Mayo Clinic proceedings. Innovations, quality & outcomes最新文献_第2页

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

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

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

引用次数: 0

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

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

引用次数: 0

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

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

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

引用次数: 0

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

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

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

引用次数: 0

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

引用次数: 0

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

引用次数: 0

Donation After Circulatory Death Donor Prognostication: An Emerging Challenge in Heart Transplantation 循环死亡捐献者预后：心脏移植手术面临的新挑战

Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2024-08-11 DOI: 10.1016/j.mayocpiqo.2024.07.006

引用次数: 0

Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2024-08-11 DOI: 10.1016/j.mayocpiqo.2024.06.003

引用次数: 0

Improving Patient Safety Through Proper Ordering and Administration of Andexanet Alfa 通过正确订购和使用 Andexanet Alfa 改善患者安全

Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2024-08-01 DOI: 10.1016/j.mayocpiqo.2024.03.003

{"title":"Improving Patient Safety Through Proper Ordering and Administration of Andexanet Alfa","authors":"","doi":"10.1016/j.mayocpiqo.2024.03.003","DOIUrl":"10.1016/j.mayocpiqo.2024.03.003","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate prescribing practices for the anti-Xa reversal agent, andexanet alfa, to identify challenges in ordering and administering this medication, and to offer recommendations to improve patient safety.</p></div><div><h3>Patients and Methods</h3><p>This retrospective study reviewed all adult patients treated with andexanet alfa (AA) at a single institution between January 1, 2018, and March 31, 2020. We identified ordering and administration benchmarks based on recommendations from previous clinical trials on AA. We then reviewed these medical records to determine compliance with these benchmarks. We also collected data related to thrombotic complications and mortality.</p></div><div><h3>Results</h3><p>Twenty-two AA dosing sets (loading and infusion dose) were given to 20 patients. Eight (36%) dosing sets met our ordering benchmarks regarding appropriate dose, time since last direct oral anticoagulants, urgency of administration, and documentation. Three (14%) dosing sets met the administrative benchmarks of being started within 30 minutes of the initial order, and 13 (59%) dosing sets had timely infusion of the infusion dose after the loading dose. No dosing set met all our administration benchmarks. There was 1 thrombotic event within 24 hours of the correct AA dose and 1 potential death related to AA.</p></div><div><h3>Conclusion</h3><p>This study highlights challenges in ordering and administering AA at our institution and brings awareness to potential similar concerns at other institutions. These challenges also identified the need for optimized order sets, a streamlined administration process, and frequent provider education to improve patient safety.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000134/pdfft?md5=0798b850a649b22639f8402e72ce6e3f&pid=1-s2.0-S2542454824000134-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141946748","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 : 2024-07-18 DOI: 10.1016/j.mayocpiqo.2024.06.002

引用次数: 0