Mayo Clinic proceedings. Innovations, quality & outcomes最新文献_第4页

Well-Being Activities Among Internal Medicine Physicians: Results of a National Survey 内科医生的幸福活动：一项全国调查的结果

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-10-10 DOI: 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.

目的评估美国内科医生参与个人幸福活动的频率和人口学预测因素。参与者和方法一项全国性横断面调查于2023年6月23日至2024年5月8日进行，目标是随机抽样执业内科医生。收集了人口统计学特征和幸福活动（锻炼、冥想、爱好、志愿服务和社会活动）频率的数据。在1421名受邀医生中，629名（44.3%）回应。使用描述性统计和多变量逻辑回归来评估参与水平，并分析参与频率与医生人口学特征之间的关系。结果在629名受访者中，幸福感活动的参与度各不相同。报告高敬业度的医生比例为：运动（过去7天≥4次）54.1%(339/627)，爱好（过去30天≥4次）43.7%(272/623)，冥想（过去7天≥1次）32.6%(207 /628)，志愿服务（过去30天≥1次）31.5%(197/625)，社交活动（过去30天≥4次）26.9%（168/624）。从事医疗实践的时间长短与参与锻炼和志愿活动的几率显著相关。与白人受访者相比，黑人或非裔美国人受访者更有可能做志愿者，而不太可能从事业余爱好。亚洲受访者更有可能冥想，而不太可能参加社交活动和从事业余爱好。性别差异只出现在冥想中，女性的参与度更高。结论内科医生对各种个人幸福活动的参与度较高，且存在显著的人口统计学差异。我们的研究结果强调了在设计提高医生幸福感和减少职业倦怠的举措时考虑个体医生特征的重要性。

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引用次数: 0

Vital Signs–Only Machine Learning Model for Acute Inpatient Deterioration: A Retrospective Multicenter Study 急性住院病人恶化的仅生命体征机器学习模型：一项回顾性多中心研究

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-09-19 DOI: 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.

目的开发与生命体征监测设备兼容的预测模型，以识别有临床恶化风险的患者，这些患者被定义为需要快速反应小组干预或计划外的重症监护病房转移。患者和方法选择2019年1月1日至2023年7月31日期间在一家多院医疗机构普通护理或遥测病床住院的227,858名患者的目标生命体征。筛选高质量数据后，使用30,118例患者训练光梯度增强机，并保留30,095例患者进行盲验证。我们开发了一种机器学习模型，旨在最大限度地减少误报，同时保持识别低患病率临床恶化事件的临床相关性。结果该模型的敏感性为73.4% (95% CI, 72.2% ~ 74.4%)，阳性预测值（PPV）为30.4% (95% CI, 29.6% ~ 31.3%)， c统计量为0.874 (95% CI, 0.867 ~ 0.881)，每例患者每天的报警率为0.170 (95% CI, 0.167 ~ 0.173)，标准化报警率为2.41 （95% CI, 2.31 ~ 2.51）。医院分层分析显示，罗切斯特部位的PPV最高，达到54.9% (95% CI, 52.9%-57.0%)，比EPIC恶化指数高出46%或6倍（7.57%）。实现高PPV是至关重要的，因为它确保了更大比例的警报是真阳性的，减少了假警报的负担。结果的显著改善来自于新的双窗口特征提取方法。该技术使模型能够捕捉患者状态的长期趋势和近期变化，从而提高预测性能。

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引用次数: 0

Association Between Trunk Fat Mass Index and Diabetes in a Multinational Population 多国人群躯干脂肪质量指数与糖尿病的关系

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-09-19 DOI: 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.

目的研究跨国人群中躯干脂肪质量指数（TFMI）与糖尿病在相同体重指数（BMI[以体重公斤除以身高米的平方计算]）类别中的横断面关联。参与者和方法我们对来自英国、美国和韩国的年龄在40岁及以上的57,764人的数据进行了整理和汇总。2015-2023年在英国，2011-2018年在美国，2008-2011年在韩国，使用双能x射线吸收仪进行躯干脂肪团成像。糖尿病的患病率来源于自我报告的病史。此外，还进行了血浆生化分析，以更新糖尿病患者的人数。结果在体重指数为正常的参与者中，糖尿病的相对风险（rr）从TFMI五分位数1增加到5，呈线性趋势（P<.001）。TFMI五分之一组中患糖尿病的风险约为五分之一组的3倍（男性- rr， 3.06； 95%可信区间[CI]， 2.17-4.34；女性- 3.35;95% CI, 2.08-5.39）。这种显著的线性趋势（P<.001）在超重和肥胖个体中也存在（超重男性- rr， 1.92; 95% CI, 1.50-2.47；超重女性- rr， 2.25; 95% CI, 1.73-2.91；肥胖男性- rr， 2.47; 95% CI, 1.83-3.35；肥胖女性- 2.79;95% CI, 2.04-3.83）。结论：在特定的BMI类别中，躯干脂肪量高的人比中心脂肪量低的人更容易患糖尿病。

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引用次数: 0

Dynamic Changes in Bilirubin Predict 90-Day Mortality in Patients With Hepatocellular Carcinoma and Acute Decompensations of Cirrhosis: The HCC-AD Score 胆红素动态变化预测肝细胞癌和肝硬化急性失代偿患者90天死亡率：HCC-AD评分

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-09-12 DOI: 10.1016/j.mayocpiqo.2025.100661

Oliver Moore MBBS , Fran Neveu-Coble BN , Scott Read PhD , Wai-See Ma MBChB , Adnan Nagriel PhD , Anna Di Bartolomeo MBBS , Jacob George PhD , Golo Ahlenstiel PhD

Objective

To develop a score to predict 90-day mortality in patients with hepatocellular carcinoma (HCC) admitted with an acute decompensation (AD) event of chronic liver disease.

Patients and Methods

This retrospective cohort study was conducted at Blacktown and Westmead Hospitals in Australia, including patients with decompensated cirrhosis and concomitant HCC between January 1, 2012, and May 31, 2023. Participants were separated into derivation (n=233) and validation (n=132) cohorts. Demographic and clinical data were collected at admission and day 7. Independent predictors for 90-day transplant-free survival were entered into classification and regression tree analysis to develop the HCC-AD score. Discrimination was assessed in the validation cohort using Harrell C statistic. Subgroup analysis was conducted for each Barcelona Clinic Liver Cancer (BCLC) class with comparisons made to current scores.

Results

A cohort of 355 patients was considered. Admission bilirubin (P=.009) and 7-day change in bilirubin (P=.018) remained significant for 90-day mortality in multivariable analysis. The HCC-acute decompensation (AD) score stratified patients into 3 risk groups with predicted mortality of 26%, 49%, and 89%, respectively. The HCC-AD score showed good discrimination (Harrell C=0.731). Cox regression analysis determined the HCC-AD score remained predictive in BCLC B (P<.001), C (P<.001), and D (P=.010) scored HCC. The model for end-stage liver disease 3.0 (P=.058) and Child-Pugh (P=.11) scores were not predictive in BCLC D HCC.

Conclusion

A simple score that stratifies patients with HCC into 3 risk categories based on changes in bilirubin predicts 90-day mortality following an acute decompensatory event. It is superior to other scores in advanced HCC.

目的建立一种评分方法来预测合并慢性肝病急性失代偿（AD）事件的肝细胞癌（HCC）患者90天死亡率。患者和方法这项回顾性队列研究在澳大利亚的Blacktown和Westmead医院进行，包括2012年1月1日至2023年5月31日期间患有失代偿性肝硬化和合并HCC的患者。参与者被分为衍生组（n=233）和验证组（n=132）。入院和第7天收集人口学和临床资料。对90天无移植生存的独立预测因子进行分类和回归树分析，得出HCC-AD评分。在验证队列中采用Harrell C统计量评估歧视。对巴塞罗那临床肝癌（BCLC）的每个类别进行亚组分析，并与当前评分进行比较。结果纳入355例患者。在多变量分析中，入院胆红素（P= 0.009）和7天胆红素变化（P= 0.018）对90天死亡率仍有显著影响。hcc急性失代偿（AD）评分将患者分为3个危险组，预测死亡率分别为26%、49%和89%。HCC-AD评分具有较好的判别性（Harrell C=0.731）。Cox回归分析表明，HCC- ad评分对BCLC B （P < 0.01）、C （P < 0.01）和D （P < 0.01）评分的HCC仍具有预测作用。终末期肝病模型3.0 （P= 0.058）和Child-Pugh （P= 0.11）评分对BCLC - D型HCC无预测作用。结论基于胆红素变化将HCC患者分为3个危险类别的简单评分可预测急性失代偿事件后90天的死亡率。在晚期HCC中，它优于其他评分。

{"title":"Dynamic Changes in Bilirubin Predict 90-Day Mortality in Patients With Hepatocellular Carcinoma and Acute Decompensations of Cirrhosis: The HCC-AD Score","authors":"Oliver Moore MBBS , Fran Neveu-Coble BN , Scott Read PhD , Wai-See Ma MBChB , Adnan Nagriel PhD , Anna Di Bartolomeo MBBS , Jacob George PhD , Golo Ahlenstiel PhD","doi":"10.1016/j.mayocpiqo.2025.100661","DOIUrl":"10.1016/j.mayocpiqo.2025.100661","url":null,"abstract":"<div><h3>Objective</h3><div>To develop a score to predict 90-day mortality in patients with hepatocellular carcinoma (HCC) admitted with an acute decompensation (AD) event of chronic liver disease.</div></div><div><h3>Patients and Methods</h3><div>This retrospective cohort study was conducted at Blacktown and Westmead Hospitals in Australia, including patients with decompensated cirrhosis and concomitant HCC between January 1, 2012, and May 31, 2023. Participants were separated into derivation (n=233) and validation (n=132) cohorts. Demographic and clinical data were collected at admission and day 7. Independent predictors for 90-day transplant-free survival were entered into classification and regression tree analysis to develop the HCC-AD score. Discrimination was assessed in the validation cohort using Harrell C statistic. Subgroup analysis was conducted for each Barcelona Clinic Liver Cancer (BCLC) class with comparisons made to current scores.</div></div><div><h3>Results</h3><div>A cohort of 355 patients was considered. Admission bilirubin (<em>P</em>=.009) and 7-day change in bilirubin (<em>P</em>=.018) remained significant for 90-day mortality in multivariable analysis. The HCC-acute decompensation (AD) score stratified patients into 3 risk groups with predicted mortality of 26%, 49%, and 89%, respectively. The HCC-AD score showed good discrimination (Harrell C=0.731). Cox regression analysis determined the HCC-AD score remained predictive in BCLC B (<em>P</em><.001), C (<em>P</em><.001), and D (<em>P</em>=.010) scored HCC. The model for end-stage liver disease 3.0 (<em>P</em>=.058) and Child-Pugh (<em>P</em>=.11) scores were not predictive in BCLC D HCC.</div></div><div><h3>Conclusion</h3><div>A simple score that stratifies patients with HCC into 3 risk categories based on changes in bilirubin predicts 90-day mortality following an acute decompensatory event. It is superior to other scores in advanced HCC.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100661"},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048362","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

Risk of Juvenile Idiopathic Arthritis Following HPV9 Vaccination: A Retrospective Cohort Study Before and During the COVID-19 Pandemic 接种HPV9疫苗后青少年特发性关节炎的风险：COVID-19大流行之前和期间的回顾性队列研究

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-09-09 DOI: 10.1016/j.mayocpiqo.2025.100647

Ming-Chin Tsai MD , Hsin-Hua Chen MD, PhD , Wen-Yu Wu MD , Yung-Chieh Huang MD , Chiann-Yi Hsu MSc , Lin-Shien Fu MD

Objective

To evaluate whether 9-valent human papillomavirus (HPV9) vaccination is associated with an increased risk of juvenile idiopathic arthritis (JIA), particularly during the coronavirus disease-2019 (COVID-19) pandemic.

Patients and Methods

We conducted a retrospective cohort study using TriNetX U.S. Collaborative Network data from January 1, 2016, to December 31, 2023. Girls aged 9-13 years who received their first HPV9 dose in either the prepandemic (2016-2019) or pandemic (2020-2023) period were matched with unvaccinated controls. Exclusion criteria included previous JIA diagnosis, antirheumatic drug use, or positive rheumatoid factor. Incidence of new-onset JIA was tracked over 8 days to 36 months. Cox regression and Kaplan-Meier survival analysis were used to evaluate hazard ratios (HRs) and JIA-free survival.

Results

Among 99,243 vaccinated and 1.1 million control individuals, HPV9 recipients had a significantly reduced risk of JIA at 36 months in both periods (HR 2016-2019, 0.207, P<.001; HR 2020-2023, 0.287, P<.001). No increased risk was observed during the early postvaccination period. The estimated cumulative probability of JIA did not differ significantly between vaccinated groups across the 2 periods (P=.9), nor among unvaccinated controls (P=.238), indicating no modifying effect from COVID-19.

Conclusion

The HPV9 vaccination was associated with a lower risk of JIA, and this effect can last at least for 3 years. The COVID-19 pandemic did not alter this relationship. These findings reinforce the immunological safety of HPV9 and provide reassurance for adolescent vaccination programs, even in pandemic contexts.

目的评估9价人乳头瘤病毒（HPV9）疫苗接种是否与青少年特发性关节炎（JIA）风险增加相关，特别是在冠状病毒病-2019 （COVID-19）大流行期间。患者和方法我们使用TriNetX美国协作网络（U.S. Collaborative Network） 2016年1月1日至2023年12月31日的数据进行了一项回顾性队列研究。在大流行前（2016-2019年）或大流行期间（2020-2023年）接种了第一剂HPV9疫苗的9-13岁女孩与未接种疫苗的对照组相匹配。排除标准包括既往JIA诊断、使用抗风湿药物或类风湿因子阳性。在8天至36个月期间追踪新发JIA的发生率。采用Cox回归和Kaplan-Meier生存分析评估风险比（hr）和无jia生存。结果在99243名疫苗接种者和110万对照组中，HPV9接种者在两个时期的36个月发生JIA的风险均显著降低（HR 2016-2019, 0.207, P<.001; HR 2020-2023, 0.287, P<.001）。在疫苗接种后早期未观察到风险增加。在两个时期，接种疫苗组之间JIA的估计累积概率无显著差异（P=.9），未接种疫苗的对照组之间也无显著差异（P=.238），表明COVID-19没有改变作用。结论接种HPV9疫苗与JIA发生风险降低相关，且这种效果至少可持续3年。COVID-19大流行并未改变这种关系。这些发现加强了HPV9的免疫安全性，并为青少年疫苗接种计划提供了保证，即使在大流行背景下也是如此。

{"title":"Risk of Juvenile Idiopathic Arthritis Following HPV9 Vaccination: A Retrospective Cohort Study Before and During the COVID-19 Pandemic","authors":"Ming-Chin Tsai MD , Hsin-Hua Chen MD, PhD , Wen-Yu Wu MD , Yung-Chieh Huang MD , Chiann-Yi Hsu MSc , Lin-Shien Fu MD","doi":"10.1016/j.mayocpiqo.2025.100647","DOIUrl":"10.1016/j.mayocpiqo.2025.100647","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether 9-valent human papillomavirus (HPV9) vaccination is associated with an increased risk of juvenile idiopathic arthritis (JIA), particularly during the coronavirus disease-2019 (COVID-19) pandemic.</div></div><div><h3>Patients and Methods</h3><div>We conducted a retrospective cohort study using TriNetX U.S. Collaborative Network data from January 1, 2016, to December 31, 2023. Girls aged 9-13 years who received their first HPV9 dose in either the prepandemic (2016-2019) or pandemic (2020-2023) period were matched with unvaccinated controls. Exclusion criteria included previous JIA diagnosis, antirheumatic drug use, or positive rheumatoid factor. Incidence of new-onset JIA was tracked over 8 days to 36 months. Cox regression and Kaplan-Meier survival analysis were used to evaluate hazard ratios (HRs) and JIA-free survival.</div></div><div><h3>Results</h3><div>Among 99,243 vaccinated and 1.1 million control individuals, HPV9 recipients had a significantly reduced risk of JIA at 36 months in both periods (HR 2016-2019, 0.207, <em>P</em><.001; HR 2020-2023, 0.287, <em>P</em><.001). No increased risk was observed during the early postvaccination period. The estimated cumulative probability of JIA did not differ significantly between vaccinated groups across the 2 periods (<em>P</em>=.9), nor among unvaccinated controls (<em>P</em>=.238), indicating no modifying effect from COVID-19.</div></div><div><h3>Conclusion</h3><div>The HPV9 vaccination was associated with a lower risk of JIA, and this effect can last at least for 3 years. The COVID-19 pandemic did not alter this relationship. These findings reinforce the immunological safety of HPV9 and provide reassurance for adolescent vaccination programs, even in pandemic contexts.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100647"},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145019006","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

A Dual-Modality Ultrasound Video Recognition Model for Distinguishing Subpleural Pulmonary Nodules 胸膜下肺结节的双模超声视频识别模型

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-09-09 DOI: 10.1016/j.mayocpiqo.2025.100659

Yin Wang MD, PhD , Mengjun Shen MD , Ke Bi MD , Wei Yang MD, PhD , Xiaofei Ye MD, PhD , Qing Tang MD, PhD , Yi Zhang MD , Yang Cong MD , Huiming Zhu MD , Hongwei Chen MD , Chunhong Tang MD , Martin R. Prince MD, PhD

Objective

To develop a deep learning model based on dual-modality ultrasound (DMUS) video recognition for the differential diagnosis of benign and malignant subpleural pulmonary nodules (SPNs).

Patients and Methods

Participant data (n=193, median age, 58 years [IQR, 34-66 years]; 123 men) with SPNs, prospectively collected from January 7, to December 21, 2020, were divided into training (n=154) and validation (n=39) sets in an 8:2 ratio. Additionally, independent internal (n=88) and external (n=91) test sets were prospectively collected from January 10 to June 25, 2021. The nature of the SPNs was determined through biopsy (n=306) and clinical follow-up (n=66). Our model integrated DMUS videos, time-intensity curves, and clinical information. The model’s performance was evaluated using area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity and compared with state-of-the-art video classification models, as well as ultrasound and computed tomography diagnoses made by radiologists.

Results

In the internal test set, our model accurately distinguished malignant from benign SPNs with an AUC, accuracy, sensitivity, and specificity of 0.91, 91% (80 of 88), 90% (27 of 30), and 91% (53 of 58), outperforming state-of-the-art video classification models (all P<.05). In the external test set, the model achieved the accuracy, sensitivity, and specificity of 89% (81 of 91), 84% (27 of 32), and 92% (54 of 59), which were higher than the parameters for radiologist interpretations of ultrasound (81% [74 of 91], 63% [20 of 32], and 92% [54 of 59]) and computed tomography (76% [69 of 91], 91% [29 of 32], and 68% [40 of 59]), respectively.

Conclusion

This deep learning model based on DMUS video recognition enhances the performance of ultrasound in differentiating benign from malignant SPNs.

Trial Registration

clinicaltrials.gov Identifier: ChiCTR1800019828

目的建立基于双模超声（DMUS）视频识别的深度学习模型用于良恶性胸膜下肺结节（SPNs）鉴别诊断。患者和方法前瞻性收集2020年1月7日至12月21日SPNs患者数据（n=193，中位年龄58岁[IQR， 34-66岁]；123名男性），按8:2的比例分为训练组（n=154）和验证组（n=39）。此外，在2021年1月10日至6月25日期间，前瞻性地收集了独立的内部（n=88）和外部（n=91）测试集。spn的性质通过活检（n=306）和临床随访（n=66）确定。我们的模型集成了DMUS视频、时间强度曲线和临床信息。该模型的性能通过接受者工作特征曲线下的面积、准确性、灵敏度和特异性进行评估，并与最先进的视频分类模型以及放射科医生的超声和计算机断层扫描诊断进行比较。结果在内部测试集中，我们的模型准确地区分了恶性和良性spn， AUC、准确度、灵敏度和特异性分别为0.91、91%（88分之80）、90%（30分之27）和91%(58分之53)，优于最先进的视频分类模型（均为P<； 0.05）。在外部测试集中，该模型的准确性、灵敏度和特异性分别为89%（81 / 91）、84%（27 / 32）和92%(54 / 59)，高于放射医师超声解释的参数（81%[74 / 91]、63%[20 / 32]和92%[54 / 59]）和计算机断层扫描（76%[69 / 91]、91%[29 / 32]和68%[40 / 59]）。结论基于DMUS视频识别的深度学习模型提高了超声对SPNs良恶性的鉴别能力。临床试验注册号：ChiCTR1800019828

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引用次数: 0

Association of Mood or Affect With Respiratory-Related Quality of Life, Lung Function, and All-Cause Mortality in Fibrotic Interstitial Lung Disease 纤维化间质性肺病患者的情绪或情绪与呼吸相关生活质量、肺功能和全因死亡率的关系

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-08-29 DOI: 10.1016/j.mayocpiqo.2025.100660

Urbee Disha Peterson DO, MS , Madison Beenken MS , Teng Moua MD

Objective

To assess whether self-reported acute mood or affect is associated with other patient-reported outcome measures, lung function, and all-cause mortality, in patients with fibrotic interstitial lung disease (f-ILD).

Patients and Methods

The Positive and Negative Affect Schedule (PANAS) is a 20-item questionnaire reflecting recent mood or affect over the past week, reported as Positive, Negative, or Ratio (Positive:Negative) subscores. Baseline and serial PANAS scores were assessed for their correlation with the Chronic Respiratory Questionnaire, Self-Management Assessment Scale 30, and lung function over a 3-year study period, and association with incident anxiety, depression, and all-cause mortality.

Results

In total, 199 patients with f-ILD were enrolled. Baseline PANAS scores correlated moderately with Chronic Respiratory Questionnaire and Self-Management Assessment Scale 30 scores. Higher PANAS Positive and Ratio scores were associated with higher percent predicted forced vital capacity. Mean PANAS scores were higher or lower when stratified by clinically suspected anxiety and/or depression and predictive of all-cause mortality on adjusted analysis, respectively. Incident anxiety and/or depression was not associated with worse survival outcome.

Conclusion

Self-reported acute mood or affect may be associated with RR-QoL, lung function, and adjusted all-cause mortality in patients with f-ILD.

目的评估纤维化间质性肺病（f-ILD）患者自我报告的急性情绪或情绪是否与其他患者报告的结局指标、肺功能和全因死亡率相关。患者和方法积极和消极情绪表（PANAS）是一份20项的问卷，反映了过去一周内最近的情绪或情绪，报告为积极，消极或比率（积极：消极）分值。在3年的研究期间，评估基线和系列PANAS评分与慢性呼吸问卷、自我管理评估量表30和肺功能的相关性，以及与突发焦虑、抑郁和全因死亡率的相关性。结果共纳入199例f-ILD患者。基线PANAS评分与慢性呼吸问卷和自我管理评估量表30分有中度相关。较高的PANAS阳性和Ratio评分与较高的预测强迫肺活量百分比相关。在调整分析中，按临床疑似焦虑和/或抑郁分层和预测全因死亡率时，平均PANAS评分分别较高或较低。突发焦虑和/或抑郁与较差的生存结果无关。结论自述急性心境或情绪可能与f-ILD患者的RR-QoL、肺功能和校正全因死亡率相关。

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引用次数: 0

Practice Improvement Project: Developing a Platform for a Remote At-Home Preoperative Evaluation for Elective Noncardiac Procedures 实践改进项目：为选择性非心脏手术开发远程家庭术前评估平台

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-08-25 DOI: 10.1016/j.mayocpiqo.2025.100657

Joshua Ivare MD, MS , David N. Tryon MD , Adam K. Jacob MD , Timothy B. Curry MD, PhD , Amir Lerman MD

Objective

To assess the feasibility, safety, and patient satisfaction associated with a remote cardiac evaluation protocol during a preanesthesia medical evaluation (PAME) before elective noncardiac surgical procedures.

Patients and Methods

Eligible patients undergoing elective noncardiac procedures from May 1, 2022 to September 30, 2023 were selected from an anesthesia triage list at a single health care center. Patients received electronic devices for remote blood pressure measurement and 12-lead electrocardiogram collection. Patients either had a telemedicine-based PAME (tPAME) visit or an in-person PAME (iPAME) visit afterward. Patients’ charts were reviewed 30 days after procedure to identify after procedure complications. Patients were asked to provide feedback about their experiences through a digital after procedure satisfaction survey. Comparisons between the tPAME group and the iPAME group were made with χ², Fisher exact, or Mann-Whitney U tests.

Results

Of 129 eligible patients, 48 (37.2%) participated in the study. 29 (60.4%) patients had an iPAME visit, and 19 (39.6%) patients had a tPAME visit. There were no major adverse cardiovascular events after a remote cardiac evaluation in the iPAME and the tPAME groups. One (3.4%) patient in the iPAME group developed a deep vein thrombosis and pulmonary embolism after procedure, and 1 (3.4%) patient in the iPAME group had an emergency room visit within 30 days after their procedure. Patients were very satisfied with their experience in the study.

Conclusion

These findings support the concept that a remote cardiac evaluation during a PAME before elective noncardiac procedures is feasible, safe, and associated with high patient satisfaction.

目的评估选择性非心脏手术前麻醉前医学评估（PAME）中远程心脏评估方案的可行性、安全性和患者满意度。患者与方法：选取于2022年5月1日至2023年9月30日在同一医疗保健中心接受选择性非心脏手术的符合条件的患者。患者使用电子设备进行远程血压测量和12导联心电图采集。患者要么进行基于远程医疗的PAME （tPAME）访问，要么随后进行亲自PAME （iPAME）访问。术后30天回顾患者的病历以确定术后并发症。患者被要求通过数字手术后满意度调查提供他们的体验反馈。tPAME组与iPAME组间比较采用χ2、Fisher精确检验或Mann-Whitney U检验。结果129例符合条件的患者中，48例（37.2%）参加了研究。iPAME访视29例（60.4%），tPAME访视19例（39.6%）。iPAME组和tPAME组在远程心脏评估后没有出现主要的心血管不良事件。iPAME组1例（3.4%）患者术后出现深静脉血栓形成和肺栓塞，iPAME组1例（3.4%）患者术后30天内急诊就诊。病人对他们在研究中的经历非常满意。结论：这些研究结果支持了在选择性非心脏手术前进行PAME期间远程心脏评估是可行的、安全的，并且与高患者满意度相关。

{"title":"Practice Improvement Project: Developing a Platform for a Remote At-Home Preoperative Evaluation for Elective Noncardiac Procedures","authors":"Joshua Ivare MD, MS , David N. Tryon MD , Adam K. Jacob MD , Timothy B. Curry MD, PhD , Amir Lerman MD","doi":"10.1016/j.mayocpiqo.2025.100657","DOIUrl":"10.1016/j.mayocpiqo.2025.100657","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the feasibility, safety, and patient satisfaction associated with a remote cardiac evaluation protocol during a preanesthesia medical evaluation (PAME) before elective noncardiac surgical procedures.</div></div><div><h3>Patients and Methods</h3><div>Eligible patients undergoing elective noncardiac procedures from May 1, 2022 to September 30, 2023 were selected from an anesthesia triage list at a single health care center. Patients received electronic devices for remote blood pressure measurement and 12-lead electrocardiogram collection. Patients either had a telemedicine-based PAME (tPAME) visit or an in-person PAME (iPAME) visit afterward. Patients’ charts were reviewed 30 days after procedure to identify after procedure complications. Patients were asked to provide feedback about their experiences through a digital after procedure satisfaction survey. Comparisons between the tPAME group and the iPAME group were made with χ<sup>2</sup>, Fisher exact, or Mann-Whitney U tests.</div></div><div><h3>Results</h3><div>Of 129 eligible patients, 48 (37.2%) participated in the study. 29 (60.4%) patients had an iPAME visit, and 19 (39.6%) patients had a tPAME visit. There were no major adverse cardiovascular events after a remote cardiac evaluation in the iPAME and the tPAME groups. One (3.4%) patient in the iPAME group developed a deep vein thrombosis and pulmonary embolism after procedure, and 1 (3.4%) patient in the iPAME group had an emergency room visit within 30 days after their procedure. Patients were very satisfied with their experience in the study.</div></div><div><h3>Conclusion</h3><div>These findings support the concept that a remote cardiac evaluation during a PAME before elective noncardiac procedures is feasible, safe, and associated with high patient satisfaction.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100657"},"PeriodicalIF":0.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144893507","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

Comorbidity Disease Pattern in Japanese Elderly Population: A Network-Based Analysis 日本老年人群共病模式：基于网络的分析

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-08-20 DOI: 10.1016/j.mayocpiqo.2025.100646

Shuko Nojiri PhD , Wataru Urasaki MSc , Masao Iwagami MD, PhD , Masashi Nagao MD, PhD , Takuya Uematsu MSc , Muneaki Ishijima MD, PhD , Hiroyuki Daida MD, PhD , Yuji Nishizaki MD, PhD

Objective

To clarify the disease pattern for elderly individuals in the general population in Japan with multimorbidity networks based on an analysis of common chronic conditions.

Patients and Methods

This study is a population study of disease network analysis in elderly in Japan. We obtained medical records for 4,797,907 elderly patients in Japan (from January 1, 2020 to December 31, 2020) from administrative claim databases. The administrative claim records were transformed for temporal disease occurrence pattern analysis and used to find frequently occurring disease sequences to predict the onset of disease progression.

Results

In those aged 75 years and older, circulatory and respiratory diseases gained predominance, while the burden of mental disorders remained substantial across all age groups. In men aged below 75 years, disseminated intravascular coagulation co-occurred frequently with acute myocardial infarction and respiratory failure. In women aged below 75 years, the pairing of vestibular dysfunction and hearing loss exhibited the highest association. For women aged 75 years and older, renal disease pairings, psychiatric comorbidities, and fall-related injuries were dominant. Network analyses reported increasing multimorbidity complexity with age. Respiratory, circulatory, and digestive disease clusters were central across age groups, with psychiatric and fracture-related conditions becoming more prominent in older adults, particularly women. Disease heatmaps further highlighted systemic comorbidity hubs involving pneumonia, iron deficiency anemia, kidney disease, and cardiovascular conditions.

Conclusion

In this study, we identified major comorbidity patterns and reported that atherosclerosis, angina pectoris, gastritis, and duodenitis were the most important comorbid diseases in the elderly population in Japan. The identification of distinctive comorbidity profiles from routine clinical data provides insights that may be leveraged to improve diagnosis and identify treatment targets for patients.

目的通过对常见慢性疾病的分析，阐明日本普通人群中多病网络老年人的疾病模式。患者与方法本研究是日本老年人疾病网络分析的人群研究。我们从行政索赔数据库中获取了4,797,907名日本老年患者的医疗记录（从2020年1月1日至2020年12月31日）。将行政权利要求记录转换为时间疾病发生模式分析，并用于发现频繁发生的疾病序列以预测疾病进展的开始。结果在75岁及以上人群中，循环系统疾病和呼吸系统疾病占主导地位，而精神障碍的负担在所有年龄组中仍然很大。在75岁以下的男性中，弥散性血管内凝血经常与急性心肌梗死和呼吸衰竭同时发生。在75岁以下的女性中，前庭功能障碍和听力损失的相关性最高。对于75岁及以上的女性，肾脏疾病配对、精神合并症和跌倒相关损伤是主要因素。网络分析报告，随着年龄的增长，多病复杂性增加。呼吸、循环和消化系统疾病是各年龄组的中心，精神疾病和骨折相关疾病在老年人，特别是女性中变得更加突出。疾病热图进一步强调了系统性合并症中心，包括肺炎、缺铁性贫血、肾脏疾病和心血管疾病。结论在这项研究中，我们确定了主要的合并症模式，并报道动脉粥样硬化、心绞痛、胃炎和十二指肠炎是日本老年人最重要的合并症。从常规临床数据中识别出独特的合并症概况，可以为提高诊断和确定患者的治疗目标提供见解。

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引用次数: 0

An Artificial Intelligence-Enabled Electrocardiogram to Evaluate Patients With Dyspnea in the Emergency Department 在急诊科评估呼吸困难患者的人工智能心电图

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-08-20 DOI: 10.1016/j.mayocpiqo.2025.100652

Hee Tae Yu MD, PhD , Laura E. Walker MD , Eunjung Lee PhD , Muhannad Abbasi MBBCh , Samuel Wopperer MD , Gal Tsaban MD, PhD , Kathleen Kopecky MD , Francisco Lopez-Jimenez MD , Paul Friedman MD , Zachi Attia PhD , Jae K. Oh MD

Objective

To evaluate whether an Artificial Intelligence-Enabled Electrocardiogram (AI-ECG) for diastolic function/filling pressure can determine whether dyspnea in emergency department (ED) patients is cardiac in origin.

Patients and Methods

We identified 2412 patients aged 18 years or older presented with dyspnea/shortness of breath to the ED who had an ECG performed at the time of evaluation from January 2020 to December 2022. The AI-ECG for determining left ventricular diastolic function to identify the patients with cardiac cause of dyspnea was assessed, using the final diagnosis based on subsequent evaluation.

Results

Of the 2412 patients, 966 (40%) were found to have cardiac dyspnea, and the remaining 1446 (60%) were noncardiac. The AI-ECG-estimated diastolic function was divided into 4 groups: 922 (38.2%) were normal, 245 (10.2%) grade 1, 1192 (49.4%) grade 2, and 53 (2.2%) grade 3. The probability of cardiac dyspnea was considerably higher in patients with grade 2 (62.2%±48.5%) and 3 (83%±37.9%) diastolic function compared with normal (14.1%±34.8%) and grade 1 (20.8%±40.7%). The incidence of cardiac dyspnea increased as the probability of increasing filling pressure increased on AI-ECG.

Conclusion

Patients often present to the ED with undifferentiated dyspnea. It is important to promptly determine whether the symptoms have cardiac origin. Cardiac dyspnea often reflects elevated left ventricular filling pressures. Artificial intelligence-enhanced 12-lead electrocardiograms can precisely assess diastolic function and filling pressures. Among patients who presented to the ED with dyspnea/shortness of breath, AI-ECG assessing diastolic function strongly distinguished whether the cause was cardiac.

目的评价人工智能心电图（AI-ECG）舒张功能/充盈压力是否可以判断急诊科（ED）患者呼吸困难是否由心脏原因引起。患者和方法我们确定了2412名年龄在18岁或以上的患者，他们在2020年1月至2022年12月评估时进行了心电图检查，出现呼吸困难/呼吸短促。评估AI-ECG检测左室舒张功能以识别心源性呼吸困难患者，根据后续评价进行最终诊断。结果2412例患者中，966例（40%）为心源性呼吸困难，其余1446例（60%）为非心源性呼吸困难。ai - ecg舒张功能评分分为4组：正常922例（38.2%），1级245例（10.2%），2级1192例（49.4%），3级53例（2.2%）。舒张功能2级（62.2%±48.5%）和3级（83%±37.9%）患者发生心源性呼吸困难的概率明显高于正常（14.1%±34.8%）和1级（20.8%±40.7%）患者。心源性呼吸困难的发生率随着心电充盈压力增大的概率增加而增加。结论急诊科患者多以未分化性呼吸困难就诊。重要的是要及时确定症状是否有心脏起源。心源性呼吸困难常反映左心室充盈压力升高。人工智能增强的12导联心电图可以精确评估舒张功能和充盈压力。在以呼吸困难/呼吸短促向ED就诊的患者中，通过AI-ECG评估舒张功能，可以很好地区分是否是心脏原因。

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引用次数: 0