Pub Date : 2024-01-04DOI: 10.1016/j.mayocpiqo.2023.12.003
Ishaan Gupta MBBS, Ilana Nelson-Greenberg MD, Scott Mitchell Wright MD, Ché Matthew Harris MD, MS
Objective
To determine the change in rates of physical restraint (PR) use and associated outcomes among hospitalized adults.
Patients and Methods
Using national inpatient sample databases, we analyzed years 2011-2014 and 2016-2019 to determine trends of PR usage. We also compared the years 2011-2012 and 2018-2019 to investigate rates of PR use, in-hospital mortality, length of stay, and total hospital charges.
Results
There were 242,994,110 hospitalizations during the study period. 1,538,791 (0.63%) had coding to signify PRs, compared with 241,455,319 (99.3%), which did not. From 2011 to 2014, there was a significant increase in PR use (p-trend<.01) and a nonsignificant increase in PR rates from 2016-2019 (p-trend=.07). Over time, PR use increased (2011-2012: 0.52% vs 2018-2019: 0.73%; p<.01). Patients with PRs reported a higher adjusted odds for in-hospital mortality in 2011-2012 (adjusted odds ratio [aOR], 3.9; 95% CI, 3.7-4.2; p<.01) and 2018-2019 (aOR, 3.5; 95% CI, 3.4-3.7; p<.01). Length of stay was prolonged for patients with PRs in 2011-2012 (adjusted mean difference [aMD], 4.3 days; 95% CI, 4.1-4.5; p<.01) and even longer in 2018-2019 (aMD, 5.8 days; 95% CI, 5.6-6.0; p<.01). Total hospital charges were higher for patients with PRs in 2011-2012 (aMD, +$55,003; 95% CI, $49,309-$60,679; p<.01). Following adjustment for inflation, total charges remained higher for patients with PRs compared with those without PRs in 2018-2019 (aMD, +$70,018; 95% CI, $65,355-$74,680; p<.01).
Conclusion
Overall, PR rates did not decrease across the study period, suggesting that messaging and promulgating best practice guidelines have yet to translate into a substantive change in practice patterns.
{"title":"Physical Restraint Usage in Hospitals Across the United States: 2011-2019","authors":"Ishaan Gupta MBBS, Ilana Nelson-Greenberg MD, Scott Mitchell Wright MD, Ché Matthew Harris MD, MS","doi":"10.1016/j.mayocpiqo.2023.12.003","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.12.003","url":null,"abstract":"<div><h3>Objective</h3><p>To determine the change in rates of physical restraint (PR) use and associated outcomes among hospitalized adults.</p></div><div><h3>Patients and Methods</h3><p>Using national inpatient sample databases, we analyzed years 2011-2014 and 2016-2019 to determine trends of PR usage. We also compared the years 2011-2012 and 2018-2019 to investigate rates of PR use, in-hospital mortality, length of stay, and total hospital charges.</p></div><div><h3>Results</h3><p>There were 242,994,110 hospitalizations during the study period. 1,538,791 (0.63%) had coding to signify PRs, compared with 241,455,319 (99.3%), which did not. From 2011 to 2014, there was a significant increase in PR use (<em>p-</em>trend<.01) and a nonsignificant increase in PR rates from 2016-2019 (<em>p-</em>trend=.07). Over time, PR use increased (2011-2012: 0.52% vs 2018-2019: 0.73%; <em>p</em><.01). Patients with PRs reported a higher adjusted odds for in-hospital mortality in 2011-2012 (adjusted odds ratio [aOR], 3.9; 95% CI, 3.7-4.2; <em>p</em><.01) and 2018-2019 (aOR, 3.5; 95% CI, 3.4-3.7; <em>p</em><.01). Length of stay was prolonged for patients with PRs in 2011-2012 (adjusted mean difference [aMD], 4.3 days; 95% CI, 4.1-4.5; <em>p</em><.01) and even longer in 2018-2019 (aMD, 5.8 days; 95% CI, 5.6-6.0; <em>p</em><.01). Total hospital charges were higher for patients with PRs in 2011-2012 (aMD, +$55,003; 95% CI, $49,309-$60,679; <em>p</em><.01). Following adjustment for inflation, total charges remained higher for patients with PRs compared with those without PRs in 2018-2019 (aMD, +$70,018; 95% CI, $65,355-$74,680; <em>p</em><.01).</p></div><div><h3>Conclusion</h3><p>Overall, PR rates did not decrease across the study period, suggesting that messaging and promulgating best practice guidelines have yet to translate into a substantive change in practice patterns.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000784/pdfft?md5=251e31df642d392cd42bba037377ce0e&pid=1-s2.0-S2542454823000784-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139107407","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 : 2023-12-26DOI: 10.1016/j.mayocpiqo.2023.11.002
Kaitlin Roehl PA-C , Carolyn Mead-Harvey MS , Heidi M. Connolly MD , Joseph A. Dearani MD , Felicia S. Schaap APRN, AGACNP-BC , Susanna L. Liljenstolpe APRN, FNP-C , Linda B. Osborn RN , C. Charles Jain MD , Donald J. Hagler Sr. MD , Francois Marcotte MD , David S. Majdalany MD
Objective
To assess risks and benefits of cardiac intervention in adults with Down syndrome (DS).
Patients and Methods
A retrospective review was conducted using data from a study we published in 2010. Patients aged 18 years or older with DS who underwent cardiac operation or percutaneous intervention from February 2009 through April 2022 (new cohort) were compared with patients in the previous study (January 1969 through November 2007; remote cohort) at Mayo Clinic.
Results
In total, 81 adults (43 men; 38 women) with DS underwent 89 cardiac interventions (84 surgical; 5 percutaneous) at a mean age of 33 years. Twenty-six patients presented with complete atrioventricular canal defect (17%) or tetralogy of Fallot (15%). The most common adult procedures were valve interventions: mitral (31%), tricuspid (15%), and pulmonary (12%). Of pulmonary valve interventions in the new cohort, 33% were performed percutaneously. The postoperative mortality rate was low (1% total). The mean time between last operation and death was 16 years.
Conclusion
Adults with DS can undergo cardiac operation and percutaneous intervention with low morbidity and mortality risk and good long-term survival.
{"title":"Safety and Efficacy of Surgical and Percutaneous Cardiac Interventions for Adults With Down Syndrome","authors":"Kaitlin Roehl PA-C , Carolyn Mead-Harvey MS , Heidi M. Connolly MD , Joseph A. Dearani MD , Felicia S. Schaap APRN, AGACNP-BC , Susanna L. Liljenstolpe APRN, FNP-C , Linda B. Osborn RN , C. Charles Jain MD , Donald J. Hagler Sr. MD , Francois Marcotte MD , David S. Majdalany MD","doi":"10.1016/j.mayocpiqo.2023.11.002","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.11.002","url":null,"abstract":"<div><h3>Objective</h3><p>To assess risks and benefits of cardiac intervention in adults with Down syndrome (DS).</p></div><div><h3>Patients and Methods</h3><p>A retrospective review was conducted using data from a study we published in 2010. Patients aged 18 years or older with DS who underwent cardiac operation or percutaneous intervention from February 2009 through April 2022 (new cohort) were compared with patients in the previous study (January 1969 through November 2007; remote cohort) at Mayo Clinic.</p></div><div><h3>Results</h3><p>In total, 81 adults (43 men; 38 women) with DS underwent 89 cardiac interventions (84 surgical; 5 percutaneous) at a mean age of 33 years. Twenty-six patients presented with complete atrioventricular canal defect (17%) or tetralogy of Fallot (15%). The most common adult procedures were valve interventions: mitral (31%), tricuspid (15%), and pulmonary (12%). Of pulmonary valve interventions in the new cohort, 33% were performed percutaneously. The postoperative mortality rate was low (1% total). The mean time between last operation and death was 16 years.</p></div><div><h3>Conclusion</h3><p>Adults with DS can undergo cardiac operation and percutaneous intervention with low morbidity and mortality risk and good long-term survival.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000735/pdfft?md5=adb10ed4913539d603291b2c058c3d1c&pid=1-s2.0-S2542454823000735-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139050152","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 : 2023-12-25DOI: 10.1016/j.mayocpiqo.2023.11.003
Nathan A. Seven MD , Karen A. Truitt DO , Ross A. Dierkhising MS , Nathan P. Young DO
Objective
To describe our practice of electronic consultations (e-consults) and assess safety and risk factors for subsequent face-to-face consultations.
Patients and Methods
A retrospective cohort study of all e-consults completed in a community neurology practice between May 5, 2018, and June 31, 2019, was completed. Clinical and demographic variables were compared between the successful and unsuccessful (defined by presence of subsequent face-to-face consultation) cohorts. Hazard ratios (HR) were calculated using Cox regression model. Kaplan-Meier probability analysis (with 95% CIs) of subsequent face-to-face consultation was performed. Case examples highlighting potential harm were summarized.
Results
In total, 302 e-consults were reviewed. The most frequent referrals were for headache (n=125, 41.4%), dysesthesia (n=40, 13.2%), and abnormal imaging finding (n=27, 8.9%). The most common e-consult questions were for treatment (57.6%) and diagnostic evaluation (48.0%) recommendations. Moreover, 24.8% (n=75) of e-consults were followed by face-to-face consultations, with primary risk factors including female sex (HR, 1.9), referral for headache (HR, 1.7), and final diagnosis of migraine (HR, 2.0) or long-term migraine (HR, 5.0). Potential harm related to delayed diagnosis/treatment was identified in 6 (2.0%) patients with migraine and 4 (1.3%) without migraine presenting to emergency department.
Conclusion
Utilization of e-consults may safely improve access to neurologic expertise and prevent the need for some visits, which may have required a face-to-face visit. In patients with chronic migraine, e-consults should be considered short-term and followed by face-to-face consultation as soon as access allows. Neurologists performing e-consults should be able to triage patients to face-to-face consultation, particularly when diagnosis is uncertain or the neurologic examination may help guide appropriate testing.
{"title":"Electronic Consultations in a Community Neurology Practice: A Retrospective Study Informing Best Practice","authors":"Nathan A. Seven MD , Karen A. Truitt DO , Ross A. Dierkhising MS , Nathan P. Young DO","doi":"10.1016/j.mayocpiqo.2023.11.003","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.11.003","url":null,"abstract":"<div><h3>Objective</h3><p>To describe our practice of electronic consultations (e-consults) and assess safety and risk factors for subsequent face-to-face consultations.</p></div><div><h3>Patients and Methods</h3><p>A retrospective cohort study of all e-consults completed in a community neurology practice between May 5, 2018, and June 31, 2019, was completed. Clinical and demographic variables were compared between the successful and unsuccessful (defined by presence of subsequent face-to-face consultation) cohorts. Hazard ratios (HR) were calculated using Cox regression model. Kaplan-Meier probability analysis (with 95% CIs) of subsequent face-to-face consultation was performed. Case examples highlighting potential harm were summarized.</p></div><div><h3>Results</h3><p>In total, 302 e-consults were reviewed. The most frequent referrals were for headache (n=125, 41.4%), dysesthesia (n=40, 13.2%), and abnormal imaging finding (n=27, 8.9%). The most common e-consult questions were for treatment (57.6%) and diagnostic evaluation (48.0%) recommendations. Moreover, 24.8% (n=75) of e-consults were followed by face-to-face consultations, with primary risk factors including female sex (HR, 1.9), referral for headache (HR, 1.7), and final diagnosis of migraine (HR, 2.0) or long-term migraine (HR, 5.0). Potential harm related to delayed diagnosis/treatment was identified in 6 (2.0%) patients with migraine and 4 (1.3%) without migraine presenting to emergency department.</p></div><div><h3>Conclusion</h3><p>Utilization of e-consults may safely improve access to neurologic expertise and prevent the need for some visits, which may have required a face-to-face visit. In patients with chronic migraine, e-consults should be considered short-term and followed by face-to-face consultation as soon as access allows. Neurologists performing e-consults should be able to triage patients to face-to-face consultation, particularly when diagnosis is uncertain or the neurologic examination may help guide appropriate testing.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000747/pdfft?md5=34d543c79ed67e1a33863ede1816bd8e&pid=1-s2.0-S2542454823000747-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038572","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 : 2023-12-14DOI: 10.1016/j.mayocpiqo.2023.09.006
Elvira Mukhametova MD , Alena Militskova MS , Artur Biktimirov MD , Nikita Kharin MS , Elena Semenova MS , Oskar Sachenkov PhD , Tatiana Baltina PhD , Igor Lavrov MD, PhD
Objective
To evaluate the effect of transcutaneous (tSCS) and epidural electrical spinal cord stimulation (EES) in facilitating volitional movements, balance, and nonmotor functions, in this observational study, tSCS and EES were consecutively tested in 2 participants with motor complete spinal cord injury (SCI).
Participants and Methods
Two participants (a 48-year-old woman and a 28-year-old man), both classified as motor complete spinal injury, were enrolled in the study. Both participants went through a unified protocol, such as an initial electrophysiological assessment of neural connectivity, consecutive tSCS and EES combined with 8 wks of motor training with electromyography (EMG) and kinematic evaluation. The study was conducted from May 1, 2019, to December 31, 2021.
Results
In both participants, tSCS reported a minimal improvement in voluntary movements still essential to start tSCS-enabled rehabilitation. Compared with tSCS, following EES showed immediate improvement in voluntary movements, whereas tSCS was more effective in improving balance and posture. Continuous improvement in nonmotor functions was found during tSCS-enabled and then during EES-enabled motor training.
Conclusion
Results report a significant difference in the effect of tSCS and EES on the recovery of neurologic functions and support consecutive tSCS and EES applications as a potential therapy for SCI. The proposed approach may help in selecting patients with SCI responsive to neuromodulation. It would also help initiate neuromodulation and rehabilitation therapy early, particularly for motor complete SCI with minimal effect from conventional rehabilitation.
{"title":"Consecutive Transcutaneous and Epidural Spinal Cord Neuromodulation to Modify Clinical Complete Paralysis—the Proof of Concept","authors":"Elvira Mukhametova MD , Alena Militskova MS , Artur Biktimirov MD , Nikita Kharin MS , Elena Semenova MS , Oskar Sachenkov PhD , Tatiana Baltina PhD , Igor Lavrov MD, PhD","doi":"10.1016/j.mayocpiqo.2023.09.006","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.09.006","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the effect of transcutaneous (tSCS) and epidural electrical spinal cord stimulation (EES) in facilitating volitional movements, balance, and nonmotor functions, in this observational study, tSCS and EES were consecutively tested in 2 participants with motor complete spinal cord injury (SCI).</p></div><div><h3>Participants and Methods</h3><p>Two participants (a 48-year-old woman and a 28-year-old man), both classified as motor complete spinal injury, were enrolled in the study. Both participants went through a unified protocol, such as an initial electrophysiological assessment of neural connectivity, consecutive tSCS and EES combined with 8 wks of motor training with electromyography (EMG) and kinematic evaluation. The study was conducted from May 1, 2019, to December 31, 2021.</p></div><div><h3>Results</h3><p>In both participants, tSCS reported a minimal improvement in voluntary movements still essential to start tSCS-enabled rehabilitation. Compared with tSCS, following EES showed immediate improvement in voluntary movements, whereas tSCS was more effective in improving balance and posture. Continuous improvement in nonmotor functions was found during tSCS-enabled and then during EES-enabled motor training.</p></div><div><h3>Conclusion</h3><p>Results report a significant difference in the effect of tSCS and EES on the recovery of neurologic functions and support consecutive tSCS and EES applications as a potential therapy for SCI. The proposed approach may help in selecting patients with SCI responsive to neuromodulation. It would also help initiate neuromodulation and rehabilitation therapy early, particularly for motor complete SCI with minimal effect from conventional rehabilitation.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000644/pdfft?md5=c15d5171a92a6d907c575eb820ff6c71&pid=1-s2.0-S2542454823000644-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138633570","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 : 2023-11-24DOI: 10.1016/j.mayocpiqo.2023.10.001
Sarah B. Nahhal MD , Johnny Zakhour MD , Abdel Hadi Shmoury MD , Tedy Sawma MD , Sara F. Haddad MD , Tamara Abdallah MSc , Nada Kara Zahreddine CIC , Joseph Tannous MHRM , Nisrine Haddad Pharm D , Nesrine Rizk MD , Souha S. Kanj MD
Objective
To report the microbiological profile of the pathogens implicated in blood stream infections (BSI) in hospitalized coronavirus disease 2019 (COVID-19) patients and to examine the risk factors associated with multidrug-resistant organisms (MDROs) causing BSI.
Patients and Methods
Between March 2020 and September 2021, 1647 patients were hospitalized with COVID-19 at the American University of Beirut. From 85 patients, 299 positive blood cultures were reported to the Infection Control and Prevention Program. The BSI was defined as 1 positive blood culture for bacterial or fungal pathogens. The following organisms were considered MDROs: methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp, carbapenem-resistant Enterobacterales spp., carbapenem-resistant Pseudomonas aeruginosa, MDR Acinetobacter baumannii only susceptible to colistin or tigecycline, and Candida auris.
Results
We identified 99 true positive BSI events. Gram-negative bacteria accounted for 38.4 %, followed by Gram-positive bacteria (37.4%), and fungi (24.2%). The most isolated species were Candida spp. (23%), 3 of which were C. auris, followed by Enterobacterales spp. (13%), Enterococcus spp. (12%), S. aureus (9%), P. aeruginosa (9%), and A. baumannii (3%). The MDROs represented 26% of the events. The overall mortality rate was 78%. The time to acquisition of BSI in patients with MDROs was significantly longer compared with that of non-MDROs (20.2 days vs 11.2 days). And there was a significantly shorter time from acquisition of BSI to mortality between MDROs and non-MDROs (1.5 vs 8.3 days).
Conclusion
Rigorous infection prevention and control measures and antimicrobial stewardship are important to prevent antimicrobial resistance progression, especially in low-resource settings.
{"title":"Blood Stream Infections in COVID-19 Patients From a Tertiary Care Center in Lebanon: Causative Pathogens and Rates of Multi-Drug Resistant Organisms","authors":"Sarah B. Nahhal MD , Johnny Zakhour MD , Abdel Hadi Shmoury MD , Tedy Sawma MD , Sara F. Haddad MD , Tamara Abdallah MSc , Nada Kara Zahreddine CIC , Joseph Tannous MHRM , Nisrine Haddad Pharm D , Nesrine Rizk MD , Souha S. Kanj MD","doi":"10.1016/j.mayocpiqo.2023.10.001","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.10.001","url":null,"abstract":"<div><h3>Objective</h3><p>To report the microbiological profile of the pathogens implicated in blood stream infections (BSI) in hospitalized coronavirus disease 2019 (COVID-19) patients and to examine the risk factors associated with multidrug-resistant organisms (MDROs) causing BSI.</p></div><div><h3>Patients and Methods</h3><p>Between March 2020 and September 2021, 1647 patients were hospitalized with COVID-19 at the American University of Beirut. From 85 patients, 299 positive blood cultures were reported to the Infection Control and Prevention Program. The BSI was defined as 1 positive blood culture for bacterial or fungal pathogens. The following organisms were considered MDROs: methicillin-resistant <em>Staphylococcus aureus</em>, vancomycin-resistant <em>Enterococcus</em> spp, carbapenem-resistant <em>Enterobacterales</em> spp., carbapenem-resistant <em>Pseudomonas aeruginosa</em>, MDR <em>Acinetobacter baumannii</em> only susceptible to colistin or tigecycline, and <em>Candida auris.</em></p></div><div><h3>Results</h3><p>We identified 99 true positive BSI events. Gram-negative bacteria accounted for 38.4 %, followed by Gram-positive bacteria (37.4%), and fungi (24.2%). The most isolated species were <em>Candida</em> spp. (23%), 3 of which were <em>C. auris</em>, followed by <em>Enterobacterales</em> spp. (13%), <em>Enterococcus</em> spp. (12%), <em>S. aureus</em> (9%), <em>P. aeruginosa</em> (9%), and <em>A. baumannii</em> (3%). The MDROs represented 26% of the events. The overall mortality rate was 78%. The time to acquisition of BSI in patients with MDROs was significantly longer compared with that of non-MDROs (20.2 days vs 11.2 days). And there was a significantly shorter time from acquisition of BSI to mortality between MDROs and non-MDROs (1.5 vs 8.3 days).</p></div><div><h3>Conclusion</h3><p>Rigorous infection prevention and control measures and antimicrobial stewardship are important to prevent antimicrobial resistance progression, especially in low-resource settings.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000681/pdfft?md5=b0a82eabdc062d57635e0b37f75841c8&pid=1-s2.0-S2542454823000681-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138413007","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 : 2023-11-23DOI: 10.1016/j.mayocpiqo.2023.09.005
Debra A. Gilin PhD , Gregory G. Anderson MSc , Seyedehsan Etezad MSc , Dayna Lee-Baggley PhD , Angela M. Cooper PhD, RPsych , Roberta J. Preston EdD
Objective
To evaluate the efficacy of a wellness leadership intervention for improving the empathy, burnout, and physiological stress of medical faculty leaders.
Participants and Methods
Participants were 49 medical faculty leaders (80% physicians, 20% basic scientists; 67% female). The 6-week course was evaluated with a 15-week longitudinal waitlist-control quasi-experiment from September 1, 2021, through December 20, 2021 (during the COVID-19 pandemic). We analyzed 3 pretest-posttest-posttest and 6 weekly survey measurements of affective empathy and burnout, and mean=85 (SD=31) aggregated daily resting heart rates per participant, using 2-level hierarchical linear modeling.
Results
The course found a preventive effect for leaders’ burnout escalation. As the control group awaited the course, their empathy decreased (coefficientTime=−1.27; P=.02) and their resting heart rates increased an average of 1.4 beats/min (coefficientTime=0.18; P<.001), reflecting the toll of the pandemic. Intervention group leaders reported no empathy decrements (coefficientTime=.33; P=.59) or escalated resting heart rate (coefficientTime=−0.05; P=.27) during the same period. Dose-response analysis revealed that both groups reduced their self-rated burnout over the 6 weeks of the course (coefficientTime=−0.28; P=.007), and those who attended more of the course showed less heart rate increase (coefficientTime∗Dosage=−0.05; P<.001). In addition, 12.73% of the within-person fluctuation in empathy was associated with burnout and resting heart rate.
Conclusion
A wellness leadership intervention helped prevent burnout escalation and empathy decrement in medical faculty leaders during the COVID-19 pandemic, showing potential to improve the supportiveness and psychological safety of the medical training environment.
{"title":"Impact of a Wellness Leadership Intervention on the Empathy, Burnout, and Resting Heart Rate of Medical Faculty","authors":"Debra A. Gilin PhD , Gregory G. Anderson MSc , Seyedehsan Etezad MSc , Dayna Lee-Baggley PhD , Angela M. Cooper PhD, RPsych , Roberta J. Preston EdD","doi":"10.1016/j.mayocpiqo.2023.09.005","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.09.005","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the efficacy of a wellness leadership intervention for improving the empathy, burnout, and physiological stress of medical faculty leaders.</p></div><div><h3>Participants and Methods</h3><p>Participants were 49 medical faculty leaders (80% physicians, 20% basic scientists; 67% female). The 6-week course was evaluated with a 15-week longitudinal waitlist-control quasi-experiment from September 1, 2021, through December 20, 2021 (during the COVID-19 pandemic). We analyzed 3 pretest-posttest-posttest and 6 weekly survey measurements of affective empathy and burnout, and mean=85 (SD=31) aggregated daily resting heart rates per participant, using 2-level hierarchical linear modeling.</p></div><div><h3>Results</h3><p>The course found a preventive effect for leaders’ burnout escalation. As the control group awaited the course, their empathy decreased (coefficient<sub>Time</sub>=−1.27; <em>P</em>=.02) and their resting heart rates increased an average of 1.4 beats/min (coefficient<sub>Time</sub>=0.18; <em>P</em><.001), reflecting the toll of the pandemic. Intervention group leaders reported no empathy decrements (coefficient<sub>Time</sub>=.33; <em>P</em>=.59) or escalated resting heart rate (coefficient<sub>Time</sub>=−0.05; <em>P</em>=.27) during the same period. Dose-response analysis revealed that both groups reduced their self-rated burnout over the 6 weeks of the course (coefficient<sub>Time</sub>=−0.28; <em>P</em>=.007), and those who attended more of the course showed less heart rate increase (coefficient<sub>Time∗Dosage</sub>=−0.05; <em>P</em><.001). In addition, 12.73% of the within-person fluctuation in empathy was associated with burnout and resting heart rate.</p></div><div><h3>Conclusion</h3><p>A wellness leadership intervention helped prevent burnout escalation and empathy decrement in medical faculty leaders during the COVID-19 pandemic, showing potential to improve the supportiveness and psychological safety of the medical training environment.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000632/pdfft?md5=06b08332fb7a367a7844d8925992f219&pid=1-s2.0-S2542454823000632-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138413122","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 : 2023-11-15DOI: 10.1016/j.mayocpiqo.2023.09.002
Carlos Perez-Vega MD , Devang K. Sanghavi MBBS, MD , Pablo Moreno Franco MD , Ryan M. Chadha MD , Alberto E. Ardon MD , Elird Bojaxhi MD , Klaus D. Torp MD , Lisa A. Marshall RN , Tiffany M. Halstead RN , Valentino E. Ford RN , Lynda M. Christel , Sanjeet S. Grewal MD , Kaisorn L. Chaichana MD , Alfredo Quinones-Hinojosa MD , Levi W. Howard DO , W. Christopher Fox MD , William D. Freeman MD , NPCU Group
Objective
To describe the safety and feasibility of a fast-track pathway for neurosurgical craniotomy patients receiving care in a neurosciences progressive care unit (NPCU).
Patients and Methods
Traditionally, most craniotomy patients are admitted to the neurosciences intensive care unit (NSICU) for postoperative follow-up. Decreased availability of NSICU beds during the coronavirus disease-2019 delta surge led our team to establish a de-novo NPCU to preserve capacity for patients requiring high level of care and would bypass routine NSICU admissions. Patients were selected a priori by treating neurosurgeons on the basis of the potential need for high-level ICU services. After operation, selected patients were transferred to the postoperative care unit, where suitability for NPCU transfer was reassessed with checklist-criteria. This process was continued after the delta surge.
Results
From July 1, 2021 to September 30, 2022, 57 patients followed the NPCU protocol. Thirty-four (59.6%) were women, and the mean age was 56 years. Fifty-seven craniotomies for 34 intra-axial and 23 extra-axial lesions were performed. After assessment and application of the checklist-criteria, 55 (96.5%) were transferred to NPCU, and only 2 (3.5%) were transferred to ICU. All 55 patients followed in NPCU had good safety outcomes without requiring NSICU transfer. This saved $143,000 and led to 55 additional ICU beds for emergent admissions.
Conclusion
This fast-track craniotomy protocol provides early experience that a surgeon-selected group of patients may be suitably monitored outside the traditional NSICU. This system has the potential to reduce overall health care expenses, increase capacity for NSICU bed availability, and change the paradigm of NSICU admission.
{"title":"Safety and Feasibility of a Fast-Track Pathway for Neurosurgical Craniotomy Patients: Bypassing the Intensive Care Unit","authors":"Carlos Perez-Vega MD , Devang K. Sanghavi MBBS, MD , Pablo Moreno Franco MD , Ryan M. Chadha MD , Alberto E. Ardon MD , Elird Bojaxhi MD , Klaus D. Torp MD , Lisa A. Marshall RN , Tiffany M. Halstead RN , Valentino E. Ford RN , Lynda M. Christel , Sanjeet S. Grewal MD , Kaisorn L. Chaichana MD , Alfredo Quinones-Hinojosa MD , Levi W. Howard DO , W. Christopher Fox MD , William D. Freeman MD , NPCU Group","doi":"10.1016/j.mayocpiqo.2023.09.002","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.09.002","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the safety and feasibility of a fast-track pathway for neurosurgical craniotomy patients receiving care in a neurosciences progressive care unit (NPCU).</p></div><div><h3>Patients and Methods</h3><p>Traditionally, most craniotomy patients are admitted to the neurosciences intensive care unit (NSICU) for postoperative follow-up. Decreased availability of NSICU beds during the coronavirus disease-2019 delta surge led our team to establish a de-novo NPCU to preserve capacity for patients requiring high level of care and would bypass routine NSICU admissions. Patients were selected a priori by treating neurosurgeons on the basis of the potential need for high-level ICU services. After operation, selected patients were transferred to the postoperative care unit, where suitability for NPCU transfer was reassessed with checklist-criteria. This process was continued after the delta surge.</p></div><div><h3>Results</h3><p>From July 1, 2021 to September 30, 2022, 57 patients followed the NPCU protocol. Thirty-four (59.6%) were women, and the mean age was 56 years. Fifty-seven craniotomies for 34 intra-axial and 23 extra-axial lesions were performed. After assessment and application of the checklist-criteria, 55 (96.5%) were transferred to NPCU, and only 2 (3.5%) were transferred to ICU. All 55 patients followed in NPCU had good safety outcomes without requiring NSICU transfer. This saved $143,000 and led to 55 additional ICU beds for emergent admissions.</p></div><div><h3>Conclusion</h3><p>This fast-track craniotomy protocol provides early experience that a surgeon-selected group of patients may be suitably monitored outside the traditional NSICU. This system has the potential to reduce overall health care expenses, increase capacity for NSICU bed availability, and change the paradigm of NSICU admission.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000607/pdfft?md5=a56a283ce489e0ca2e6be377689ea371&pid=1-s2.0-S2542454823000607-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136592881","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 : 2023-11-15DOI: 10.1016/j.mayocpiqo.2023.09.003
Colt Williams MD , Leigh Meyer BA , Omar Kawam BS , Konstantinos Leventakos MD, PhD , Erin S. DeMartino MD
Objective
To characterize the financial toxicity experienced by advanced cancer patients enrolled in phase I oncology trials.
Patients and Methods
We conducted structured interviews with cancer patients participating in phase I clinical trials. Using a thematic analysis approach, we identified recurring themes in patients’ experiences of financial toxicity resulting from trial participation.
Results
Seven major themes emerged from the interviews: (1) the burden of travel, (2) a willingness to pursue treatment despite financial risk, (3) fear of destitution, (4) financial toxicity equaling physical toxicity, (5) changes in food spending, (6) reluctance to confide in the study investigator about financial toxicity, and (7) difficulty navigating financial aid. These themes highlight the multifaceted financial challenges faced by patients in early phase clinical trials and the need for targeted support services.
Conclusion
Our findings underscore the relevance of financial toxicity in the context of phase I clinical trials and provide insights into the diverse challenges faced by advanced cancer patients. These challenges likely augment the disparities seen in trial enrollment for historically marginalized populations. Addressing financial toxicity in this population is crucial for improving patient outcomes and quality of life. Future research should focus on developing effective interventions and support services tailored to the needs of patients in early phase clinical trials.
{"title":"The Faces of Financial Toxicity: A Qualitative Interview Study of Financial Toxicity in Advanced Cancer Patients in Phase I Oncology Trials","authors":"Colt Williams MD , Leigh Meyer BA , Omar Kawam BS , Konstantinos Leventakos MD, PhD , Erin S. DeMartino MD","doi":"10.1016/j.mayocpiqo.2023.09.003","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.09.003","url":null,"abstract":"<div><h3>Objective</h3><p>To characterize the financial toxicity experienced by advanced cancer patients enrolled in phase I oncology trials.</p></div><div><h3>Patients and Methods</h3><p>We conducted structured interviews with cancer patients participating in phase I clinical trials. Using a thematic analysis approach, we identified recurring themes in patients’ experiences of financial toxicity resulting from trial participation.</p></div><div><h3>Results</h3><p>Seven major themes emerged from the interviews: (1) the burden of travel, (2) a willingness to pursue treatment despite financial risk, (3) fear of destitution, (4) financial toxicity equaling physical toxicity, (5) changes in food spending, (6) reluctance to confide in the study investigator about financial toxicity, and (7) difficulty navigating financial aid. These themes highlight the multifaceted financial challenges faced by patients in early phase clinical trials and the need for targeted support services.</p></div><div><h3>Conclusion</h3><p>Our findings underscore the relevance of financial toxicity in the context of phase I clinical trials and provide insights into the diverse challenges faced by advanced cancer patients. These challenges likely augment the disparities seen in trial enrollment for historically marginalized populations. Addressing financial toxicity in this population is crucial for improving patient outcomes and quality of life. Future research should focus on developing effective interventions and support services tailored to the needs of patients in early phase clinical trials.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000619/pdfft?md5=cd60d1b204c8779198cb8220d6ff9acd&pid=1-s2.0-S2542454823000619-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136592880","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 : 2023-10-29DOI: 10.1016/j.mayocpiqo.2023.09.004
Inas S. Khayal PhD , Rebecca L. Butcher MS, MPH , Colin H. McLeish MD, MBA , Yujia Shentu MD, MS , Amber E. Barnato MD, MPH, MS
Objective
To identify the factors that influence the mortality review process at health systems, including how mortality review is conducted, cases are adjudicated, and results are used.
Methods
We conducted a qualitative analysis of the mortality review processes of 6 US health systems from February 1, 2021 to June 31, 2021. The data sources included individual and small-group semi-structured interviews with mortality review team members and a content analysis of site artifacts (eg, guiding principles, chart abstraction forms, review workflows, and clinical pathways developed from past mortality reviews). We analyzed each site’s mortality review process, goals and incentives for mortality review, historical and evolving aspects of mortality review, personnel involved, and post-review use of findings.
Results
Across the 6 systems, we interviewed a total of 24 mortality review experts and analyzed 26 site documents. We identified 3 thematic factors that influence mortality review processes: organizational intent, organizational structures for mortality review, and the mental models of individuals involved in the review process. Two subthemes emerged within organizational intent: (1) identifying preventable deaths to lower (clinical or financial) risk and (2) using death cases to guide system improvement. Sites varied in governance and decision rights concerning mortality review and adjudication, with 2 subthemes within organizational structures: (1) centralized-hierarchical and (2) decentralized or multidisciplinary. The analysis of mental models of participating reviewers revealed 2 themes: (1) confirmation of preventability and (2) identification of patterns or “signals.”
Conclusion
Understanding the factors that influence mortality review allows health systems to better leverage mortality review for institutional improvement and to develop training that builds shared mental models to enhance the review process.
{"title":"Organizational Intent, Organizational Structures, and Reviewer Mental Models Influence Mortality Review Processes","authors":"Inas S. Khayal PhD , Rebecca L. Butcher MS, MPH , Colin H. McLeish MD, MBA , Yujia Shentu MD, MS , Amber E. Barnato MD, MPH, MS","doi":"10.1016/j.mayocpiqo.2023.09.004","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.09.004","url":null,"abstract":"<div><h3>Objective</h3><p>To identify the factors that influence the mortality review process at health systems, including how mortality review is conducted, cases are adjudicated, and results are used.</p></div><div><h3>Methods</h3><p>We conducted a qualitative analysis of the mortality review processes of 6 US health systems from February 1, 2021 to June 31, 2021. The data sources included individual and small-group semi-structured interviews with mortality review team members and a content analysis of site artifacts (eg, guiding principles, chart abstraction forms, review workflows, and clinical pathways developed from past mortality reviews). We analyzed each site’s mortality review process, goals and incentives for mortality review, historical and evolving aspects of mortality review, personnel involved, and post-review use of findings.</p></div><div><h3>Results</h3><p>Across the 6 systems, we interviewed a total of 24 mortality review experts and analyzed 26 site documents. We identified 3 thematic factors that influence mortality review processes: organizational intent, organizational structures for mortality review, and the mental models of individuals involved in the review process. Two subthemes emerged within organizational intent: (1) identifying preventable deaths to lower (clinical or financial) risk and (2) using death cases to guide system improvement. Sites varied in governance and decision rights concerning mortality review and adjudication, with 2 subthemes within organizational structures: (1) centralized-hierarchical and (2) decentralized or multidisciplinary. The analysis of mental models of participating reviewers revealed 2 themes: (1) confirmation of preventability and (2) identification of patterns or “signals.”</p></div><div><h3>Conclusion</h3><p>Understanding the factors that influence mortality review allows health systems to better leverage mortality review for institutional improvement and to develop training that builds shared mental models to enhance the review process.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71765500","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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