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

{"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}

{"title":"Association Between Educational Status and Mortality According to Diabetes Status Among US Adults","authors":"Toshiaki Komura BA ,&nbsp;Naoki Kondo MD, PhD ,&nbsp;Karan Bhatt BS ,&nbsp;Kosuke Inoue MD, PhD","doi":"10.1016/j.mayocpiqo.2023.04.007","DOIUrl":"10.1016/j.mayocpiqo.2023.04.007","url":null,"abstract":"<div><h3>Objective</h3><p>To examine differences in the association between educational attainment and mortality by the presence of diabetes and diabetic retinopathy (DR)—a major complication of diabetes.</p></div><div><h3>Patients and Methods</h3><p>We used a nationally representative sample of 54,924 US adults aged 20 years or older with diabetes from the National Health and Nutrition Examination Survey 1999-2018 and its mortality data through 2019. We applied the multivariable Cox proportional hazard models to investigate the associations between educational attainment (low, less than high school; middle, high school; and high, more than high school) and all-cause mortality according to diabetes status: nondiabetes, diabetes without DR, and diabetes with DR. Differences in the survival rate by educational attainment were evaluated using the slope inequality index (SII).</p></div><div><h3>Results</h3><p>Among the 54,924 participants (mean age, 49.9 years), adults in the low educational group reported an increased risk of all-cause mortality compared with those of the high educational group in any diabetes status (nondiabetes—hazard ratio [HR], 1.69; 95% CI, 1.56-1.82; diabetes without DR—HR, 1.61; 95% CI, 1.37-1.90; diabetes with DR—HR, 1.43; 95% CI, 1.10-1.86). SIIs among the diabetes without DR group and diabetes with DR group were 22.17 and 20.87 per 1000 person-years, respectively, which were 2 times greater than those among the nondiabetes group (SII=9.94).</p></div><div><h3>Conclusion</h3><p>The differences in the mortality risks owing to the educational attainment increased by the presence of diabetes regardless of the complication of DR. Our findings indicate that prevention of diabetes itself is critical to mitigate health disparities by socioeconomic status such as education status.</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/e4/45/main.PMC10250573.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9619021","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":"Humans as an Essential Source of Safety: A Frameshift for System Resilience","authors":"Heather L. Farley MD, MHCDS ,&nbsp;Elizabeth M. Harry MD ,&nbsp;Christine A. Sinsky MD ,&nbsp;Elizabeth W. Boehm BA ,&nbsp;Michael R. Privitera MD, MS ,&nbsp;Edward R. Melnick MD, MHS","doi":"10.1016/j.mayocpiqo.2023.05.001","DOIUrl":"10.1016/j.mayocpiqo.2023.05.001","url":null,"abstract":"","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/f2/cd/main.PMC10250566.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9992419","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":"Evaluation of a Computable Phenotype for Successful Cognitive Aging","authors":"Glenn Smith PhD ,&nbsp;Amber Miller MPH ,&nbsp;David E. Marra PhD ,&nbsp;Yonghui Wu PhD ,&nbsp;Jiang Bian PhD ,&nbsp;Demetrius M. Maraganore MD ,&nbsp;Stephen Anton PhD","doi":"10.1016/j.mayocpiqo.2023.04.006","DOIUrl":"10.1016/j.mayocpiqo.2023.04.006","url":null,"abstract":"<div><h3>Objective</h3><p>To establish, apply, and evaluate a computable phenotype for the recruitment of individuals with successful cognitive aging.</p></div><div><h3>Participants and Methods</h3><p>Interviews with 10 aging experts identified electronic health record (EHR)-available variables representing successful aging among individuals aged 85 years and older. On the basis of the identified variables, we developed a rule-based computable phenotype algorithm composed of 17 eligibility criteria. Starting September 1, 2019, we applied the computable phenotype algorithm to all living persons aged 85 years and older at the University of Florida Health, which identified 24,024 individuals. This sample was comprised of 13,841 (58%) women, 13,906 (58%) Whites, and 16,557 (69%) non-Hispanics. A priori permission to be contacted for research had been obtained for 11,898 individuals, of whom 470 responded to study announcements and 333 consented to evaluation. Then, we contacted those who consented to evaluate whether their cognitive and functional status clinically met out successful cognitive aging criteria of a modified Telephone Interview for Cognitive Status score of more than 27 and Geriatric Depression Scale of less than 6. The study was completed on December 31, 2022.</p></div><div><h3>Results</h3><p>Of the 45% of living persons aged 85 years and older included in the University of Florida Health EHR database identified by the computable phenotype as successfully aged, approximately 4% of these responded to study announcements and 333 consented, of which 218 (65%) met successful cognitive aging criteria through direct evaluation.</p></div><div><h3>Conclusion</h3><p>The study evaluated a computable phenotype algorithm for the recruitment of individuals for a successful aging study using large-scale EHRs. Our study provides proof of concept of using big data and informatics as aids for the recruitment of individuals for prospective cohort studies.</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/cd/92/main.PMC10250575.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9992422","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 Professional Society Guideline Publications in Medicine Subspecialties From 2012 to 2022: Implications for Clinical Care and Health Policy","authors":"Nikita Jhawar MD ,&nbsp;William Klaus Mai MD ,&nbsp;Artur Schneider DO ,&nbsp;William Michael Schmidt MD ,&nbsp;Guozhen Xie BS ,&nbsp;Abhishek Sharma MBBS ,&nbsp;Christopher Bennett Parker ,&nbsp;Fred Kusumoto MD","doi":"10.1016/j.mayocpiqo.2023.04.005","DOIUrl":"10.1016/j.mayocpiqo.2023.04.005","url":null,"abstract":"<div><p>Clinical guidelines have become an integral part of clinical care. We assessed professional society-based clinical guidelines from 2012 to 2022 to elucidate the trends in numbers of documents, recommendations, and classes of recommendations. Our results found that 40% of the guidelines do not follow all recommendations made by the Institute of Medicine for trustworthy documents. There has been a significant increase in documents in cardiology, gastroenterology, and hematology/oncology. In addition, of more than 20,000 recommendations, there was significant variability in recommendations made by different professional societies within a specialty. In documents from 11 of the 14 professional societies, more than 50% of the recommendations are supported with the lowest levels of evidence. In cardiology, in addition to the guideline documents, 140 nonguideline documents provide 1812 recommendations using the guideline verbiage, and 74% of the recommendations are supported by the lowest level of evidence. These data have important implications for health care because guidelines and guideline-like documents can be used for health policy issues such as assessment of quality of care, medical liability, education, and payment.</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/75/4e/main.PMC10319849.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9807417","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}