Pub Date : 2025-03-03DOI: 10.1016/j.mayocpiqo.2025.100600
Patrice A. Vinsard MD , Josef Pleticha MD , Emily E. Sharpe MD , Jason K. Panchamia DO , David A. Olsen MD , Hans P. Sviggum MD , Sherief F. Shawki MB, MD , Kevin T. Behm MD , David W. Larson MD, MBA , Allison M. LeMahieu MS , Adam D. Niesen MD , Adam W. Amundson MD
Objective
To determine the optimal dose of intrathecal morphine and hydromorphone in patients undergoing minimally invasive colorectal operation for postoperative analgesia.
Patients and Methods
The study was a double-blinded clinical dosing trial that randomized patients to intrathecal morphine or hydromorphone from March 12, 2021, to February 17, 2023. Intrathecal dosing was determined by a sequential up-down method using a biased-coin design. Doses of the subsequent patients were stepped up or down based on the success or failure of the previous dose. The primary outcome was the dose effective in 90% of patients (ED90) to achieve numeric rating pain scores ≤4 with postoperative opioid requirements ≤15 oral morphine equivalent at 12 hours.
Results
Eighty patients completed the study with 40 patients in each group. The ED90 for intrathecal morphine and hydromorphone could not be determined for the examined dose ranges. The ED50 for morphine was 100 mcg and for hydromorphone was 75 mcg. Morphine median (interquartile range [IQR]) numeric rating scale scores was 3.0 (1.5-4.5) at 12 hours and 3.0 (2.0-4.0) at 24 hours, whereas hydromorphone median (IQR) numeric rating scale were 3.0 (1.5-5.0) at 12 hours and 3.0 (2.0-5.0) at 24 hours. As the dosage of hydromorphone increased, moderate to severe pruritus increased (P=.009).
Conclusion
The study could not establish an ED90 for IT dosing for minimally invasive colorectal surgical patients. However, we did determine the ED50 for both agents. No serious adverse events were observed throughout the study duration.
Trial Registration
clinicaltrials.gov Identifier: NCT04752033
{"title":"A Prospective Randomized Dose-Finding Study of Intrathecal Opioids for Postoperative Analgesia After Minimally Invasive Colorectal Operation","authors":"Patrice A. Vinsard MD , Josef Pleticha MD , Emily E. Sharpe MD , Jason K. Panchamia DO , David A. Olsen MD , Hans P. Sviggum MD , Sherief F. Shawki MB, MD , Kevin T. Behm MD , David W. Larson MD, MBA , Allison M. LeMahieu MS , Adam D. Niesen MD , Adam W. Amundson MD","doi":"10.1016/j.mayocpiqo.2025.100600","DOIUrl":"10.1016/j.mayocpiqo.2025.100600","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the optimal dose of intrathecal morphine and hydromorphone in patients undergoing minimally invasive colorectal operation for postoperative analgesia.</div></div><div><h3>Patients and Methods</h3><div>The study was a double-blinded clinical dosing trial that randomized patients to intrathecal morphine or hydromorphone from March 12, 2021, to February 17, 2023. Intrathecal dosing was determined by a sequential up-down method using a biased-coin design. Doses of the subsequent patients were stepped up or down based on the success or failure of the previous dose. The primary outcome was the dose effective in 90% of patients (ED<sub>90</sub>) to achieve numeric rating pain scores ≤4 with postoperative opioid requirements ≤15 oral morphine equivalent at 12 hours.</div></div><div><h3>Results</h3><div>Eighty patients completed the study with 40 patients in each group. The ED<sub>90</sub> for intrathecal morphine and hydromorphone could not be determined for the examined dose ranges. The ED<sub>50</sub> for morphine was 100 mcg and for hydromorphone was 75 mcg. Morphine median (interquartile range [IQR]) numeric rating scale scores was 3.0 (1.5-4.5) at 12 hours and 3.0 (2.0-4.0) at 24 hours, whereas hydromorphone median (IQR) numeric rating scale were 3.0 (1.5-5.0) at 12 hours and 3.0 (2.0-5.0) at 24 hours. As the dosage of hydromorphone increased, moderate to severe pruritus increased (<em>P</em>=.009).</div></div><div><h3>Conclusion</h3><div>The study could not establish an ED<sub>90</sub> for IT dosing for minimally invasive colorectal surgical patients. However, we did determine the ED<sub>50</sub> for both agents. No serious adverse events were observed throughout the study duration.</div></div><div><h3>Trial Registration</h3><div><span><span>clinicaltrials.gov</span><svg><path></path></svg></span> Identifier: NCT04752033</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 2","pages":"Article 100600"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528623","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}
Pub Date : 2025-02-26DOI: 10.1016/j.mayocpiqo.2025.100598
Levi W. Disrud CCRC, CRAT, CCT , William H. Swain MD , Halley Davison MBA/HCM , Tara Gosse MS, FACHE , Manfred M. Kubler MD , David M. Harmon MD , Paul A. Friedman MD , Peter A. Noseworthy MD , Anthony H. Kashou MD
Telehealth consultation with a physician can be an attractive option for eligible patients. In this pilot study, we evaluate the feasibility and efficiency of an FDA approved 12-lead electrocardiogram (ECG) device, Smeartheart, that can be used remotely in the patients’ home before telehealth appointments with a cardiac electrophysiologist. We scheduled a phone call with 10 patients who used this device as part of their care. Eight patients were able to obtain a diagnostic quality ECG. Telephone call appointments with ECG technicians took a median of 51 minutes, and it took patients an average of 2.2 attempts to record a usable ECG. We also identified barriers to the use of the Smartheart device, including internet accessibility, training material, patient functional status, and motion artifact that may inform more widespread study and utilization of remote-recorded 12-lead ECGs. We conclude that the Smartheart device may have clinical use with remote use in routine clinical care, although the best use of this technology requires further study.
{"title":"A Pilot Study of the Home-Based 12-Lead Electrocardiogram in Clinical Practice","authors":"Levi W. Disrud CCRC, CRAT, CCT , William H. Swain MD , Halley Davison MBA/HCM , Tara Gosse MS, FACHE , Manfred M. Kubler MD , David M. Harmon MD , Paul A. Friedman MD , Peter A. Noseworthy MD , Anthony H. Kashou MD","doi":"10.1016/j.mayocpiqo.2025.100598","DOIUrl":"10.1016/j.mayocpiqo.2025.100598","url":null,"abstract":"<div><div>Telehealth consultation with a physician can be an attractive option for eligible patients. In this pilot study, we evaluate the feasibility and efficiency of an FDA approved 12-lead electrocardiogram (ECG) device, Smeartheart, that can be used remotely in the patients’ home before telehealth appointments with a cardiac electrophysiologist. We scheduled a phone call with 10 patients who used this device as part of their care. Eight patients were able to obtain a diagnostic quality ECG. Telephone call appointments with ECG technicians took a median of 51 minutes, and it took patients an average of 2.2 attempts to record a usable ECG. We also identified barriers to the use of the Smartheart device, including internet accessibility, training material, patient functional status, and motion artifact that may inform more widespread study and utilization of remote-recorded 12-lead ECGs. We conclude that the Smartheart device may have clinical use with remote use in routine clinical care, although the best use of this technology requires further study.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 2","pages":"Article 100598"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487645","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}
Pub Date : 2025-02-26DOI: 10.1016/j.mayocpiqo.2025.100599
Alanna M. Chamberlain PhD, MPH , Derek W. Ebner MD , Gregory D. Jenkins MS , Mallik Greene PhD , Lila J. Finney Rutten PhD, MPH
Objective
To provide contemporary data on subsequent screening after negative-result multitarget stool DNA (mt-sDNA) tests and follow-up colonoscopy after positive-result mt-sDNA tests.
Patients and Methods
Negative-result mt-sDNA tests (for patients aged 50-72 years) and positive-result mt-sDNA tests (for patients aged 50-75 years) were identified among average risk patients from a 9-county region in Southeast Minnesota from January 1, 2016 to December 31, 2022. Competing risks models of time to subsequent colorectal cancer (CRC) screening were modeled separately for the negative mt-sDNA and positive mt-sDNA cohorts. Multistate Cox proportional hazards models compared rates of CRC screening modality by patient demographic characteristics.
Results
At 3.5 years after a negative-result mt-sDNA test (n=18,739 tests), 55.0% (95% CI, 53.9%-56.3%) of patients were rescreened, which increased to 81.0% (95% CI, 80.0%-82.1%) at 5 years. Most tests were repeat mt-sDNA tests (48.3% at 3.5 years; 95% CI, 47.2%-49.5%). Rescreening with any modality was more likely with older age and among females and less likely among Black persons, Asian persons, and those with other or mixed race. After a positive-result mt-sDNA test (n=2863 tests), 80.9% (95% CI, 79.6%-82.6%) and 84.4% (95% CI, 83.2%-86.0%) of patients completed follow-up colonoscopy by 6 months and 1 year, respectively. Those of other or mixed race had lower rates of follow-up colonoscopy compared with White persons.
Conclusion
Although rates of overall rescreening after a negative-result mt-sDNA test and follow-up colonoscopy after positive-result mt-sDNA tests were high, racial disparities were apparent. Targeted interventions are needed to improve equity in CRC screening adherence and follow-up care across diverse patient populations.
{"title":"Follow-up Colorectal Cancer Screening After Negative-Result and Positive-Result Multitarget Stool DNA Tests: A Population-Based Study in Southeast Minnesota","authors":"Alanna M. Chamberlain PhD, MPH , Derek W. Ebner MD , Gregory D. Jenkins MS , Mallik Greene PhD , Lila J. Finney Rutten PhD, MPH","doi":"10.1016/j.mayocpiqo.2025.100599","DOIUrl":"10.1016/j.mayocpiqo.2025.100599","url":null,"abstract":"<div><h3>Objective</h3><div>To provide contemporary data on subsequent screening after negative-result multitarget stool DNA (mt-sDNA) tests and follow-up colonoscopy after positive-result mt-sDNA tests.</div></div><div><h3>Patients and Methods</h3><div>Negative-result mt-sDNA tests (for patients aged 50-72 years) and positive-result mt-sDNA tests (for patients aged 50-75 years) were identified among average risk patients from a 9-county region in Southeast Minnesota from January 1, 2016 to December 31, 2022. Competing risks models of time to subsequent colorectal cancer (CRC) screening were modeled separately for the negative mt-sDNA and positive mt-sDNA cohorts. Multistate Cox proportional hazards models compared rates of CRC screening modality by patient demographic characteristics.</div></div><div><h3>Results</h3><div>At 3.5 years after a negative-result mt-sDNA test (n=18,739 tests), 55.0% (95% CI, 53.9%-56.3%) of patients were rescreened, which increased to 81.0% (95% CI, 80.0%-82.1%) at 5 years. Most tests were repeat mt-sDNA tests (48.3% at 3.5 years; 95% CI, 47.2%-49.5%). Rescreening with any modality was more likely with older age and among females and less likely among Black persons, Asian persons, and those with other or mixed race. After a positive-result mt-sDNA test (n=2863 tests), 80.9% (95% CI, 79.6%-82.6%) and 84.4% (95% CI, 83.2%-86.0%) of patients completed follow-up colonoscopy by 6 months and 1 year, respectively. Those of other or mixed race had lower rates of follow-up colonoscopy compared with White persons.</div></div><div><h3>Conclusion</h3><div>Although rates of overall rescreening after a negative-result mt-sDNA test and follow-up colonoscopy after positive-result mt-sDNA tests were high, racial disparities were apparent. Targeted interventions are needed to improve equity in CRC screening adherence and follow-up care across diverse patient populations.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 2","pages":"Article 100599"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487644","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}
Pub Date : 2025-02-20DOI: 10.1016/j.mayocpiqo.2025.100590
Elena L. Stains BS , Amy L. Kennalley MBS , Maria Tian MBS , Kevin F. Boehnke PhD , Chadd K. Kraus DO, MPH , Brian J. Piper PhD
Objective
To compare the 2017 National Academies of Sciences, Engineering, and Medicine cannabis report to state medical cannabis (MC) laws defining approved qualifying conditions (QC) from 2017 and 2024 and to determine the evidence level of the QCs approved in each state.
Patients and Methods
The 2017 National Academies of Sciences (NAS) report assessed therapeutic evidence for over 20 medical conditions treated with MC. We identified the QCs of 38 states (including Washington DC) where MC was legal in 2024 and compared them to the QCs listed by these states in 2017. The QCs were then categorized on the basis of NAS-established levels of evidence: limited, moderate, or substantial/conclusive evidence of effectiveness, limited evidence of ineffectiveness, or no/insufficient evidence to support or refute effectiveness. This study was completed from January 31, 2023 to June 20, 2024.
Results
Most states listed at least one QC with substantial evidence—80.0% in 2017 and 97.0% in 2024. However, in 2024 only 8.3% of the QCs on states’ QC lists met the standard of substantial/conclusive evidence. Of the 20 most popular QCs in the country in 2017 and 2024, one only (long-term pain) was categorized by the NAS as having substantial evidence for effectiveness. However, 7 were rated as either ineffective (eg, glaucoma) or insufficient evidence.
Conclusion
Most QCs lack evidence for use on the basis of the 2017 NAS report. Many states recommend QCs with little evidence (amyotrophic lateral sclerosis) or even those for which MC is ineffective (depression). These findings highlight a disparity between state-level MC recommendations and the evidence to support them.
{"title":"Medical Cannabis in the United States: Comparing 2017 and 2024 State Qualifying Conditions to the 2017 National Academies of Sciences Report","authors":"Elena L. Stains BS , Amy L. Kennalley MBS , Maria Tian MBS , Kevin F. Boehnke PhD , Chadd K. Kraus DO, MPH , Brian J. Piper PhD","doi":"10.1016/j.mayocpiqo.2025.100590","DOIUrl":"10.1016/j.mayocpiqo.2025.100590","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the 2017 National Academies of Sciences, Engineering, and Medicine cannabis report to state medical cannabis (MC) laws defining approved qualifying conditions (QC) from 2017 and 2024 and to determine the evidence level of the QCs approved in each state.</div></div><div><h3>Patients and Methods</h3><div>The 2017 National Academies of Sciences (NAS) report assessed therapeutic evidence for over 20 medical conditions treated with MC. We identified the QCs of 38 states (including Washington DC) where MC was legal in 2024 and compared them to the QCs listed by these states in 2017. The QCs were then categorized on the basis of NAS-established levels of evidence: limited, moderate, or substantial/conclusive evidence of effectiveness, limited evidence of ineffectiveness, or no/insufficient evidence to support or refute effectiveness. This study was completed from January 31, 2023 to June 20, 2024.</div></div><div><h3>Results</h3><div>Most states listed at least one QC with substantial evidence—80.0% in 2017 and 97.0% in 2024. However, in 2024 only 8.3% of the QCs on states’ QC lists met the standard of substantial/conclusive evidence. Of the 20 most popular QCs in the country in 2017 and 2024, one only (long-term pain) was categorized by the NAS as having substantial evidence for effectiveness. However, 7 were rated as either ineffective (eg, glaucoma) or insufficient evidence.</div></div><div><h3>Conclusion</h3><div>Most QCs lack evidence for use on the basis of the 2017 NAS report. Many states recommend QCs with little evidence (amyotrophic lateral sclerosis) or even those for which MC is ineffective (depression). These findings highlight a disparity between state-level MC recommendations and the evidence to support them.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 2","pages":"Article 100590"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453515","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}
Pub Date : 2025-02-19DOI: 10.1016/j.mayocpiqo.2025.100597
Mark D. Peterson PhD, MS , Michael O’Leary BS , Kathryn Ashbaugh BS , Heidi Haapala MD , Mary Schmidt DO , Neil Kamdar MA , Edward A. Hurvitz MD
Objective
To examine the most common patterns of pain and symptom management strategies among adults living with cerebral palsy (CP), and to determine if there are differences by pain phenotype or co-occurring neurodevelopmental disorders.
Patients and Methods
Federally insured beneficiaries were included if they had an ICD-9-CM/ICD-10-CM diagnosis code for CP (N=41,595). The study took place from January 10, 2024, to December 15, 2024. Medication and therapy prescription estimates for pain and CP symptom management were examined for the entire cohort, and between individuals with and without neurodevelopmental disorders and across pain phenotypes.
Results
The most common pharmaceutical/nontherapy-based pain and symptom management interventions included high frequency prescriptions for antiepileptics (58%), antidepressants (49%), benzodiazepines (43%), nonsteroidal anti-inflammatories (43%), nonperioperative opioids (42%), antipsychotics (33%), muscle relaxants (31%), irritable bowel syndrome-specific drugs (20%), clonidine (12%), anticholinergics (11%), and botulinum toxin A injections (6%). Physical and occupational therapy were prescribed for 41% of the study cohort. Significant differences in treatment patterns were found for individuals with co-occurring neurodevelopmental disorders, and across pain phenotypes. Notably, for individuals with a mixed pain phenotype, nearly 80% were prescribed nonperioperative opioids.
Conclusion
Adults with CP have a high prescription prevalence of nonperioperative opioids and common nonopioid pain and symptom management.
{"title":"Medication and Therapy Profiles for Pain and Symptom Management Among Adults With Cerebral Palsy","authors":"Mark D. Peterson PhD, MS , Michael O’Leary BS , Kathryn Ashbaugh BS , Heidi Haapala MD , Mary Schmidt DO , Neil Kamdar MA , Edward A. Hurvitz MD","doi":"10.1016/j.mayocpiqo.2025.100597","DOIUrl":"10.1016/j.mayocpiqo.2025.100597","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the most common patterns of pain and symptom management strategies among adults living with cerebral palsy (CP), and to determine if there are differences by pain phenotype or co-occurring neurodevelopmental disorders.</div></div><div><h3>Patients and Methods</h3><div>Federally insured beneficiaries were included if they had an ICD-9-CM/ICD-10-CM diagnosis code for CP (N=41,595). The study took place from January 10, 2024, to December 15, 2024. Medication and therapy prescription estimates for pain and CP symptom management were examined for the entire cohort, and between individuals with and without neurodevelopmental disorders and across pain phenotypes.</div></div><div><h3>Results</h3><div>The most common pharmaceutical/nontherapy-based pain and symptom management interventions included high frequency prescriptions for antiepileptics (58%), antidepressants (49%), benzodiazepines (43%), nonsteroidal anti-inflammatories (43%), nonperioperative opioids (42%), antipsychotics (33%), muscle relaxants (31%), irritable bowel syndrome-specific drugs (20%), clonidine (12%), anticholinergics (11%), and botulinum toxin A injections (6%). Physical and occupational therapy were prescribed for 41% of the study cohort. Significant differences in treatment patterns were found for individuals with co-occurring neurodevelopmental disorders, and across pain phenotypes. Notably, for individuals with a mixed pain phenotype, nearly 80% were prescribed nonperioperative opioids.</div></div><div><h3>Conclusion</h3><div>Adults with CP have a high prescription prevalence of nonperioperative opioids and common nonopioid pain and symptom management.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 2","pages":"Article 100597"},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444415","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}
Pub Date : 2025-02-01DOI: 10.1016/j.mayocpiqo.2024.11.003
Jane R. Schubart PhD , Eric W. Schaefer MS , Susan E. Mills MPH , Dacre R.T. Knight MD , Chan Shen PhD , Clair A. Francomano MD
Objective
To determine the financial impact of Ehlers-Danlos syndromes (EDS) on patients in the United States by examining the medical expenses incurred by patients.
Patients and Methods
We used a convenience sample approach and disseminated a self-reported survey questionnaire to individuals with EDS via patient advocacy organizations and support groups across the country, social media, and health professionals from April 1, 2023, to December 31, 2023. The survey focused on the out-of-pocket medical expenses incurred by patients.
Results
The final analytic data set included 884 responses. Responses were received from individuals in all 50 states and the District of Columbia. More than 50% reported individual income less than $25,000, and more than 30% reported household income less than $50,000. More than 80% of respondents had some type of commercial insurance and 29% reported receiving Medicaid. Respondents received more financial assistance from their family and friends than from government sources. The total median out-of-pocket financial cost by our analysis was $13,450 (IQR: $6500-$25,800). Of the 838 who responded to the question, “Did the affected person receive the health care they needed?”, 19% answered “no”, 51% answered “yes, sometimes”, and 30% answered “yes, most of the time”.
Conclusion
The factors contributing to financial impact include both direct and indirect costs of accessing and receiving medical care. Our study findings highlight the magnitude of the burden of health care spending on patients with EDS.
{"title":"The Financial Impact of Ehlers-Danlos Syndromes on Patients in the United States in 2022","authors":"Jane R. Schubart PhD , Eric W. Schaefer MS , Susan E. Mills MPH , Dacre R.T. Knight MD , Chan Shen PhD , Clair A. Francomano MD","doi":"10.1016/j.mayocpiqo.2024.11.003","DOIUrl":"10.1016/j.mayocpiqo.2024.11.003","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the financial impact of Ehlers-Danlos syndromes (EDS) on patients in the United States by examining the medical expenses incurred by patients.</div></div><div><h3>Patients and Methods</h3><div>We used a convenience sample approach and disseminated a self-reported survey questionnaire to individuals with EDS via patient advocacy organizations and support groups across the country, social media, and health professionals from April 1, 2023, to December 31, 2023. The survey focused on the out-of-pocket medical expenses incurred by patients.</div></div><div><h3>Results</h3><div>The final analytic data set included 884 responses. Responses were received from individuals in all 50 states and the District of Columbia. More than 50% reported individual income less than $25,000, and more than 30% reported household income less than $50,000. More than 80% of respondents had some type of commercial insurance and 29% reported receiving Medicaid. Respondents received more financial assistance from their family and friends than from government sources. The total median out-of-pocket financial cost by our analysis was $13,450 (IQR: $6500-$25,800). Of the 838 who responded to the question, “Did the affected person receive the health care they needed?”, 19% answered “no”, 51% answered “yes, sometimes”, and 30% answered “yes, most of the time”.</div></div><div><h3>Conclusion</h3><div>The factors contributing to financial impact include both direct and indirect costs of accessing and receiving medical care. Our study findings highlight the magnitude of the burden of health care spending on patients with EDS.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 1","pages":"Article 100586"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11713486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960745","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}
Pub Date : 2025-02-01DOI: 10.1016/j.mayocpiqo.2024.11.002
Kavita Prasad MD , Abhiram Prasad MD , Natalie L. Dyer PhD , Brent A. Bauer MD , Jennifer N. Soderlind BA , Karen M. Fischer MPH , Ivana T. Croghan PhD , Caroline C. Kaufman PhD , David H. Rosmarin PhD , Dietlind L. Wahner-Roedler MD
Objective
To evaluate the use of complementary and integrative medicine (CIM) among a low-income population with mental health diagnoses and to assess differences in social determinants of health (SDOH) on the basis of CIM use.
Patients and Methods
We surveyed patients with mental health diagnoses and/or substance use disorders during outpatient evaluations between August 11, 2020, and November 18, 2021, at a community behavioral health center in Rochester, MN. We measured knowledge of current CIM, interest in future use of CIM, and SDOH. Differences in mean number of SDOH risk factors were compared by use or nonuse of any CIM.
Results
Among 102 patients, depression (87%) and anxiety (85%) diagnoses were common. Moreover, 72% of patients used at least 1 CIM. The 3 most common modalities were prayer (41%), spirituality (37%), and music (36%). CIM use had perceived benefits for mood (49%), stress (49%), and sadness (43%). One-third of patients added CIM to conventional treatments, and 19% reported that traditional medical treatments did not work well for their symptoms. More than two-thirds had not discussed their use of CIM with their physicians. Social isolation and loneliness were common. The number of SDOH risk factors did differ by use of CIM.
Conclusion
Prayer, spirituality, and music are frequently used by patients with mental health disorders and were perceived to be helpful in relieving symptoms. CIM use was not related to SDOH risk factors. Integrating CIM therapies may be beneficial for improving mental health in this population.
{"title":"Use of Complementary and Integrative Medicine Among Low-Income Persons With Mental Health Disorders","authors":"Kavita Prasad MD , Abhiram Prasad MD , Natalie L. Dyer PhD , Brent A. Bauer MD , Jennifer N. Soderlind BA , Karen M. Fischer MPH , Ivana T. Croghan PhD , Caroline C. Kaufman PhD , David H. Rosmarin PhD , Dietlind L. Wahner-Roedler MD","doi":"10.1016/j.mayocpiqo.2024.11.002","DOIUrl":"10.1016/j.mayocpiqo.2024.11.002","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the use of complementary and integrative medicine (CIM) among a low-income population with mental health diagnoses and to assess differences in social determinants of health (SDOH) on the basis of CIM use.</div></div><div><h3>Patients and Methods</h3><div>We surveyed patients with mental health diagnoses and/or substance use disorders during outpatient evaluations between August 11, 2020, and November 18, 2021, at a community behavioral health center in Rochester, MN. We measured knowledge of current CIM, interest in future use of CIM, and SDOH. Differences in mean number of SDOH risk factors were compared by use or nonuse of any CIM.</div></div><div><h3>Results</h3><div>Among 102 patients, depression (87%) and anxiety (85%) diagnoses were common. Moreover, 72% of patients used at least 1 CIM. The 3 most common modalities were prayer (41%), spirituality (37%), and music (36%). CIM use had perceived benefits for mood (49%), stress (49%), and sadness (43%). One-third of patients added CIM to conventional treatments, and 19% reported that traditional medical treatments did not work well for their symptoms. More than two-thirds had not discussed their use of CIM with their physicians. Social isolation and loneliness were common. The number of SDOH risk factors did differ by use of CIM.</div></div><div><h3>Conclusion</h3><div>Prayer, spirituality, and music are frequently used by patients with mental health disorders and were perceived to be helpful in relieving symptoms. CIM use was not related to SDOH risk factors. Integrating CIM therapies may be beneficial for improving mental health in this population.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 1","pages":"Article 100585"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933902","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}
Pub Date : 2025-02-01DOI: 10.1016/j.mayocpiqo.2024.100589
Simon Parlow MD , Richard G. Jung MD, PhD , Pietro Di Santo MD , Joanne Joseph MD , Stephanie Skanes MD , Omar Abdel-Razek MD , Graeme Prosperi-Porta MSc, MD , Pouya Motazedian MD , Michael Froeschl MSc, MD , Marino Labinaz MD , Rebecca Mathew MD , F. Daniel Ramirez MSc, MD , Trevor Simard MD, PhD , Benjamin Hibbert MD, PhD
Objective
To examine the role of noninvasive testing (NIT) before invasive coronary angiography (ICA) by evaluating the association between a positive myocardial perfusion imaging (MPI) or computed tomography angiography (CTA) result and the decision to perform coronary revascularization.
Patients and Methods
We screened all patients who received ICA between August 1, 2015, and July 31, 2019, and identified those who received MPI or CTA within the preceding 12 months. We considered MPI to be a positive result if it found moderate or severe ischemia in a specific coronary territory and CTA to be a positive result if it identified a stenosis greater than 50% in any major coronary artery.
Results
Of the 17,181 individual procedures, 2183 were included. Positive CTA had an odds ratio (OR) of 2.68 (95% CI, 1.82-3.94) for revascularization and positive MPI an OR of 1.29 (95% CI, 1.07-1.56). Overall sensitivity for CTA in the prediction of revascularization was 80.4% (95% CI, 75.7%-84.6%), with vessel-level sensitivity ranging from 57.3% (95% CI, 47.5%-66.7%) to 71.8% (95% CI, 65.8%-77.4%). Overall sensitivity of MPI was 48.2% (95% CI, 44.7%-51.7%), with territory-specific sensitivity ranging from 33.7% (95% CI, 29.9%-37.7%) to 36.5% (95% CI, 32.6%-40.6%). Overall specificity for CTA was low, at 39.5% (32.9%-46.3%), but higher when evaluating at the vessel level, ranging from 60.3% (95% CI, 54.5%-66.0%) to 83.5% (95% CI, 79.6%-86.9%). Overall specificity for MPI was 58.1% (95% CI, 54.9%-61.3%), with territory-specific specificity ranging from 78.6% (95% CI, 76.1%-80.9%) to 78.9% (95% CI, 76.5%-81.3%).
Conclusion
In this population of patients referred for ICA, positive CTA was more closely associated with revascularization than MPI. Further studies are necessary to determine the role of NIT before ICA.
{"title":"Utility of Noninvasive Testing Before Invasive Coronary Angiography in the Assessment for Revascularization","authors":"Simon Parlow MD , Richard G. Jung MD, PhD , Pietro Di Santo MD , Joanne Joseph MD , Stephanie Skanes MD , Omar Abdel-Razek MD , Graeme Prosperi-Porta MSc, MD , Pouya Motazedian MD , Michael Froeschl MSc, MD , Marino Labinaz MD , Rebecca Mathew MD , F. Daniel Ramirez MSc, MD , Trevor Simard MD, PhD , Benjamin Hibbert MD, PhD","doi":"10.1016/j.mayocpiqo.2024.100589","DOIUrl":"10.1016/j.mayocpiqo.2024.100589","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the role of noninvasive testing (NIT) before invasive coronary angiography (ICA) by evaluating the association between a positive myocardial perfusion imaging (MPI) or computed tomography angiography (CTA) result and the decision to perform coronary revascularization.</div></div><div><h3>Patients and Methods</h3><div>We screened all patients who received ICA between August 1, 2015, and July 31, 2019, and identified those who received MPI or CTA within the preceding 12 months. We considered MPI to be a positive result if it found moderate or severe ischemia in a specific coronary territory and CTA to be a positive result if it identified a stenosis greater than 50% in any major coronary artery.</div></div><div><h3>Results</h3><div>Of the 17,181 individual procedures, 2183 were included. Positive CTA had an odds ratio (OR) of 2.68 (95% CI, 1.82-3.94) for revascularization and positive MPI an OR of 1.29 (95% CI, 1.07-1.56). Overall sensitivity for CTA in the prediction of revascularization was 80.4% (95% CI, 75.7%-84.6%), with vessel-level sensitivity ranging from 57.3% (95% CI, 47.5%-66.7%) to 71.8% (95% CI, 65.8%-77.4%). Overall sensitivity of MPI was 48.2% (95% CI, 44.7%-51.7%), with territory-specific sensitivity ranging from 33.7% (95% CI, 29.9%-37.7%) to 36.5% (95% CI, 32.6%-40.6%). Overall specificity for CTA was low, at 39.5% (32.9%-46.3%), but higher when evaluating at the vessel level, ranging from 60.3% (95% CI, 54.5%-66.0%) to 83.5% (95% CI, 79.6%-86.9%). Overall specificity for MPI was 58.1% (95% CI, 54.9%-61.3%), with territory-specific specificity ranging from 78.6% (95% CI, 76.1%-80.9%) to 78.9% (95% CI, 76.5%-81.3%).</div></div><div><h3>Conclusion</h3><div>In this population of patients referred for ICA, positive CTA was more closely associated with revascularization than MPI. Further studies are necessary to determine the role of NIT before ICA.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 1","pages":"Article 100589"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030655","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}
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