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

{"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}

{"title":"Rates Among Hospitalized Patients With COVID-19 Treated With Convalescent Plasma: A Systematic Review and Meta-Analysis","authors":"Jonathon W. Senefeld PhD ,&nbsp;Ellen K. Gorman BS ,&nbsp;Patrick W. Johnson BS ,&nbsp;M. Erin Moir PhD ,&nbsp;Stephen A. Klassen PhD ,&nbsp;Rickey E. Carter PhD ,&nbsp;Nigel S. Paneth MD ,&nbsp;David J. Sullivan MD ,&nbsp;Olaf H. Morkeberg BA ,&nbsp;R. Scott Wright MD ,&nbsp;DeLisa Fairweather PhD ,&nbsp;Katelyn A. Bruno PhD ,&nbsp;Shmuel Shoham MD ,&nbsp;Evan M. Bloch MBChB, MS ,&nbsp;Daniele Focosi MD ,&nbsp;Jeffrey P. Henderson MD, PhD ,&nbsp;Justin E. Juskewitch MD, PhD ,&nbsp;Liise-Anne Pirofski MD ,&nbsp;Brenda J. Grossman MD, MPH ,&nbsp;Aaron A.R. Tobian MD, PhD ,&nbsp;Michael J. Joyner MD","doi":"10.1016/j.mayocpiqo.2023.09.001","DOIUrl":"10.1016/j.mayocpiqo.2023.09.001","url":null,"abstract":"<div><h3>Objective</h3><p>To examine the association of COVID-19 convalescent plasma transfusion with mortality and the differences between subgroups in hospitalized patients with COVID-19.</p></div><div><h3>Patients and Methods</h3><p>On October 26, 2022, a systematic search was performed for clinical studies of COVID-19 convalescent plasma in the literature from January 1, 2020, to October 26, 2022. Randomized clinical trials and matched cohort studies investigating COVID-19 convalescent plasma transfusion compared with standard of care treatment or placebo among hospitalized patients with confirmed COVID-19 were included. The electronic search yielded 3841 unique records, of which 744 were considered for full-text screening. The selection process was performed independently by a panel of 5 reviewers. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were extracted by 5 independent reviewers in duplicate and pooled using an inverse-variance random effects model. The prespecified end point was all-cause mortality during hospitalization.</p></div><div><h3>Results</h3><p>Thirty-nine randomized clinical trials enrolling 21,529 participants and 70 matched cohort studies enrolling 50,160 participants were included in the systematic review. Separate meta-analyses reported that transfusion of COVID-19 convalescent plasma was associated with a decrease in mortality compared with the control cohort for both randomized clinical trials (odds ratio [OR], 0.87; 95% CI, 0.76-1.00) and matched cohort studies (OR, 0.76; 95% CI, 0.66-0.88). The meta-analysis of subgroups revealed 2 important findings. First, treatment with convalescent plasma containing high antibody levels was associated with a decrease in mortality compared with convalescent plasma containing low antibody levels (OR, 0.85; 95% CI, 0.73 to 0.99). Second, earlier treatment with COVID-19 convalescent plasma was associated with a decrease in mortality compared with the later treatment cohort (OR, 0.63; 95% CI, 0.48 to 0.82).</p></div><div><h3>Conclusion</h3><p>During COVID-19 convalescent plasma use was associated with a 13% reduced risk of mortality, implying a mortality benefit for hospitalized patients with COVID-19, particularly those treated with convalescent plasma containing high antibody levels treated earlier in the disease course.</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/5c/54/main.PMC10582279.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686748","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":"Characteristics and Outcomes of Patients Requiring Repeat Intensive Care Unit Consults","authors":"Matthew T. Freedman MD ,&nbsp;Kathryn H. Libby MD ,&nbsp;Kristin B. Miller MD, MS ,&nbsp;Markos G. Kashiouris MD, MPH","doi":"10.1016/j.mayocpiqo.2023.07.009","DOIUrl":"10.1016/j.mayocpiqo.2023.07.009","url":null,"abstract":"<div><h3>Objective</h3><p>To better understand the mortality and notable characteristics of patients initially denied intensive care unit (ICU) admission that are later admitted on reconsultation.</p></div><div><h3>Patients and Methods</h3><p>We collected data regarding all adult inpatients (n=3725) who received one or more ICU consults at an academic tertiary care hospital medical center between January 1, 2018 and October 1, 2021. We compared patients who were initially denied ICU admission and later admitted on reconsultation (C2A1, n=144) with those who were admitted after the first consultation (C1A1, n=2286) and those denied at first consult and never later admitted (C1A0, n=1295).</p></div><div><h3>Results</h3><p>Ten percent of patients initially rejected by the ICU were later admitted on reconsultation. There was no significant difference in the adjusted hospital death odds ratios between C1A1 and C2A1 (0.67; 95% CI 0.43-1.01; <em>P</em>=.11). Assessing subgroups of the C2A1 population, we found that 8.2% (n=100) of full code patients were later admitted to the ICU on reconsultation vs 23.2% (n=40) of do not attempt resuscitation patients (<em>P</em>&lt;.001); 7.6% (n=77) of patients initially consulted from the emergency department were later admitted to the ICU on reconsultation vs 15.1% (n=52) of patients initially consulted from an inpatient setting (<em>P</em>&lt;.001).</p></div><div><h3>Conclusion</h3><p>In this cohort, we demonstrated that patients admitted on repeat ICU consultation have no significant difference in mortality compared with equivalent patients admitted after the first consultation. Understanding and further exploring the consequences of these ICU reconsultations is vital to developing optimal critical care triaging practices.</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/45/cf/main.PMC10482889.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10224017","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":"Maximizing Solid Organ and Face Transplant Procurement Team Coordination: The Posterior Tibial Artery Flap as an Ideal Sentinel Flap","authors":"Marissa A. Suchyta PhD ,&nbsp;Brian Carlsen MD ,&nbsp;Karim Bakri MBBS ,&nbsp;Hatem Amer MD ,&nbsp;Samir Mardini MD","doi":"10.1016/j.mayocpiqo.2022.04.006","DOIUrl":"10.1016/j.mayocpiqo.2022.04.006","url":null,"abstract":"<div><p>Face transplantation became a reality with the first case performed in 2005. Facial tissue allograft procurement is technically complex and time-intensive. Brain-dead deceased donors are frequently, if not always, multiorgan donors. Every effort should be made during face allograft recovery to minimize any risk to the recovery of lifesaving solid organs. Some programs require the procurement of a myofascial vascularized skin graft to function as a sentinel flap allowing frequent monitoring for rejection without negatively impacting the esthetics of the face graft. Up till now, the flap used has been the radial forearm flap. Procuring the radial forearm flap places the procuring team in close proximity to the head and torso, where the face recovery and the solid organ recovery teams would require unhindered access. Here, we present the posterior tibial artery flap as an alternative flap that would provide benefits to the coordination of the multiple teams working to procure organs from a deceased donor.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ba/1b/main.PMC10267432.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9654001","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":"Ultrasound Enhancing Agents with Transthoracic Echocardiography for Maximal Wall Thickness in Hypertrophic Cardiomyopathy","authors":"John P. Bois MD ,&nbsp;Chadi Ayoub MBBS, PhD ,&nbsp;Jeffrey B. Geske MD ,&nbsp;Yee Weng Wong MBBS, MHS ,&nbsp;Muhannad A. Abbasi MBBCh ,&nbsp;Thomas A. Foley MD ,&nbsp;Sharon L. Mulvagh MD ,&nbsp;Christopher G. Scott MS ,&nbsp;Steve R. Ommen MD ,&nbsp;Patricia A. Pellikka MD","doi":"10.1016/j.mayocpiqo.2023.06.002","DOIUrl":"10.1016/j.mayocpiqo.2023.06.002","url":null,"abstract":"<div><h3>Objectives</h3><p>To determine whether ultrasound enhancing agent (UEA) changes maximal wall thickness (WT) in hypertrophic cardiomyopathy (HCM), and if it improves correlation with magnetic resonance imaging (MRI).</p></div><div><h3>Patients and Methods</h3><p>A total of 107 patients with HCM were prospectively enrolled at a single tertiary referral center between July 10, 2014, and August 31, 2017, and underwent transthoracic echocardiography (TTE) with and without UEA and MRI. Maximal WT measurements were compared, and variability among the 3 modalities was evaluated using a simple linear regression analysis and paired <em>t</em> tests and Bland-Altman plots. Interobserver variability for each technique was assessed.</p></div><div><h3>Results</h3><p>Most (63%) of cardiac imagers found UEA helpful in determining maximal WT by TTE, with 49% reporting change in WT. Of 52 patients where UEA changed WT measurement, 32 (62%) reported an increase and 20 (38%) reported a decrease in WT. The UEA did not alter the median discrepancy in WT between MRI and TTE. However, where UEA increased reported WT, the difference between MRI and TTE improved in 79% of cases (<em>P</em>=.001) from 2.0-0.5mm. In those with scar on MRI, UEA improved agreement of WT between TTE and MRI compared with that of TTE without UEA (79% vs 39%; <em>P</em>=.011). Interclass correlation coefficient for WT for TTE without UEA, with UEA, and MRI was 0.84; (95% CI, 0.61-0.92), 0.88; (95%CI, 0.82-0.92), and 0.97; (95%CI, 0.96-0.98), respectively.</p></div><div><h3>Conclusion</h3><p>Although use of UEA did not eliminate differences in WT discrepancy between modalities, the addition of UEA to TTE aided in WT determination and improved correlation with MRI in those with greater WT and in all patients with myocardial scars.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d6/14/main.PMC10371766.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9887088","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":"Impact of Atrial Fibrillation on Outcomes in Patients Hospitalized With Nontraumatic Intracerebral Hemorrhage","authors":"Sahith Reddy Thotamgari MD ,&nbsp;Akhilesh Babbili MD ,&nbsp;Prabandh Bucchanolla MD ,&nbsp;Samarthkumar Thakkar MD ,&nbsp;Harsh P. Patel MD ,&nbsp;Maja B. Spaseski MD ,&nbsp;Jonathan Graff-Radford MD ,&nbsp;Alejandro A. Rabinstein MD ,&nbsp;Zain Ul Abideen Asad MD, MS ,&nbsp;Samuel J. Asirvatham MD ,&nbsp;David R. Holmes Jr. MD ,&nbsp;Abhishek Deshmukh MD ,&nbsp;Christopher V. DeSimone MD, PhD","doi":"10.1016/j.mayocpiqo.2023.04.008","DOIUrl":"10.1016/j.mayocpiqo.2023.04.008","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the effect of atrial fibrillation (AF) on outcomes in hospitalizations for non-traumatic intracerebral hemorrhage (ICH).</p></div><div><h3>Patients and Methods</h3><p>We queried the National Inpatient Sample database between January 1, 2016, and December 31, 2019, to identify hospitalizations with an index diagnosis of non-traumatic ICH using ICD-10 code I61. The cohort was divided into patients with and without AF. Propensity score matching was used to balance the covariates between AF and non-AF groups. Logistic regression was used to analyze the association. All statistical analyses were performed using weighted values.</p></div><div><h3>Results</h3><p>Our cohort included 292,725 hospitalizations with a primary discharge diagnosis of non-traumatic ICH. From this group, 59,005 (20%) recorded a concurrent diagnosis of AF, and 46% of these patients with AF were taking anticoagulants. Patients with AF reported a higher Elixhauser comorbidity index (19.8±6.0 vs 16.6±6.4; <em>P</em>&lt;.001) before propensity matching. After propensity matching, the multivariate analysis reported that AF (aOR, 2.34; 95% CI, 2.26-2.42; <em>P</em>&lt;.001) and anticoagulation drug use (aOR, 1.32; 95% CI, 1.28-1.37; <em>P</em>&lt;.001) were independently associated with all-cause in-hospital mortality. Moreover, AF was significantly associated with respiratory failure requiring mechanical ventilation (odds ratio, 1.57; 95% CI, 1.52-1.62; <em>P</em>&lt;.001) and acute heart failure (odds ratio, 1.26; 95% CI, 1.19-1.33; <em>P</em>&lt;.001) compared with the absence of AF.</p></div><div><h3>Conclusion</h3><p>These data suggest that non-traumatic ICH hospitalizations with coexistent AF are associated with worse in-hospital outcomes such as higher mortality and acute heart failure.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/80/ce/main.PMC10250577.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9975359","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":"Financial Toxicity in the Clinical Encounter: A Paired Survey of Patient and Clinician Perceptions","authors":"Andrea Garcia-Bautista MD ,&nbsp;Celia Kamath PhD ,&nbsp;Nicolas Ayala MBBS ,&nbsp;Emma Behnken BA ,&nbsp;Rachel E. Giblon MS ,&nbsp;Derek Gravholt MS ,&nbsp;María José Hernández-Leal PhD ,&nbsp;Jessica Hidalgo MD ,&nbsp;Montserrat Leon Garcia PharmD, MPH ,&nbsp;Elizabeth H. Golembiewski MPH, PhD ,&nbsp;Andrea Maraboto MD ,&nbsp;Angela Sivly CCRP ,&nbsp;Juan P. Brito MD","doi":"10.1016/j.mayocpiqo.2023.05.003","DOIUrl":"10.1016/j.mayocpiqo.2023.05.003","url":null,"abstract":"<div><h3>Objective</h3><p>To compare the agreement between patient and clinician perceptions of care-related financial issues.</p></div><div><h3>Patients and Methods</h3><p>We surveyed patient-clinician dyads immediately after an outpatient medical encounter between September 2019 and May 2021. They were asked to separately rate (1-10) patient’s level of difficulty in paying medical bills and the importance of discussing cost issues with that patient during clinical encounters. We calculated agreement between patient-clinician ratings using the intraclass correlation coefficient and used random effects regression models to identify patient predictors of paired score differences in difficulty and importance of ratings.</p></div><div><h3>Results</h3><p>58 pairs of patients (n=58) and clinicians (n=40) completed the survey. Patient-clinician agreement was poor for both measures, but higher for difficulty in paying medical bills (intraclass correlation coefficient=0.375; 95% CI, 0.13-0.57) than for the importance of discussing cost (−0.051; 95% CI, −0.31 to 0.21). Agreement on difficulty in paying medical bills was not lower in encounters with conversations about the cost of care. In adjusted models, poor patient-clinician agreement on difficulty in paying medical bills was associated with lower patient socioeconomic status and education level, whereas poor agreement on patient-perceived importance of discussing cost was significant for patients who were White, married, reported 1 or more long-term conditions, and had higher education and income levels.</p></div><div><h3>Conclusion</h3><p>Even in encounters where cost conversations occurred, there was poor patient-clinician agreement on ratings of the patient’s difficulty in paying medical bills and perceived importance of discussing cost issues. Clinicians need more training and support in detecting the level of financial burden and tailoring cost conversations to the needs of individual patients.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5f/1c/main.PMC10285501.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10091330","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}