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Code Intracerebral Hemorrhage: A Quality Improvement Pilot Study 编码脑出血:一项质量改进试点研究
Pub Date : 2026-01-17 DOI: 10.1016/j.mayocpiqo.2025.100690
Ehab Harahsheh MBBS , Oana M. Dumitrascu MD, MSc , Katelyn Marsden MBBS, MSc , Vanesa K. Vanderhye MSN , Justin Cramer MD , Cumara B. O’Carroll MD, MPH

Objective

To improve adherence to current national guideline-recommended practices for managing acute spontaneous intracerebral hemorrhage (ICH) in patients presenting to Mayo Clinic Arizona emergency department.

Patients and Methods

We launched a quality improvement initiative from April 1, 2024, to April 30, 2025, using the Define-Measure-Analyze-Improve-Control framework. Initial 6-month goals included: (1) administering antihypertensive treatment within 30 minutes of identifying ICH in ≥80% of patients with systolic blood pressure >150 mm Hg; (2) reversing anticoagulation within 45 minutes in ≥80% of anticoagulated patients; (3) performing repeat computed tomography head scans at 6 hours post-ICH identification in ≥80% of patients; and (4) initiating vascular neurology and neurosurgery assessments within 15 minutes of ICH recognition. Identified care gaps, informed by stakeholder feedback, led to the creation of a standardized Code ICH protocol and an emergency department-specific ICH electronic medical record power plan.

Results

Twenty patients were included in the 1-6-month interval (Code ICH activated in 15/20 (75%) of eligible patients) and 12 patients in the 7-13 month interval (Code ICH activated in 8/12 [67%]). Antihypertensive medication administration within 30 minutes occurred in 92% (11/12) and 100% (3/3) of patients with systolic blood pressure >150 mm Hg. Anticoagulation reversal within 45 minutes was achieved in all eligible patients (100%, 2/2). Repeat computed tomography scans at 6 hours post-ICH identification were completed in 93% (11/12) and 100% (8/8) of patients at respective time points. Immediate vascular neurology evaluations were performed in all patients, and neurosurgery consultations occurred in 87% (20/23). A sustainability plan was developed postintervention to maintain continued Code ICH activation and compliance.

Conclusion

Implementation of a structured Code ICH protocol facilitated prompt neurological assessments and adherence with current national acute ICH management guidelines.
目的提高对目前国家指南推荐的急性自发性脑出血(ICH)患者在亚利桑那州梅奥诊所急诊科的治疗依从性。患者和方法我们从2024年4月1日至2025年4月30日启动了一项质量改进计划,采用定义-测量-分析-改进-控制框架。最初的6个月目标包括:(1)≥80%收缩压≤150 mm Hg的患者在发现脑出血后30分钟内给予降压治疗;(2)≥80%抗凝患者在45分钟内逆转抗凝;(3)≥80%的患者在脑出血确诊后6小时进行重复头部ct扫描;(4)在脑出血识别后15分钟内启动血管神经学和神经外科评估。根据利益攸关方的反馈,确定了护理差距,从而制定了标准化的ICH代码协议和针对急诊科的ICH电子病历电源计划。结果20例患者在1-6个月的时间间隔(符合条件的患者中有15/20(75%)激活了ICH代码),12例患者在7-13个月的时间间隔(8/12[67%]激活了ICH代码)。92%(11/12)和100%(3/3)收缩压为150 mm Hg的患者在30分钟内给予降压药物,所有符合条件的患者在45分钟内实现抗凝逆转(100%,2/2)。分别有93%(11/12)和100%(8/8)的患者在各自的时间点完成脑出血确诊后6小时的重复计算机断层扫描。所有患者均立即进行血管神经学评估,87%(20/23)的患者进行了神经外科会诊。干预后制定了可持续性计划,以保持持续的ICH守则的激活和遵守。结论:实施结构化的Code ICH协议有助于及时进行神经学评估,并遵守当前国家急性ICH管理指南。
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引用次数: 0
Multifeature Ultrasound-Based Classification for Breast Lesions: A Comparative Study of PONS Image Enhancement Technology 基于超声多特征的乳腺病变分类:PONS图像增强技术的比较研究
Pub Date : 2026-01-14 DOI: 10.1016/j.mayocpiqo.2025.100691
Sabahattin M. Daloglu MPhil , Ceren Coskun BSc , Gokce Bekar MSc , Senanur Sahin BSc , Haley P. Letter MD , Harvey Castro MD , Soner Hacihaliloglu MBA , Ilker Hacihaliloglu PhD

Objective

To overcome critical limitations of B-mode ultrasound in artificial intelligence diagnostics—including poor image quality and operator variability—by developing a multifeature framework that combines raw B-mode scans with 2 optimized representations (enhanced ultrasound and quality-improved ultrasound) for robust breast cancer classification.

Patients and Methods

We conducted a retrospective study of 62,912 breast ultrasound scans (100%) from 688 patients (100%) at the Mayo Clinic (from December 01, 1989 to March 30, 2024). The study compared 3 deep learning architectures—graph convolutional networks (GCNs), masked autoencoders (MAEs), and multi-scale convolutional neural network (MSCNN)—using either standard B-mode inputs alone or combined with our enhanced features. Performance was evaluated through 3-fold cross-validation at the patient-level, with primary metrics including accuracy, area under the curve, F1-score, sensitivity, and specificity.

Results

The multifeature approach reported substantial improvements across all metrics. For GCNs, multifeature integration increased accuracy from 0.508 to 0.845 and F1-score from 0.067 to 0.835. Sensitivity improved dramatically from 5.6% to 91.7%, while specificity showed a modest decrease from 85.7% to 79.0%. The MAE models showed different but complementary strengths, with multifeature integration improving accuracy from 0.775 to 0.873, F1-score from 0.785 to 0.822, and achieving perfect specificity (100%) while maintaining clinically acceptable sensitivity (71.1%). The MSCNN, included as a baseline convolutional architecture, showed minimal improvement with multifeature integration, with accuracy increasing slightly from 0.571 to 0.585 and specificity from 0.667 to 0.819. These results highlight the superior capability of GCNs and MAEs to effectively leverage multifeature information in breast ultrasound analysis compared with conventional MSCNN.

Conclusion

PONS-enhanced multifeature ultrasound significantly improves breast cancer detection accuracy versus B-mode alone, offering complementary clinical solutions: GCNs for high sensitivity screening (91.7%) and MAEs for high-specificity diagnosis (100%). Results demonstrate clinical potential across diverse populations, with future work exploring enhanced fusion strategies.
目的克服b超在人工智能诊断中的关键局限性,包括图像质量差和操作人员的可变性,通过开发一个多特征框架,将原始b超扫描与两种优化表示(增强超声和质量改进超声)相结合,实现强大的乳腺癌分类。患者和方法我们对1989年12月1日至2024年3月30日在梅奥诊所(Mayo Clinic)就诊的688例患者(100%)进行了62912次乳房超声扫描(100%)的回顾性研究。该研究比较了3种深度学习架构——图卷积网络(GCNs)、掩模自动编码器(MAEs)和多尺度卷积神经网络(MSCNN)——分别使用标准b模式输入或结合我们的增强功能。通过患者水平的3倍交叉验证来评估性能,主要指标包括准确性、曲线下面积、f1评分、敏感性和特异性。结果多特征方法报告了所有指标的实质性改进。对于GCNs,多特征集成将准确率从0.508提高到0.845,f1得分从0.067提高到0.835。敏感性从5.6%显著提高到91.7%,而特异性从85.7%适度下降到79.0%。MAE模型表现出不同但互补的优势,多特征整合将准确率从0.775提高到0.873,f1评分从0.785提高到0.822,在保持临床可接受的敏感性(71.1%)的同时达到完美的特异性(100%)。作为基线卷积架构的MSCNN在多特征整合后表现出最小的改善,准确率从0.571略微增加到0.585,特异性从0.667略微增加到0.819。这些结果突出了与传统MSCNN相比,GCNs和MAEs在乳腺超声分析中有效利用多特征信息的优势。结论pons增强的多特征超声较单纯b超可显著提高乳腺癌的检测准确率,为临床提供了GCNs高灵敏度筛查(91.7%)和MAEs高特异性诊断(100%)的互补解决方案。研究结果显示了在不同人群中的临床潜力,未来的工作将探索增强融合策略。
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引用次数: 0
Bridging the Gap: Identifying and Overcoming Barriers to CAR-T Access Through Streamlined and Standardized Pathways 弥合差距:通过简化和标准化的途径识别和克服CAR-T准入的障碍
Pub Date : 2026-01-05 DOI: 10.1016/j.mayocpiqo.2025.100693
Kanishka Uttam Chandani MBBS, Nandita Khera MD, MPH
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引用次数: 0
A Masked Intruder: Extranodal Natural Killer/T-Cell Lymphoma Mimicking Preseptal Cellulitis 隐藏的入侵者:结外自然杀手/ t细胞淋巴瘤模拟间隔前蜂窝织炎
Pub Date : 2025-12-30 DOI: 10.1016/j.mayocpiqo.2025.100689
Shane A. Fuentes MD , Gregory J. Griepentrog MD , Rebecca L. King MD , N. Nora Bennani MD , Supavit Chesdachai MD
Extranodal natural killer/T-cell lymphoma is a rare, aggressive, Epstein-Barr virus-associated malignancy. We reported an unusual case of a woman in her middle 40s presenting with progressive left-sided periorbital swelling, redness, and pain, initially treated as a refractory preseptal cellulitis. Despite aggressive antibiotic therapy, symptoms worsened. Imaging showed inflammatory stranding and phlegmonous enhancement involving the left orbit. A biopsy revealed the diagnosis of primary orbital extranodal natural killer/T-cell lymphoma (nasal type) without sinonasal involvement, which is extremely uncommon. This case emphasized the need to consider other noninfectious diagnoses in patients with preseptal cellulitis unresponsive to antibiotics.
结外自然杀伤/ t细胞淋巴瘤是一种罕见的、侵袭性的、与eb病毒相关的恶性肿瘤。我们报告了一个不寻常的病例,一名40多岁的女性表现为进行性左侧眶周肿胀,红肿和疼痛,最初作为难治性隔前蜂窝织炎治疗。尽管进行了积极的抗生素治疗,症状还是恶化了。影像学显示炎性搁浅及痰增强累及左眼眶。活检显示原发性眼眶结外自然杀伤细胞/ t细胞淋巴瘤(鼻型),不累及鼻窦,这是非常罕见的。本病例强调需要考虑对抗生素无反应的隔膜前蜂窝织炎患者的其他非感染性诊断。
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引用次数: 0
Organic Pollutants and Risk of Type 2 Diabetes: A Systematic Review and Meta-analysis 有机污染物与2型糖尿病风险:系统综述和荟萃分析
Pub Date : 2025-12-15 DOI: 10.1016/j.mayocpiqo.2025.100677
Yousif M. Hydoub MBBS , Ricardo Loor-Torres MD , Abdul Qadeer MBBS , Kinaan Farhan MBBS , Thaer K. Swaid MBBS , Hanieh Sadat Tabatabaei Yeganeh MBBS , Joelle N. Friesen MD , Shangwe Kiliaki CNP, DNP , Iman Fawad MBBS , Danielle J. Gerberi MLIS, AHIP , Thirumurugan Prakasam PhD , Rainer Lohmann PhD , M. Hassan Murad MD, MPH , Sagar B. Dugani MD, PhD, MPH

Objective

To evaluate the associations between organic pollutants (OPs) and risk of type 2 diabetes (T2D).

Patients and Methods

We searched Medline, Embase, Scopus, Web of Science, and Cochrane Central from inception through March 18, 2024. We included studies reporting the adjusted or unadjusted association between serum concentration of OPs and risk of T2D. We excluded studies on type 1 diabetes, self-reported exposure, and if fewer than 100 T2D cases. We classified OPs using 2 classification methods and reported pooled risk estimates using a random-effects model (odds ratio [95% CI]) and assessed risk of bias at the levels of OPs and their classes. We conducted sex- and concentration-stratified analyses.

Results

From 20,531 articles, we included 44 (0.2%) studies of 83 individual and 38 combination OPs in 54,967 participants. All but 1 study had low risk of bias. Ten of 12 OP classes were associated with risk of T2D, polychlorinated dibenzo-p-furans had the highest association (OR, 2.54; 95% CI, 1.94-3.33). Polychlorinated dibenzo-p-dioxins showed a significant association in men (OR, 3.21; 95% CI, 1.81-5.71). Polychlorinated biphenyls (OR, 1.72; 95% CI, 1.55-1.92) and dichlorodiphenyltrichloroethane (DDT) and DDT-like compounds (OR, 1.14; 95% CI, 1.01-1.29) showed a significant association in women. Moreover, 28 (33.7%) individual and 21 (55.3%) combination OPs had a significant association. Polychlorinated biphenyl 157 (OR, 1.93; 95% CI, 1.27-2.92) and organochlorine pesticides (OR, 4.35; 95% CI, 1.90-9.98) had the highest risk of T2D.

Conclusion

Several OPs were associated with higher risk of T2D. Future work should evaluate the concentration threshold at which OPs increase risk to inform both T2D screening and OP advisories and regulation.
目的探讨有机污染物(OPs)与2型糖尿病(T2D)发病风险的关系。患者和方法我们检索了Medline, Embase, Scopus, Web of Science和Cochrane Central从成立到2024年3月18日。我们纳入了报告血清OPs浓度与T2D风险之间调整或未调整关联的研究。我们排除了1型糖尿病、自我报告暴露和少于100例T2D病例的研究。我们使用两种分类方法对OPs进行分类,并使用随机效应模型(优势比[95% CI])报告合并风险估计,并评估OPs及其类别水平上的偏倚风险。我们进行了性别和浓度分层分析。结果从20,531篇文章中,我们纳入了44项(0.2%)研究,涉及54,967名参与者,83名个体和38名联合OPs。除1项研究外,其他研究的偏倚风险均较低。12个OP类别中有10个与T2D风险相关,多氯二苯并对呋喃的相关性最高(OR, 2.54; 95% CI, 1.94-3.33)。多氯二苯并对二恶英在男性中显示出显著相关性(OR, 3.21; 95% CI, 1.81-5.71)。多氯联苯(OR, 1.72; 95% CI, 1.55-1.92)和二氯二苯三氯乙烷(DDT)和DDT样化合物(OR, 1.14; 95% CI, 1.01-1.29)在女性中显示出显著的相关性。个体OPs 28例(33.7%),组合OPs 21例(55.3%)。多氯联苯157 (OR, 1.93; 95% CI, 1.27-2.92)和有机氯农药(OR, 4.35; 95% CI, 1.90-9.98)发生T2D的风险最高。结论多种OPs与T2D发生风险增高有关。未来的工作应该评估OPs增加风险的浓度阈值,以便为T2D筛查和OP建议和监管提供信息。
{"title":"Organic Pollutants and Risk of Type 2 Diabetes: A Systematic Review and Meta-analysis","authors":"Yousif M. Hydoub MBBS ,&nbsp;Ricardo Loor-Torres MD ,&nbsp;Abdul Qadeer MBBS ,&nbsp;Kinaan Farhan MBBS ,&nbsp;Thaer K. Swaid MBBS ,&nbsp;Hanieh Sadat Tabatabaei Yeganeh MBBS ,&nbsp;Joelle N. Friesen MD ,&nbsp;Shangwe Kiliaki CNP, DNP ,&nbsp;Iman Fawad MBBS ,&nbsp;Danielle J. Gerberi MLIS, AHIP ,&nbsp;Thirumurugan Prakasam PhD ,&nbsp;Rainer Lohmann PhD ,&nbsp;M. Hassan Murad MD, MPH ,&nbsp;Sagar B. Dugani MD, PhD, MPH","doi":"10.1016/j.mayocpiqo.2025.100677","DOIUrl":"10.1016/j.mayocpiqo.2025.100677","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the associations between organic pollutants (OPs) and risk of type 2 diabetes (T2D).</div></div><div><h3>Patients and Methods</h3><div>We searched Medline, Embase, Scopus, Web of Science, and Cochrane Central from inception through March 18, 2024. We included studies reporting the adjusted or unadjusted association between serum concentration of OPs and risk of T2D. We excluded studies on type 1 diabetes, self-reported exposure, and if fewer than 100 T2D cases. We classified OPs using 2 classification methods and reported pooled risk estimates using a random-effects model (odds ratio [95% CI]) and assessed risk of bias at the levels of OPs and their classes. We conducted sex- and concentration-stratified analyses.</div></div><div><h3>Results</h3><div>From 20,531 articles, we included 44 (0.2%) studies of 83 individual and 38 combination OPs in 54,967 participants. All but 1 study had low risk of bias. Ten of 12 OP classes were associated with risk of T2D, polychlorinated dibenzo-p-furans had the highest association (OR, 2.54; 95% CI, 1.94-3.33). Polychlorinated dibenzo-p-dioxins showed a significant association in men (OR, 3.21; 95% CI, 1.81-5.71). Polychlorinated biphenyls (OR, 1.72; 95% CI, 1.55-1.92) and dichlorodiphenyltrichloroethane (DDT) and DDT-like compounds (OR, 1.14; 95% CI, 1.01-1.29) showed a significant association in women. Moreover, 28 (33.7%) individual and 21 (55.3%) combination OPs had a significant association. Polychlorinated biphenyl 157 (OR, 1.93; 95% CI, 1.27-2.92) and organochlorine pesticides (OR, 4.35; 95% CI, 1.90-9.98) had the highest risk of T2D.</div></div><div><h3>Conclusion</h3><div>Several OPs were associated with higher risk of T2D. Future work should evaluate the concentration threshold at which OPs increase risk to inform both T2D screening and OP advisories and regulation.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"10 1","pages":"Article 100677"},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Operationalizing Access for Chimeric Antigen Receptor T cell Therapies: A Cross-functional Perspective 嵌合抗原受体T细胞治疗的操作通路:跨功能视角
Pub Date : 2025-12-10 DOI: 10.1016/j.mayocpiqo.2025.100682
Surya Singh MD , Carol Greulich MBA , Ariel Perez MD , Kelly Terrell MBA, BSN , Julie Walz-Jensen BS, RN , Michael D. Dalzell BA
Chimeric antigen receptor T cell (CAR T) treatment efficacy has been shown to be greater in those who receive timely infusions, while mortality rates increase with each month’s delay in treatment. Yet health care infrastructure constraints, an intricate treatment process, and reimbursement complexities present challenges that affect timely patient access to CAR T therapy. Best practices for decreasing time to treatment are not well established. Autolus Inc convened an expert panel of 3 advisors from established hematopoietic stem-cell transplant centers and 3 advisors with extensive national or regional payer experience to identify operational barriers that contribute to treatment delays as well as potential means for addressing them. Opportunities exist to expand treatment capacity by reducing redundant prerequisites for treatment center certification and through collaboration between established centers and newer centers that need critical expertise to gain accreditation. Aligning clinical criteria are important for improving clinician understanding of the treatment process, facilitating timely referral to treatment centers, and streamlining payer authorization processes. Negotiating financial arrangements is the most time-consuming step of the process before CAR T manufacturing can begin; contracts between treatment centers and payers can help to facilitate timely care, but single-case agreements are necessary for treatment centers and payers without extensive CAR T experience. Single-case agreements should consider each side’s experience and financial exposure. In identifying obstacles to timely care and working through potential solutions, participants developed a genuine appreciation for the interdependence among stakeholders. Recognition of mutual interest is a starting point for cross-functional cooperation.
嵌合抗原受体T细胞(CAR - T)治疗的效果在及时接受输注的患者中更大,而死亡率随着治疗的每一个月的延迟而增加。然而,卫生保健基础设施的限制、复杂的治疗过程和报销的复杂性构成了影响患者及时获得CAR - T治疗的挑战。减少治疗时间的最佳做法尚未得到很好的确立。Autolus公司召集了一个专家小组,由3名来自成熟的造血干细胞移植中心的顾问和3名具有广泛国家或地区付款经验的顾问组成,以确定导致治疗延误的操作障碍以及解决这些障碍的潜在方法。通过减少治疗中心认证的冗余先决条件,以及通过已建立的中心与需要关键专业知识才能获得认证的新中心之间的合作,存在扩大治疗能力的机会。调整临床标准对于提高临床医生对治疗过程的理解、促进及时转诊到治疗中心以及简化付款人授权流程非常重要。在CAR - T制造开始之前,谈判财务安排是这个过程中最耗时的一步;治疗中心和付款人之间的合同有助于促进及时护理,但对于没有丰富CAR - T经验的治疗中心和付款人来说,单一案例协议是必要的。单一案例协议应考虑双方的经验和财务风险。在确定及时护理的障碍和寻找可能的解决办法的过程中,与会者对利益攸关方之间的相互依存产生了真正的认识。认识到共同利益是跨职能合作的起点。
{"title":"Operationalizing Access for Chimeric Antigen Receptor T cell Therapies: A Cross-functional Perspective","authors":"Surya Singh MD ,&nbsp;Carol Greulich MBA ,&nbsp;Ariel Perez MD ,&nbsp;Kelly Terrell MBA, BSN ,&nbsp;Julie Walz-Jensen BS, RN ,&nbsp;Michael D. Dalzell BA","doi":"10.1016/j.mayocpiqo.2025.100682","DOIUrl":"10.1016/j.mayocpiqo.2025.100682","url":null,"abstract":"<div><div>Chimeric antigen receptor T cell (CAR T) treatment efficacy has been shown to be greater in those who receive timely infusions, while mortality rates increase with each month’s delay in treatment. Yet health care infrastructure constraints, an intricate treatment process, and reimbursement complexities present challenges that affect timely patient access to CAR T therapy. Best practices for decreasing time to treatment are not well established. Autolus Inc convened an expert panel of 3 advisors from established hematopoietic stem-cell transplant centers and 3 advisors with extensive national or regional payer experience to identify operational barriers that contribute to treatment delays as well as potential means for addressing them. Opportunities exist to expand treatment capacity by reducing redundant prerequisites for treatment center certification and through collaboration between established centers and newer centers that need critical expertise to gain accreditation. Aligning clinical criteria are important for improving clinician understanding of the treatment process, facilitating timely referral to treatment centers, and streamlining payer authorization processes. Negotiating financial arrangements is the most time-consuming step of the process before CAR T manufacturing can begin; contracts between treatment centers and payers can help to facilitate timely care, but single-case agreements are necessary for treatment centers and payers without extensive CAR T experience. Single-case agreements should consider each side’s experience and financial exposure. In identifying obstacles to timely care and working through potential solutions, participants developed a genuine appreciation for the interdependence among stakeholders. Recognition of mutual interest is a starting point for cross-functional cooperation.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"10 1","pages":"Article 100682"},"PeriodicalIF":0.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Retrospective Analysis of Long-term Impact of COVID-19 Pandemic on Mammographic Breast Cancer Screening COVID-19大流行对乳腺x线摄影筛查长期影响的回顾性分析
Pub Date : 2025-12-06 DOI: 10.1016/j.mayocpiqo.2025.100680
Dhauna Karam Prasad MD , Alyssa K. McGary MS , Heidi E. Kosiorek MS , Joshua C. Pritchett MD , Richard L. Ellis MD , Kathryn J. Ruddy MD, MPH , Tufia C. Haddad MD , Mohammed Yousufuddin MD

Objective

To determine whether the initial decrease in mammographic breast cancer screening (MBCS) rates with the corona virus disease of 2019 (COVID-19) pandemic persisted in the postpandemic times and quantify the impact of health care disparities.

Patients and Methods

This retrospective study analyzed data from March 1, 2017 to March 31, 2023 to assess annual MBCS among eligible women (40-75 years) in the Mayo Clinic system. The study period was divided into 4 phases: pre-COVID-19 (2017-2020), early pandemic (2020-2021), mid-pandemic (2021-2022), and late pandemic (2022-2023). Mixed-effects poisson regression estimated incidence rate ratios (IRR), and difference-in-differences assessed temporal trends.

Results

The cohort included 239,804 women with a median age of 57 years, of whom 34.9% resided in rural counties. By race, 92% were White, 3.1% Black, 0.4% American Indians, 0.1% Native Hawaiians, 3% Asian, and 1.3% others. Compared with the pre-COVID-19 period, there was a significant decrease in MBCS rate in the early pandemic (IRR=0.891, P<.001), and though the rate improved in the mid-pandemic and late pandemic periods, they remained below the prepandemic level (IRR=0.941, P<.001; IRR=0.922, P<.001, respectively). Rural counties had lower MBCS rates compared with urban (IRR = 0.914, P<.001). Compared to White race, other races had lower MBCS rates with the Black race having the lowest (IRR=0.692, P<.001). Difference-in-differences analysis revealed that the relative gap between MBCS rates in minority/rural groups did not significantly widen or narrow during the pandemic.

Conclusion

The COVID-19 pandemic was associated with sustained declines in MBCS through early 2023, disproportionately affecting vulnerable populations but did not widen pre-existing disparities, highlighting the benefits of targeted interventions.
目的探讨2019冠状病毒病(COVID-19)大流行后乳腺x线乳腺癌筛查(MBCS)率的初始下降是否持续,并量化医疗保健差异的影响。患者和方法本回顾性研究分析了2017年3月1日至2023年3月31日的数据,以评估梅奥诊所系统中符合条件的女性(40-75岁)的年度MBCS。研究期分为4个阶段:covid -19前期(2017-2020年)、大流行早期(2020-2021年)、大流行中期(2021-2022年)和大流行晚期(2022-2023年)。混合效应泊松回归估计了发病率比(IRR),差异中的差异评估了时间趋势。结果该队列包括239804名妇女,中位年龄为57岁,其中34.9%居住在农村县。按种族划分,92%为白人,3.1%为黑人,0.4%为美洲印第安人,0.1%为夏威夷原住民,3%为亚洲人,1.3%为其他人种。与疫情前相比,大流行早期MBCS率显著下降(IRR=0.891, p < 0.01),大流行中期和后期虽有所改善,但仍低于疫情前水平(IRR=0.941, p < 0.01; IRR=0.922, p < 0.01)。农村县的MBCS发生率低于城市县(IRR = 0.914, P<.001)。与白人相比,其他种族的MBCS发生率较低,其中黑人最低(IRR=0.692, P<.001)。差异中的差异分析显示,在大流行期间,少数民族/农村群体中MBCS发病率之间的相对差距没有显著扩大或缩小。到2023年初,2019冠状病毒病大流行与MBCS持续下降有关,对弱势群体的影响不成比例,但并未扩大已有的差距,这凸显了有针对性干预措施的好处。
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引用次数: 0
Long-Term Change in Vitamin D Status and its Association With Change in Total Hip Bone Mineral Density in Older Women: A Population-Based Cohort Study 老年妇女维生素D状态的长期变化及其与髋部总骨密度变化的关系:一项基于人群的队列研究
Pub Date : 2025-12-03 DOI: 10.1016/j.mayocpiqo.2025.100681
Karl Michaëlsson PhD , Håkan Melhus PhD , Liisa Byberg PhD , Eva Warensjö Lemming PhD , Bodil Svennblad PhD , Jonas Höijer MSc , Hannah L. Brooke PhD

Objective

To examine if long-term constant low vitamin D status in the sunny season has a greater impact on bone mineral density (BMD) over time than long-term constant low vitamin D status in the dark season.

Patients and Methods

In a longitudinal cohort study conducted from November 3, 2003 to May 22, 2019, 1802 Swedish women living in Uppsala County (latitude 58oN) (mean baseline age of 65 years and average follow-up of 12 years) had vitamin D status measured by serum 25-hydroxyvitamin D concentration (S-25OHD). Participants were stratified by season of blood draw (dark [November-April] vs sunny [May-October]). We examined the association of long-term stable season-specific S-25OHD with 12-year changes in total hip BMD, measured by dual-energy x-ray absorptiometry, and investigated if increasing S-25OHD during follow-up influenced changes in BMD by baseline S-25OHD levels and season.

Results

Compared with longitudinally sunny season constant S-25OHD>70 nmol/L, women with sunny season constant S-25OHD<40 nmol/L displayed 10.0% (95% CI,3.8%-16.1%) lower total hip BMD at follow-up. No difference in BMD was observed by dark season S-25OHD. Among women with baseline sunny season S-25OHD<45 nmol/L, each 20 nmol/L increase in S-25OHD during follow-up was associated with a 2.5% increase in hip BMD (95% CI,0.5-4.6). This estimate was attenuated when increasing the low S-25OHD cut-off and was not observed with dark season samples.

Conclusion

Women with sunny season S-25OHD<40-50 nmol/L are a likely target group for vitamin D interventions to improve BMD. Blood samples taken during the dark season are less informative for determining future bone health.
目的探讨在阳光充足季节长期持续低维生素D状态是否比在黑暗季节长期持续低维生素D状态对骨密度(BMD)的影响更大。患者和方法在2003年11月3日至2019年5月22日进行的一项纵向队列研究中,1802名居住在乌普萨拉县(纬度58oN)的瑞典女性(平均基线年龄65岁,平均随访12年)通过血清25-羟基维生素D浓度(S-25OHD)测量维生素D状态。参与者按抽血季节(阴天[11月- 4月]和晴天[5月- 10月])进行分层。我们通过双能x线吸收仪检测了长期稳定的季节特异性S-25OHD与12年髋关节总骨密度变化的关系,并研究了随访期间S-25OHD的增加是否会影响基线S-25OHD水平和季节对骨密度变化的影响。结果与纵向阳光季节恒定S-25OHD>;70 nmol/L相比,阳光季节恒定S-25OHD>; 40 nmol/L的女性在随访时髋部总骨密度降低10.0% (95% CI,3.8%-16.1%)。暗季S-25OHD对骨密度无显著影响。在基线阳光季节S-25OHD为45 nmol/L的女性中,随访期间S-25OHD每增加20 nmol/L,髋部骨密度增加2.5% (95% CI,0.5-4.6)。当增加低S-25OHD截止值时,这一估计减弱,并且在暗季样本中未观察到。结论阳光季节s - 25ohd40 -50 nmol/L的女性可能是维生素D干预改善骨密度的目标人群。在黑暗季节采集的血液样本对确定未来骨骼健康的信息较少。
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引用次数: 0
The Impact of a Remote Patient Care Program on Health Care Costs and Utilization Among Medicare Patients With Chronic Disease 远程病人护理计划对医疗保健费用和慢性病患者利用的影响
Pub Date : 2025-11-28 DOI: 10.1016/j.mayocpiqo.2025.100679
David I. Feldman MD, MPH , Spencer Reynolds MBA , Sarine Babikian PhD , Brian D. Stein MD, MS , Jessica Schlicher MD, MBA , Eve Cunningham MD, MBA , Theodore Feldman MD , Randall Curnow MD, MBA , Jing Zheng MS , Puneet Budhiraja MS , Marat Fudim MD, MHS
Remote patient monitoring coupled with technology-enabled, guideline-directed clinical care—or remote patient care (RPC)—has consistently led to improved outcomes for Medicare patients with chronic diseases. However, the ability for RPC to drive reductions in total cost of care and health care utilization is limited. We sought to determine whether an RPC program can reduce health care costs and utilization. Using patient-level Medicare claims data, a difference in difference analysis was conducted to assess the impact of an RPC program compared with a propensity score–matched control group on total health care costs and resource utilization over a 12-month period following program activation. The retrospective analysis included patients enrolled into an RPC program from July 1, 2022 to October 31, 2023 from primary care and cardiology clinics across 15 states. The RPC program included a group of clinicians who monitored and triaged vitals and conducted clinical visits using standardized clinical protocols to facilitate guideline-directed clinical interventions. We compared 5872 patients enrolled in an RPC program to 11,449 eligible propensity score–matched control patients. RPC resulted in a statistically significant reduction in total cost of care (−$1302 per patient per year; P<.01), which was driven primarily by a reduction in inpatient costs (−$1428 per patient per year; P<.01). Patients enrolled in the RPC program also had a lower rate of hospitalizations (−23 vs +41/1000 patients/y; 27% reduction; P<.01). These data highlight the potential for a nationwide RPC program to lead to significant cost savings and a reduction in health care utilization among Medicare patients at scale.
远程患者监测与技术支持、指导的临床护理(或远程患者护理(RPC))相结合,一直为患有慢性病的医疗保险患者带来改善的结果。然而,RPC推动降低医疗总成本和医疗保健利用的能力是有限的。我们试图确定RPC程序是否可以降低医疗保健成本和利用率。使用患者层面的医疗保险索赔数据,进行了差异分析,以评估RPC计划与倾向得分匹配的对照组在计划启动后12个月内对总医疗保健成本和资源利用的影响。回顾性分析包括从2022年7月1日至2023年10月31日在15个州的初级保健和心脏病诊所参加RPC项目的患者。RPC项目包括一组临床医生,他们监测和分类生命体征,并使用标准化的临床协议进行临床访问,以促进指导临床干预。我们比较了5872名参与RPC项目的患者和11449名符合倾向评分匹配的对照患者。RPC在统计上显著降低了总护理成本(每位患者每年- 1302美元;P< 0.01),这主要是由于住院费用的降低(每位患者每年- 1428美元;P< 0.01)。参与RPC计划的患者住院率也较低(- 23 vs +41/1000患者/年;减少27%;P< 0.01)。这些数据强调了全国范围内的RPC计划的潜力,以导致显著的成本节约和减少医疗保健利用在医疗保险患者的规模。
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引用次数: 0
Reviewers for Mayo Clinic Proceedings: Innovations, Quality & Outcomes (2025) 梅奥诊所会刊:创新,质量和结果(2025)
Pub Date : 2025-11-21 DOI: 10.1016/j.mayocpiqo.2025.100678
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引用次数: 0
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Mayo Clinic proceedings. Innovations, quality & outcomes
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