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

{"title":"Show Me CKDintercept Initiative: A Collective Impact Approach to Improve Population Health in Missouri","authors":"Katelyn Laue MPH ,&nbsp;Megan Schultz MPH ,&nbsp;Elizabeth Talbot-Montgomery BS ,&nbsp;Alexandra Garrick MSEd ,&nbsp;Anuja Java MD ,&nbsp;Christine Corbett DNP ,&nbsp;Dana M. Lammert MA ,&nbsp;JoAnna Rogers BA ,&nbsp;Kathleen Davis BS ,&nbsp;Kunal Malhotra MD ,&nbsp;Marie Philipneri MD, PhD ,&nbsp;Mary Ann Kimbel RN ,&nbsp;Reem A. Mustafa MD, MPH, PhD ,&nbsp;Valerie Hardesty MPH","doi":"10.1016/j.mayocpiqo.2023.12.004","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.12.004","url":null,"abstract":"<div><p>Ninety percent of people with chronic kidney disease (CKD) remain undiagnosed, most people at risk do not receive guideline-concordant testing, and disparities of care and outcomes exist across all stages of the disease. To improve CKD diagnosis and management across primary care, the National Kidney Foundation launched a collective impact (CI) initiative known as Show Me CKDintercept. The initiative was implemented in Missouri, USA from January 2021 to June 2022, using a data strategy, stakeholder engagement and relationship mapping, learning in action working groups (LAWG), and a virtual leadership summit. The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework was used to evaluate success. The initiative united 159 stakeholders from 81 organizations (Reach) to create an urgency for change and engage new CKD champions (Effectiveness). The adoption resulted in 53% of participants committed to advancing the roadmap (Adoption). Short-term results reported success in laying a foundation for CI across Missouri. The long-term success of the CI initiative in addressing the public health burden of kidney disease remains to be determined. The project reported the potential use of a CI initiative to build leadership consensus to drive measurable public health improvements nationwide.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000796/pdfft?md5=3379d449c38ed551f518b28186bbcf8c&pid=1-s2.0-S2542454823000796-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433539","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":"A Practical Guide to Identify Patients With Multifocal Motor Neuropathy, a Treatable Immune-Mediated Neuropathy","authors":"Jeffrey A. Allen MD ,&nbsp;Amy E. Clarke MSN, RN, IgCN ,&nbsp;Thomas Harbo MD, PhD","doi":"10.1016/j.mayocpiqo.2023.12.002","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.12.002","url":null,"abstract":"<div><p>Multifocal motor neuropathy (MMN) is a rare immune-mediated motor neuropathy characterized by asymmetric weakness that preferentially affects distal upper limb muscles. The clinical features of MMN may be difficult to differentiate from motor neuron disease. Other conditions that may be mistaken for MMN include inclusion body myositis, chronic inflammatory demyelinating polyradiculoneuropathy, hereditary neuropathy with liability to pressure palsy, focal neuropathies, and radiculopathies. A key distinguishing electrophysiologic feature of MMN is the motor nerve conduction block located at noncompressible sites. MMN is a treatable neuropathy; therefore it is important that primary care physicians are aware of the features of the disease to identify potential patients and make referrals to a neuromuscular specialist in a timely manner. This review provides an overview of the disease, highlights key differential diagnoses, and describes available treatment options for patients with MMN.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000772/pdfft?md5=6908eb31b86706aaefb249267e2f9ad0&pid=1-s2.0-S2542454823000772-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139398842","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":"When Occipital Artery Biopsy is Preferred to Temporal Biopsy for Giant Cell Arteritis: A Step-By-Step Description of the Surgical Technique","authors":"May Dvir MS ,&nbsp;Ghaith Almhanni MD ,&nbsp;Huzaif Qaisar MBBS ,&nbsp;Andrew Calvin MD ,&nbsp;Tiziano Tallarita MD","doi":"10.1016/j.mayocpiqo.2023.12.005","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.12.005","url":null,"abstract":"<div><p>Giant cell arteritis is an autoimmune disease that affects large and medium blood vessels of the head and neck. Its prompt treatment is mandatory to avoid severe and permanent complications, such as blindness. Temporal artery biopsy is an important part of the diagnostic work-up, especially in those patients with cranial symptoms or in the elderly with a fever of unknown origin. Most patients have signs and symptoms matching the distribution of their arterial involvement. In the case scenario of occipital headache or nuchal pain, a biopsy of the occipital artery may be preferred to a temporal artery biopsy. This article provides important anatomical details of the course of the occipital artery and explains, in a stepwise fashion, how to perform an occipital artery biopsy.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000802/pdfft?md5=5835fc74ecc8e41fb2f1579fc2a6948a&pid=1-s2.0-S2542454823000802-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139107409","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":"Females Display Lower Risk of Myocardial Infarction From Higher Estimated Cardiorespiratory Fitness Than Males: The Tromsø Study 1994-2014","authors":"Edvard H. Sagelv PhD ,&nbsp;Andrea Casolo PhD ,&nbsp;Anne Elise Eggen PhD ,&nbsp;Kim Arne Heitmann PhD ,&nbsp;Kristoffer R. Johansen MSc ,&nbsp;Maja-Lisa Løchen PhD ,&nbsp;Ellisiv B. Mathiesen PhD ,&nbsp;Bente Morseth PhD ,&nbsp;Inger Njølstad PhD ,&nbsp;John O. Osborne PhD ,&nbsp;Karianne Hagerupsen MSc ,&nbsp;Sigurd Pedersen PhD ,&nbsp;Tom Wilsgaard PhD","doi":"10.1016/j.mayocpiqo.2023.12.007","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.12.007","url":null,"abstract":"<div><h3>Objective</h3><p>To examine the dose-response association between estimated cardiorespiratory fitness (eCRF) and risk of myocardial infarction (MI).</p></div><div><h3>Patients and Methods</h3><p>Adults who attended Tromsø Study surveys 4-6 (Janurary 1,1994-December 20, 2008) with no previous cardiovascular disease were followed up through December 31, 2014 for incident MI. Associations were examined using restricted cubic splines Fine and Gray regressions, adjusted for education, smoking, alcohol, diet, sex, adiposity, physical activity, study survey, and age (timescale) in the total cohort and subsamples with hyperlipidemia (n=2956), hypertension (n=8290), obesity (n=5784), metabolic syndrome (n=1410), smokers (n=3823), and poor diet (n=3463) and in those who were physically inactive (n=6255).</p></div><div><h3>Results</h3><p>Of 14,285 participants (mean age ± SD, 53.7±11.4 years), 979 (6.9%) experienced MI during follow-up (median, 7.2 years; 25th-75th, 5.3-14.6 years). Females with median eCRF (32 mL/kg/min) had 43% lower MI risk (subdistributed hazard ratio [SHR], 0.57; 95% CI, 0.48-0.68) than those at the 10th percentile (25 mL/kg/min) as reference. The lowest MI risk was observed at 47 mL/kg/min (SHR, 0.02; 95% CI, 0.01-0.11). Males had 26% lower MI risk at median eCRF (40 mL/kg/min; SHR, 0.74; 95% CI, 0.63-0.86) than those at the 10th percentile (32 mL/kg/min), and the lowest risk was 69% (SHR, 0.31; 95% CI, 0.14-0.71) at 60 mL/kg/min. The associations were similar in subsamples with cardiovascular disease risk factors.</p></div><div><h3>Conclusion</h3><p>Higher eCRF associated with lower MI risk in females and males, but associations were more pronounced among females than those in males. This suggest eCRF as a vital estimate to implement in medical care to identify individuals at high risk of future MI, especially for females.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000826/pdfft?md5=faf6ca2d58c1b47ae0380a6e7c317a24&pid=1-s2.0-S2542454823000826-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139111519","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 Expanding Scope of Alpha 1 Antitrypsin Deficiency","authors":"Friedrich Kueppers MD","doi":"10.1016/j.mayocpiqo.2023.12.001","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.12.001","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000760/pdfft?md5=a1663219cf14da6138b5036a565c14de&pid=1-s2.0-S2542454823000760-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139107408","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":"Daylight Saving Time Practice and the Rate of Adverse Cardiovascular Events in the United States: A Probabilistic Assessment in a Large Nationwide Study","authors":"Benjamin A. Satterfield MD, PhD ,&nbsp;Ozan Dikilitas MD ,&nbsp;Holly Van Houten BA ,&nbsp;Xiaoxi Yao PhD, MPH ,&nbsp;Bernard J. Gersh MBChB, DPhil","doi":"10.1016/j.mayocpiqo.2023.12.006","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.12.006","url":null,"abstract":"<div><p>We investigated the association of daylight saving time (DST) transitions with the rates of adverse cardiovascular events in a large, US-based nationwide study. The study cohort included 36,116,951 unique individuals from deidentified administrative claims data of the OptumLabs Data Warehouse. There were 74,722 total adverse cardiovascular events during DST transition and the control weeks (2 weeks before and after) in spring and autumn of 2015-2019. We used Bayesian hierarchical Poisson regression models to estimate event rate ratios representing the ratio of composite adverse cardiovascular event rates between DST transition and control weeks. There was an average increase of 3% (95% uncertainty interval, −3% to −10%) and 4% (95% uncertainty interval, −2% to −12%) in adverse cardiovascular event rates during Monday and Friday of the spring DST transition, respectively. The probability of this being associated with a moderate-to-large increase in the event rates (estimate event rate ratio, &gt;1.10) was estimated to be less than 6% for Monday and Friday, and less than 1% for the remaining days. During autumn DST transition, the probability of any decrease in adverse cardiovascular event rates was estimated to be less than 46% and a moderate-to-large decrease in the event rates to be less than 4% across all days. Results were similar when adjusted by age. In conclusion, spring DST transition had a suggestive association with a minor increase in adverse cardiovascular event rates but with a very low estimated probability to be of clinical importance. Our findings suggest that DST transitions are unlikely to meaningfully impact the rate of cardiovascular events.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000814/pdfft?md5=8383a94342c93556eb14bd0bb98b66ae&pid=1-s2.0-S2542454823000814-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139107410","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":"Physical Restraint Usage in Hospitals Across the United States: 2011-2019","authors":"Ishaan Gupta MBBS,&nbsp;Ilana Nelson-Greenberg MD,&nbsp;Scott Mitchell Wright MD,&nbsp;Ché Matthew Harris MD, MS","doi":"10.1016/j.mayocpiqo.2023.12.003","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.12.003","url":null,"abstract":"<div><h3>Objective</h3><p>To determine the change in rates of physical restraint (PR) use and associated outcomes among hospitalized adults.</p></div><div><h3>Patients and Methods</h3><p>Using national inpatient sample databases, we analyzed years 2011-2014 and 2016-2019 to determine trends of PR usage. We also compared the years 2011-2012 and 2018-2019 to investigate rates of PR use, in-hospital mortality, length of stay, and total hospital charges.</p></div><div><h3>Results</h3><p>There were 242,994,110 hospitalizations during the study period. 1,538,791 (0.63%) had coding to signify PRs, compared with 241,455,319 (99.3%), which did not. From 2011 to 2014, there was a significant increase in PR use (<em>p-</em>trend&lt;.01) and a nonsignificant increase in PR rates from 2016-2019 (<em>p-</em>trend=.07). Over time, PR use increased (2011-2012: 0.52% vs 2018-2019: 0.73%; <em>p</em>&lt;.01). Patients with PRs reported a higher adjusted odds for in-hospital mortality in 2011-2012 (adjusted odds ratio [aOR], 3.9; 95% CI, 3.7-4.2; <em>p</em>&lt;.01) and 2018-2019 (aOR, 3.5; 95% CI, 3.4-3.7; <em>p</em>&lt;.01). Length of stay was prolonged for patients with PRs in 2011-2012 (adjusted mean difference [aMD], 4.3 days; 95% CI, 4.1-4.5; <em>p</em>&lt;.01) and even longer in 2018-2019 (aMD, 5.8 days; 95% CI, 5.6-6.0; <em>p</em>&lt;.01). Total hospital charges were higher for patients with PRs in 2011-2012 (aMD, +$55,003; 95% CI, $49,309-$60,679; <em>p</em>&lt;.01). Following adjustment for inflation, total charges remained higher for patients with PRs compared with those without PRs in 2018-2019 (aMD, +$70,018; 95% CI, $65,355-$74,680; <em>p</em>&lt;.01).</p></div><div><h3>Conclusion</h3><p>Overall, PR rates did not decrease across the study period, suggesting that messaging and promulgating best practice guidelines have yet to translate into a substantive change in practice patterns.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000784/pdfft?md5=251e31df642d392cd42bba037377ce0e&pid=1-s2.0-S2542454823000784-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139107407","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":"Safety and Efficacy of Surgical and Percutaneous Cardiac Interventions for Adults With Down Syndrome","authors":"Kaitlin Roehl PA-C ,&nbsp;Carolyn Mead-Harvey MS ,&nbsp;Heidi M. Connolly MD ,&nbsp;Joseph A. Dearani MD ,&nbsp;Felicia S. Schaap APRN, AGACNP-BC ,&nbsp;Susanna L. Liljenstolpe APRN, FNP-C ,&nbsp;Linda B. Osborn RN ,&nbsp;C. Charles Jain MD ,&nbsp;Donald J. Hagler Sr. MD ,&nbsp;Francois Marcotte MD ,&nbsp;David S. Majdalany MD","doi":"10.1016/j.mayocpiqo.2023.11.002","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.11.002","url":null,"abstract":"<div><h3>Objective</h3><p>To assess risks and benefits of cardiac intervention in adults with Down syndrome (DS).</p></div><div><h3>Patients and Methods</h3><p>A retrospective review was conducted using data from a study we published in 2010. Patients aged 18 years or older with DS who underwent cardiac operation or percutaneous intervention from February 2009 through April 2022 (new cohort) were compared with patients in the previous study (January 1969 through November 2007; remote cohort) at Mayo Clinic.</p></div><div><h3>Results</h3><p>In total, 81 adults (43 men; 38 women) with DS underwent 89 cardiac interventions (84 surgical; 5 percutaneous) at a mean age of 33 years. Twenty-six patients presented with complete atrioventricular canal defect (17%) or tetralogy of Fallot (15%). The most common adult procedures were valve interventions: mitral (31%), tricuspid (15%), and pulmonary (12%). Of pulmonary valve interventions in the new cohort, 33% were performed percutaneously. The postoperative mortality rate was low (1% total). The mean time between last operation and death was 16 years.</p></div><div><h3>Conclusion</h3><p>Adults with DS can undergo cardiac operation and percutaneous intervention with low morbidity and mortality risk and good long-term survival.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000735/pdfft?md5=adb10ed4913539d603291b2c058c3d1c&pid=1-s2.0-S2542454823000735-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139050152","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 Consultations in a Community Neurology Practice: A Retrospective Study Informing Best Practice","authors":"Nathan A. Seven MD ,&nbsp;Karen A. Truitt DO ,&nbsp;Ross A. Dierkhising MS ,&nbsp;Nathan P. Young DO","doi":"10.1016/j.mayocpiqo.2023.11.003","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.11.003","url":null,"abstract":"<div><h3>Objective</h3><p>To describe our practice of electronic consultations (e-consults) and assess safety and risk factors for subsequent face-to-face consultations.</p></div><div><h3>Patients and Methods</h3><p>A retrospective cohort study of all e-consults completed in a community neurology practice between May 5, 2018, and June 31, 2019, was completed. Clinical and demographic variables were compared between the successful and unsuccessful (defined by presence of subsequent face-to-face consultation) cohorts. Hazard ratios (HR) were calculated using Cox regression model. Kaplan-Meier probability analysis (with 95% CIs) of subsequent face-to-face consultation was performed. Case examples highlighting potential harm were summarized.</p></div><div><h3>Results</h3><p>In total, 302 e-consults were reviewed. The most frequent referrals were for headache (n=125, 41.4%), dysesthesia (n=40, 13.2%), and abnormal imaging finding (n=27, 8.9%). The most common e-consult questions were for treatment (57.6%) and diagnostic evaluation (48.0%) recommendations. Moreover, 24.8% (n=75) of e-consults were followed by face-to-face consultations, with primary risk factors including female sex (HR, 1.9), referral for headache (HR, 1.7), and final diagnosis of migraine (HR, 2.0) or long-term migraine (HR, 5.0). Potential harm related to delayed diagnosis/treatment was identified in 6 (2.0%) patients with migraine and 4 (1.3%) without migraine presenting to emergency department.</p></div><div><h3>Conclusion</h3><p>Utilization of e-consults may safely improve access to neurologic expertise and prevent the need for some visits, which may have required a face-to-face visit. In patients with chronic migraine, e-consults should be considered short-term and followed by face-to-face consultation as soon as access allows. Neurologists performing e-consults should be able to triage patients to face-to-face consultation, particularly when diagnosis is uncertain or the neurologic examination may help guide appropriate testing.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000747/pdfft?md5=34d543c79ed67e1a33863ede1816bd8e&pid=1-s2.0-S2542454823000747-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038572","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":"Consecutive Transcutaneous and Epidural Spinal Cord Neuromodulation to Modify Clinical Complete Paralysis—the Proof of Concept","authors":"Elvira Mukhametova MD ,&nbsp;Alena Militskova MS ,&nbsp;Artur Biktimirov MD ,&nbsp;Nikita Kharin MS ,&nbsp;Elena Semenova MS ,&nbsp;Oskar Sachenkov PhD ,&nbsp;Tatiana Baltina PhD ,&nbsp;Igor Lavrov MD, PhD","doi":"10.1016/j.mayocpiqo.2023.09.006","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.09.006","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the effect of transcutaneous (tSCS) and epidural electrical spinal cord stimulation (EES) in facilitating volitional movements, balance, and nonmotor functions, in this observational study, tSCS and EES were consecutively tested in 2 participants with motor complete spinal cord injury (SCI).</p></div><div><h3>Participants and Methods</h3><p>Two participants (a 48-year-old woman and a 28-year-old man), both classified as motor complete spinal injury, were enrolled in the study. Both participants went through a unified protocol, such as an initial electrophysiological assessment of neural connectivity, consecutive tSCS and EES combined with 8 wks of motor training with electromyography (EMG) and kinematic evaluation. The study was conducted from May 1, 2019, to December 31, 2021.</p></div><div><h3>Results</h3><p>In both participants, tSCS reported a minimal improvement in voluntary movements still essential to start tSCS-enabled rehabilitation. Compared with tSCS, following EES showed immediate improvement in voluntary movements, whereas tSCS was more effective in improving balance and posture. Continuous improvement in nonmotor functions was found during tSCS-enabled and then during EES-enabled motor training.</p></div><div><h3>Conclusion</h3><p>Results report a significant difference in the effect of tSCS and EES on the recovery of neurologic functions and support consecutive tSCS and EES applications as a potential therapy for SCI. The proposed approach may help in selecting patients with SCI responsive to neuromodulation. It would also help initiate neuromodulation and rehabilitation therapy early, particularly for motor complete SCI with minimal effect from conventional rehabilitation.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000644/pdfft?md5=c15d5171a92a6d907c575eb820ff6c71&pid=1-s2.0-S2542454823000644-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138633570","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}