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

{"title":"Improving Intravenous and Subcutaneous Insulin Overlap During Treatment of Diabetic Ketoacidosis: A Quality Improvement Project","authors":"Andrew A. Welch DO ,&nbsp;David Toro-Tobon MD ,&nbsp;Kharisa N. Rachmasari MD ,&nbsp;Rashi B. Sandooja MBBS ,&nbsp;Leili Rahimi MD ,&nbsp;Sneha Mohan MBBS ,&nbsp;Jennifer R. Hewlett MD ,&nbsp;Jennifer Clark MD ,&nbsp;Arvind Maheshwari MD ,&nbsp;Catherine Zhang MD ,&nbsp;Juan P. Brito MD","doi":"10.1016/j.mayocpiqo.2024.03.008","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2024.03.008","url":null,"abstract":"<div><h3>Objective</h3><p>To reduce the frequency of insufficient overlap of intravenous (IV) and subcutaneous (SC) insulin during the treatment of diabetic ketoacidosis (DKA) as a quality improvement project.</p></div><div><h3>Patients and Methods</h3><p>Rates of insufficient IV and SC insulin overlap (&lt; 2-hour overlap, SC insulin given after IV insulin discontinuation, or no SC insulin given after IV insulin discontinuation) were assessed in adults with DKA treated with IV insulin at a large tertiary care referral center in Rochester, Minnesota, from July 1, 2021, to March 15, 2023. After a preintervention analysis period, an electronic medical record–based best practice advisory was introduced to notify hospital providers discontinuing IV insulin if SC long-acting insulin had not been given in the previous 2-6 hours. Demographic characteristics and clinical outcomes before and after intervention were compared.</p></div><div><h3>Results</h3><p>A total of 352 patient encounters were included (251 in the preintervention phase and 101 in the postintervention phase). The rate of insufficient IV to SC insulin overlap decreased from (88 of 251) 35.1% before intervention to (20 of 101) 19.8% after intervention (<em>P</em>=.005). The rate of posttransition hypoglycemia (&lt;70 mg/dL; to convert to mmol/L, multiply by 0.0259) decreased from (27 of 251) 10.7% to (4 of 101) 4% after intervention (<em>P</em>=.04). Rates of posttransition hyperglycemia (&gt;250 mg/dL), rebound DKA, length of hospital stay, and duration of IV insulin therapy were similar before and after intervention.</p></div><div><h3>Conclusion</h3><p>Using quality improvement methodology, the rates of insufficient IV to SC insulin overlap during treatment of DKA in a large tertiary care referral center were measured and reduced through an electronic medical record–based best practice advisory targeting hospital providers.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000237/pdfft?md5=18b5044057996369c6c3a9a2e0bdac68&pid=1-s2.0-S2542454824000237-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141078062","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":"Advancing Lifestyle Medicine in New York City’s Public Health Care System","authors":"John S. Babich BS ,&nbsp;Michelle McMacken MD ,&nbsp;Lilian Correa MA, MPH, RDN ,&nbsp;Krisann Polito-Moller BS, NBC-HWC ,&nbsp;Kevin Chen MD, MHS ,&nbsp;Eric Adams MPA ,&nbsp;Samantha Morgenstern MS, RD, CDN ,&nbsp;Mitchell Katz MD ,&nbsp;Theodore G. Long MD, MHS ,&nbsp;Shivam Joshi MD ,&nbsp;Andrew B. Wallach MD ,&nbsp;Sapana Shah MD, MPH ,&nbsp;Rebecca Boas MD, MBA","doi":"10.1016/j.mayocpiqo.2024.01.005","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2024.01.005","url":null,"abstract":"<div><p>Chronic diseases are the leading cause of death and disability in the United States, and much of this burden can be attributed to lifestyle and behavioral risk factors. Lifestyle medicine is an approach to preventing and treating lifestyle-related chronic disease using evidence-based lifestyle modification as a primary modality. NYC Health + Hospitals, the largest municipal public health care system in the United States, is a national pioneer in incorporating lifestyle medicine systemwide. In 2019, a pilot lifestyle medicine program was launched at NYC Health + Hospitals/Bellevue to improve cardiometabolic health in high-risk patients through intensive support for evidence-based lifestyle changes. Analyses of program data collected from January 29, 2019 to February 26, 2020 demonstrated feasibility, high demand for services, high patient satisfaction, and clinically and statistically significant improvements in cardiometabolic risk factors. This pilot is being expanded to 6 new NYC Health + Hospitals sites spanning all 5 NYC boroughs. As part of the expansion, many changes have been implemented to enhance the original pilot model, scale services effectively, and generate more interest and incentives in lifestyle medicine for staff and patients across the health care system, including a plant-based default meal program for inpatients. This narrative review describes the pilot model and outcomes, the expansion process, and lessons learned to serve as a guide for other health systems.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000201/pdfft?md5=a86ed4db89fa2cfcb4f41c6f57148900&pid=1-s2.0-S2542454824000201-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141078745","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":"Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Severe Ischemic Left Ventricular Systolic Dysfunction","authors":"Ruth A. Mathew Kalathil MD ,&nbsp;Akshay Machanahalli Balakrishna MD ,&nbsp;Ahmed El-Shaer MD ,&nbsp;Andrew M. Goldsweig MD, MS ,&nbsp;Khagendra Dahal MD ,&nbsp;Saraschandra Vallabhajosyula MD, MSc ,&nbsp;Ahmed Aboeata MD","doi":"10.1016/j.mayocpiqo.2024.04.002","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2024.04.002","url":null,"abstract":"<div><p>Coronary artery disease is the most common cause of heart failure, which is the leading cause of cardiovascular-related death worldwide. There are insufficient data to make strong recommendations for percutaneous coronary intervention (PCI) in patients with severe ischemic left ventricular systolic dysfunction (LVSD). In that context, we performed a meta-analysis to compare the outcomes of PCI with those of optimal medical therapy alone in patients with severe ischemic LVSD. A systematic search was conducted in PubMed, EMBASE, and <span>ClinicalTrials.gov</span><svg><path></path></svg> from inception to December 2023. Our outcome of interest was all-cause mortality in patients undergoing PCI vs medical therapy. We used random effects models to aggregate data and to calculate pooled incidence and relative risk with 95% CIs. Four studies including 2 randomized controlled trials with 2080 patients (PCI, 1082; optimal medical therapy, 998) were included. All-cause mortality did not differ significantly between the groups: 168 patients (15.5%) in the PCI group vs 200 patients (20.0%) in the optimal medical therapy group (relative risk, 0.88; 95% CI, 0.75-1.09; <em>P</em>=.25). In conclusion, the available evidence indicates that PCI does not improve all-cause mortality in patients with severe LVSD without lifestyle-limiting anginal symptoms. Further data are needed to identify subgroups of patients better served by each modality.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000250/pdfft?md5=7fe4927a10a4fe4f8a0c1dbe0c0317dd&pid=1-s2.0-S2542454824000250-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141068240","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":"Supporting Sustainable Health Behavior Change: The Whole is Greater Than the Sum of Its Parts","authors":"Jessica A. Matthews DBH, NBC-HWC, DipACLM, FACLM ,&nbsp;Simon Matthews MHlthSc, NBC-HWC, PCC, DipIBLM, FASLM ,&nbsp;Mark D. Faries PhD ,&nbsp;Ruth Q. Wolever PhD, NBC-HWC","doi":"10.1016/j.mayocpiqo.2023.10.002","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.10.002","url":null,"abstract":"<div><p>Behavior change is the foundation for effective lifestyle prescriptions, yet such change is individualized, nonlinear and typically requires ongoing support. Health and wellness coaching (HWC) is a behavior change intervention with rapidly accruing evidence of positive impact on health behaviors such as exercise, nutrition and stress management. Furthermore, HWC enhances prevention and mitigates exacerbation of chronic lifestyle diseases, at least in the short-term (up to 6 months post intervention). Although the impact on long-term stability of behavior change remains unclear, it is evident that effective partnering with patients using key communication strategies, autonomy promotion, and flexible permissiveness can empower patients to develop healthy lifestyles. This partnership can be cultivated by clinicians as well as clinical team members including nationally board-certified coaches. Although much research is needed regarding the ongoing maintenance of lifestyle changes beyond 6 months, this article seeks to equip clinicians with current evidence, theoretical insights and practical strategies from a “coach approach” to foster more intrinsic forms of motivation which, in turn, empowers patients to adopt and maintain health-promoting behaviors.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000225/pdfft?md5=070b9e0b12433a14fa5430cd746b3a71&pid=1-s2.0-S2542454824000225-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141068242","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":"Phenotypic Clusters and Multimorbidity in Hypermobile Ehlers-Danlos Syndrome","authors":"Taylor Petrucci BS ,&nbsp;S. Jade Barclay MPH ,&nbsp;Cortney Gensemer PhD ,&nbsp;Jordan Morningstar BS ,&nbsp;Victoria Daylor BFA ,&nbsp;Kathryn Byerly BS ,&nbsp;Erika Bistran BS ,&nbsp;Molly Griggs MEd ,&nbsp;James M. Elliot PhD ,&nbsp;Teresa Kelechi RN, PhD ,&nbsp;Shannon Phillips RN, PhD ,&nbsp;Michelle Nichols RN, PhD ,&nbsp;Steven Shapiro DMD, MD ,&nbsp;Sunil Patel MD ,&nbsp;Nabila Bouatia-Naji PhD ,&nbsp;Russell A. Norris PhD","doi":"10.1016/j.mayocpiqo.2024.04.001","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2024.04.001","url":null,"abstract":"<div><h3>Objective</h3><p>To perform a retrospective clinical study in order to investigate phenotypic penetrance within a large registry of patients with hypermobile Ehlers-Danlos syndrome (hEDS) to enhance diagnostic and treatment guidelines by understanding associated comorbidities and improving accuracy in diagnosis.</p></div><div><h3>Patients and Methods</h3><p>From May 1, 2021 to July 31, 2023, 2149 clinically diagnosed patients with hEDS completed a self-reported survey focusing on diagnostic and comorbid conditions prevalence. K-means clustering was applied to analyze survey responses, which were then compared across gender groups to identify variations and gain clinical insights.</p></div><div><h3>Results</h3><p>Analysis of clinical manifestations in this cross-sectional cohort revealed insights into multimorbidity patterns across organ systems, identifying 3 distinct patient groups. Differences among these phenotypic clusters provided insights into diversity within the population with hEDS and indicated that Beighton scores are unreliable for multimorbidity phenotyping.</p></div><div><h3>Conclusion</h3><p>Clinical data on the phenotypic presentation and prevalence of comorbidities in patients with hEDS have historically been limited. This study provides comprehensive data sets on phenotypic presentation and comorbidity prevalence in patients with hEDS, highlighting factors often overlooked in diagnosis. The identification of distinct patient groups emphasizes variations in hEDS manifestations beyond current guidelines and emphasizes the necessity of comprehensive multidisciplinary care for those with hEDS.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000249/pdfft?md5=173024d0e7b069283554ef79152bdff4&pid=1-s2.0-S2542454824000249-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140947604","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":"Robotic-Assisted Resection of Rare Mitral Valve Hemangioma","authors":"Raffaele Rocco MD,&nbsp;Richard Daly MD,&nbsp;Armin Arghami MD","doi":"10.1016/j.mayocpiqo.2024.03.007","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2024.03.007","url":null,"abstract":"<div><p>Cardiac hemangiomas are extremely rare tumors accounting for only 1.5%-2.5% of all cardiac tumors. According to most recent literature, only 13 mitral valve hemangiomas have been reported. A 78-year-old man was undergoing routine transthoracic echocardiography monitoring for an ascending aortic dilation when a vegetation on the mitral leaflet was incidentally detected. This lesion presented as a 0.5- × 0.6-cm mobile mass arising from the medial aspect of the A2 cusp. Despite the asymptomatic nature of the aforementioned lesion, resection was pursued given presumed diagnosis of papillary fibroelastoma and concern for risk of stroke. The mass was resected using minimally invasive robotic approach, and final pathology was consistent with hemangioma.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000213/pdfft?md5=08b94c39e8745d053e31c79dd69d294d&pid=1-s2.0-S2542454824000213-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140893915","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":"Comparative Analysis of Coronavirus disease 2019 Vaccine Efficacy in Heart Transplant Recipients on Standardized Immunotherapy Regimens","authors":"Shriya Sharma MBBS ,&nbsp;Jose Ruiz MD ,&nbsp;Rohan Goswami MD","doi":"10.1016/j.mayocpiqo.2024.03.006","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2024.03.006","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the effect of coronavirus disease 2019 (COVID-19) infection on heart transplant recipients requiring immunotherapy. To investigate the effectiveness of vaccination in immunosuppressed heart transplant recipients during the initial years of the COVID-19 pandemic, and to examine the timing of COVID-19 infections in heart transplant recipients’ posttransplantation.</p></div><div><h3>Patients and Methods</h3><p>International data on COVID-19 infection in immunosuppressed populations is limited. Heart transplant recipients requiring immunotherapy are at risk for increased complications with COVID-19 infection. The availability of vaccination and temporal trends in this population has not been well described. We report outcomes in immunosuppressed patients during the initial years of the COVID-19 pandemic from March 1, 2019, to October 31, 2021, at Mayo Clinic in Florida.</p></div><div><h3>Results</h3><p>A total of 98 patients were reviewed, of which 49 were COVID-19–positive (CP), and 49 were negative (CN). The cohort was well matched, with a median age of 58 years (49–65 years) in both groups. Females consisted of 41% in the CP group and 18.4% in the CN group. Immunosuppression was not significantly different for CP or CN patients. The median time from transplant to CP was 384 days (237–677 days). The CN group’s median follow-up after transplant was 947 days (737–1191 days). The CP hospitalization rate was 24% with only 1 death. More CP patients were vaccinated than the CN group (92% vs 78%, <em>P</em>=.025).</p></div><div><h3>Conclusion</h3><p>Our study sheds light on COVID-19’s effect on heart transplant recipients and vaccination in this population. Our findings suggest a potentially heightened infection risk within the first 1.5 years posttransplant, highlighting the need to optimize management strategies and vaccine efficacy in this vulnerable group.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S254245482400016X/pdfft?md5=b13b7a1948941ea314fb34482e3f38fc&pid=1-s2.0-S254245482400016X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140649184","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":"Second Victim Experiences of Health Care Learners and the Influence of the Training Environment on Postevent Adaptation","authors":"Lily Huang BA ,&nbsp;Kirsten A. Riggan MA, MS ,&nbsp;Vanessa E. Torbenson MD ,&nbsp;Alayna K. Osborne BLA ,&nbsp;Sherry S. Chesak PhD, RN ,&nbsp;Robyn E. Finney DNAP ,&nbsp;Megan A. Allyse PhD ,&nbsp;Enid Y. Rivera-Chiauzzi MD","doi":"10.1016/j.mayocpiqo.2024.03.004","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2024.03.004","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the experience of medical and graduate learners with second victim experience (SVE) after medical errors or adverse patient outcomes, including impact on training and identification of factors that shape their postevent recovery.</p></div><div><h3>Patients and Methods</h3><p>The validated Second Victim Experience and Support Tool-Revised (SVEST-R), Physician Well-Being Index, and supplemental open-ended questions were administered to multidisciplinary health care learners between April 8, 2022, and May 30, 2022, across a large academic health institution. Open-ended responses were qualitatively analyzed for iterative themes related to impact of SVE on the training experience.</p></div><div><h3>Results</h3><p>Of the 206 survey respondents, 144 answered at least 1 open-ended question, with 62.1% (n=91) reporting at least 1 SVE. Participants discussed a wide range of SVEs and indicated that their postevent response was influenced by their training environment. Lack of support from supervisors and staff exacerbated high stress situations. Some trainees felt blamed and unsupported after a traumatic experience. Others emphasized that positive training experiences and supportive supervisors helped them grow and regain confidence. Learners described postevent processing strategies helpful to their recovery. Some, however, felt disincentivized from seeking support.</p></div><div><h3>Conclusion</h3><p>This multidisciplinary study of learners found that the training environment was influential in postevent recovery. Our findings support the need for the inclusion of education on SVEs and adaptive coping mechanisms as part of health care professional educational curriculums. Educators and health care staff may benefit from enhanced education on best practices to support trainees after stressful or traumatic patient events.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000146/pdfft?md5=a3e08f64fc27afd23d9ade7aa9dbd4ef&pid=1-s2.0-S2542454824000146-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140645325","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":"Accuracy of a Cancer Registry Versus Clinical Care Team Chart Abstraction in Identifying Cancer Recurrence","authors":"Elsa A. Sutton MD ,&nbsp;Benjamin C. Kamdem Talom BA ,&nbsp;Daniel K. Ebner MD, MPH ,&nbsp;Taylor M. Weiskittel MS ,&nbsp;William G. Breen MD ,&nbsp;Roman O. Kowalchuk MD ,&nbsp;Heather J. Gunn PhD ,&nbsp;Courtney N. Day MS ,&nbsp;Eric J. Moore MD ,&nbsp;Sara J. Holton CTR, BS Health/Health Care Administration/Management ,&nbsp;Kathryn M. Van Abel MD ,&nbsp;Chadi N. Abdel-Halim MD ,&nbsp;David M. Routman MD ,&nbsp;Mark R. Waddle MD","doi":"10.1016/j.mayocpiqo.2024.03.005","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2024.03.005","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the completeness and reliability of recurrence data from an institutional cancer registry for patients with head and neck cancer.</p></div><div><h3>Patients and Methods</h3><p>Recurrence information was collected by radiation oncology and otolaryngology researchers. This was compared with the institutional cancer registry for continuous patients treated with radiation therapy for head and neck cancer at a tertiary cancer center. The sensitivity and specificity of institutional cancer registry data was calculated using manual review as the gold standard. False negative recurrences were compared to true positive recurrences to assess for differences in patient characteristics.</p></div><div><h3>Results</h3><p>A total of 1338 patients who were treated from January 1, 2010, through December 31, 2017, were included in a cancer registry and underwent review. Of them, 375 (30%) had confirmed cancer recurrences, 45 (3%) had concern for recurrence without radiologic or pathologic confirmation, and 31 (2%) had persistent disease. Most confirmed recurrences were distant (37%) or distant plus locoregional (29%), whereas few were local (11%), regional (9%), or locoregional (14%) alone. The cancer registry accuracy was 89.4%, sensitivity 61%, and specificity 99%. Time to recurrence was associated with registry accuracy. True positives had recurrences at a median of 414 days vs 1007 days for false negatives.</p></div><div><h3>Conclusion</h3><p>Currently, institutional cancer registry recurrence data lacks the required accuracy for implementation into studies without manual confirmation. Longer follow-up of cancer status will likely improve sensitivity. No identified differences in patients accounted for differences in sensitivity. New, ideally automated, data abstraction tools are needed to improve detection of cancer recurrences and minimize manual chart review.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000158/pdfft?md5=bf5abceedb4c15e1a256e36e01002b88&pid=1-s2.0-S2542454824000158-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140622483","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":"Emergency Department Visits Before Cancer Diagnosis Among Women at Mayo Clinic","authors":"Sally K. Stauder BS ,&nbsp;Shalmali R. Borkar MBBS, MPH ,&nbsp;Amy E. Glasgow MHA ,&nbsp;Tage L. Runkle MA ,&nbsp;Mark E. Sherman MD ,&nbsp;Aaron C. Spaulding PhD ,&nbsp;Michael M. Mohseni MD ,&nbsp;Christopher C. DeStephano MD, MPH","doi":"10.1016/j.mayocpiqo.2024.03.002","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2024.03.002","url":null,"abstract":"<div><h3>Objective</h3><p>To determine associations of incident cancer diagnoses in women with recent emergency department (ED) care.</p></div><div><h3>Patients and Methods</h3><p>A retrospective cohort study analyzing biological females aged 18 years and older, who were diagnosed with an incident primary cancer (12 cancer types studied) from January 1, 2015, to December 31, 2021, from electronic health records. The primary outcome was a cancer diagnosis within 6 months of a preceding ED visit. Secondary outcomes included patient factors associated with a preceding ED visit.</p></div><div><h3>Results</h3><p>Of 25,736 patients (median age of 62 years, range 18-101) diagnosed with an incident primary cancer, 1938 (7.5%) had an ED visit ≤6 months before a diagnosis. The ED-associated cancer cases were highest in lung cancer (n=514, 14.7%) followed by acute lymphoblastic leukemia (n=22, 13.3%). Patient factors increasing the likelihood of ED evaluation before diagnosis included 18-50 years of age (OR=1.32; 95% CI, 1.09-1.61), Elixhauser score (measure of comorbidities) &gt;4 (OR=17.90; 95% CI, 14.21-22.76), use of Medicaid or other government insurance (OR=2.10; 95% CI, 1.63-2.69), residence within the institutional catchment areas (OR=3.18; 95% CI, 2.78-3.66), non-Hispanic Black race/ethnicity (OR=1.41; 95% CI, 1.04-1.88), and established primary care provider at Mayo Clinic (OR=1.45; 95% CI, 1.28-1.65). The ED visits were more likely in those who died within 6 months of diagnosis (n=327, 37.8%) than those who did not die (n=1611, 6.5%).</p></div><div><h3>Conclusion</h3><p>Patient characteristics identified in this study offer opportunities to provide cancer risk assessment and health navigation, particularly among individuals with comorbidities and limited health care access.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000122/pdfft?md5=d0c6ab1674cb5c9c76aef60175aad8e3&pid=1-s2.0-S2542454824000122-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140347059","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}