancer were included. Summary data including ExT characteristics (eg, modality, cardiorespiratory fitness, and functional capacity results), safety (eg, adverse events [AE]), and methodological quality (eg, guideline adherence) was evaluated.</div></div><div><h3>Results</h3><div>A total of 642 unique studies with 94,960 patients (58.6±9.9 years; 49% women) were included. Among the 26 ExT modalities used, the maximal cardiopulmonary exercise test (CPET) with measurement of gas exchange (n=284, 40%) and the 6-minute walk test (6MWT) (n=240, 34%) were the most frequently performed. Of the 284 studies that conducted CPET, n=204 (72%) studies reported peak oxygen consumption in mL·kg^-1·min^-1; average peak oxygen consumption was 21.8±5.8 mL·kg^-1·min^-1. Of the 237 studies that conducted 6MWT, 155 (65%) reported distance in meters (m); average distance was 445m±79 m. A total of n=36 (23%) studies reported an average distance above 500 meter. The AEs were monitored in 58 (9.0%) studies wherein a total of 120 non-serious AEs were reported among n=5699 patients (0.02%). Methodological quality and reporting varied considerably.</div></div><div><h3>Conclusion</h3><div>The findings of this systematic review indicate that CPET with gas exchange and field-based tests such as the 6MWT are widely used; however, future research should prioritize improving safety monitoring, appropriate test selection, and methodological consistency to enhance the applicability of ExT in oncology care.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100628"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254722","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":"Associations Between Cancer and Atrial Fibrillation: The Atherosclerosis Risk in Communities Study","authors":"Romil R. Parikh MBBS, PhD, MPH ,&nbsp;Chetan Shenoy MD ,&nbsp;Jeffrey R. Misialek MPH ,&nbsp;Anne Blaes MD ,&nbsp;Faye L. Norby PhD, MPH ,&nbsp;Anna E. Prizment PhD ,&nbsp;Elsayed Z. Soliman MSc, MD ,&nbsp;Laura R. Loehr MD, PhD ,&nbsp;Alvaro Alonso MD, PhD ,&nbsp;Corinne E. Joshu MPH, PhD ,&nbsp;Elizabeth A. Platz ScD, MPH ,&nbsp;Lin Yee Chen MD, MS","doi":"10.1016/j.mayocpiqo.2025.100634","DOIUrl":"10.1016/j.mayocpiqo.2025.100634","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate temporal associations of cancer with subsequent incident atrial fibrillation (AF) and temporal associations of AF with subsequent incident cancer, within 3, 3 to 12, and &gt;12 months after index diagnosis.</div></div><div><h3>Patients and Methods</h3><div>We included 13,748 community-dwelling adults (mean age, 54 years) in the Atherosclerosis Risk in Communities study without cancer or AF histories at baseline (follow-up between January 1, 1987, and December 31, 2019). Atrial fibrillation was ascertained from electrocardiograms at study visits and health records. Cancer was ascertained via linkage with state registries and health records. We estimated associations of cancer with AF risk and AF with cancer risk by time since diagnosis using Cox regression, adjusting for shared risk factors and other cardiovascular diseases.</div></div><div><h3>Results</h3><div>In 3909 adults, cancer was diagnosed before AF. Atrial fibrillation risk was the highest within 3 months after cancer diagnosis (hazard ratio [HR], 11.71; 95% CI, 9.52-14.41), followed by 3 to 12 months (HR, 2.07; 95% CI, 1.54-2.80) and &gt;12 months (HR, 1.46; 95% CI, 1.29-1.64). In 1973 adults, AF was diagnosed before cancer. Cancer risk was the highest within 3 months of AF diagnosis (HR, 2.24; 95% CI, 1.47-3.41), followed by 3 to 12 months (HR, 1.28; 95% CI, 0.91-1.80) and &gt;12 months (HR, 1.09; 95% CI, 0.91-1.29).</div></div><div><h3>Conclusion</h3><div>In adult cancer patients, AF risk is the highest within 3 months after diagnosis and remains significantly elevated throughout survivorship but could be due to detection bias. Cancer risk is strongest within 3 months of AF diagnosis but significantly attenuated over time, suggesting detection bias and reverse causation.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100634"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263593","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}