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

{"title":"Dynamic Changes in Bilirubin Predict 90-Day Mortality in Patients With Hepatocellular Carcinoma and Acute Decompensations of Cirrhosis: The HCC-AD Score","authors":"Oliver Moore MBBS ,&nbsp;Fran Neveu-Coble BN ,&nbsp;Scott Read PhD ,&nbsp;Wai-See Ma MBChB ,&nbsp;Adnan Nagriel PhD ,&nbsp;Anna Di Bartolomeo MBBS ,&nbsp;Jacob George PhD ,&nbsp;Golo Ahlenstiel PhD","doi":"10.1016/j.mayocpiqo.2025.100661","DOIUrl":"10.1016/j.mayocpiqo.2025.100661","url":null,"abstract":"<div><h3>Objective</h3><div>To develop a score to predict 90-day mortality in patients with hepatocellular carcinoma (HCC) admitted with an acute decompensation (AD) event of chronic liver disease.</div></div><div><h3>Patients and Methods</h3><div>This retrospective cohort study was conducted at Blacktown and Westmead Hospitals in Australia, including patients with decompensated cirrhosis and concomitant HCC between January 1, 2012, and May 31, 2023. Participants were separated into derivation (n=233) and validation (n=132) cohorts. Demographic and clinical data were collected at admission and day 7. Independent predictors for 90-day transplant-free survival were entered into classification and regression tree analysis to develop the HCC-AD score. Discrimination was assessed in the validation cohort using Harrell C statistic. Subgroup analysis was conducted for each Barcelona Clinic Liver Cancer (BCLC) class with comparisons made to current scores.</div></div><div><h3>Results</h3><div>A cohort of 355 patients was considered. Admission bilirubin (<em>P</em>=.009) and 7-day change in bilirubin (<em>P</em>=.018) remained significant for 90-day mortality in multivariable analysis. The HCC-acute decompensation (AD) score stratified patients into 3 risk groups with predicted mortality of 26%, 49%, and 89%, respectively. The HCC-AD score showed good discrimination (Harrell C=0.731). Cox regression analysis determined the HCC-AD score remained predictive in BCLC B (<em>P</em>&lt;.001), C (<em>P</em>&lt;.001), and D (<em>P</em>=.010) scored HCC. The model for end-stage liver disease 3.0 (<em>P</em>=.058) and Child-Pugh (<em>P</em>=.11) scores were not predictive in BCLC D HCC.</div></div><div><h3>Conclusion</h3><div>A simple score that stratifies patients with HCC into 3 risk categories based on changes in bilirubin predicts 90-day mortality following an acute decompensatory event. It is superior to other scores in advanced HCC.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100661"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048362","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":"Practice Improvement Project: Developing a Platform for a Remote At-Home Preoperative Evaluation for Elective Noncardiac Procedures","authors":"Joshua Ivare MD, MS ,&nbsp;David N. Tryon MD ,&nbsp;Adam K. Jacob MD ,&nbsp;Timothy B. Curry MD, PhD ,&nbsp;Amir Lerman MD","doi":"10.1016/j.mayocpiqo.2025.100657","DOIUrl":"10.1016/j.mayocpiqo.2025.100657","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the feasibility, safety, and patient satisfaction associated with a remote cardiac evaluation protocol during a preanesthesia medical evaluation (PAME) before elective noncardiac surgical procedures.</div></div><div><h3>Patients and Methods</h3><div>Eligible patients undergoing elective noncardiac procedures from May 1, 2022 to September 30, 2023 were selected from an anesthesia triage list at a single health care center. Patients received electronic devices for remote blood pressure measurement and 12-lead electrocardiogram collection. Patients either had a telemedicine-based PAME (tPAME) visit or an in-person PAME (iPAME) visit afterward. Patients’ charts were reviewed 30 days after procedure to identify after procedure complications. Patients were asked to provide feedback about their experiences through a digital after procedure satisfaction survey. Comparisons between the tPAME group and the iPAME group were made with χ², Fisher exact, or Mann-Whitney U tests.</div></div><div><h3>Results</h3><div>Of 129 eligible patients, 48 (37.2%) participated in the study. 29 (60.4%) patients had an iPAME visit, and 19 (39.6%) patients had a tPAME visit. There were no major adverse cardiovascular events after a remote cardiac evaluation in the iPAME and the tPAME groups. One (3.4%) patient in the iPAME group developed a deep vein thrombosis and pulmonary embolism after procedure, and 1 (3.4%) patient in the iPAME group had an emergency room visit within 30 days after their procedure. Patients were very satisfied with their experience in the study.</div></div><div><h3>Conclusion</h3><div>These findings support the concept that a remote cardiac evaluation during a PAME before elective noncardiac procedures is feasible, safe, and associated with high patient satisfaction.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100657"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144893507","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":"An Artificial Intelligence-Enabled Electrocardiogram to Evaluate Patients With Dyspnea in the Emergency Department","authors":"Hee Tae Yu MD, PhD ,&nbsp;Laura E. Walker MD ,&nbsp;Eunjung Lee PhD ,&nbsp;Muhannad Abbasi MBBCh ,&nbsp;Samuel Wopperer MD ,&nbsp;Gal Tsaban MD, PhD ,&nbsp;Kathleen Kopecky MD ,&nbsp;Francisco Lopez-Jimenez MD ,&nbsp;Paul Friedman MD ,&nbsp;Zachi Attia PhD ,&nbsp;Jae K. Oh MD","doi":"10.1016/j.mayocpiqo.2025.100652","DOIUrl":"10.1016/j.mayocpiqo.2025.100652","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether an Artificial Intelligence-Enabled Electrocardiogram (AI-ECG) for diastolic function/filling pressure can determine whether dyspnea in emergency department (ED) patients is cardiac in origin.</div></div><div><h3>Patients and Methods</h3><div>We identified 2412 patients aged 18 years or older presented with dyspnea/shortness of breath to the ED who had an ECG performed at the time of evaluation from January 2020 to December 2022. The AI-ECG for determining left ventricular diastolic function to identify the patients with cardiac cause of dyspnea was assessed, using the final diagnosis based on subsequent evaluation.</div></div><div><h3>Results</h3><div>Of the 2412 patients, 966 (40%) were found to have cardiac dyspnea, and the remaining 1446 (60%) were noncardiac. The AI-ECG-estimated diastolic function was divided into 4 groups: 922 (38.2%) were normal, 245 (10.2%) grade 1, 1192 (49.4%) grade 2, and 53 (2.2%) grade 3. The probability of cardiac dyspnea was considerably higher in patients with grade 2 (62.2%±48.5%) and 3 (83%±37.9%) diastolic function compared with normal (14.1%±34.8%) and grade 1 (20.8%±40.7%). The incidence of cardiac dyspnea increased as the probability of increasing filling pressure increased on AI-ECG.</div></div><div><h3>Conclusion</h3><div>Patients often present to the ED with undifferentiated dyspnea. It is important to promptly determine whether the symptoms have cardiac origin. Cardiac dyspnea often reflects elevated left ventricular filling pressures. Artificial intelligence-enhanced 12-lead electrocardiograms can precisely assess diastolic function and filling pressures. Among patients who presented to the ED with dyspnea/shortness of breath, AI-ECG assessing diastolic function strongly distinguished whether the cause was cardiac.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100652"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879948","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":"Association Between Trunk Fat Mass Index and Diabetes in a Multinational Population","authors":"Chibueze Ogbonnaya MS, PhD ,&nbsp;Madison Kindred MS, PhD ,&nbsp;Carl J. Lavie MD, FACC ,&nbsp;Hannah Oh MPH, ScD ,&nbsp;Min-Jeong Shin PhD ,&nbsp;Xuemei Sui MD, MPH, PhD ,&nbsp;Jason Jaggers MS, PhD ,&nbsp;Ryan Porter MS, PhD ,&nbsp;Dahyun Park MS, PhD ,&nbsp;Jin E. Kim BS ,&nbsp;Jessica Gong MS, PhD ,&nbsp;Vivek K. Prasad MBBS, MPH, PhD","doi":"10.1016/j.mayocpiqo.2025.100658","DOIUrl":"10.1016/j.mayocpiqo.2025.100658","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the cross-sectional association between trunk fat mass index (TFMI) and diabetes across individuals within the same body mass index (BMI [calculated as the weight in kilograms divided by the height in meters squared]) categories in a multinational population.</div></div><div><h3>Participants and Methods</h3><div>We harmonized and pooled data on 57,764 individuals aged 40 years and older from the United Kingdom, the United States, and South Korea. Trunk fat mass imaging was performed using a dual-energy X-ray absorptiometry device during 2015-2023 in the United Kingdom, 2011-2018 in the United States, and 2008-2011 in South Korea. The prevalence of diabetes was derived from the self-reported medical history. Additionally, plasma biochemistry analyses were conducted to update the number of participants with diabetes.</div></div><div><h3>Results</h3><div>Among participants classified as having a normal weight based on BMI, the relative risks (RRs) of diabetes increased from TFMI quintiles 1 to 5 with the linear trend (<em>P</em>&lt;.001). The risk of diabetes among individuals in TFMI quintile 5 was around 3 times greater than those in quintile 1 (men—RR, 3.06; 95% confidence interval [CI], 2.17-4.34; women—3.35; 95% CI, 2.08-5.39). This significant linear trend (P&lt;.001) in RRs was also present in overweight and obese individuals (overweight men—RR, 1.92; 95% CI, 1.50-2.47; overweight women—RR, 2.25; 95% CI, 1.73-2.91; obese men—RR, 2.47; 95% CI, 1.83-3.35; obese women—2.79; 95% CI, 2.04-3.83).</div></div><div><h3>Conclusion</h3><div>Within a specific BMI category, individuals with a high trunk fat mass are more likely to experience diabetes compared with those with lower levels of central fat.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100658"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104708","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":"2025-08-01","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":"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":"2025-08-01","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":"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":"2025-08-01","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":"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":"2025-08-01","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":"Prospective Evaluation of Artificial Intelligence Imaging Support Software for Acute Ischemic Stroke in the Mayo Clinic Telestroke Network","authors":"Brett H. Smith MD ,&nbsp;Jackson G. Wolfe ,&nbsp;Alvina Karam MD ,&nbsp;Bart M. Demarkschalk MD ,&nbsp;Courtney M. Hrdlicka MD ,&nbsp;Deena M. Nasr DO ,&nbsp;Felix E. Chukwudelunzu MD ,&nbsp;Charisse A. Nord MA ,&nbsp;Emily A. Pahl BA ,&nbsp;Claire Fernandez PhD ,&nbsp;Sam Wood ,&nbsp;Zoe VJ. Woodhead PhD ,&nbsp;Davide Carone MD, DPhil ,&nbsp;George Harston MBBS, Dphil ,&nbsp;Stephen W. English MD, MBA","doi":"10.1016/j.mayocpiqo.2025.100631","DOIUrl":"10.1016/j.mayocpiqo.2025.100631","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the real-world impact of artificial intelligence-driven decision support imaging software for patients with acute ischemic stroke in a mature telestroke network in the United States.</div></div><div><h3>Patients and Methods</h3><div>We conducted a prospective evaluation of stroke imaging support software in a robust, predominantly rural telestroke network (17 sites in Minnesota and Wisconsin). Data was collected from all patients who underwent video telestroke evaluation in a 3-month preimplementation period before installation of the software (from February 10, 2024 to May 9, 2024) and a 3-month postimplementation period while the software was in use (from May 10, 2024 to August 9, 2024). The preimplementation and postimplementation cohorts were directly compared (no control group included). Primary outcome measures were treatment rates and time to treatment (both treatment decision and delivery) for intravenous thrombolysis (IVT) and endovascular therapy (EVT); secondary outcomes included transfer rates, transfer times, and end user survey results.</div></div><div><h3>Results</h3><div>Total of 444 telestroke cases were included in the preimplementation period, and 463 in the postimplementation period. Comparing preimplementation and postimplementation periods, the rate of IVT treatment delivery rose from 26.6% to 35.0% of potentially eligible patients (<em>P</em>=.24), whereas EVT treatment delivery remained at 31%. Time to IVT delivery reduced from 47 minutes to 41 minutes (<em>P</em>=.772), and time to EVT treatment rose from 156 minutes to 157 minutes (<em>P</em>=.771). Overall rates of treatment (IVT or EVT) rose from 23.1% to 23.9% of potentially eligible patients (<em>P</em>=.944). Although none of the clinical outcomes reached statistical significance, the survey results reported good user satisfaction with algorithm performance and image viewing.</div></div><div><h3>Conclusion</h3><div>This study reported a nonsignificant increase in treatment rates and a decrease in time to treatment decisions. Future trials with larger sample sizes are needed to validate the real-world benefits of decision support software for acute ischemic stroke in an established telestroke network.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100631"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169601","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":"Financial Toxicity of Partial Versus Whole Breast Irradiation: A Systematic Review","authors":"Taema Brinjikji MD ,&nbsp;Kimberly S. Corbin MD ,&nbsp;Zhen Wang PhD ,&nbsp;M. Hassan Murad MD ,&nbsp;Dean A. Shumway MD","doi":"10.1016/j.mayocpiqo.2025.100632","DOIUrl":"10.1016/j.mayocpiqo.2025.100632","url":null,"abstract":"<div><h3>Objective</h3><div>To determine if accelerated partial breast irradiation (APBI) is associated with less financial toxicity (financial difficulties that patients experience due to treatment, such as out-of-pocket costs, transportation costs, and time away from work) than whole breast irradiation (WBI).</div></div><div><h3>Patients and Methods</h3><div>We searched bibliographic databases for studies published from database inception through April 2024. Eligible studies were randomized clinical trials and observational studies that evaluated financial toxicity of APBI or WBI treatments among adult women with early-stage breast cancer. Pairs of independent reviewers selected the studies.</div></div><div><h3>Results</h3><div>Nine studies met the inclusion criteria. One study using the comprehensive score for financial toxicity did not report a significant difference between APBI and WBI. Four studies using the European Organization for Research and Treatment of Cancer QLQ-C30 financial difficulties question reported greater financial difficulties with WBI when compared with APBI, with 2 studies reporting differences within 3 months of radiotherapy and 2 studies reporting differences at 1-2 years. Four studies evaluated the cost of travel and days away from work and reported less financial impact associated with APBI when compared with WBI.</div></div><div><h3>Conclusion</h3><div>APBI is associated with less financial toxicity than WBI, which may be dependent on the shorter duration of treatment.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100632"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144205104","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}