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

{"title":"Impact of Age and Variant Time Period on Clinical Presentation and Outcomes of Hospitalized Coronavirus Disease 2019 Patients","authors":"Pratyaksh K. Srivastava MD ,&nbsp;Alexandra M. Klomhaus PhD ,&nbsp;David M. Tehrani MD ,&nbsp;Gregg C. Fonarow MD ,&nbsp;Boback Ziaeian MD, PhD ,&nbsp;Pooja S. Desai MD ,&nbsp;Asim Rafique MD ,&nbsp;James de Lemos MD ,&nbsp;Rushi V. Parikh MD ,&nbsp;Eric H. Yang MD","doi":"10.1016/j.mayocpiqo.2023.07.004","DOIUrl":"10.1016/j.mayocpiqo.2023.07.004","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the impact of age and COVID-19 variant time period on morbidity and mortality among those hospitalized with COVID-19.</p></div><div><h3>Patients and Methods</h3><p>Patients from the American Heart Association’s Get With The Guidelines COVID-19 cardiovascular disease registry (January 20, 2020-February 14, 2022) were divided into groups based on whether they presented during periods of wild type/alpha, delta, or omicron predominance. They were further subdivided by age (young: 18-40 years; older: more than 40 years), and characteristics and outcomes were compared.</p></div><div><h3>Results</h3><p>The cohort consisted of 45,421 hospitalized COVID-19 patients (wild type/alpha period: 41,426, delta period: 3349, and omicron period: 646). Among young patients (18-40 years), presentation during delta was associated with increased odds of severe COVID-19 (OR, 1.6; 95% CI, 1.3-2.1), major adverse cardiovascular events (MACE) (OR, 1.8; 95% CI, 1.3-2.5), and in-hospital mortality (OR, 2.2; 95% CI, 1.5-3.3) when compared with presentation during wild type/alpha. Among older patients (more than 40 years), presentation during delta was associated with increased odds of severe COVID-19 (OR, 1.2; 95% CI, 1.1-1.3), MACE (OR, 1.5; 95% CI, 1.4-1.7), and in-hospital mortality (OR, 1.4; 95% CI, 1.3-1.6) when compared with wild type/alpha. Among older patients (more than 40 years), presentation during omicron associated with decreased odds of severe COVID-19 (OR, 0.7; 95% CI, 0.5-0.9) and in-hospital mortality (OR, 0.6; 95% CI, 0.5-0.9) when compared with wild type/alpha.</p></div><div><h3>Conclusion</h3><p>Among hospitalized adults with COVID-19, presentation during a time of delta predominance was associated with increased odds of severe COVID-19, MACE, and in-hospital mortality compared with presentation during wild type/alpha. Among older patients (aged more than 40 years), presentation during omicron was associated with decreased odds of severe COVID-19 and in-hospital mortality compared with wild type/alpha.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10507578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41176040","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":"Fulfillment and Validity of the Kidney Health Evaluation Measure for People with Diabetes","authors":"Silvia Ferrè PhD ,&nbsp;Amy Storfer-Isser PhD ,&nbsp;Kelsy Kinderknecht MS ,&nbsp;Elizabeth Montgomery BS ,&nbsp;Miriam Godwin MS ,&nbsp;Ashby Andrews MA, MS ,&nbsp;Stephan Dunning MBA ,&nbsp;Mary Barton MD ,&nbsp;Dan Roman BS ,&nbsp;John Cuddeback MD, PhD ,&nbsp;Nikita Stempniewicz MS ,&nbsp;Chi D. Chu MD ,&nbsp;Delphine S. Tuot MD ,&nbsp;Joseph A. Vassalotti MD","doi":"10.1016/j.mayocpiqo.2023.07.002","DOIUrl":"10.1016/j.mayocpiqo.2023.07.002","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the fulfillment and validity of the kidney health evaluation for people with diabetes (KED) Healthcare Effectiveness Data Information Set (HEDIS) measure.</p></div><div><h3>Patients and Methods</h3><p>Optum Labs Data Warehouse (OLDW) was used to identify the nationally distributed US population aged 18 years and older, with diabetes, between January 1, 2017, and December 31, 2017. The OLDW includes deidentified medical, pharmacy, laboratory, and electronic health record (EHR) data. The KED fulfillment was defined in 2017 as both estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio testing within the measurement year. The KED validity was assessed using bivariate analyses of KED fulfillment with diabetes care measures in 2017 and chronic kidney disease (CKD) diagnosis and evidence-based kidney protective interventions in 2018.</p></div><div><h3>Results</h3><p>Among eligible 5,635,619 Medicare fee-for-service beneficiaries, 736,875 Medicare advantage (MA) beneficiaries, and 660,987 commercial patients, KED fulfillment was 32.2%, 38.7%, and 37.7%, respectively. Albuminuria testing limited KED fulfillment with urinary albumin-creatinine ratio testing (&lt;40%) and eGFR testing (&gt;90%). The KED fulfillment was positively associated with receipt of diabetes care in 2017, CKD diagnosis in 2018, and evidence-based kidney protective interventions in 2018. The KED fulfillment trended lower for Black race, Medicare-Medicaid dual eligibility status, low neighborhood income, and low education status.</p></div><div><h3>Conclusion</h3><p>Less than 40% of adults with diabetes received guideline-recommended testing for CKD in 2017. Routine KED was associated with diabetes care and evidence-based CKD interventions. Increasing guideline-recommended testing for CKD among people with diabetes should lead to timely and equitable CKD detection and treatment.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10480072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10184969","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":"In-Hospital Versus Out-of-Hospital Stroke Onset Comparison of Process Metrics in a Community Primary Stroke Center","authors":"Felix E. Chukwudelunzu MD, MBA ,&nbsp;Bart Demaerschalk MD, MSc ,&nbsp;Leonardo Fugoso MD ,&nbsp;Emeka Amadi MBBS, MD ,&nbsp;Donn Dexter MD ,&nbsp;Angela Gullicksrud RN ,&nbsp;Clinton Hagen MS","doi":"10.1016/j.mayocpiqo.2023.07.003","DOIUrl":"10.1016/j.mayocpiqo.2023.07.003","url":null,"abstract":"<div><h3>Objective</h3><p>To examine in-hospital stroke onset metrics and outcomes, quality of care, and mortality compared with out-of-hospital stroke in a single community-based primary stroke center.</p></div><div><h3>Patients and Methods</h3><p>Medical records of in-hospital stroke onset were compared with out-of-hospital stroke onset alert data between January 1, 2013 and December 31, 2019. Time-sensitive stroke process metric data were collected for each incident stroke alert. The primary focus of interest was the time-sensitive stroke quality metrics. Secondary focus pertained to thrombolysis treatment or complications, and mortality. Descriptive and univariable statistical analyses were applied. Kruskal-Wallis and χ² tests were used to compare median values and categorical data between prespecified groups. The statistical significance was set at α=0.05.</p></div><div><h3>Results</h3><p>The out-of-hospital group reported a more favorable response to time-sensitive stroke process metrics than the in-hospital group, as measured by median stroke team response time (15.0 vs 26.0 minutes; <em>P</em>≤.0001) and median head computed tomography scan completion time (12.0 vs 41.0 minutes; <em>P</em>=.0001). There was no difference in the stroke alert time between the 2 groups (14.0 vs 8.0 minutes; <em>P</em>=.089). Longer hospital length of stay (4 vs 3 days; <em>P</em>=.004) and increased hospital mortality (19.3% vs 7.4%; <em>P</em>=.0032) were observed for the in-hospital group.</p></div><div><h3>Conclusions</h3><p>The key findings in this study were that time-sensitive stroke process metrics and stroke outcome measures were superior for the out-of-hospital groups compared with the in-hospital groups. Focusing on improving time-sensitive stroke process metrics may improve outcomes in the in-hospital stroke cohort.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f4/2c/main.PMC10504462.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10279509","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":"Home-Based Physical Activity Program With Health Coaching for Participants With Chronic Obstructive Pulmonary Disease in Sweden: A Proof-of-Concept Pilot Study","authors":"Maria V. Benzo MD, MS ,&nbsp;Maria Hagströmer PhD ,&nbsp;Malin Nygren-Bonnier PhD ,&nbsp;Roberto P. Benzo MD, MS ,&nbsp;Marian E. Papp PhD","doi":"10.1016/j.mayocpiqo.2023.07.005","DOIUrl":"10.1016/j.mayocpiqo.2023.07.005","url":null,"abstract":"<div><p>Home-based interventions are at the center stage of current health care demands. There is a clear need to translate pulmonary rehabilitation into a home-based setting. This 8-week pilot study aimed to determine the feasibility of a home-based physical activity program for participants with chronic obstructive pulmonary disease (COPD) in Sweden. Patients with COPD, aged 40 years or older and clinically stable in the past 3 months, were recruited. The program used a fitness tracker to monitor step count, weekly health coaching calls using motivational interviewing, and video-guided mindful movements. The outcome measures were adherence to the 8-week program’s video-guided exercises (number of times videos were watched), adherence to health coaching calls (minimum 8), monthly and daily step count, and quality of life (QoL) using the chronic respiratory questionnaire. Thirteen participants were enrolled, and 12 participants adhered to health coaching calls and step monitoring. We had 643 video-exercise views, which exceeded the minimum standard (576 views). The mean difference comparing total monthly steps from baseline and the 8-week time point was 47,039 steps (95% CI, –113,625 to 1623.5; <em>P</em>=.06). The minimal clinical improvement of 500 daily steps was found for 8 of the patients. No significant improvement was found in the QoL measures and mental health. We found the home-based physical activity program to be a feasible intervention. Patients reported high adherence to tracking step counts, health coaching calls, and video-guided exercise. No improvements in QoL or monthly step count emerged; however, we found high adherence and a positive trend in the number of monthly step counts, and improvements of at least 500 daily step counts improved in most patients with this small sample size.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10551807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41160719","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":"Implications of a Supernumerary Nipple Breast Cancer in a BReast CAncer Sequence Variation Carrier: A Case Report","authors":"Will Sperduto MD, MBS ,&nbsp;Ann McCullough MD ,&nbsp;Donald Northfelt MD ,&nbsp;Lisa McGee MD ,&nbsp;Barbara Pockaj MD ,&nbsp;Kristen Jogerst MD, MPH","doi":"10.1016/j.mayocpiqo.2023.08.006","DOIUrl":"10.1016/j.mayocpiqo.2023.08.006","url":null,"abstract":"<div><p>Supernumerary nipples develop on the chest and abdominopelvic regions along the embryonic milk line. Their anatomy varies from isolated accessory nipples to complete supernumerary nipples (accessory nipple, areola, and underlying glandular breast tissue). Patients with a pathogenic BReast CAncer (BRCA) sequence variation are at an increased cumulative risk of developing breast cancer, and it is the standard of care for them to be offered medical or surgical risk reduction. Given the relatively low prevalence of breast cancer within supernumerary nipples and ectopic glandular breast tissue, no current recommendations exist to guide multidisciplinary management of patients with BRCA sequence variations and ectopic breast tissue. Our case is of a 62-year-old female BRCA-1 carrier with a previous history of right breast cancer who developed a new primary breast cancer within a supernumerary nipple after undergoing surgical risk reduction. With no current consensus on the surgical management of supernumerary nipples in BRCA-1 carriers, our recommendation is to perform a thorough physical examination before risk-reducing operation. If supernumerary nipples or ectopic glandular breast tissue are present, wide-local excision of the tissue should be offered for more complete surgical risk reduction.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/12/47/main.PMC10518438.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41159066","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":"Exercise Therapy in the Management of Peripheral Arterial Disease","authors":"Ahmad O. Hallak MD ,&nbsp;Fatima Z. Hallak MD ,&nbsp;Yusuf O. Hallak MD ,&nbsp;Osama O. Hallak MD ,&nbsp;Aaron W. Hayson MD ,&nbsp;Sadia A. Tanami MD ,&nbsp;William L. Bennett MD, PhD ,&nbsp;Carl J. Lavie MD","doi":"10.1016/j.mayocpiqo.2023.08.004","DOIUrl":"10.1016/j.mayocpiqo.2023.08.004","url":null,"abstract":"<div><p>The incidence and prevalence of peripheral artery disease (PAD) are increasing globally and have a marked economic burden in the United States. The American Heart Association/American College of Cardiology guidelines recommend exercise therapy as a Class 1A, but its utilization remains suboptimal. This state-of-the-art review aims to provide a comprehensive review of the most updated information available on PAD, along with its risk factors, management options, outcomes, economic burden, and the role of exercise therapy in managing PAD.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7e/66/main.PMC10562863.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41224286","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":"Diagnostic Yield of 16S Ribosomal Ribonucleic Acid Gene-Based Targeted Metagenomic Sequencing for Evaluation of Pleural Space Infection: A Prospective Study","authors":"Luis Gimenez-Miranda MD ,&nbsp;Bilal F. Samhouri MD ,&nbsp;Matthew J. Wolf MS ,&nbsp;Dagny K. Anderson MD ,&nbsp;David E. Midthun MD ,&nbsp;Kaiser G. Lim MD ,&nbsp;Ryan M. Kern MD ,&nbsp;Robin Patel MD ,&nbsp;Eva M. Carmona MD, PhD","doi":"10.1016/j.mayocpiqo.2023.07.010","DOIUrl":"10.1016/j.mayocpiqo.2023.07.010","url":null,"abstract":"<div><h3>Objective</h3><p>To better understand the microbial profile of complicated parapneumonic effusions and empyema, and to evaluate whether antimicrobial selection would differ if guided by targeted metagenomic sequencing (tMGS) <em>vs</em> conventional cultures (CCs) alone.</p></div><div><h3>Patients and Methods</h3><p>We analyzed the pleural fluid of a cohort of 47 patients undergoing thoracentesis from January 1, 2017 to August 31, 2019, to characterize their microbial profile. All samples underwent 16S ribosomal ribonucleic acid gene polymerase chain reaction, followed by tMGS.</p></div><div><h3>Results</h3><p>Pleural space infection was deemed clinically present in 20 of the 47 (43%) participants. Of those, n=7 (35%) had positive pleural fluid cultures and n=14 (70%) had positive tMGS results. The organisms identified by tMGS were concordant with CCs; however, tMGS detected additional bacterial species over CCs alone. <em>Streptococcus</em> and <em>Staphylococcus species</em> were the most common organisms identified, with <em>Streptococcus intermedius/constellatus</em> identified in 5 patients<em>.</em> Polymicrobial infections were found in 6 of the 20 patients, with anaerobes being the most common organisms identified in these cases.</p></div><div><h3>Conclusion</h3><p><em>Streptococci</em> and <em>staphylococci</em> were the most common organisms identified in infected pleural fluid. Anaerobes were common in polymicrobial infections. When compared with CCs, tMGS had higher sensitivity than CCs. Targeted metagenomic sequencing identified additional organisms, not identified by CCs, with associated potential management implications.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f1/f5/main.PMC10474564.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10208211","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":"Expanding the Role of the Surgical Preoperative Evaluation Clinic: Impact on Risk and Quality Outcome Measures","authors":"Michael Smerina MD ,&nbsp;Adrian G. Dumitrascu MD ,&nbsp;Aaron C. Spaulding PhD ,&nbsp;James W. Manz MD ,&nbsp;Razvan M. Chirila MD","doi":"10.1016/j.mayocpiqo.2023.07.006","DOIUrl":"10.1016/j.mayocpiqo.2023.07.006","url":null,"abstract":"<div><h3>Objective</h3><p>To prove that inpatient-adjusted surgical risk and quality outcome measures can be considerably impacted by interventions to improve documentation in the preoperative evaluation (POE) clinic.</p></div><div><h3>Patients and Methods</h3><p>We designed a quality improvement project with a multidisciplinary team in our POE clinic to more accurately reflect surgical risk and impact expected surgical quality outcomes through improved documentation. Interventions included an improved patient record acquisition process and extensive POE provider education regarding patient comorbidities’ documentation. For patients admitted after their planned operations, POE clinic comprehensive evaluation notes were linked to inpatient History and Physical notes. High complexity patients seen from October 1, 2018 to December 31, 2018 were the preintervention cohort, and the patients seen from January 1, 2019 to December 31, 2019 were the postintervention cohort.</p></div><div><h3>Results</h3><p>The primary outcome measures included the total number of coded diagnoses per encounter and the number of coded hierarchical condition categories per encounter. The secondary outcomes included the calculated severity of illness, risk of mortality, case-mix index, and risk-adjustment factor. Postintervention results show statistically significant increases in all primary outcomes with a <em>P</em>&lt;.05. All secondary outcome measures reported positive change.</p></div><div><h3>Conclusion</h3><p>Our interventions confirm that a comprehensive POE and thorough documentation provide a more accurate clinical depiction of the preoperative patient, which in turn impacts quality outcomes in inpatient surgical settings. These results are impactful for direct and indirect patient care and publicly reported hospital and provider level performance data.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fd/34/main.PMC10562114.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41224287","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":"Assessment of Prevalence, Clinical Characteristics, and Risk Factors Associated With “Low Flow State” Using Cardiac Magnetic Resonance","authors":"Yifang Yuan MD ,&nbsp;David Herrington MD ,&nbsp;Joao A.C. Lima MD ,&nbsp;R. Brandon Stacey MD ,&nbsp;David Zhao MD ,&nbsp;James Thomas MD ,&nbsp;Mario Garcia MD ,&nbsp;Min Pu MD, PhD","doi":"10.1016/j.mayocpiqo.2023.08.003","DOIUrl":"10.1016/j.mayocpiqo.2023.08.003","url":null,"abstract":"<div><h3>Objective</h3><p>To assess prevalence, clinical characteristics, and risk factors associated with low flow state (LFS) in a multiethnic population with normal left ventricular ejection fraction (LVEF).</p></div><div><h3>Patients and Methods</h3><p>The study included 4398 asymptomatic participants undergoing cardiac magnetic resonance from July 17, 2000, to August 29, 2002. Left ventricular (LV) mass, volume, and myocardial contraction fraction were assessed. Low flow state was defined as stroke volume index (SVi of &lt;35 mL/m²). Clinical characteristics, cardiac risk factors, and cardiac magnetic resonance findings were compared between LFS and normal flow state (NFS) groups (NFS: SVi of ≥35 mL/m²).</p></div><div><h3>Results</h3><p>There were significant differences in the prevalence of LFS in different ethnic groups. Individuals with LFS were older (66±9.6 vs 61±10 years; <em>P</em>&lt;.0001). The prevalence of LFS was 19% in the group aged older than 70 years. The logistic multivariable regression analysis found that age was independently associated with LFS. The LFS group had significantly higher prevalence of diabetes (30% vs 24%; <em>P</em>=.001), LV mass-volume ratio (1.13±0.22 vs 0.91±0.15; <em>P</em>&lt;.0001), inflammatory markers, a lower LV mass index (59±10 vs 65±11 kg/m2; <em>P</em>&lt;.001), lower myocardial contraction fraction (58.1±10.6% vs 75.7±13%; <em>P</em>&lt;.001), and a lower left atrial size index (32.2±4.6 vs 36.7±5.9 mm/m2; <em>P</em>&lt;.0001) than NFS.</p></div><div><h3>Conclusion</h3><p>Low flow state may be considered an under-recognized clinical entity associated with increasing age, multiple risk factors, increased inflammatory markers, a lower LV mass index, and suboptimal myocardial performance despite the presence of normal LVEF and absence of valvular disease.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/58/16/main.PMC10562103.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41224285","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":"Type 2 Diabetes Increases the Risk of Serious and Life-Threatening Conditions Among Adults With Traumatic Spinal Cord Injury","authors":"Michelle A. Meade PhD ,&nbsp;Zhe Yin MS ,&nbsp;Paul Lin MS ,&nbsp;Neil Kamdar MA ,&nbsp;Gianna Rodriguez MD ,&nbsp;Michael McKee MD, MPH ,&nbsp;Mark D. Peterson PhD, MS","doi":"10.1016/j.mayocpiqo.2023.08.002","DOIUrl":"10.1016/j.mayocpiqo.2023.08.002","url":null,"abstract":"<div><h3>Objective</h3><p>To compare the incidence of and adjusted hazards for serious and life-threatening morbidities among adults with traumatic spinal cord injury (TSCI) with and without type 2 diabetes (T2D).</p></div><div><h3>Participants and Methods</h3><p>A retrospective longitudinal cohort study was conducted from September 1, 2022 to February 2, 2023, among privately insured beneficiaries if they had an International Classification of Diseases, 9th Revision or 10th Revision, Clinical Modification diagnostic code for TSCI (n=9081). Incidence estimates of serious and life-threatening morbidities, and more common secondary and long-term health conditions, were compared at 5 years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for serious and life-threatening morbidities.</p></div><div><h3>Results</h3><p>Adults living with TSCI and T2D had a higher incidence of all of the morbidities assessed as compared with nondiabetic adults with TSCI. Fully adjusted survival models reported that adults with TSCI and T2D had a greater hazard for most of the serious and life-threatening conditions assessed, including sepsis (hazard ratio [HR]: 1.65), myocardial infarction (HR: 1.63), osteomyelitis (HR: 1.9), and stroke or transient ischemic attack (HR: 1.59). Rates for comorbid and secondary conditions were higher for individuals with TSCI and T2D, such as pressure sores, urinary tract infections, and depression, even after controlling for sociodemographic and comorbid conditions.</p></div><div><h3>Conclusion</h3><p>Adults living with TSCI and T2D have a significantly higher incidence of and risk of developing serious and life-threatening morbidities as compared with nondiabetic adults with TSCI.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d5/7a/main.PMC10562090.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41224288","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}