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

{"title":"Follow-up Colorectal Cancer Screening After Negative-Result and Positive-Result Multitarget Stool DNA Tests: A Population-Based Study in Southeast Minnesota","authors":"Alanna M. Chamberlain PhD, MPH ,&nbsp;Derek W. Ebner MD ,&nbsp;Gregory D. Jenkins MS ,&nbsp;Mallik Greene PhD ,&nbsp;Lila J. Finney Rutten PhD, MPH","doi":"10.1016/j.mayocpiqo.2025.100599","DOIUrl":"10.1016/j.mayocpiqo.2025.100599","url":null,"abstract":"<div><h3>Objective</h3><div>To provide contemporary data on subsequent screening after negative-result multitarget stool DNA (mt-sDNA) tests and follow-up colonoscopy after positive-result mt-sDNA tests.</div></div><div><h3>Patients and Methods</h3><div>Negative-result mt-sDNA tests (for patients aged 50-72 years) and positive-result mt-sDNA tests (for patients aged 50-75 years) were identified among average risk patients from a 9-county region in Southeast Minnesota from January 1, 2016 to December 31, 2022. Competing risks models of time to subsequent colorectal cancer (CRC) screening were modeled separately for the negative mt-sDNA and positive mt-sDNA cohorts. Multistate Cox proportional hazards models compared rates of CRC screening modality by patient demographic characteristics.</div></div><div><h3>Results</h3><div>At 3.5 years after a negative-result mt-sDNA test (n=18,739 tests), 55.0% (95% CI, 53.9%-56.3%) of patients were rescreened, which increased to 81.0% (95% CI, 80.0%-82.1%) at 5 years. Most tests were repeat mt-sDNA tests (48.3% at 3.5 years; 95% CI, 47.2%-49.5%). Rescreening with any modality was more likely with older age and among females and less likely among Black persons, Asian persons, and those with other or mixed race. After a positive-result mt-sDNA test (n=2863 tests), 80.9% (95% CI, 79.6%-82.6%) and 84.4% (95% CI, 83.2%-86.0%) of patients completed follow-up colonoscopy by 6 months and 1 year, respectively. Those of other or mixed race had lower rates of follow-up colonoscopy compared with White persons.</div></div><div><h3>Conclusion</h3><div>Although rates of overall rescreening after a negative-result mt-sDNA test and follow-up colonoscopy after positive-result mt-sDNA tests were high, racial disparities were apparent. Targeted interventions are needed to improve equity in CRC screening adherence and follow-up care across diverse patient populations.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 2","pages":"Article 100599"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487644","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.2025.100596","DOIUrl":"10.1016/j.mayocpiqo.2025.100596","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 2","pages":"Article 100596"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444416","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":"Medical Cannabis in the United States: Comparing 2017 and 2024 State Qualifying Conditions to the 2017 National Academies of Sciences Report","authors":"Elena L. Stains BS ,&nbsp;Amy L. Kennalley MBS ,&nbsp;Maria Tian MBS ,&nbsp;Kevin F. Boehnke PhD ,&nbsp;Chadd K. Kraus DO, MPH ,&nbsp;Brian J. Piper PhD","doi":"10.1016/j.mayocpiqo.2025.100590","DOIUrl":"10.1016/j.mayocpiqo.2025.100590","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the 2017 National Academies of Sciences, Engineering, and Medicine cannabis report to state medical cannabis (MC) laws defining approved qualifying conditions (QC) from 2017 and 2024 and to determine the evidence level of the QCs approved in each state.</div></div><div><h3>Patients and Methods</h3><div>The 2017 National Academies of Sciences (NAS) report assessed therapeutic evidence for over 20 medical conditions treated with MC. We identified the QCs of 38 states (including Washington DC) where MC was legal in 2024 and compared them to the QCs listed by these states in 2017. The QCs were then categorized on the basis of NAS-established levels of evidence: limited, moderate, or substantial/conclusive evidence of effectiveness, limited evidence of ineffectiveness, or no/insufficient evidence to support or refute effectiveness. This study was completed from January 31, 2023 to June 20, 2024.</div></div><div><h3>Results</h3><div>Most states listed at least one QC with substantial evidence—80.0% in 2017 and 97.0% in 2024. However, in 2024 only 8.3% of the QCs on states’ QC lists met the standard of substantial/conclusive evidence. Of the 20 most popular QCs in the country in 2017 and 2024, one only (long-term pain) was categorized by the NAS as having substantial evidence for effectiveness. However, 7 were rated as either ineffective (eg, glaucoma) or insufficient evidence.</div></div><div><h3>Conclusion</h3><div>Most QCs lack evidence for use on the basis of the 2017 NAS report. Many states recommend QCs with little evidence (amyotrophic lateral sclerosis) or even those for which MC is ineffective (depression). These findings highlight a disparity between state-level MC recommendations and the evidence to support them.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 2","pages":"Article 100590"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453515","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":"Medication and Therapy Profiles for Pain and Symptom Management Among Adults With Cerebral Palsy","authors":"Mark D. Peterson PhD, MS ,&nbsp;Michael O’Leary BS ,&nbsp;Kathryn Ashbaugh BS ,&nbsp;Heidi Haapala MD ,&nbsp;Mary Schmidt DO ,&nbsp;Neil Kamdar MA ,&nbsp;Edward A. Hurvitz MD","doi":"10.1016/j.mayocpiqo.2025.100597","DOIUrl":"10.1016/j.mayocpiqo.2025.100597","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the most common patterns of pain and symptom management strategies among adults living with cerebral palsy (CP), and to determine if there are differences by pain phenotype or co-occurring neurodevelopmental disorders.</div></div><div><h3>Patients and Methods</h3><div>Federally insured beneficiaries were included if they had an ICD-9-CM/ICD-10-CM diagnosis code for CP (N=41,595). The study took place from January 10, 2024, to December 15, 2024. Medication and therapy prescription estimates for pain and CP symptom management were examined for the entire cohort, and between individuals with and without neurodevelopmental disorders and across pain phenotypes.</div></div><div><h3>Results</h3><div>The most common pharmaceutical/nontherapy-based pain and symptom management interventions included high frequency prescriptions for antiepileptics (58%), antidepressants (49%), benzodiazepines (43%), nonsteroidal anti-inflammatories (43%), nonperioperative opioids (42%), antipsychotics (33%), muscle relaxants (31%), irritable bowel syndrome-specific drugs (20%), clonidine (12%), anticholinergics (11%), and botulinum toxin A injections (6%). Physical and occupational therapy were prescribed for 41% of the study cohort. Significant differences in treatment patterns were found for individuals with co-occurring neurodevelopmental disorders, and across pain phenotypes. Notably, for individuals with a mixed pain phenotype, nearly 80% were prescribed nonperioperative opioids.</div></div><div><h3>Conclusion</h3><div>Adults with CP have a high prescription prevalence of nonperioperative opioids and common nonopioid pain and symptom management.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 2","pages":"Article 100597"},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444415","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":"The Financial Impact of Ehlers-Danlos Syndromes on Patients in the United States in 2022","authors":"Jane R. Schubart PhD ,&nbsp;Eric W. Schaefer MS ,&nbsp;Susan E. Mills MPH ,&nbsp;Dacre R.T. Knight MD ,&nbsp;Chan Shen PhD ,&nbsp;Clair A. Francomano MD","doi":"10.1016/j.mayocpiqo.2024.11.003","DOIUrl":"10.1016/j.mayocpiqo.2024.11.003","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the financial impact of Ehlers-Danlos syndromes (EDS) on patients in the United States by examining the medical expenses incurred by patients.</div></div><div><h3>Patients and Methods</h3><div>We used a convenience sample approach and disseminated a self-reported survey questionnaire to individuals with EDS via patient advocacy organizations and support groups across the country, social media, and health professionals from April 1, 2023, to December 31, 2023. The survey focused on the out-of-pocket medical expenses incurred by patients.</div></div><div><h3>Results</h3><div>The final analytic data set included 884 responses. Responses were received from individuals in all 50 states and the District of Columbia. More than 50% reported individual income less than $25,000, and more than 30% reported household income less than $50,000. More than 80% of respondents had some type of commercial insurance and 29% reported receiving Medicaid. Respondents received more financial assistance from their family and friends than from government sources. The total median out-of-pocket financial cost by our analysis was $13,450 (IQR: $6500-$25,800). Of the 838 who responded to the question, “Did the affected person receive the health care they needed?”, 19% answered “no”, 51% answered “yes, sometimes”, and 30% answered “yes, most of the time”.</div></div><div><h3>Conclusion</h3><div>The factors contributing to financial impact include both direct and indirect costs of accessing and receiving medical care. Our study findings highlight the magnitude of the burden of health care spending on patients with EDS.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 1","pages":"Article 100586"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11713486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960745","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":"Use of Complementary and Integrative Medicine Among Low-Income Persons With Mental Health Disorders","authors":"Kavita Prasad MD ,&nbsp;Abhiram Prasad MD ,&nbsp;Natalie L. Dyer PhD ,&nbsp;Brent A. Bauer MD ,&nbsp;Jennifer N. Soderlind BA ,&nbsp;Karen M. Fischer MPH ,&nbsp;Ivana T. Croghan PhD ,&nbsp;Caroline C. Kaufman PhD ,&nbsp;David H. Rosmarin PhD ,&nbsp;Dietlind L. Wahner-Roedler MD","doi":"10.1016/j.mayocpiqo.2024.11.002","DOIUrl":"10.1016/j.mayocpiqo.2024.11.002","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the use of complementary and integrative medicine (CIM) among a low-income population with mental health diagnoses and to assess differences in social determinants of health (SDOH) on the basis of CIM use.</div></div><div><h3>Patients and Methods</h3><div>We surveyed patients with mental health diagnoses and/or substance use disorders during outpatient evaluations between August 11, 2020, and November 18, 2021, at a community behavioral health center in Rochester, MN. We measured knowledge of current CIM, interest in future use of CIM, and SDOH. Differences in mean number of SDOH risk factors were compared by use or nonuse of any CIM.</div></div><div><h3>Results</h3><div>Among 102 patients, depression (87%) and anxiety (85%) diagnoses were common. Moreover, 72% of patients used at least 1 CIM. The 3 most common modalities were prayer (41%), spirituality (37%), and music (36%). CIM use had perceived benefits for mood (49%), stress (49%), and sadness (43%). One-third of patients added CIM to conventional treatments, and 19% reported that traditional medical treatments did not work well for their symptoms. More than two-thirds had not discussed their use of CIM with their physicians. Social isolation and loneliness were common. The number of SDOH risk factors did differ by use of CIM.</div></div><div><h3>Conclusion</h3><div>Prayer, spirituality, and music are frequently used by patients with mental health disorders and were perceived to be helpful in relieving symptoms. CIM use was not related to SDOH risk factors. Integrating CIM therapies may be beneficial for improving mental health in this population.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 1","pages":"Article 100585"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933902","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":"Utility of Noninvasive Testing Before Invasive Coronary Angiography in the Assessment for Revascularization","authors":"Simon Parlow MD ,&nbsp;Richard G. Jung MD, PhD ,&nbsp;Pietro Di Santo MD ,&nbsp;Joanne Joseph MD ,&nbsp;Stephanie Skanes MD ,&nbsp;Omar Abdel-Razek MD ,&nbsp;Graeme Prosperi-Porta MSc, MD ,&nbsp;Pouya Motazedian MD ,&nbsp;Michael Froeschl MSc, MD ,&nbsp;Marino Labinaz MD ,&nbsp;Rebecca Mathew MD ,&nbsp;F. Daniel Ramirez MSc, MD ,&nbsp;Trevor Simard MD, PhD ,&nbsp;Benjamin Hibbert MD, PhD","doi":"10.1016/j.mayocpiqo.2024.100589","DOIUrl":"10.1016/j.mayocpiqo.2024.100589","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the role of noninvasive testing (NIT) before invasive coronary angiography (ICA) by evaluating the association between a positive myocardial perfusion imaging (MPI) or computed tomography angiography (CTA) result and the decision to perform coronary revascularization.</div></div><div><h3>Patients and Methods</h3><div>We screened all patients who received ICA between August 1, 2015, and July 31, 2019, and identified those who received MPI or CTA within the preceding 12 months. We considered MPI to be a positive result if it found moderate or severe ischemia in a specific coronary territory and CTA to be a positive result if it identified a stenosis greater than 50% in any major coronary artery.</div></div><div><h3>Results</h3><div>Of the 17,181 individual procedures, 2183 were included. Positive CTA had an odds ratio (OR) of 2.68 (95% CI, 1.82-3.94) for revascularization and positive MPI an OR of 1.29 (95% CI, 1.07-1.56). Overall sensitivity for CTA in the prediction of revascularization was 80.4% (95% CI, 75.7%-84.6%), with vessel-level sensitivity ranging from 57.3% (95% CI, 47.5%-66.7%) to 71.8% (95% CI, 65.8%-77.4%). Overall sensitivity of MPI was 48.2% (95% CI, 44.7%-51.7%), with territory-specific sensitivity ranging from 33.7% (95% CI, 29.9%-37.7%) to 36.5% (95% CI, 32.6%-40.6%). Overall specificity for CTA was low, at 39.5% (32.9%-46.3%), but higher when evaluating at the vessel level, ranging from 60.3% (95% CI, 54.5%-66.0%) to 83.5% (95% CI, 79.6%-86.9%). Overall specificity for MPI was 58.1% (95% CI, 54.9%-61.3%), with territory-specific specificity ranging from 78.6% (95% CI, 76.1%-80.9%) to 78.9% (95% CI, 76.5%-81.3%).</div></div><div><h3>Conclusion</h3><div>In this population of patients referred for ICA, positive CTA was more closely associated with revascularization than MPI. Further studies are necessary to determine the role of NIT before ICA.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 1","pages":"Article 100589"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030655","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.2024.11.005","DOIUrl":"10.1016/j.mayocpiqo.2024.11.005","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 1","pages":"Article 100588"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933834","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":"Prevalence of Weapons in the Health Care Setting: A Systematic Review and Meta-Analysis","authors":"Sarayna S. McGuire MD, MS ,&nbsp;Casey M. Clements MD, PhD ,&nbsp;Dana J. Gerberi MLIS ,&nbsp;M. Hassan Murad MD, MPH","doi":"10.1016/j.mayocpiqo.2024.11.004","DOIUrl":"10.1016/j.mayocpiqo.2024.11.004","url":null,"abstract":"<div><div>This study aimed to systematicically evaluate and quantify the prevalence of weapons in the health care setting. A systematic search of MEDLINE, Embase, Scopus, Web of Science, CINAHL, and EBSCO MegaFILE was performed from inception to January 12, 2024. The primary outcome was the prevalence of weapons in the health care setting on patients and/or visitors. Prevalence was pooled across studies and estimated using a random effects model. Subgroup analyses were done based on types of weapons, characteristics of weapon carriers, weapons screening/detection technology, and screened population characteristics. A total of 14 observational studies were included. All studies were from the United States and were published between 1984 and 2023. Weapons prevalence ranged from 0.4% to 26.3% among populations screened in the included studies. The overall pooled weapons prevalence was 4.0% (95% CI, 2.0%-7.8%). Most weapons were bladed (3.8%; 95% CI, 1.5%-8.9%), followed by other weapons (0.6%; 95% CI, 0.3%-1.3%), and firearms (0.1%; 95% CI, 0.02%-0.5%; <em>P</em>&lt;.01). Weapons prevalence was 2.0% (95% CI, 0.7%-5.8%) among individuals entering the hospital setting, compared with 1.6% (95% CI, 0.7%-3.4%) of individuals entering the emergency department and highest (24.3%; 95% CI, 21.6%-27.2%) when major trauma patients were hand-searched. Prevalence was higher in males than that in females (11.1% vs 3.1%; <em>P</em>=.01). Weapons should be expected on individuals presenting to hospitals in the United States; however, prevalence varied widely based on the setting, type of patients, and detection method.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 1","pages":"Article 100587"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11713507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960744","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":"One Small Step by the National Institutes of Health Can be a Giant Leap for Persons With Disability","authors":"Zuhair Niazi,&nbsp;Taimur Sher MBBS, MD","doi":"10.1016/j.mayocpiqo.2024.11.001","DOIUrl":"10.1016/j.mayocpiqo.2024.11.001","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"8 6","pages":"Pages 549-550"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904622","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}