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

{"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}

{"title":"Accuracy of Outcome Ascertainment in Long-Term Mortality After Coronary Artery Bypass Grafting","authors":"Kensuke Yokoi MD ,&nbsp;Atsushi Tanaka MD ,&nbsp;Goro Yoshioka MD ,&nbsp;Masahiko Hara MD ,&nbsp;Keiji Kamohara MD ,&nbsp;Koichi Node MD","doi":"10.1016/j.mayocpiqo.2024.08.006","DOIUrl":"10.1016/j.mayocpiqo.2024.08.006","url":null,"abstract":"<div><div>Long-term outcome ascertainment can be affected by the follow-up performance and needs to use a different data source for more comprehensive data capture. However, a universal tracking system is absent in Japan, and long-term outcomes are often ascertained through electronic medical records (EMRs), the reliability of which is uncertain. In this study, we compared EMR-based and direct outreach–based collections on outcome ascertainment accuracy in 500 patients who underwent coronary artery bypass grafting. Mortality data for all patients were extracted from the EMR, as standard data collection. When patient death was not confirmed in the EMR, we enhanced to collect updated mortality information by direct outreach to patients, their family, or their physicians, as enhanced direct outreach data. As a result, the Kaplan-Meier curves found a notable separation between different data sources analyzed. Interestingly, mortality events in the latter half of the follow-up period (median, 6.5 years) were overestimated in the EMR-based data collection analysis because of the reduced number of actively tracked cases, highlighting a potential bias in the EMR-based data collection on long-term prognoses. Our findings suggest that an active follow-up strategy with better adherence will enhance the accuracy of long-term outcome ascertainment and be helpful to build more reliable real-world evidence.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 6","pages":"Pages 502-504"},"PeriodicalIF":0.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418679","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":"Intracardiac Shunts Among Patients Undergoing Oil-Based Contrast Lymphangiography: Prevalence and Rate of Systemic Arterial Embolic Complications","authors":"Wade Nedderman MD ,&nbsp;Emily Bendel MD ,&nbsp;Jason Anderson MD ,&nbsp;Chris Reisenauer MD ,&nbsp;Edwin Takahashi MD ,&nbsp;Erica Knavel Koepsel MD ,&nbsp;Stephanie Polites MD ,&nbsp;Scott Thompson MD, PhD","doi":"10.1016/j.mayocpiqo.2024.08.003","DOIUrl":"10.1016/j.mayocpiqo.2024.08.003","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the prevalence of systemic embolic complications after oil-based contrast lymphangiography.</div></div><div><h3>Patients and Methods</h3><div>A retrospective medical record review of all patients undergoing oil-based lymphangiographic procedures from January 1, 2000, to December 31, 2021 was performed to identify the following: (a) the rate of systemic embolic complications after the procedure; (b) the presence of preprocedure echocardiographic assessment for right-to-left shunting; and (c) the presence of right-to-left shunting after a systemic embolic complication.</div></div><div><h3>Results</h3><div>A total of 350 patients (200 male, 57%) underwent 400 oil-based lymphangiographic procedures. A total of 2 systemic embolic complications occurred for a prevalence of 0.5% (2/400). Preprocedure echocardiography was performed in 226 patients (226/350, 65%). Identification of a right-to-left shunt was made in 25 patients (25/226, 11%, with the majority reporting shunting at rest (23/25, 92%). Of the patients with systemic embolic complications, one had multifocal systemic oil contrast emboli, and one had a large territorial cerebrovascular infarct without the presence of oil-based contrast noted. Both cases underwent preprocedure echocardiography reporting a structurally normal heart with no evidence of a shunt through color flow Doppler evaluation, but neither case had undergone a true shunt study. Both patients were identified to have a right-to-left shunt during the dedicated echocardiographic shunt study postprocedure.</div></div><div><h3>Conclusion</h3><div>Risk of a systemic embolic complication after oil-based contrast lymphangiography is rare but can be catastrophic. A standardized assessment for patients undergoing the procedure may be necessary to identify those at risk and to allow for appropriate preventive strategies to be employed.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 6","pages":"Pages 494-501"},"PeriodicalIF":0.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418677","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.2024.08.004","DOIUrl":"10.1016/j.mayocpiqo.2024.08.004","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 6","pages":"Page 493"},"PeriodicalIF":0.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418681","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":"Prognostic Factors and Epidemiology of Amyotrophic Lateral Sclerosis in Southeastern United States","authors":"Erica Engelberg-Cook PhD ,&nbsp;Jaimin S. Shah MD ,&nbsp;Andre Teixeira da Silva Hucke MS ,&nbsp;Diana V. Vera-Garcia MD ,&nbsp;Jany E. Dagher ,&nbsp;Megan H. Donahue BS ,&nbsp;Veronique V. Belzil MS, PhD ,&nbsp;Björn Oskarsson MD","doi":"10.1016/j.mayocpiqo.2024.07.008","DOIUrl":"10.1016/j.mayocpiqo.2024.07.008","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the performance of known survival predictors and evaluate their stratification capability in patients with amyotrophic lateral sclerosis (ALS).</p></div><div><h3>Patients and Methods</h3><p>We analyzed demographic and clinical variables collected at the Mayo Clinic, Florida ALS center during the first clinical visit of 1442 (100%) patients with ALS.</p></div><div><h3>Results</h3><p>Our cohort had a median (interquartile range [IQR]) age at diagnosis of 64.8 (57-72) years; 1350 (92%) were non-Hispanic White; and 771 (53.5%) were male. The median (IQR) diagnostic delay was 10.1 (6-18) months, body mass index was 25.4 (23-49), and forced vital capacity was 72% (52%-87%). Approximately 12% of patients tested carried a pathologic <em>C9orf72</em> hexanucleotide repeat expansion. Median (IQR) ALS functional rating scale-revised score was 35 (29-40) and ALS cognitive behavioral screen score was 15 (12-17). The median (IQR) survival after diagnosis was 17.2 (9-31) months, and survival from symptom onset was 30 (20-48) months. We found that older age decreased forced vital capacity, and fast-progressing ALS functional rating scale-revised scores significantly (<em>P</em>&lt;.0001) influence survival curves and associated hazard risk.</p></div><div><h3>Conclusion</h3><p>Although results obtained from our cohort are consistent with other reports (eg, men with spinal onset experience a longer survival than women with bulbar onset), they remind us of the complexity of the disease’s natural history and the limited prognostic power of the most common clinical predictors.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 5","pages":"Pages 482-492"},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000523/pdfft?md5=a5e3c1695eb2a43f63cf5c69f1afb112&pid=1-s2.0-S2542454824000523-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142238887","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.2024.08.002","DOIUrl":"10.1016/j.mayocpiqo.2024.08.002","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 5","pages":"Page 481"},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000547/pdfft?md5=b523cbff122c08855578da6523edadf9&pid=1-s2.0-S2542454824000547-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142238888","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.2024.06.004","DOIUrl":"10.1016/j.mayocpiqo.2024.06.004","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 5","pages":"Page 480"},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000419/pdfft?md5=be1165306f045c068c0c4517b3f96812&pid=1-s2.0-S2542454824000419-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168713","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 Measures and Mortality Attribution in Health Care: The Diabetes and Endocrinology Example","authors":"Lorenzo Olivero MD ,&nbsp;Jorge Sinclair MD ,&nbsp;Trisha Singh MD ,&nbsp;Aditya A. Khanijo MBBS ,&nbsp;Gunjan Mundhra MBBS ,&nbsp;Ana-Maria Chindris MD ,&nbsp;Terri Menser PhD ,&nbsp;Pablo Moreno Franco MD ,&nbsp;Benjamin D. Pollock PhD ,&nbsp;Razvan M. Chirila MD","doi":"10.1016/j.mayocpiqo.2024.08.001","DOIUrl":"10.1016/j.mayocpiqo.2024.08.001","url":null,"abstract":"<div><p>This study investigated the accuracy of mortality attributions assigned by the US News and World Report (USNWR) to the diabetes and endocrinology specialty. We reviewed medical records of all consecutive Medicare fee-for-service inpatients at Mayo Clinic, Florida (Jacksonville, Florida) with a Medicare Severity Diagnosis Related Group included in the USNWR Diabetes &amp; Endocrinology specialty cohort admitted from November 2018 to April 2022, with documented mortality in our institution’s electronic health record within 30 days of the index admission. A clinician adjudicated the primary cause of death, categorizing it as diabetes or endocrine, cancer, failure to thrive, or other. Among 49 deceased patients, only 7 (14.3%) had diabetes or an endocrine-related cause of death. Cancer (49.0%) and failure to thrive (30.6%) were the leading causes. This substantial discrepancy (86% misattribution) suggests USNWR’s methodology might not precisely reflect the quality of care, potentially misleading patients and impacting hospital rankings.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 5","pages":"Pages 475-479"},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454824000535/pdfft?md5=13e13dc82a20e1c13a4b590ae2b0c6c8&pid=1-s2.0-S2542454824000535-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142151965","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":"Lifestyle Medicine in Medical Education: Maximizing Impact","authors":"Beth Frates MD, FACLM, DipABLM ,&nbsp;Hugo A. Ortega MD, MSEd, DipABLM ,&nbsp;Kelly J. Freeman MSN, AGPCNP-BC, DipACLM ,&nbsp;John Patrick T. Co MD, MPH, MBA ,&nbsp;Melissa Bernstein PhD, RDN, LD, FAND, DipACLM","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":"8 5","pages":"Pages 451-474"},"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}