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

{"title":"Utility of Noninvasive Testing Before Invasive Coronary Angiography in the Assessment for Revascularization.","authors":"Simon Parlow, Richard G Jung, Pietro Di Santo, Joanne Joseph, Stephanie Skanes, Omar Abdel-Razek, Graeme Prosperi-Porta, Pouya Motazedian, Michael Froeschl, Marino Labinaz, Rebecca Mathew, F Daniel Ramirez, Trevor Simard, Benjamin Hibbert","doi":"10.1016/j.mayocpiqo.2024.100589","DOIUrl":"10.1016/j.mayocpiqo.2024.100589","url":null,"abstract":"<p><strong>Objective: </strong>To examine the role of noninvasive testing (NIT) before invasive coronary angiography (ICA) by evaluating the association between a positive myocardial perfusion imaging (MPI) or computed tomography angiography (CTA) result and the decision to perform coronary revascularization.</p><p><strong>Patients and methods: </strong>We screened all patients who received ICA between August 1, 2015, and July 31, 2019, and identified those who received MPI or CTA within the preceding 12 months. We considered MPI to be a positive result if it found moderate or severe ischemia in a specific coronary territory and CTA to be a positive result if it identified a stenosis greater than 50% in any major coronary artery.</p><p><strong>Results: </strong>Of the 17,181 individual procedures, 2183 were included. Positive CTA had an odds ratio (OR) of 2.68 (95% CI, 1.82-3.94) for revascularization and positive MPI an OR of 1.29 (95% CI, 1.07-1.56). Overall sensitivity for CTA in the prediction of revascularization was 80.4% (95% CI, 75.7%-84.6%), with vessel-level sensitivity ranging from 57.3% (95% CI, 47.5%-66.7%) to 71.8% (95% CI, 65.8%-77.4%). Overall sensitivity of MPI was 48.2% (95% CI, 44.7%-51.7%), with territory-specific sensitivity ranging from 33.7% (95% CI, 29.9%-37.7%) to 36.5% (95% CI, 32.6%-40.6%). Overall specificity for CTA was low, at 39.5% (32.9%-46.3%), but higher when evaluating at the vessel level, ranging from 60.3% (95% CI, 54.5%-66.0%) to 83.5% (95% CI, 79.6%-86.9%). Overall specificity for MPI was 58.1% (95% CI, 54.9%-61.3%), with territory-specific specificity ranging from 78.6% (95% CI, 76.1%-80.9%) to 78.9% (95% CI, 76.5%-81.3%).</p><p><strong>Conclusion: </strong>In this population of patients referred for ICA, positive CTA was more closely associated with revascularization than MPI. Further studies are necessary to determine the role of NIT before ICA.</p>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 1","pages":"100589"},"PeriodicalIF":0.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030655","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}

{"title":"One Small Step by the National Institutes of Health Can be a Giant Leap for Persons With Disability.","authors":"Zuhair Niazi, Taimur Sher","doi":"10.1016/j.mayocpiqo.2024.11.001","DOIUrl":"10.1016/j.mayocpiqo.2024.11.001","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 6","pages":"549-550"},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904622","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}

{"title":"Reviewers for Mayo Clinic Proceedings: Innovations, Quality & Outcomes (2024)","authors":"","doi":"10.1016/j.mayocpiqo.2024.10.003","DOIUrl":"10.1016/j.mayocpiqo.2024.10.003","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 6","pages":"Page 548"},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698329","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}

{"title":"","authors":"","doi":"10.1016/j.mayocpiqo.2024.10.002","DOIUrl":"10.1016/j.mayocpiqo.2024.10.002","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 6","pages":"Page 536"},"PeriodicalIF":0.0,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656716","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}

{"title":"Minnesota Hospitals’ Plans for Implementing Statewide Guidance on Allocation of Scarce Critical Care Resources During the COVID-19 Pandemic","authors":"Kirsten A. Riggan MS, MA ,&nbsp;Sarah Kesler MD ,&nbsp;Debra DeBruin PhD ,&nbsp;Susan M. Wolf JD ,&nbsp;Jonathon P. Leider PhD ,&nbsp;Nneka Sederstrom MPH, PhD ,&nbsp;Jeffrey Dichter MD ,&nbsp;Erin S. DeMartino MD","doi":"10.1016/j.mayocpiqo.2024.09.003","DOIUrl":"10.1016/j.mayocpiqo.2024.09.003","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess hospitals’ plans for implementing Minnesota’s statewide guidance for allocating scarce critical care resources during the COVID-19 pandemic.</div></div><div><h3>Patients and Methods</h3><div>Individuals from 23 hospitals across Minnesota were invited to complete a 25-item survey between July 20, 2020, and September 18, 2020 to understand how hospitals in the state intended to operationalize statewide clinical triage instructions for scarce resources (including mechanical ventilation) and written ethics guidance on the allocation of critical care resources in the event crisis standards of care triggered triage.</div></div><div><h3>Results</h3><div>Of individuals invited from 23 hospitals, 14 hospitals completed the survey (60.9% institutional response rate) and described plans for triage at their respective hospitals. Planned triage team composition and size varied. Hospitals’ plans for which individuals should assign a triage score (reflecting patients’ illness severity) also differed markedly. Most respondents described plans for staff training to address potential bias in triage.</div></div><div><h3>Conclusion</h3><div>Despite explicit state guidance to encourage consistency across hospitals, we found considerable heterogeneity in implementation plans. Plans diverged from Minnesota’s written ethics guidance on whether to consider race during triage to help mitigate health disparities. Inconsistencies between the state’s 2 guidance documents could explain some of these differences. Collaboration between hospitals and committees developing statewide guidance may help identify barriers to effective operationalization. Ongoing review of published guidance and hospital plans can identify issues of clarity and consistency and promote equitable triage.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 6","pages":"Pages 537-547"},"PeriodicalIF":0.0,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656714","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}

{"title":"Abnormal Exercise Gas Exchange Before Pulmonary Emboli Diagnosis","authors":"Timothy Edwards MS ,&nbsp;Elisabet Børsheim PhD ,&nbsp;Andrew R. Tomlinson MD","doi":"10.1016/j.mayocpiqo.2024.10.001","DOIUrl":"10.1016/j.mayocpiqo.2024.10.001","url":null,"abstract":"<div><div>A 20-year-old male underwent diagnostic testing due to unexplained shortness of breath and chest discomfort. He had no previous medical problems and was not taking any medications. Initial evaluations included cardiopulmonary exercise testing (CPET), which yielded results that were reported as normal. However, over the following 2 months, his symptoms worsened considerably, including dyspnea with climbing stairs and then hemoptysis. Seeking urgent medical care, he presented to the emergency department, where he underwent further testing and was admitted to the hospital. Computed tomography angiogram reported bilateral pulmonary emboli. His parents requested a second opinion regarding the analysis of the CPET data, which revealed previously overlooked abnormalities. This overlooked data delayed pulmonary embolism diagnosis, and the patient ultimately required bilateral pulmonary thromboendarterectomy. In this case, we describe the hallmark signs of pulmonary vascular disease seen during CPET and offer clinical pearls to aid in timely detection.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 6","pages":"Pages 530-535"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656715","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}

{"title":"Post-Coronavirus Disease 2019 Effects in an Active University Population: A Within-Campus Cross-Sectional Study at a Major Educational Institution","authors":"Marcelo Hernández-Mora MD ,&nbsp;René Arredondo-Hernández PhD ,&nbsp;Carmen A. Castañeda-Camacho MD ,&nbsp;Pamela X. Cervantes-Gutierrez MD ,&nbsp;Gonzalo Castillo-Rojas PhD ,&nbsp;Samuel Ponce de León MD ,&nbsp;Yolanda López-Vidal PhD","doi":"10.1016/j.mayocpiqo.2024.09.004","DOIUrl":"10.1016/j.mayocpiqo.2024.09.004","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the associations among post-coronavirus disease 2019 (COVID-19) prevalence; risk factors and comorbidities have not been firmly established within a university outpatient population.</div></div><div><h3>Patients and Methods</h3><div>Records from 881 COVID-19 outpatient patients (504 females [57.9%] and 366 males [42.07%]), most of whom were between 30 and 40 years of age (mean=37.3 years old; 95% CI, 36.5-38.2), with initial infection data from February 2020 to August 2022 were reviewed once, whereas the survey took place during 2 different moments during the pandemic. The first period (April 20, 2021, to June 21, 2021) yielded 279 responses, whereas in the second period (June 23, 2021, to October 4, 2021), 602 responses were recorded. The instrument used contained 20 questions across 3 main domains: general information, data related to infection and adverse effects, and service satisfaction experience.</div></div><div><h3>Results</h3><div>All the patients were positive for immunoglobulin G antibodies against nucleocapsid by the third week. Post-COVID-19 symptoms arose at least 2 weeks after recovery from the initial illness; 654 individuals reported at least one symptom after the acute COVID-19 period, for a post-COVID-19 prevalence of 74.96%. The most frequent symptoms were fatigue (84%), headache (71%), and difficulty concentrating (71%). More than 60% of participants reported at least one comorbidity, among which the most common ones were obesity (35.9%), smoking (17.5%), and hypertension (12.2%).</div></div><div><h3>Conclusion</h3><div>In this study, we assessed post-COVID-19 prevalence among outpatients and found that comorbidities were strongly related to consequences impacting quality of life and mental health burden.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 6","pages":"Pages 521-529"},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656713","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}

{"title":"Development of a New Instrument to Measure Workplace Mental Health and Well-Being","authors":"Neil J. MacKinnon PhD ,&nbsp;Preshit N. Ambade DrPH ,&nbsp;Zach T. Hoffman MS ,&nbsp;Kaamya Mehra BS, MD(c) ,&nbsp;Brittany Ange EdD ,&nbsp;Alyssa Ruffa MPH ,&nbsp;Denise Kornegay MSW ,&nbsp;Nadine Odo MPH","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":"8 6","pages":"Pages 507-516"},"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}

{"title":"Rethinking Risk in Hypertrophic Cardiomyopathy: Assessing the Role of Myocardial Fibrosis and Left Ventricular Hypertrophy in Sudden Cardiac Death","authors":"Amro Badr MD ,&nbsp;Juan Farina MD ,&nbsp;Reza Arsanjani MD ,&nbsp;Srekar Ravi MD ,&nbsp;Michael O'Shea MD ,&nbsp;Omar Baqal MD ,&nbsp;Olubadewa Fatunde MD ,&nbsp;Jeffrey B. Geske MD ,&nbsp;Konstantinos C. Siontis MD ,&nbsp;Said Alsidawi MD","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":"8 6","pages":"Pages 517-520"},"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}

{"title":"Electronic Health Records, Health Outcomes, and Vital Statistics: Opportunities and Challenges","authors":"Aaron C. Spaulding PhD, MHA","doi":"10.1016/j.mayocpiqo.2024.08.005","DOIUrl":"10.1016/j.mayocpiqo.2024.08.005","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 6","pages":"Pages 505-506"},"PeriodicalIF":0.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418676","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}