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

{"title":"Building a Cancer Care Clinic for Transgender and Gender Diverse Individuals","authors":"Elizabeth J. Cathcart-Rake MD ,&nbsp;Amye Tevaarwerk MD ,&nbsp;Aminah Jatoi MD ,&nbsp;Evelyn F. Carroll MD ,&nbsp;NFN Scout MA, PhD ,&nbsp;Victor G. Chedid MD, MS ,&nbsp;Cesar A. Gonzalez PhD ,&nbsp;Kelli Fee-Schroeder DNP, RN, OCN ,&nbsp;Jewel M. Kling MD, MPH ,&nbsp;Chrisandra L. Shufelt MD, MS ,&nbsp;Jennifer L. Ridgeway PhD ,&nbsp;Caroline Davidge-Pitts MBBCh","doi":"10.1016/j.mayocpiqo.2024.07.007","DOIUrl":"10.1016/j.mayocpiqo.2024.07.007","url":null,"abstract":"<div><p>Transgender and gender diverse (TGD) people experience disparities in cancer care, including more late-stage diagnoses, worse cancer-related outcomes, and an increased number of unaddressed and more severe symptoms related to cancer and cancer-directed therapy. This article outlines plans to address the unique needs of TGD people through a TGD-focused oncology clinic. Such a clinic could be structured by upholding the following tenets: (1) champion a supportive, gender-affirming environment that seeks to continuously improve, (2) include a transdisciplinary team of specialists who are dedicated to TGD cancer care, and (3) initiate and embrace TGD-patient-centric research on health outcomes and health care delivery.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 5","pages":"Pages 443-450"},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000481/pdfft?md5=7e3b48bbfa7e691ca0319b97234056da&pid=1-s2.0-S2542454824000481-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142040888","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":"Perioperative Mortality: A Retrospective Cohort Study of 75,446 Noncardiac Surgery Patients","authors":"Gregory A. Nuttall MD ,&nbsp;Michael P. Merren MD, MS ,&nbsp;Julian Naranjo DO ,&nbsp;Erica R. Portner RRT, LRT ,&nbsp;Amanda R. Ambrose MD ,&nbsp;Charanjit S. Rihal MD","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":"8 5","pages":"Pages 435-442"},"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}

{"title":"Redesigning the Care of Musculoskeletal Conditions With Lifestyle Medicine","authors":"Kristi E. Artz MD ,&nbsp;Timothy D. Phillips PT, DPT ,&nbsp;Janine M. Moore PT, MS, OCS ,&nbsp;Kara E. Tibbe MBA","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":"8 5","pages":"Pages 418-430"},"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}

{"title":"","authors":"","doi":"10.1016/j.mayocpiqo.2024.07.005","DOIUrl":"10.1016/j.mayocpiqo.2024.07.005","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 5","pages":"Page 416"},"PeriodicalIF":0.0,"publicationDate":"2024-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000468/pdfft?md5=70625411aa00e73f4226645f66a19f26&pid=1-s2.0-S2542454824000468-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954017","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.2024.07.004","DOIUrl":"10.1016/j.mayocpiqo.2024.07.004","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 5","pages":"Page 417"},"PeriodicalIF":0.0,"publicationDate":"2024-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000456/pdfft?md5=9a758ddb2931642c85b8b6236406719b&pid=1-s2.0-S2542454824000456-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954018","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":"Donation After Circulatory Death Donor Prognostication: An Emerging Challenge in Heart Transplantation","authors":"Stephen W. English MD, MBA ,&nbsp;Alejandro A. Rabinstein MD ,&nbsp;Melissa A. Lyle MD","doi":"10.1016/j.mayocpiqo.2024.07.006","DOIUrl":"10.1016/j.mayocpiqo.2024.07.006","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 5","pages":"Pages 431-434"},"PeriodicalIF":0.0,"publicationDate":"2024-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S254245482400047X/pdfft?md5=87e486c33d4cbaee72dac73d60727771&pid=1-s2.0-S254245482400047X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954015","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.2024.06.003","DOIUrl":"10.1016/j.mayocpiqo.2024.06.003","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 5","pages":"Page 415"},"PeriodicalIF":0.0,"publicationDate":"2024-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000407/pdfft?md5=768b9e700a0f7d98cd4a661c8cf6ca5d&pid=1-s2.0-S2542454824000407-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954016","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":"Improving Patient Safety Through Proper Ordering and Administration of Andexanet Alfa","authors":"Krystof Stanek MD ,&nbsp;Mohammad T. Hussain MD ,&nbsp;Aaron C. Spaulding PhD ,&nbsp;Shalmali Borkar MD, MPH ,&nbsp;Marwan E. Shaikh MD","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":"8 4","pages":"Pages 407-414"},"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}

{"title":"","authors":"","doi":"10.1016/j.mayocpiqo.2024.06.002","DOIUrl":"10.1016/j.mayocpiqo.2024.06.002","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 4","pages":"Page 406"},"PeriodicalIF":0.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000390/pdfft?md5=ef633af538b59f7757a6b251daacb926&pid=1-s2.0-S2542454824000390-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141637506","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":"Multimodal Imaging in Mycobacterium Chimaera Cardiovascular Infections: The Mayo Clinic Experience","authors":"Shravya Vinnakota MBBS ,&nbsp;Alex D. Tarabochia MD ,&nbsp;Nicholas Y. Tan MD, MS ,&nbsp;William R. Miranda MD ,&nbsp;Lawrence J. Sinak MD ,&nbsp;Nandan S. Anavekar MBBCh ,&nbsp;Omar Abu Saleh MD ,&nbsp;Gabor Bagameri MD ,&nbsp;Courtney E. Bennett DO","doi":"10.1016/j.mayocpiqo.2024.05.006","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2024.05.006","url":null,"abstract":"<div><h3>Objective</h3><p>To review the salient features of multimodality cardiovascular imaging in patients with disseminated <em>Mycobacterium chimaera</em> (MC) infections after exposure to contaminated heater-cooler units during cardiopulmonary bypass.</p></div><div><h3>Patients and Methods</h3><p>Twelve patients with confirmed MC infection were retrospectively identified after a review from January 1, 2010, to April 30, 2021. The electronic medical records were examined with a focus on transthoracic echocardiography, transesophageal echocardiography, cardiac computed tomography (CT), cardiac magnetic resonance imaging, and positron emission tomography-CT.</p></div><div><h3>Results</h3><p>Three (27.3%) patients had diagnostic findings of endocarditis on transthoracic echocardiography, with most patients having nonspecific abnormalities including elevated prosthetic valve gradients or prosthetic leaflet thickening. Transesophageal echocardiography identified 4 (36.7%) patients with vegetations and 3 (27.3%) with aortic root abscess or pseudoaneurysm, with more common findings such as mild aortic root or prosthetic leaflet thickening. Six (50%) patients underwent cardiac CT imaging, which found aortic root pseudoaneurysms or abscesses, prosthetic ring dehiscence, and leaflet thickening. Three (25%) patients underwent cardiac magnetic resonance imaging demonstrating prosthetic valve vegetations, leaflet thickening, and abnormal myocardial delayed enhancement in a noncoronary distribution, suggesting myocarditis. Ten (83%) patients underwent positron emission tomography-CT, 4 (40%) had an abnormal fluorodeoxyglucose uptake around the cardiac prosthetic material, and 7 (70%) had a fluorodeoxyglucose uptake in other organs, suggesting concomitant multiorgan involvement.</p></div><div><h3>Conclusion</h3><p>Multimodality cardiovascular imaging is central to the management of patients with disseminated MC and can help establish a preliminary diagnosis while awaiting confirmatory microbiological data, potentially reducing the time to diagnosis. Imaging findings are subtle and atypical, not always meeting classically modified Duke’s criteria for infectious endocarditis. Clinicians should have a high index of suspicion for the disease and a low threshold for repeat imaging when initial testing is equivocal.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 4","pages":"Pages 396-405"},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000389/pdfft?md5=e415a91f7884077294b492224abb29fa&pid=1-s2.0-S2542454824000389-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141595657","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}