Pub Date : 2025-11-12DOI: 10.1016/j.mayocpiqo.2025.100671
O. Kenrik Duru MD, MSHS , Radica Alicic MD , Muthiah Vaduganathan MD, MPH , Wendy L. St. Peter PharmD , Glenda V. Roberts BS , Janani Rangaswami MD , Susanne B. Nicholas MD, MPH, PhD , Joshua J. Neumiller PharmD , Roy O. Mathew MD , Patrick Gee PhD , Katherine R. Tuttle MD
Objective
To assess coordinated cardiovascular-kidney-metabolic (CKM) care programs, including program types, components, and outcomes.
Patients and Methods
We searched Embase and Medline for studies from January 1, 2015 through March 9, 2023, and congress abstracts from January 1, 2021 through March 9, 2023. For inclusion, patients were required to have ≥2 CKM conditions and the coordinated care program assessed the effectiveness of either treatment, monitoring, or risk reduction of all 3 conditions. Two reviewers extracted and assessed the data for accuracy. Randomized controlled trials were assessed for potential bias in the design, conduct, and reporting of clinical trials risk of bias using the Cochrane risk of bias tool, version 2. Observational studies were assessed using the Newcastle-Ottawa Scale.
Results
A total of 22 international studies met our inclusion criteria; interventions included patient visits to multidisciplinary team (MDT) care clinics (n=9), pharmacist integration (n=5), patient engagement and education (n=6), or MDT/multispecialty team meetings (n=2). The sample size of studies ranged from 14 to 9601. Overall, results showed greater patient satisfaction and fewer health-related problems with coordinated care programs versus usual care, with increased attendance rates and decreased health care costs for virtual consultations, and further reductions for programs integrating telehealth.
Conclusion
Coordinated care for patients with CKM conditions may improve clinical outcomes and reduce healthcare costs. Future research is needed to develop programs with standard reporting, to assess overall effectiveness, and to identify best practices for implementing coordinated care programs. Limitations included heterogeneity in the interventions’ design, delivery, CKM population, and outcomes assessed.
{"title":"A Systematic Literature Review of Coordinated Care in Cardiovascular-Kidney-Metabolic Conditions","authors":"O. Kenrik Duru MD, MSHS , Radica Alicic MD , Muthiah Vaduganathan MD, MPH , Wendy L. St. Peter PharmD , Glenda V. Roberts BS , Janani Rangaswami MD , Susanne B. Nicholas MD, MPH, PhD , Joshua J. Neumiller PharmD , Roy O. Mathew MD , Patrick Gee PhD , Katherine R. Tuttle MD","doi":"10.1016/j.mayocpiqo.2025.100671","DOIUrl":"10.1016/j.mayocpiqo.2025.100671","url":null,"abstract":"<div><h3>Objective</h3><div>To assess coordinated cardiovascular-kidney-metabolic (CKM) care programs, including program types, components, and outcomes.</div></div><div><h3>Patients and Methods</h3><div>We searched Embase and Medline for studies from January 1, 2015 through March 9, 2023, and congress abstracts from January 1, 2021 through March 9, 2023. For inclusion, patients were required to have ≥2 CKM conditions and the coordinated care program assessed the effectiveness of either treatment, monitoring, or risk reduction of all 3 conditions. Two reviewers extracted and assessed the data for accuracy. Randomized controlled trials were assessed for potential bias in the design, conduct, and reporting of clinical trials risk of bias using the Cochrane risk of bias tool, version 2. Observational studies were assessed using the Newcastle-Ottawa Scale.</div></div><div><h3>Results</h3><div>A total of 22 international studies met our inclusion criteria; interventions included patient visits to multidisciplinary team (MDT) care clinics (n=9), pharmacist integration (n=5), patient engagement and education (n=6), or MDT/multispecialty team meetings (n=2). The sample size of studies ranged from 14 to 9601. Overall, results showed greater patient satisfaction and fewer health-related problems with coordinated care programs versus usual care, with increased attendance rates and decreased health care costs for virtual consultations, and further reductions for programs integrating telehealth.</div></div><div><h3>Conclusion</h3><div>Coordinated care for patients with CKM conditions may improve clinical outcomes and reduce healthcare costs. Future research is needed to develop programs with standard reporting, to assess overall effectiveness, and to identify best practices for implementing coordinated care programs. Limitations included heterogeneity in the interventions’ design, delivery, CKM population, and outcomes assessed.</div></div><div><h3>Trial Registration</h3><div>PROSPERO Identifier: CRD42023409731</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 6","pages":"Article 100671"},"PeriodicalIF":0.0,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145520554","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}
Pub Date : 2025-11-11DOI: 10.1016/j.mayocpiqo.2025.100676
Martin H. Thornhill MBBS, BDS, PhD , Peter B. Lockhart DDS , Mark J. Dayer MBBS, PhD , Bernard D. Prendergast BM, BS, DM , Larry M. Baddour MD
Objective
To quantify the risk of infective endocarditis (IE) following different invasive dental procedures in patients with cardiac risk factors that place them at low-risk, moderate-risk, or high-risk of developing IE.
Patients and Methods
The linked IBM MarketScan administrative databases were used to integrate deidentified patient-level health data for all enrollees over 18 years of age with employer-provided commercial/Medicare-supplemental medical and dental coverage, or Medicaid benefits, with more than 16 months of data from May 1, 2007, to August 31, 2015.
Results
In the resulting 9.6 million patient cohort, IE incidence in the 4-months following 53.6 million invasive dental procedures was quantified. In high-risk individuals (e.g. previous IE, prosthetic/repaired heart valves, or cyanotic congenital heart disease), IE incidence in the 4 months following an IDP was 2195 IE cases/million procedures - ∼125 times higher than in low-risk (OR 126.3; 95% CI, 113.5-140.6; P<.001). The IE-risk was even greater following extractions (incidence 8680 IE cases/million extractions, OR 171.4; 95% CI, 136.7-214.8; P<.001) or other oral surgical procedures (incidence 13,458 IE cases/million procedures; OR 245.5; 95% CI, 165.1-365.1; P<.001). Moderate-risk individuals were at significantly lower IE-risk, and low-risk individuals were at negligible risk.
Conclusion
The risk of IE was high in high-risk individuals following all types of IDP (particularly following extractions and other oral surgical procedures) and vastly exceeded the risk of adverse drug reactions following antibiotic prophylaxis. Our data therefore support guidance recommending high-risk individuals receive antibiotic prophylaxis and provide quantitative information concerning the IE-risk that can be used to educate and obtain informed consent from patients.
{"title":"Infective Endocarditis Risk After Invasive Dental Procedures","authors":"Martin H. Thornhill MBBS, BDS, PhD , Peter B. Lockhart DDS , Mark J. Dayer MBBS, PhD , Bernard D. Prendergast BM, BS, DM , Larry M. Baddour MD","doi":"10.1016/j.mayocpiqo.2025.100676","DOIUrl":"10.1016/j.mayocpiqo.2025.100676","url":null,"abstract":"<div><h3>Objective</h3><div>To quantify the risk of infective endocarditis (IE) following different invasive dental procedures in patients with cardiac risk factors that place them at low-risk, moderate-risk, or high-risk of developing IE.</div></div><div><h3>Patients and Methods</h3><div>The linked IBM MarketScan administrative databases were used to integrate deidentified patient-level health data for all enrollees over 18 years of age with employer-provided commercial/Medicare-supplemental medical and dental coverage, or Medicaid benefits, with more than 16 months of data from May 1, 2007, to August 31, 2015.</div></div><div><h3>Results</h3><div>In the resulting 9.6 million patient cohort, IE incidence in the 4-months following 53.6 million invasive dental procedures was quantified. In high-risk individuals (e.g. previous IE, prosthetic/repaired heart valves, or cyanotic congenital heart disease), IE incidence in the 4 months following an IDP was 2195 IE cases/million procedures - ∼125 times higher than in low-risk (OR 126.3; 95% CI, 113.5-140.6; <em>P</em><.001). The IE-risk was even greater following extractions (incidence 8680 IE cases/million extractions, OR 171.4; 95% CI, 136.7-214.8; <em>P</em><.001) or other oral surgical procedures (incidence 13,458 IE cases/million procedures; OR 245.5; 95% CI, 165.1-365.1; <em>P</em><.001). Moderate-risk individuals were at significantly lower IE-risk, and low-risk individuals were at negligible risk.</div></div><div><h3>Conclusion</h3><div>The risk of IE was high in high-risk individuals following all types of IDP (particularly following extractions and other oral surgical procedures) and vastly exceeded the risk of adverse drug reactions following antibiotic prophylaxis. Our data therefore support guidance recommending high-risk individuals receive antibiotic prophylaxis and provide quantitative information concerning the IE-risk that can be used to educate and obtain informed consent from patients.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 6","pages":"Article 100676"},"PeriodicalIF":0.0,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145520555","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}
Pub Date : 2025-11-07DOI: 10.1016/j.mayocpiqo.2025.100674
Brittany L. Adler MD , Alison W. Rebman MPH , Tae Chung MD , John B. Miller MD , Marzieh Keshtkarjahromi MD, MPH , Ting Yang PhD , Chatuthanai Savigamin MD, MSc, MPH , Alba Azola MD , Peter C. Rowe MD , John N. Aucott MD
Objective
To determine the prevalence of autonomic symptoms in post-treatment Lyme disease (PTLD) and identify clinical factors that associate with abnormal hemodynamics on the 10-minute active stand test.
Patients and Methods
We administered the Composite Autonomic Symptom Score-31 survey to 37 patients with PTLD and compared them with a cohort of patients with postural orthostatic tachycardia syndrome (POTS) without a known history of Lyme disease. We also report the 10-minute active stand test performed in 210 patients with PTLD recruited from July 1, 2016 through October 31, 2024.
Results
Patients with PTLD had higher total Composite Autonomic Symptom Survey 31 scores than healthy controls and reported similar vasomotor, urinary, and pupillomotor symptom burden as patients with POTS. On the 10-minute active stand test, 9 of the 210 (4.29%) patients with PTLD had orthostatic tachycardia. Although the prevalence of orthostatic tachycardia in patients was not significantly different from that of healthy controls, those with orthostatic tachycardia were more likely to be earlier in their disease course and had higher rates of steroid use (P=.009) and antibiotic exposure (P=.007) after Lyme disease.
Conclusion
Autonomic symptoms are common in PTLD. The 10-minute active stand test identified a subgroup of patients with orthostatic tachycardia that associated with distinct clinical features of Lyme disease.
{"title":"Autonomic Symptoms in Post-Treatment Lyme Disease: Insights From the COMPASS-31 and the 10-Minute Active Stand Test","authors":"Brittany L. Adler MD , Alison W. Rebman MPH , Tae Chung MD , John B. Miller MD , Marzieh Keshtkarjahromi MD, MPH , Ting Yang PhD , Chatuthanai Savigamin MD, MSc, MPH , Alba Azola MD , Peter C. Rowe MD , John N. Aucott MD","doi":"10.1016/j.mayocpiqo.2025.100674","DOIUrl":"10.1016/j.mayocpiqo.2025.100674","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the prevalence of autonomic symptoms in post-treatment Lyme disease (PTLD) and identify clinical factors that associate with abnormal hemodynamics on the 10-minute active stand test.</div></div><div><h3>Patients and Methods</h3><div>We administered the Composite Autonomic Symptom Score-31 survey to 37 patients with PTLD and compared them with a cohort of patients with postural orthostatic tachycardia syndrome (POTS) without a known history of Lyme disease. We also report the 10-minute active stand test performed in 210 patients with PTLD recruited from July 1, 2016 through October 31, 2024.</div></div><div><h3>Results</h3><div>Patients with PTLD had higher total Composite Autonomic Symptom Survey 31 scores than healthy controls and reported similar vasomotor, urinary, and pupillomotor symptom burden as patients with POTS. On the 10-minute active stand test, 9 of the 210 (4.29%) patients with PTLD had orthostatic tachycardia. Although the prevalence of orthostatic tachycardia in patients was not significantly different from that of healthy controls, those with orthostatic tachycardia were more likely to be earlier in their disease course and had higher rates of steroid use (<em>P</em>=.009) and antibiotic exposure (<em>P</em>=.007) after Lyme disease.</div></div><div><h3>Conclusion</h3><div>Autonomic symptoms are common in PTLD. The 10-minute active stand test identified a subgroup of patients with orthostatic tachycardia that associated with distinct clinical features of Lyme disease.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 6","pages":"Article 100674"},"PeriodicalIF":0.0,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467316","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}
Pub Date : 2025-11-07DOI: 10.1016/j.mayocpiqo.2025.100675
Radhika K. Neicheril MD , Yosef Manla MD , Daniel Chacon MD , Kaylee Sarna MSc , Alice Sonnino MD , Jared Piotrkowski MD , Kevin Perry MD , David Snipelisky MD
Objective
To examine the association between the implementation of high-sensitivity cardiac troponin (hs-cTn) and downstream resource utilization in patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS).
Patients and Methods
We analyzed 461 ED encounters of patients with suspected ACS between January 1, 2022 and December 12, 2022. The final propensity score–matched analysis included 300 encounters in which the conventional cardiac troponin (c-cTn) assay (n=150) or hs-cTn assay (n=150) was used. Groups were compared for downstream resource utilization, including cardiology consults, cardiovascular imaging, disposition of care, ED length of stay, and 30-day outcomes, using appropriate statistical testing.
Results
Compared with the c-cTn group, the hs-cTn group had a lower rate of requiring cardiology consults (6 [4%] vs 45 [30%]; P<.001) and reduced downstream utilization of echocardiograms (10 [6.7%] vs 59 [39.3%]; P<.001), nuclear stress tests (6 [4%] vs 27 [18%] P<.001), and cardiac catheterization (2 [1.3%] vs 27 [18%]; P<.001). Significantly fewer patients were referred to observation (17 [11.3%] vs 96 [64%]; P<.001) or admitted (7 [4.7%] vs 42 [28%]; P<.001) in the hs-cTn assay group. In addition, the median ED length of stay was significantly shorter in the hs-cTn group (4 vs 28 hours; P<.001). The 30-day outcomes, including readmission for ACS (0 [0%] vs 0 [0%]; P>.99) or mortality (0 [0%] vs 1 [0.7%]; P>.99) rates, were comparable.
Conclusion
Implementing hs-cTn in the ED can significantly reduce downstream testing and hospital resource utilization. Wider adoption of hs-cTn assays could present an opportunity to optimize care of patients with suspected ACS.
{"title":"Implementation of a High-Sensitivity Troponin Assay and Its Association With Resource Utilization in Patients With Suspected Acute Coronary Syndrome","authors":"Radhika K. Neicheril MD , Yosef Manla MD , Daniel Chacon MD , Kaylee Sarna MSc , Alice Sonnino MD , Jared Piotrkowski MD , Kevin Perry MD , David Snipelisky MD","doi":"10.1016/j.mayocpiqo.2025.100675","DOIUrl":"10.1016/j.mayocpiqo.2025.100675","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the association between the implementation of high-sensitivity cardiac troponin (hs-cTn) and downstream resource utilization in patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS).</div></div><div><h3>Patients and Methods</h3><div>We analyzed 461 ED encounters of patients with suspected ACS between January 1, 2022 and December 12, 2022. The final propensity score–matched analysis included 300 encounters in which the conventional cardiac troponin (c-cTn) assay (n=150) or hs-cTn assay (n=150) was used. Groups were compared for downstream resource utilization, including cardiology consults, cardiovascular imaging, disposition of care, ED length of stay, and 30-day outcomes, using appropriate statistical testing.</div></div><div><h3>Results</h3><div>Compared with the c-cTn group, the hs-cTn group had a lower rate of requiring cardiology consults (6 [4%] vs 45 [30%]; <em>P</em><.001) and reduced downstream utilization of echocardiograms (10 [6.7%] vs 59 [39.3%]; <em>P</em><.001), nuclear stress tests (6 [4%] vs 27 [18%] <em>P</em><.001), and cardiac catheterization (2 [1.3%] vs 27 [18%]; <em>P</em><.001). Significantly fewer patients were referred to observation (17 [11.3%] vs 96 [64%]; <em>P</em><.001) or admitted (7 [4.7%] vs 42 [28%]; <em>P</em><.001) in the hs-cTn assay group. In addition, the median ED length of stay was significantly shorter in the hs-cTn group (4 vs 28 hours; <em>P</em><.001). The 30-day outcomes, including readmission for ACS (0 [0%] vs 0 [0%]; <em>P</em>>.99) or mortality (0 [0%] vs 1 [0.7%]; <em>P</em>>.99) rates, were comparable.</div></div><div><h3>Conclusion</h3><div>Implementing hs-cTn in the ED can significantly reduce downstream testing and hospital resource utilization. Wider adoption of hs-cTn assays could present an opportunity to optimize care of patients with suspected ACS.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 6","pages":"Article 100675"},"PeriodicalIF":0.0,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467317","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}
Pub Date : 2025-11-04DOI: 10.1016/j.mayocpiqo.2025.100664
Shafaq Raza Rizvi MBBS , Donna Desjardins MS , Ravinder Jeet Kaur MBBS , Christina M. Wood-Wentz MS , Daniel J. Crusan BS , Corey Reid BS , Mari Charisse Trinidad MD , Kent R. Bailey PhD , Yogish C. Kudva MD
Objective
To study contemporaneous pregnancy outcomes in women with Type 1 Diabetes (T1D).
Patients and Methods
We retrospectively studied maternal and perinatal outcomes in women with T1D, and their age and gravidity matched healthy controls (N=161 pairs) who were admitted to Mayo Clinic, Rochester, MN, for delivery from January 01, 2006, to December 31, 2020, and provided research authorization for access to medical records. Data were initially electronically retrieved with subsequent manual review.
Results
We assessed 13 maternal and 22 perinatal outcome variables in 161 women with T1D and 161 healthy women matched on relevant variables. The combined study population had a mean age of 29±5 years, basic metabolic index (BMI) of 27.5±6 kg/m2, with a mean glycated hemoglobin in the T1D group of 7.74±1.64, 6.67±1.11, and 6.93±3.1 in the first, second and third trimesters, respectively. Preeclampsia, hypothyroidism, polyhydramnios, induced premature labor and preterm delivery (including medically indicated), and cesarean section were more common in women with T1D. Perinatal outcomes more prevalent among T1D pregnancies were preterm delivery, large for gestational age, cardiac (structural and functional defects), upper gastrointestinal complications, jaundice, neonatal hypoglycemia treated with intravenous dextrose only, hypoxia, respiratory distress syndrome with or without respiratory failure, and neonatal sepsis.
Conclusion
Pregnancies with T1D continue to be associated with suboptimal glycemic control and higher maternal and perinatal morbidity, as compared to pregnancies in women without T1D, reinforcing the urgent need for the development of interventions to improve pregnancy outcomes.
{"title":"Maternal and Perinatal Outcomes in Pregnancies With Type 1 Diabetes and Controls During a 15-Year Period (2006-2020)","authors":"Shafaq Raza Rizvi MBBS , Donna Desjardins MS , Ravinder Jeet Kaur MBBS , Christina M. Wood-Wentz MS , Daniel J. Crusan BS , Corey Reid BS , Mari Charisse Trinidad MD , Kent R. Bailey PhD , Yogish C. Kudva MD","doi":"10.1016/j.mayocpiqo.2025.100664","DOIUrl":"10.1016/j.mayocpiqo.2025.100664","url":null,"abstract":"<div><h3>Objective</h3><div>To study contemporaneous pregnancy outcomes in women with Type 1 Diabetes (T1D).</div></div><div><h3>Patients and Methods</h3><div>We retrospectively studied maternal and perinatal outcomes in women with T1D, and their age and gravidity matched healthy controls (N=161 pairs) who were admitted to Mayo Clinic, Rochester, MN, for delivery from January 01, 2006, to December 31, 2020, and provided research authorization for access to medical records. Data were initially electronically retrieved with subsequent manual review.</div></div><div><h3>Results</h3><div>We assessed 13 maternal and 22 perinatal outcome variables in 161 women with T1D and 161 healthy women matched on relevant variables. The combined study population had a mean age of 29±5 years, basic metabolic index (BMI) of 27.5±6 kg/m<sup>2</sup>, with a mean glycated hemoglobin in the T1D group of 7.74±1.64, 6.67±1.11, and 6.93±3.1 in the first, second and third trimesters, respectively. Preeclampsia, hypothyroidism, polyhydramnios, induced premature labor and preterm delivery (including medically indicated), and cesarean section were more common in women with T1D. Perinatal outcomes more prevalent among T1D pregnancies were preterm delivery, large for gestational age, cardiac (structural and functional defects), upper gastrointestinal complications, jaundice, neonatal hypoglycemia treated with intravenous dextrose only, hypoxia, respiratory distress syndrome with or without respiratory failure, and neonatal sepsis.</div></div><div><h3>Conclusion</h3><div>Pregnancies with T1D continue to be associated with suboptimal glycemic control and higher maternal and perinatal morbidity, as compared to pregnancies in women without T1D, reinforcing the urgent need for the development of interventions to improve pregnancy outcomes.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 6","pages":"Article 100664"},"PeriodicalIF":0.0,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467318","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}
Pub Date : 2025-11-02DOI: 10.1016/j.mayocpiqo.2025.100673
Laura E. Breeher MD, MPH , Elizabeth H. Lees DO, MPH , Wigdan H. Farah MBBS, MPH , Richard D. Newcomb MD, MPH , Caitlin M. Hainy APRN, CNP, DNP , Byron I. Callies Jr. CEM , Philip T. Schroeder MS , Melanie D. Swift MD, MPH
Objective
To test the World Health Organization 5 Well-Being Index assessment tool as a practical way of detecting well-being changes across health care providers (HCPs) during high-consequence infectious disease (HCID) outbreaks.
Participants and Methods
The study took place from October 2014 to March 2015 at a Midwest referral hospital with 2059 beds on 2 campuses. The study focused on a group of HCPs recruited for Ebola emergency response planning during the HCID outbreak in Africa.
Results
Average well-being scores were worse during the initial weeks and months of the Ebola emergency response planning. Scores were lower (worse) among employees actively involved in response planning.
Conclusion
Health care personnel (HCP) responding to HCID outbreaks face significant physical, cognitive, and emotional stressors Despite this, well-being assessments are not consistently integrated into emergency response plans. The World Health Organization 5 Well-Being Index assessment tool offers a practical way to detect well-being changes across HCP during HCID outbreak and response.
{"title":"Adapting the World Health Organization 5 Well-Being Index for Emergency Activation and Response Planning in a US Health Care Setting","authors":"Laura E. Breeher MD, MPH , Elizabeth H. Lees DO, MPH , Wigdan H. Farah MBBS, MPH , Richard D. Newcomb MD, MPH , Caitlin M. Hainy APRN, CNP, DNP , Byron I. Callies Jr. CEM , Philip T. Schroeder MS , Melanie D. Swift MD, MPH","doi":"10.1016/j.mayocpiqo.2025.100673","DOIUrl":"10.1016/j.mayocpiqo.2025.100673","url":null,"abstract":"<div><h3>Objective</h3><div>To test the World Health Organization 5 Well-Being Index assessment tool as a practical way of detecting well-being changes across health care providers (HCPs) during high-consequence infectious disease (HCID) outbreaks.</div></div><div><h3>Participants and Methods</h3><div>The study took place from October 2014 to March 2015 at a Midwest referral hospital with 2059 beds on 2 campuses. The study focused on a group of HCPs recruited for Ebola emergency response planning during the HCID outbreak in Africa.</div></div><div><h3>Results</h3><div>Average well-being scores were worse during the initial weeks and months of the Ebola emergency response planning. Scores were lower (worse) among employees actively involved in response planning.</div></div><div><h3>Conclusion</h3><div>Health care personnel (HCP) responding to HCID outbreaks face significant physical, cognitive, and emotional stressors Despite this, well-being assessments are not consistently integrated into emergency response plans. The World Health Organization 5 Well-Being Index assessment tool offers a practical way to detect well-being changes across HCP during HCID outbreak and response.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 6","pages":"Article 100673"},"PeriodicalIF":0.0,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467312","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}
Pub Date : 2025-10-31DOI: 10.1016/j.mayocpiqo.2025.100672
Frances C. Wilson BS , Katelyn A. Bruno PhD , DeLisa Fairweather PhD , Matthew G. Carroll BS , Ashley A. Darakjian BS , Shilpa Gajarawala PA-C , Ashley M. Zeman MD , David Shirey Jr. DPT , Tava R. Buck PT, DPT, OCS , Barbara K. Bruce PhD , Jessica M. Gehin RN , Lauren M. Boucher MS, CGC , Merci S. Greenaway PT , Chrisandra L. Shufelt MD , Dacre R.T. Knight MD
Objective
To gain a better understanding of preferred treatment modalities and referrals to better treat and manage pain symptoms, we conducted a retrospective longitudinal cohort study of patients with hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD).
Patients and Methods
A retrospective analysis of self-reported data in 290 patients diagnosed with hEDS or HSD according to the 2017 Criteria from November 1, 2019, to June 12, 2023, who completed intake and outtake questionnaires. Patients were asked questions on the severity of hypermobile, joint and muscle pain, and whether clinical referral and/or medications/treatments improved their pain.
Results
Less than 30% of patients with hEDS and HSD reported improvement of hypermobility, joint or muscle pain from any of 17 treatment modalities listed in the outtake questionnaire. Patients self-reported that physical activity/exercise significantly or borderline significantly improved pain symptoms (hypermobility pain hEDS, n=36 (46.8%) vs 10 (76.9%), P=.07; HSD, n=77 (47.8%) vs 16 (88.9%), P=.001; joint pain hEDS, n=29 (45.3%) vs 17 (73.9%), P=.03; HSD, n=59 (42.8%) vs 32 (86.5%), P<.0001; muscle pain hEDS, n=25 (44.6%) vs 12 (75.0%), P=.05; HSD, n= 59 (45.4%) vs 25 (89.3%), P<.0001), whereas patients with HSD reported that physical therapy also improved pain (hypermobility pain HSD, n=78 (48.5%) vs 15 (83.3%), P=.006; joint pain HSD, n=62 (44.9%) vs 28 (75.7%), P=.001; muscle pain HSD, n=60 (46.2%) vs 20 (71.4%), P=.02). In contrast, patients with hEDS reported that topical medications made their muscle pain worse (n=27 (48.2%) vs 3 (18.8%), P=.05) and patients with HSD that injections made their joint pain worse (n=39 (28.3%) vs 4 (10.8%), P=.03). Most patients reported that referrals improved their pain. However, 40% or more reported that referrals to allergy and immunology and rheumatology departments worsened their pain.
Conclusion
This study identified patient perceptions on treatments and referrals that improved or made their pain worse. These findings provide a starting point for future treatment guidelines, decision aids, and research on patient-reported outcomes.
为了更好地了解首选治疗方式和更好地治疗和控制疼痛症状，我们对多动性ehers - danlos综合征（hEDS）和多动性谱系障碍（HSD）患者进行了回顾性纵向队列研究。患者和方法回顾性分析了2019年11月1日至2023年6月12日期间290例根据2017年标准诊断为hEDS或HSD的患者的自我报告数据，这些患者完成了摄入和排出问卷。患者被问及运动过度、关节和肌肉疼痛的严重程度，以及临床转诊和/或药物/治疗是否改善了他们的疼痛。结果：在抽查问卷中列出的17种治疗方式中，只有不到30%的hEDS和HSD患者报告了多动、关节或肌肉疼痛的改善。患者自述体力活动/运动显著或边缘性显著改善疼痛症状(多动性疼痛hEDS， n=36 (46.8%) vs 10 (76.9%)， P= 0.07；HSD, n=77 (47.8%) vs 16 (88.9%)， P= 0.001；关节疼痛hEDS， n=29 (45.3%) vs 17 (73.9%)， P= 0.03；HSD, n=59 (42.8%) vs 32 (86.5%), P<；肌肉疼痛hEDS， n=25 (44.6%) vs 12 (75.0%)， P= 0.05；HSD, n= 59 (45.4%) vs 25 (89.3%)， P= 0.0001)，而HSD患者报告物理治疗也改善了疼痛(多动性疼痛HSD， n=78 (48.5%) vs 15 (83.3%)， P= 0.006；关节疼痛HSD， n=62 (44.9%) vs 28 (75.7%)， P= 0.001；肌肉疼痛HSD， n=60 （46.2%) vs 20 (71.4%)， P= 0.02）。相比之下，hEDS患者报告局部药物使其肌肉疼痛加重（n=27（48.2%）比3 (18.8%)，P= 0.05）， HSD患者报告注射使其关节疼痛加重（n=39（28.3%）比4 (10.8%)，P= 0.03）。大多数病人报告说转诊改善了他们的疼痛。然而，40%或更多的人报告说，转诊到过敏、免疫学和风湿病科加重了他们的疼痛。结论：本研究确定了患者对改善或加重疼痛的治疗和转诊的看法。这些发现为未来的治疗指南、决策辅助和患者报告结果的研究提供了一个起点。
{"title":"Treatment Modalities, Pain Response, and Referrals for Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders: A Retrospective Study","authors":"Frances C. Wilson BS , Katelyn A. Bruno PhD , DeLisa Fairweather PhD , Matthew G. Carroll BS , Ashley A. Darakjian BS , Shilpa Gajarawala PA-C , Ashley M. Zeman MD , David Shirey Jr. DPT , Tava R. Buck PT, DPT, OCS , Barbara K. Bruce PhD , Jessica M. Gehin RN , Lauren M. Boucher MS, CGC , Merci S. Greenaway PT , Chrisandra L. Shufelt MD , Dacre R.T. Knight MD","doi":"10.1016/j.mayocpiqo.2025.100672","DOIUrl":"10.1016/j.mayocpiqo.2025.100672","url":null,"abstract":"<div><h3>Objective</h3><div>To gain a better understanding of preferred treatment modalities and referrals to better treat and manage pain symptoms, we conducted a retrospective longitudinal cohort study of patients with hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD).</div></div><div><h3>Patients and Methods</h3><div>A retrospective analysis of self-reported data in 290 patients diagnosed with hEDS or HSD according to the 2017 Criteria from November 1, 2019, to June 12, 2023, who completed intake and outtake questionnaires. Patients were asked questions on the severity of hypermobile, joint and muscle pain, and whether clinical referral and/or medications/treatments improved their pain.</div></div><div><h3>Results</h3><div>Less than 30% of patients with hEDS and HSD reported improvement of hypermobility, joint or muscle pain from any of 17 treatment modalities listed in the outtake questionnaire. Patients self-reported that physical activity/exercise significantly or borderline significantly improved pain symptoms (hypermobility pain hEDS, n=36 (46.8%) vs 10 (76.9%), <em>P</em>=.07; HSD, n=77 (47.8%) vs 16 (88.9%), <em>P</em>=.001; joint pain hEDS, n=29 (45.3%) vs 17 (73.9%), <em>P</em>=.03; HSD, n=59 (42.8%) vs 32 (86.5%), <em>P</em><.0001; muscle pain hEDS, n=25 (44.6%) vs 12 (75.0%), <em>P</em>=.05; HSD, n= 59 (45.4%) vs 25 (89.3%), <em>P</em><.0001), whereas patients with HSD reported that physical therapy also improved pain (hypermobility pain HSD, n=78 (48.5%) vs 15 (83.3%), <em>P</em>=.006; joint pain HSD, n=62 (44.9%) vs 28 (75.7%), <em>P</em>=.001; muscle pain HSD, n=60 (46.2%) vs 20 (71.4%), <em>P</em>=.02). In contrast, patients with hEDS reported that topical medications made their muscle pain worse (n=27 (48.2%) vs 3 (18.8%), <em>P</em>=.05) and patients with HSD that injections made their joint pain worse (n=39 (28.3%) vs 4 (10.8%), <em>P</em>=.03). Most patients reported that referrals improved their pain. However, 40% or more reported that referrals to allergy and immunology and rheumatology departments worsened their pain.</div></div><div><h3>Conclusion</h3><div>This study identified patient perceptions on treatments and referrals that improved or made their pain worse. These findings provide a starting point for future treatment guidelines, decision aids, and research on patient-reported outcomes.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 6","pages":"Article 100672"},"PeriodicalIF":0.0,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418510","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}
Pub Date : 2025-10-10DOI: 10.1016/j.mayocpiqo.2025.100662
Nicole Hobson MD , M. Todd Greene PhD, MPH , Sanjay Saint MD, MPH , Amber Braker BS , Karen E. Fowler MPH , Latoya Kuhn MPH , Jason M. Engle MPH , Nathan Houchens MD
Objective
To evaluate the frequency and demographic predictors of engaging in personal well-being activities among US internal medicine physicians.
Participants and Methods
A national cross-sectional survey was conducted from June 23, 2023, through May 8, 2024, targeting a random sample of practicing internal medicine physicians. Data on demographic characteristics and frequency of well-being activities (exercise, meditation, hobbies, volunteering, and social events) were collected. Of 1421 invited physicians, 629 (44.3%) responded. Descriptive statistics and multivariable logistic regression were used to assess levels of engagement and analyze associations between engagement frequency and physician demographic characteristics.
Results
Among the 629 respondents, engagement in well-being activities varied. The percentage of physicians reporting high engagement was 54.1% (339/627) for exercise (≥4× in past 7 days), 43.7% (272/623) for hobbies (≥4× in past 30 days), 32.6% (205/628) for meditation (≥1× in past 7 days), 31.5% (197/625) for volunteering (≥1× in past 30 days), and 26.9% (168/624) for social events (≥4× in past 30 days). Length of time in medical practice was significantly associated with higher odds of engaging in exercise and volunteering. Compared with White respondents, Black or African American respondents were more likely to volunteer and less likely to engage in hobbies. Asian respondents were more likely to meditate and less likely to attend social events and engage in hobbies. Differences by sex emerged only in meditation, with higher engagement among women.
Conclusion
Internal medicine physicians showed high engagement in various personal well-being activities with substantial demographic variations observed. Our findings underscore the importance of considering individual physician characteristics when designing initiatives to enhance physician well-being and reduce burnout.
{"title":"Well-Being Activities Among Internal Medicine Physicians: Results of a National Survey","authors":"Nicole Hobson MD , M. Todd Greene PhD, MPH , Sanjay Saint MD, MPH , Amber Braker BS , Karen E. Fowler MPH , Latoya Kuhn MPH , Jason M. Engle MPH , Nathan Houchens MD","doi":"10.1016/j.mayocpiqo.2025.100662","DOIUrl":"10.1016/j.mayocpiqo.2025.100662","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the frequency and demographic predictors of engaging in personal well-being activities among US internal medicine physicians.</div></div><div><h3>Participants and Methods</h3><div>A national cross-sectional survey was conducted from June 23, 2023, through May 8, 2024, targeting a random sample of practicing internal medicine physicians. Data on demographic characteristics and frequency of well-being activities (exercise, meditation, hobbies, volunteering, and social events) were collected. Of 1421 invited physicians, 629 (44.3%) responded. Descriptive statistics and multivariable logistic regression were used to assess levels of engagement and analyze associations between engagement frequency and physician demographic characteristics.</div></div><div><h3>Results</h3><div>Among the 629 respondents, engagement in well-being activities varied. The percentage of physicians reporting high engagement was 54.1% (339/627) for exercise (≥4× in past 7 days), 43.7% (272/623) for hobbies (≥4× in past 30 days), 32.6% (205/628) for meditation (≥1× in past 7 days), 31.5% (197/625) for volunteering (≥1× in past 30 days), and 26.9% (168/624) for social events (≥4× in past 30 days). Length of time in medical practice was significantly associated with higher odds of engaging in exercise and volunteering. Compared with White respondents, Black or African American respondents were more likely to volunteer and less likely to engage in hobbies. Asian respondents were more likely to meditate and less likely to attend social events and engage in hobbies. Differences by sex emerged only in meditation, with higher engagement among women.</div></div><div><h3>Conclusion</h3><div>Internal medicine physicians showed high engagement in various personal well-being activities with substantial demographic variations observed. Our findings underscore the importance of considering individual physician characteristics when designing initiatives to enhance physician well-being and reduce burnout.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 6","pages":"Article 100662"},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145271093","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}
Pub Date : 2025-09-19DOI: 10.1016/j.mayocpiqo.2025.100663
Santiago Romero-Brufau MD, PhD , Radit Smunyahirun PhD , Timothée Filhol MiM , Lucille Niederhauser MS , Thanawin Trakoolwilaiwan MS , Gurpreet Singh PhD
Objective
To develop predictive models that are compatible with vital signs monitoring devices to identify patients at risk of clinical deterioration, defined as requiring a rapid response team intervention or an unplanned intensive care unit transfer.
Patients and Methods
Targeted vital signs from 227,858 inpatients admitted to general care or telemetry beds at a multihospital health care institution between January 1, 2019, and July 31, 2023, were selected. After filtering for high-quality data, 30,118 patients were used to train a Light Gradient Boosting Machine, and 30,095 were reserved for blind validation. We developed a machine learning model designed to minimize false positives while maintaining clinical relevance in identifying low-prevalence clinical deterioration events.
Results
At a sensitivity of 73.4% (95% CI, 72.2%-74.4%), the model achieved a positive predictive value (PPV) of 30.4% (95% CI, 29.6%-31.3%), with a C-statistic of 0.874 (95% CI, 0.867-0.881), alert rate of 0.170 (95% CI, 0.167-0.173) per patient per day, and normalized alert rate of 2.41 (95% CI, 2.31-2.51). Stratified analysis by hospital revealed that PPV was highest at the Rochester site, reaching 54.9% (95% CI, 52.9%-57.0%) and outperforming the EPIC deterioration index by 46% or a factor of 6 (7.57%).
Conclusion
Achieving a high PPV is crucial because it ensures a larger proportion of alerts are true positives, reducing the burden of false alarms. The considerable improvement in results comes from the novel 2-window feature extraction method. This technique enables the model to capture both long-term trends and recent changes in patient status, enhancing predictive performance.
{"title":"Vital Signs–Only Machine Learning Model for Acute Inpatient Deterioration: A Retrospective Multicenter Study","authors":"Santiago Romero-Brufau MD, PhD , Radit Smunyahirun PhD , Timothée Filhol MiM , Lucille Niederhauser MS , Thanawin Trakoolwilaiwan MS , Gurpreet Singh PhD","doi":"10.1016/j.mayocpiqo.2025.100663","DOIUrl":"10.1016/j.mayocpiqo.2025.100663","url":null,"abstract":"<div><h3>Objective</h3><div>To develop predictive models that are compatible with vital signs monitoring devices to identify patients at risk of clinical deterioration, defined as requiring a rapid response team intervention or an unplanned intensive care unit transfer.</div></div><div><h3>Patients and Methods</h3><div>Targeted vital signs from 227,858 inpatients admitted to general care or telemetry beds at a multihospital health care institution between January 1, 2019, and July 31, 2023, were selected. After filtering for high-quality data, 30,118 patients were used to train a Light Gradient Boosting Machine, and 30,095 were reserved for blind validation. We developed a machine learning model designed to minimize false positives while maintaining clinical relevance in identifying low-prevalence clinical deterioration events.</div></div><div><h3>Results</h3><div>At a sensitivity of 73.4% (95% CI, 72.2%-74.4%), the model achieved a positive predictive value (PPV) of 30.4% (95% CI, 29.6%-31.3%), with a C-statistic of 0.874 (95% CI, 0.867-0.881), alert rate of 0.170 (95% CI, 0.167-0.173) per patient per day, and normalized alert rate of 2.41 (95% CI, 2.31-2.51). Stratified analysis by hospital revealed that PPV was highest at the Rochester site, reaching 54.9% (95% CI, 52.9%-57.0%) and outperforming the EPIC deterioration index by 46% or a factor of 6 (7.57%).</div></div><div><h3>Conclusion</h3><div>Achieving a high PPV is crucial because it ensures a larger proportion of alerts are true positives, reducing the burden of false alarms. The considerable improvement in results comes from the novel 2-window feature extraction method. This technique enables the model to capture both long-term trends and recent changes in patient status, enhancing predictive performance.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100663"},"PeriodicalIF":0.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104709","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}
Pub Date : 2025-09-19DOI: 10.1016/j.mayocpiqo.2025.100658
Chibueze Ogbonnaya MS, PhD , Madison Kindred MS, PhD , Carl J. Lavie MD, FACC , Hannah Oh MPH, ScD , Min-Jeong Shin PhD , Xuemei Sui MD, MPH, PhD , Jason Jaggers MS, PhD , Ryan Porter MS, PhD , Dahyun Park MS, PhD , Jin E. Kim BS , Jessica Gong MS, PhD , Vivek K. Prasad MBBS, MPH, PhD
Objective
To examine the cross-sectional association between trunk fat mass index (TFMI) and diabetes across individuals within the same body mass index (BMI [calculated as the weight in kilograms divided by the height in meters squared]) categories in a multinational population.
Participants and Methods
We harmonized and pooled data on 57,764 individuals aged 40 years and older from the United Kingdom, the United States, and South Korea. Trunk fat mass imaging was performed using a dual-energy X-ray absorptiometry device during 2015-2023 in the United Kingdom, 2011-2018 in the United States, and 2008-2011 in South Korea. The prevalence of diabetes was derived from the self-reported medical history. Additionally, plasma biochemistry analyses were conducted to update the number of participants with diabetes.
Results
Among participants classified as having a normal weight based on BMI, the relative risks (RRs) of diabetes increased from TFMI quintiles 1 to 5 with the linear trend (P<.001). The risk of diabetes among individuals in TFMI quintile 5 was around 3 times greater than those in quintile 1 (men—RR, 3.06; 95% confidence interval [CI], 2.17-4.34; women—3.35; 95% CI, 2.08-5.39). This significant linear trend (P<.001) in RRs was also present in overweight and obese individuals (overweight men—RR, 1.92; 95% CI, 1.50-2.47; overweight women—RR, 2.25; 95% CI, 1.73-2.91; obese men—RR, 2.47; 95% CI, 1.83-3.35; obese women—2.79; 95% CI, 2.04-3.83).
Conclusion
Within a specific BMI category, individuals with a high trunk fat mass are more likely to experience diabetes compared with those with lower levels of central fat.
{"title":"Association Between Trunk Fat Mass Index and Diabetes in a Multinational Population","authors":"Chibueze Ogbonnaya MS, PhD , Madison Kindred MS, PhD , Carl J. Lavie MD, FACC , Hannah Oh MPH, ScD , Min-Jeong Shin PhD , Xuemei Sui MD, MPH, PhD , Jason Jaggers MS, PhD , Ryan Porter MS, PhD , Dahyun Park MS, PhD , Jin E. Kim BS , Jessica Gong MS, PhD , Vivek K. Prasad MBBS, MPH, PhD","doi":"10.1016/j.mayocpiqo.2025.100658","DOIUrl":"10.1016/j.mayocpiqo.2025.100658","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the cross-sectional association between trunk fat mass index (TFMI) and diabetes across individuals within the same body mass index (BMI [calculated as the weight in kilograms divided by the height in meters squared]) categories in a multinational population.</div></div><div><h3>Participants and Methods</h3><div>We harmonized and pooled data on 57,764 individuals aged 40 years and older from the United Kingdom, the United States, and South Korea. Trunk fat mass imaging was performed using a dual-energy X-ray absorptiometry device during 2015-2023 in the United Kingdom, 2011-2018 in the United States, and 2008-2011 in South Korea. The prevalence of diabetes was derived from the self-reported medical history. Additionally, plasma biochemistry analyses were conducted to update the number of participants with diabetes.</div></div><div><h3>Results</h3><div>Among participants classified as having a normal weight based on BMI, the relative risks (RRs) of diabetes increased from TFMI quintiles 1 to 5 with the linear trend (<em>P</em><.001). The risk of diabetes among individuals in TFMI quintile 5 was around 3 times greater than those in quintile 1 (men—RR, 3.06; 95% confidence interval [CI], 2.17-4.34; women—3.35; 95% CI, 2.08-5.39). This significant linear trend (P<.001) in RRs was also present in overweight and obese individuals (overweight men—RR, 1.92; 95% CI, 1.50-2.47; overweight women—RR, 2.25; 95% CI, 1.73-2.91; obese men—RR, 2.47; 95% CI, 1.83-3.35; obese women—2.79; 95% CI, 2.04-3.83).</div></div><div><h3>Conclusion</h3><div>Within a specific BMI category, individuals with a high trunk fat mass are more likely to experience diabetes compared with those with lower levels of central fat.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100658"},"PeriodicalIF":0.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104708","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}
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