Pub Date : 2025-06-13DOI: 10.1016/j.mayocpiqo.2025.100635
Sehreen Mumtaz MBBS , Florentina Berianu MD , Puneet Bhullar MD, MS , Jordan Phillipps MD , Madiha Iqbal MBBS , David Hodge MS , Breanna Cane MPH , Olayemi Sokumbi MD
Objective
To assess the utility of nailfold video capillaroscopy (NVC) in patients diagnosed with acute and chronic graft versus host disease (GVHD) of the skin.
Patients and Methods
Patients diagnosed with acute and chronic skin GVHD (n=11) and those without the diagnosis of GVHD (controls) (n=21) underwent NVC to assess capillary density, morphology, and hemorrhage. Statistical comparisons were made using Fisher’s exact test. The study was performed from March 1, 2024, to August 1, 2024.
Results
Patients diagnosed with acute and chronic GVHD were observed to have considerably more microhemorrhages, ramifications, and disorganized capillaries when compared with patients without a diagnosis of acute or chronic GVHD.
Conclusion
This study reveals significant NVC abnormalities in patients with GVHD, suggesting distinct microvascular features that imply potential diagnostic value. The NVC may be a valuable tool for diagnosing and monitoring GVHD and warrants further investigation in larger cohorts.
{"title":"Nailfold Video Capillaroscopy in Acute and Chronic Skin Graft Versus Host Disease","authors":"Sehreen Mumtaz MBBS , Florentina Berianu MD , Puneet Bhullar MD, MS , Jordan Phillipps MD , Madiha Iqbal MBBS , David Hodge MS , Breanna Cane MPH , Olayemi Sokumbi MD","doi":"10.1016/j.mayocpiqo.2025.100635","DOIUrl":"10.1016/j.mayocpiqo.2025.100635","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the utility of nailfold video capillaroscopy (NVC) in patients diagnosed with acute and chronic graft versus host disease (GVHD) of the skin.</div></div><div><h3>Patients and Methods</h3><div>Patients diagnosed with acute and chronic skin GVHD (n=11) and those without the diagnosis of GVHD (controls) (n=21) underwent NVC to assess capillary density, morphology, and hemorrhage. Statistical comparisons were made using Fisher’s exact test. The study was performed from March 1, 2024, to August 1, 2024.</div></div><div><h3>Results</h3><div>Patients diagnosed with acute and chronic GVHD were observed to have considerably more microhemorrhages, ramifications, and disorganized capillaries when compared with patients without a diagnosis of acute or chronic GVHD.</div></div><div><h3>Conclusion</h3><div>This study reveals significant NVC abnormalities in patients with GVHD, suggesting distinct microvascular features that imply potential diagnostic value. The NVC may be a valuable tool for diagnosing and monitoring GVHD and warrants further investigation in larger cohorts.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100635"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271897","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 : 2025-06-13DOI: 10.1016/j.mayocpiqo.2025.100630
Lindsay D. Nelson PhD , Samuel Gray BA , Courtney O. Barry PsyD , Staci A. Young PhD
Objective
To learn patient perspectives about health care in a level I trauma center for traumatic brain injury (TBI) that inform the design of better TBI systems of care.
Patients and Methods
This was a community-engaged qualitative study that enrolled 42 individuals who had been either treated and discharged home from a level I trauma center emergency department (n=21, 50%) or who were admitted to the trauma center inpatient units (n=21, 50%). Interviews, conducted from August 12, 2022, to September 22, 2023, inquired about injury, post-acute and after post-acute care, clinical and community supports received, unexpected experiences, and things that helped or hurt access to care and outcome. Thematic analyses were completed in October 2024.
Results
Four themes emerged. Participants conveyed a desire to be informed and engaged in their health and health care, reporting deficiencies, for example, in health care providers’ explanation of their TBI diagnosis, communication about in-hospital care, and discharge instructions. They reported varied difficulties navigating the health care system after discharge, resulting in no or insufficient TBI follow-up care. Third, responses illuminated the importance of social risk and resilience factors, with particularly important roles of financial strain and social support. Fourth, participants conveyed unique feelings of vulnerability and uncertainty about TBI resulting from its variable, uncertain course.
Conclusion
The findings align with and expand on findings from quantitative studies of common gaps in TBI care, whereas illuminating distinct targets for ongoing national and international efforts to develop more coordinated, patient-centered systems of care.
{"title":"Patient Experiences of and Priorities for Traumatic Brain Injury Health Care in a US Level 1 Trauma Center: A Qualitative Study","authors":"Lindsay D. Nelson PhD , Samuel Gray BA , Courtney O. Barry PsyD , Staci A. Young PhD","doi":"10.1016/j.mayocpiqo.2025.100630","DOIUrl":"10.1016/j.mayocpiqo.2025.100630","url":null,"abstract":"<div><h3>Objective</h3><div>To learn patient perspectives about health care in a level I trauma center for traumatic brain injury (TBI) that inform the design of better TBI systems of care.</div></div><div><h3>Patients and Methods</h3><div>This was a community-engaged qualitative study that enrolled 42 individuals who had been either treated and discharged home from a level I trauma center emergency department (n=21, 50%) or who were admitted to the trauma center inpatient units (n=21, 50%). Interviews, conducted from August 12, 2022, to September 22, 2023, inquired about injury, post-acute and after post-acute care, clinical and community supports received, unexpected experiences, and things that helped or hurt access to care and outcome. Thematic analyses were completed in October 2024.</div></div><div><h3>Results</h3><div>Four themes emerged. Participants conveyed a desire to be informed and engaged in their health and health care, reporting deficiencies, for example, in health care providers’ explanation of their TBI diagnosis, communication about in-hospital care, and discharge instructions. They reported varied difficulties navigating the health care system after discharge, resulting in no or insufficient TBI follow-up care. Third, responses illuminated the importance of social risk and resilience factors, with particularly important roles of financial strain and social support. Fourth, participants conveyed unique feelings of vulnerability and uncertainty about TBI resulting from its variable, uncertain course.</div></div><div><h3>Conclusion</h3><div>The findings align with and expand on findings from quantitative studies of common gaps in TBI care, whereas illuminating distinct targets for ongoing national and international efforts to develop more coordinated, patient-centered systems of care.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100630"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279281","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 : 2025-06-11DOI: 10.1016/j.mayocpiqo.2025.100628
Elisabeth Edvardsen PhD , Tormod Skogstad Nilsen PhD , Robert Novo BA , Michael Curry BS , Scott C. Adams PhD , Konstantina Matsoukas MLIS , Justin Huang BA , Jasme Lee MS , Chaya Moskowitz PhD , Lee W. Jones PhD , Jessica M. Scott PhD
Objective
To evaluate exercise testing (ExT) characteristics, safety, and methodological quality in oncology settings.
Patients and Methods
In this systematic review, we searched electronic databases (PubMed, Embase, CINAHL, and Cochrane Library) from inception to March 2024. Studies using ExT to evaluate cardiorespiratory fitness or functional capacity in adults with a history of cancer were included. Summary data including ExT characteristics (eg, modality, cardiorespiratory fitness, and functional capacity results), safety (eg, adverse events [AE]), and methodological quality (eg, guideline adherence) was evaluated.
Results
A total of 642 unique studies with 94,960 patients (58.6±9.9 years; 49% women) were included. Among the 26 ExT modalities used, the maximal cardiopulmonary exercise test (CPET) with measurement of gas exchange (n=284, 40%) and the 6-minute walk test (6MWT) (n=240, 34%) were the most frequently performed. Of the 284 studies that conducted CPET, n=204 (72%) studies reported peak oxygen consumption in mL·kg-1·min-1; average peak oxygen consumption was 21.8±5.8 mL·kg-1·min-1. Of the 237 studies that conducted 6MWT, 155 (65%) reported distance in meters (m); average distance was 445m±79 m. A total of n=36 (23%) studies reported an average distance above 500 meter. The AEs were monitored in 58 (9.0%) studies wherein a total of 120 non-serious AEs were reported among n=5699 patients (0.02%). Methodological quality and reporting varied considerably.
Conclusion
The findings of this systematic review indicate that CPET with gas exchange and field-based tests such as the 6MWT are widely used; however, future research should prioritize improving safety monitoring, appropriate test selection, and methodological consistency to enhance the applicability of ExT in oncology care.
{"title":"Exercise Testing Characteristics, Safety, and Quality in Patients with Cancer: A Systematic Review","authors":"Elisabeth Edvardsen PhD , Tormod Skogstad Nilsen PhD , Robert Novo BA , Michael Curry BS , Scott C. Adams PhD , Konstantina Matsoukas MLIS , Justin Huang BA , Jasme Lee MS , Chaya Moskowitz PhD , Lee W. Jones PhD , Jessica M. Scott PhD","doi":"10.1016/j.mayocpiqo.2025.100628","DOIUrl":"10.1016/j.mayocpiqo.2025.100628","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate exercise testing (ExT) characteristics, safety, and methodological quality in oncology settings.</div></div><div><h3>Patients and Methods</h3><div>In this systematic review, we searched electronic databases (PubMed, Embase, CINAHL, and Cochrane Library) from inception to March 2024. Studies using ExT to evaluate cardiorespiratory fitness or functional capacity in adults with a history of cancer were included. Summary data including ExT characteristics (eg, modality, cardiorespiratory fitness, and functional capacity results), safety (eg, adverse events [AE]), and methodological quality (eg, guideline adherence) was evaluated.</div></div><div><h3>Results</h3><div>A total of 642 unique studies with 94,960 patients (58.6±9.9 years; 49% women) were included. Among the 26 ExT modalities used, the maximal cardiopulmonary exercise test (CPET) with measurement of gas exchange (n=284, 40%) and the 6-minute walk test (6MWT) (n=240, 34%) were the most frequently performed. Of the 284 studies that conducted CPET, n=204 (72%) studies reported peak oxygen consumption in mL·kg<sup>-1</sup>·min<sup>-1</sup>; average peak oxygen consumption was 21.8±5.8 mL·kg<sup>-1</sup>·min<sup>-1</sup>. Of the 237 studies that conducted 6MWT, 155 (65%) reported distance in meters (m); average distance was 445m±79 m. A total of n=36 (23%) studies reported an average distance above 500 meter. The AEs were monitored in 58 (9.0%) studies wherein a total of 120 non-serious AEs were reported among n=5699 patients (0.02%). Methodological quality and reporting varied considerably.</div></div><div><h3>Conclusion</h3><div>The findings of this systematic review indicate that CPET with gas exchange and field-based tests such as the 6MWT are widely used; however, future research should prioritize improving safety monitoring, appropriate test selection, and methodological consistency to enhance the applicability of ExT in oncology care.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100628"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254722","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 : 2025-06-11DOI: 10.1016/j.mayocpiqo.2025.100634
Romil R. Parikh MBBS, PhD, MPH , Chetan Shenoy MD , Jeffrey R. Misialek MPH , Anne Blaes MD , Faye L. Norby PhD, MPH , Anna E. Prizment PhD , Elsayed Z. Soliman MSc, MD , Laura R. Loehr MD, PhD , Alvaro Alonso MD, PhD , Corinne E. Joshu MPH, PhD , Elizabeth A. Platz ScD, MPH , Lin Yee Chen MD, MS
Objective
To evaluate temporal associations of cancer with subsequent incident atrial fibrillation (AF) and temporal associations of AF with subsequent incident cancer, within 3, 3 to 12, and >12 months after index diagnosis.
Patients and Methods
We included 13,748 community-dwelling adults (mean age, 54 years) in the Atherosclerosis Risk in Communities study without cancer or AF histories at baseline (follow-up between January 1, 1987, and December 31, 2019). Atrial fibrillation was ascertained from electrocardiograms at study visits and health records. Cancer was ascertained via linkage with state registries and health records. We estimated associations of cancer with AF risk and AF with cancer risk by time since diagnosis using Cox regression, adjusting for shared risk factors and other cardiovascular diseases.
Results
In 3909 adults, cancer was diagnosed before AF. Atrial fibrillation risk was the highest within 3 months after cancer diagnosis (hazard ratio [HR], 11.71; 95% CI, 9.52-14.41), followed by 3 to 12 months (HR, 2.07; 95% CI, 1.54-2.80) and >12 months (HR, 1.46; 95% CI, 1.29-1.64). In 1973 adults, AF was diagnosed before cancer. Cancer risk was the highest within 3 months of AF diagnosis (HR, 2.24; 95% CI, 1.47-3.41), followed by 3 to 12 months (HR, 1.28; 95% CI, 0.91-1.80) and >12 months (HR, 1.09; 95% CI, 0.91-1.29).
Conclusion
In adult cancer patients, AF risk is the highest within 3 months after diagnosis and remains significantly elevated throughout survivorship but could be due to detection bias. Cancer risk is strongest within 3 months of AF diagnosis but significantly attenuated over time, suggesting detection bias and reverse causation.
{"title":"Associations Between Cancer and Atrial Fibrillation: The Atherosclerosis Risk in Communities Study","authors":"Romil R. Parikh MBBS, PhD, MPH , Chetan Shenoy MD , Jeffrey R. Misialek MPH , Anne Blaes MD , Faye L. Norby PhD, MPH , Anna E. Prizment PhD , Elsayed Z. Soliman MSc, MD , Laura R. Loehr MD, PhD , Alvaro Alonso MD, PhD , Corinne E. Joshu MPH, PhD , Elizabeth A. Platz ScD, MPH , Lin Yee Chen MD, MS","doi":"10.1016/j.mayocpiqo.2025.100634","DOIUrl":"10.1016/j.mayocpiqo.2025.100634","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate temporal associations of cancer with subsequent incident atrial fibrillation (AF) and temporal associations of AF with subsequent incident cancer, within 3, 3 to 12, and >12 months after index diagnosis.</div></div><div><h3>Patients and Methods</h3><div>We included 13,748 community-dwelling adults (mean age, 54 years) in the Atherosclerosis Risk in Communities study without cancer or AF histories at baseline (follow-up between January 1, 1987, and December 31, 2019). Atrial fibrillation was ascertained from electrocardiograms at study visits and health records. Cancer was ascertained via linkage with state registries and health records. We estimated associations of cancer with AF risk and AF with cancer risk by time since diagnosis using Cox regression, adjusting for shared risk factors and other cardiovascular diseases.</div></div><div><h3>Results</h3><div>In 3909 adults, cancer was diagnosed before AF. Atrial fibrillation risk was the highest within 3 months after cancer diagnosis (hazard ratio [HR], 11.71; 95% CI, 9.52-14.41), followed by 3 to 12 months (HR, 2.07; 95% CI, 1.54-2.80) and >12 months (HR, 1.46; 95% CI, 1.29-1.64). In 1973 adults, AF was diagnosed before cancer. Cancer risk was the highest within 3 months of AF diagnosis (HR, 2.24; 95% CI, 1.47-3.41), followed by 3 to 12 months (HR, 1.28; 95% CI, 0.91-1.80) and >12 months (HR, 1.09; 95% CI, 0.91-1.29).</div></div><div><h3>Conclusion</h3><div>In adult cancer patients, AF risk is the highest within 3 months after diagnosis and remains significantly elevated throughout survivorship but could be due to detection bias. Cancer risk is strongest within 3 months of AF diagnosis but significantly attenuated over time, suggesting detection bias and reverse causation.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100634"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263593","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 : 2025-06-04DOI: 10.1016/j.mayocpiqo.2025.100632
Taema Brinjikji MD , Kimberly S. Corbin MD , Zhen Wang PhD , M. Hassan Murad MD , Dean A. Shumway MD
Objective
To determine if accelerated partial breast irradiation (APBI) is associated with less financial toxicity (financial difficulties that patients experience due to treatment, such as out-of-pocket costs, transportation costs, and time away from work) than whole breast irradiation (WBI).
Patients and Methods
We searched bibliographic databases for studies published from database inception through April 2024. Eligible studies were randomized clinical trials and observational studies that evaluated financial toxicity of APBI or WBI treatments among adult women with early-stage breast cancer. Pairs of independent reviewers selected the studies.
Results
Nine studies met the inclusion criteria. One study using the comprehensive score for financial toxicity did not report a significant difference between APBI and WBI. Four studies using the European Organization for Research and Treatment of Cancer QLQ-C30 financial difficulties question reported greater financial difficulties with WBI when compared with APBI, with 2 studies reporting differences within 3 months of radiotherapy and 2 studies reporting differences at 1-2 years. Four studies evaluated the cost of travel and days away from work and reported less financial impact associated with APBI when compared with WBI.
Conclusion
APBI is associated with less financial toxicity than WBI, which may be dependent on the shorter duration of treatment.
{"title":"Financial Toxicity of Partial Versus Whole Breast Irradiation: A Systematic Review","authors":"Taema Brinjikji MD , Kimberly S. Corbin MD , Zhen Wang PhD , M. Hassan Murad MD , Dean A. Shumway MD","doi":"10.1016/j.mayocpiqo.2025.100632","DOIUrl":"10.1016/j.mayocpiqo.2025.100632","url":null,"abstract":"<div><h3>Objective</h3><div>To determine if accelerated partial breast irradiation (APBI) is associated with less financial toxicity (financial difficulties that patients experience due to treatment, such as out-of-pocket costs, transportation costs, and time away from work) than whole breast irradiation (WBI).</div></div><div><h3>Patients and Methods</h3><div>We searched bibliographic databases for studies published from database inception through April 2024. Eligible studies were randomized clinical trials and observational studies that evaluated financial toxicity of APBI or WBI treatments among adult women with early-stage breast cancer. Pairs of independent reviewers selected the studies.</div></div><div><h3>Results</h3><div>Nine studies met the inclusion criteria. One study using the comprehensive score for financial toxicity did not report a significant difference between APBI and WBI. Four studies using the European Organization for Research and Treatment of Cancer QLQ-C30 financial difficulties question reported greater financial difficulties with WBI when compared with APBI, with 2 studies reporting differences within 3 months of radiotherapy and 2 studies reporting differences at 1-2 years. Four studies evaluated the cost of travel and days away from work and reported less financial impact associated with APBI when compared with WBI.</div></div><div><h3>Conclusion</h3><div>APBI is associated with less financial toxicity than WBI, which may be dependent on the shorter duration of treatment.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100632"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144205104","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 : 2025-06-04DOI: 10.1016/j.mayocpiqo.2025.100633
Cristian Madrid MD , Karthik Gnanapandithan MD , Michael G. Heckman MS , Sophia G. Blumenfeld BS , Rachel Gothot MHA , Colt Cowdell MD , Michael J. Maniaci MD , Sally Anne Brown JD , Jennifer B. Cowart MD , Margaret Paulson DO , Wendelyn Bosch MD
Objective
To evaluate predictors of falls in the hospital-at-home (HaH) setting from a single institution in 3 US states.
Patients and Methods
In this retrospective study of HaH patients residing in Florida, Wisconsin, and Arizona, we identified 51 patients who fell and were matched to 153 patients without fall, between July 2020 and July 2023. Patient demographics and clinical characteristics were collected, including age, sex, race, Charlson Comorbidity Index, geographic location, body mass index, Hester Davis Scale, admission diagnosis, continuous intravenous infusion, polypharmacy, marital status/life partnership, area deprivation index, and use of supplemental oxygen. Association of patient characteristics were examined using unadjusted and multivariable logistic regression models (July 29, 2020 to July 5, 2023).
Results
The rate of falls was 6.8 per 1,000 patient bed-days. In multivariable analysis, we found that older age (odds ratio [OR; per each 10-year increase], 1.37; P=.043), higher Charlson Comorbidity Index (OR [per each 5-unit increase], 1.80; P=.012), and supplemental oxygen use (OR, 2.05; P=.045) were independent predictors of falls in the HaH setting. Although not statistically significant, an increased risk of falls was observed in patients with a diagnosis of respiratory disorder (OR, 2.07; P=.075).
Conclusion
In patients hospitalized at home, the risk of falls may increase with older age, higher Charlson Comorbidity Index, and supplemental oxygen use. Mitigation strategies to prevent falls in patients with these risk factors should be considered in the HaH setting.
{"title":"Hospital-at-Home Patient Fall Predictors","authors":"Cristian Madrid MD , Karthik Gnanapandithan MD , Michael G. Heckman MS , Sophia G. Blumenfeld BS , Rachel Gothot MHA , Colt Cowdell MD , Michael J. Maniaci MD , Sally Anne Brown JD , Jennifer B. Cowart MD , Margaret Paulson DO , Wendelyn Bosch MD","doi":"10.1016/j.mayocpiqo.2025.100633","DOIUrl":"10.1016/j.mayocpiqo.2025.100633","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate predictors of falls in the hospital-at-home (HaH) setting from a single institution in 3 US states.</div></div><div><h3>Patients and Methods</h3><div>In this retrospective study of HaH patients residing in Florida, Wisconsin, and Arizona, we identified 51 patients who fell and were matched to 153 patients without fall, between July 2020 and July 2023. Patient demographics and clinical characteristics were collected, including age, sex, race, Charlson Comorbidity Index, geographic location, body mass index, Hester Davis Scale, admission diagnosis, continuous intravenous infusion, polypharmacy, marital status/life partnership, area deprivation index, and use of supplemental oxygen. Association of patient characteristics were examined using unadjusted and multivariable logistic regression models (July 29, 2020 to July 5, 2023).</div></div><div><h3>Results</h3><div>The rate of falls was 6.8 per 1,000 patient bed-days. In multivariable analysis, we found that older age (odds ratio [OR; per each 10-year increase], 1.37; <em>P</em>=.043), higher Charlson Comorbidity Index (OR [per each 5-unit increase], 1.80; <em>P</em>=.012), and supplemental oxygen use (OR, 2.05; <em>P</em>=.045) were independent predictors of falls in the HaH setting. Although not statistically significant, an increased risk of falls was observed in patients with a diagnosis of respiratory disorder (OR, 2.07; <em>P</em>=.075).</div></div><div><h3>Conclusion</h3><div>In patients hospitalized at home, the risk of falls may increase with older age, higher Charlson Comorbidity Index, and supplemental oxygen use. Mitigation strategies to prevent falls in patients with these risk factors should be considered in the HaH setting.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100633"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144205105","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 : 2025-05-30DOI: 10.1016/j.mayocpiqo.2025.100631
Brett H. Smith MD , Jackson G. Wolfe , Alvina Karam MD , Bart M. Demarkschalk MD , Courtney M. Hrdlicka MD , Deena M. Nasr DO , Felix E. Chukwudelunzu MD , Charisse A. Nord MA , Emily A. Pahl BA , Claire Fernandez PhD , Sam Wood , Zoe VJ. Woodhead PhD , Davide Carone MD, DPhil , George Harston MBBS, Dphil , Stephen W. English MD, MBA
Objective
To explore the real-world impact of artificial intelligence-driven decision support imaging software for patients with acute ischemic stroke in a mature telestroke network in the United States.
Patients and Methods
We conducted a prospective evaluation of stroke imaging support software in a robust, predominantly rural telestroke network (17 sites in Minnesota and Wisconsin). Data was collected from all patients who underwent video telestroke evaluation in a 3-month preimplementation period before installation of the software (from February 10, 2024 to May 9, 2024) and a 3-month postimplementation period while the software was in use (from May 10, 2024 to August 9, 2024). The preimplementation and postimplementation cohorts were directly compared (no control group included). Primary outcome measures were treatment rates and time to treatment (both treatment decision and delivery) for intravenous thrombolysis (IVT) and endovascular therapy (EVT); secondary outcomes included transfer rates, transfer times, and end user survey results.
Results
Total of 444 telestroke cases were included in the preimplementation period, and 463 in the postimplementation period. Comparing preimplementation and postimplementation periods, the rate of IVT treatment delivery rose from 26.6% to 35.0% of potentially eligible patients (P=.24), whereas EVT treatment delivery remained at 31%. Time to IVT delivery reduced from 47 minutes to 41 minutes (P=.772), and time to EVT treatment rose from 156 minutes to 157 minutes (P=.771). Overall rates of treatment (IVT or EVT) rose from 23.1% to 23.9% of potentially eligible patients (P=.944). Although none of the clinical outcomes reached statistical significance, the survey results reported good user satisfaction with algorithm performance and image viewing.
Conclusion
This study reported a nonsignificant increase in treatment rates and a decrease in time to treatment decisions. Future trials with larger sample sizes are needed to validate the real-world benefits of decision support software for acute ischemic stroke in an established telestroke network.
{"title":"Prospective Evaluation of Artificial Intelligence Imaging Support Software for Acute Ischemic Stroke in the Mayo Clinic Telestroke Network","authors":"Brett H. Smith MD , Jackson G. Wolfe , Alvina Karam MD , Bart M. Demarkschalk MD , Courtney M. Hrdlicka MD , Deena M. Nasr DO , Felix E. Chukwudelunzu MD , Charisse A. Nord MA , Emily A. Pahl BA , Claire Fernandez PhD , Sam Wood , Zoe VJ. Woodhead PhD , Davide Carone MD, DPhil , George Harston MBBS, Dphil , Stephen W. English MD, MBA","doi":"10.1016/j.mayocpiqo.2025.100631","DOIUrl":"10.1016/j.mayocpiqo.2025.100631","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the real-world impact of artificial intelligence-driven decision support imaging software for patients with acute ischemic stroke in a mature telestroke network in the United States.</div></div><div><h3>Patients and Methods</h3><div>We conducted a prospective evaluation of stroke imaging support software in a robust, predominantly rural telestroke network (17 sites in Minnesota and Wisconsin). Data was collected from all patients who underwent video telestroke evaluation in a 3-month preimplementation period before installation of the software (from February 10, 2024 to May 9, 2024) and a 3-month postimplementation period while the software was in use (from May 10, 2024 to August 9, 2024). The preimplementation and postimplementation cohorts were directly compared (no control group included). Primary outcome measures were treatment rates and time to treatment (both treatment decision and delivery) for intravenous thrombolysis (IVT) and endovascular therapy (EVT); secondary outcomes included transfer rates, transfer times, and end user survey results.</div></div><div><h3>Results</h3><div>Total of 444 telestroke cases were included in the preimplementation period, and 463 in the postimplementation period. Comparing preimplementation and postimplementation periods, the rate of IVT treatment delivery rose from 26.6% to 35.0% of potentially eligible patients (<em>P</em>=.24), whereas EVT treatment delivery remained at 31%. Time to IVT delivery reduced from 47 minutes to 41 minutes (<em>P</em>=.772), and time to EVT treatment rose from 156 minutes to 157 minutes (<em>P</em>=.771). Overall rates of treatment (IVT or EVT) rose from 23.1% to 23.9% of potentially eligible patients (<em>P</em>=.944). Although none of the clinical outcomes reached statistical significance, the survey results reported good user satisfaction with algorithm performance and image viewing.</div></div><div><h3>Conclusion</h3><div>This study reported a nonsignificant increase in treatment rates and a decrease in time to treatment decisions. Future trials with larger sample sizes are needed to validate the real-world benefits of decision support software for acute ischemic stroke in an established telestroke network.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100631"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169601","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 : 2025-05-30DOI: 10.1016/j.mayocpiqo.2025.100629
Musab S. Hommos MBBS , Praneetha Elugunti MHA, MBA , Amanda M. Pullee DNP , Clay W. Walker PA-C , Karen S. Drechsel DNP , Stephanie R. Pinello MSN , Andrea Fillers MSN , Nandita Khera MD, MPH , Margaret M. Paul PhD, MS
Objective
To describe the development and deployment of a remote patient monitoring (RPM) program for hypertension and to share outcomes from an initial cohort of patients enrolled in this program.
Patients and Methods
The development of an RPM program for hypertension is described in detail. A sample of patients who were enrolled in RPM, participated for at least 2 weeks, and completed the program from January 1, 2023, to December 31, 2023, were included in the analysis. Clinical data were summarized using descriptive statistics. For comparing continuous variables, the independent samples t test was employed. For analyzing relationships between categorical variables, the χ2 test was utilized.
Results
Total of 101 patients met the inclusion criteria. The median age was 69 years with a range from 22 to 95 years; 51 (51%) were men, 93 (92%) were White, and 6 (6%) identified as Hispanic. The median length of participation in the program was 38 days, with a range from 18 to 160 days. The average blood pressure decreased during program enrollment from 153/84 to 126/75 mm Hg (P<.001), whereas heart rate decreased from 73 to 70 bpm (P=.03). On average, the number of antihypertensive drugs increased from 2.06 to 2.3 (P=.02). On average, clinicians received 1.1 messages per week per enrolled patient in RPM.
Conclusion
Developing and implementing an RPM program for hypertension is feasible with adequate resources, planning, and piloting. These programs are associated with clinically significant improvements in blood pressure control for patients with hypertension without considerably increasing calls and messages from patients beyond routine care.
{"title":"Developing and Deploying a Hypertension Remote Patient Monitoring Program 101","authors":"Musab S. Hommos MBBS , Praneetha Elugunti MHA, MBA , Amanda M. Pullee DNP , Clay W. Walker PA-C , Karen S. Drechsel DNP , Stephanie R. Pinello MSN , Andrea Fillers MSN , Nandita Khera MD, MPH , Margaret M. Paul PhD, MS","doi":"10.1016/j.mayocpiqo.2025.100629","DOIUrl":"10.1016/j.mayocpiqo.2025.100629","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the development and deployment of a remote patient monitoring (RPM) program for hypertension and to share outcomes from an initial cohort of patients enrolled in this program.</div></div><div><h3>Patients and Methods</h3><div>The development of an RPM program for hypertension is described in detail. A sample of patients who were enrolled in RPM, participated for at least 2 weeks, and completed the program from January 1, 2023, to December 31, 2023, were included in the analysis. Clinical data were summarized using descriptive statistics. For comparing continuous variables, the independent samples <em>t</em> test was employed. For analyzing relationships between categorical variables, the χ<sup>2</sup> test was utilized.</div></div><div><h3>Results</h3><div>Total of 101 patients met the inclusion criteria. The median age was 69 years with a range from 22 to 95 years; 51 (51%) were men, 93 (92%) were White, and 6 (6%) identified as Hispanic. The median length of participation in the program was 38 days, with a range from 18 to 160 days. The average blood pressure decreased during program enrollment from 153/84 to 126/75 mm Hg (<em>P</em><.001), whereas heart rate decreased from 73 to 70 bpm (<em>P</em>=.03). On average, the number of antihypertensive drugs increased from 2.06 to 2.3 (<em>P</em>=.02). On average, clinicians received 1.1 messages per week per enrolled patient in RPM.</div></div><div><h3>Conclusion</h3><div>Developing and implementing an RPM program for hypertension is feasible with adequate resources, planning, and piloting. These programs are associated with clinically significant improvements in blood pressure control for patients with hypertension without considerably increasing calls and messages from patients beyond routine care.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100629"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169602","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 : 2025-05-27DOI: 10.1016/j.mayocpiqo.2025.100625
Madison Milne-Ives PhD , Sophie R. Homer PhD , Jackie Andrade PhD , Edward Meinert PhD
Objective
To map the associations between affective, cognitive, and behavioral components of engagement with digital health interventions to provide a framework to improve intervention design, evaluation, and impact.
Patients and Methods
An exploratory multiple case study examined 3 studies evaluating a childhood obesity mobile application (NoObesity, data collection: from September 15, 2020 to June 23, 2021), a mental health conversational agent mobile application (Wysa, data collection: from December 13, 2022 to July 31, 2023), and a telephone-delivered conversational agent postsurgical assessment (Dora R1, data collection: from September 17, 2021 to January 31, 2022). Qualitative data from semi-structured interviews (NoObesity: n=15, Wysa: n=4, and Dora R1: n=20) was analyzed using a codebook thematic analysis approach to generate models mapping engagement. A cross-case analysis compared the 3 models with a hypothesized model.
Results
The case studies highlighted close associations between affective, cognitive, and behavioral components throughout the engagement process. Similar patterns of engagement were generated from the case studies, but these patterns differed from the literature-based hypothesized model in the order of influence of cognitive and affective engagement.
Conclusion
Understanding how different components of engagement interact is essential for designing interventions that mitigate barriers to engagement and maximize intervention impact. The framework provides a preliminary guide and recommendations for how to support particular components. Future research on the order of cognitive and affective components (or importance thereof) and testing the influence of particular features on engagement components could improve the framework and clinical impact.
Trial Registration
clinicaltrials.gov Identifier: NoObesity: NCT05261555; Wysa: NCT05533190; Dora R1: NCT05213390
{"title":"Mapping the Process of Engagement With Digital Health Interventions: A Cross-Case Synthesis","authors":"Madison Milne-Ives PhD , Sophie R. Homer PhD , Jackie Andrade PhD , Edward Meinert PhD","doi":"10.1016/j.mayocpiqo.2025.100625","DOIUrl":"10.1016/j.mayocpiqo.2025.100625","url":null,"abstract":"<div><h3>Objective</h3><div>To map the associations between affective, cognitive, and behavioral components of engagement with digital health interventions to provide a framework to improve intervention design, evaluation, and impact.</div></div><div><h3>Patients and Methods</h3><div>An exploratory multiple case study examined 3 studies evaluating a childhood obesity mobile application (NoObesity, data collection: from September 15, 2020 to June 23, 2021), a mental health conversational agent mobile application (Wysa, data collection: from December 13, 2022 to July 31, 2023), and a telephone-delivered conversational agent postsurgical assessment (Dora R1, data collection: from September 17, 2021 to January 31, 2022). Qualitative data from semi-structured interviews (NoObesity: n=15, Wysa: n=4, and Dora R1: n=20) was analyzed using a codebook thematic analysis approach to generate models mapping engagement. A cross-case analysis compared the 3 models with a hypothesized model.</div></div><div><h3>Results</h3><div>The case studies highlighted close associations between affective, cognitive, and behavioral components throughout the engagement process. Similar patterns of engagement were generated from the case studies, but these patterns differed from the literature-based hypothesized model in the order of influence of cognitive and affective engagement.</div></div><div><h3>Conclusion</h3><div>Understanding how different components of engagement interact is essential for designing interventions that mitigate barriers to engagement and maximize intervention impact. The framework provides a preliminary guide and recommendations for how to support particular components. Future research on the order of cognitive and affective components (or importance thereof) and testing the influence of particular features on engagement components could improve the framework and clinical impact.</div></div><div><h3>Trial Registration</h3><div><span><span>clinicaltrials.gov</span><svg><path></path></svg></span> Identifier: NoObesity: <span><span>NCT05261555</span><svg><path></path></svg></span>; Wysa: <span><span>NCT05533190</span><svg><path></path></svg></span>; Dora R1: <span><span>NCT05213390</span><svg><path></path></svg></span></div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 3","pages":"Article 100625"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144154895","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 : 2025-05-22DOI: 10.1016/j.mayocpiqo.2025.100627
Julia Moore Vogel PhD , Ting-Yang Hung BS , Erin Coughlin BS , Felipe Delgado BS , Vik Kheterpal MD , Giorgio Quer PhD , Eric Topol MD
Objective
To evaluate whether access to at-home COVID-19 tests, telemedicine, and same-day prescription delivery could reduce COVID cases, hospitalizations, and the cost of COVID care for the high-risk populations using a randomized controlled trial.
Patients and Methods
Individuals participated remotely between December 1, 2022, and May 16, 2024, with half (n=346, 51.5%) receiving the option to access 10 at-home COVID-19 tests per month for themselves and others in their household as well as telemedicine and same-day Paxlovid delivery, and half (n=325, 48.4%) following their standard testing and treatment practices. Outcome data were collected from surveys, electronic health records and claims.
Results
Intensive care unit admissions were significantly reduced for intervention participants vs control participants (0.3% vs 4.6%, n=1 vs 13; P<.001). Reported COVID case incidence did not differ significantly (19.0% vs 20.4%, n=59 vs 58; P=.69), nor did hospitalizations (5.2% vs 7.7%, n=15 vs 22; P=.14). The intervention was estimated to result in a reduction of $3650 in the cost of COVID care per person. The specific intervention used is no longer available in the market and alternatives should be considered. Evolution of SARS-CoV-2 could change the effect observed. Survey completion was higher in the intervention group.
Conclusion
In immunocompromised individuals and those at least aged 65 years, access to at-home COVID tests, telemedicine, and rapid Paxlovid delivery reduced the severity of COVID-19 infections, as reflected by a reduced need for intensive care unit admissions; this has the potential to reduce the cost of COVID care.
Trial Registration
clinicaltrials.gov Identifier: NCT05655546
目的通过一项随机对照试验，评估家庭COVID-19检测、远程医疗和当日处方递送是否可以减少高危人群的COVID-19病例、住院率和COVID-19护理成本。患者和方法个人在2022年12月1日至2024年5月16日期间远程参与，其中一半（n=346, 51.5%）选择每月为自己和家人进行10次家庭COVID-19检测，以及远程医疗和当日Paxlovid分娩，另一半（n=325, 48.4%）遵循标准检测和治疗实践。结果数据从调查、电子健康记录和索赔中收集。结果干预组与对照组相比，重症监护病房入院率显著降低(0.3% vs 4.6%, n=1 vs 13；术;措施)。报告的COVID病例发病率无显著差异(19.0% vs 20.4%, n=59 vs 58；P= 0.69)，住院率也没有差异(5.2% vs 7.7%, n=15 vs 22；P = .14点)。据估计，这一干预措施使人均COVID护理费用减少了3650美元。所使用的具体干预措施在市场上已不存在，应考虑其他替代措施。SARS-CoV-2的进化可能会改变观察到的效果。干预组的调查完成率更高。在免疫功能低下的个体和65岁以上的人群中，获得家庭COVID检测、远程医疗和快速Paxlovid递送可降低COVID感染的严重程度，这反映在重症监护病房入院需求的减少上；这有可能降低COVID护理成本。临床试验注册。gov标识符：NCT05655546
{"title":"A Randomized Trial of At-Home COVID-19 Tests, Telemedicine, and Rapid Prescription Delivery for Immunocompromised Individuals","authors":"Julia Moore Vogel PhD , Ting-Yang Hung BS , Erin Coughlin BS , Felipe Delgado BS , Vik Kheterpal MD , Giorgio Quer PhD , Eric Topol MD","doi":"10.1016/j.mayocpiqo.2025.100627","DOIUrl":"10.1016/j.mayocpiqo.2025.100627","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether access to at-home COVID-19 tests, telemedicine, and same-day prescription delivery could reduce COVID cases, hospitalizations, and the cost of COVID care for the high-risk populations using a randomized controlled trial.</div></div><div><h3>Patients and Methods</h3><div>Individuals participated remotely between December 1, 2022, and May 16, 2024, with half (n=346, 51.5%) receiving the option to access 10 at-home COVID-19 tests per month for themselves and others in their household as well as telemedicine and same-day Paxlovid delivery, and half (n=325, 48.4%) following their standard testing and treatment practices. Outcome data were collected from surveys, electronic health records and claims.</div></div><div><h3>Results</h3><div>Intensive care unit admissions were significantly reduced for intervention participants vs control participants (0.3% vs 4.6%, n=1 vs 13; <em>P</em><.001). Reported COVID case incidence did not differ significantly (19.0% vs 20.4%, n=59 vs 58; <em>P</em>=.69), nor did hospitalizations (5.2% vs 7.7%, n=15 vs 22; <em>P</em>=.14). The intervention was estimated to result in a reduction of $3650 in the cost of COVID care per person. The specific intervention used is no longer available in the market and alternatives should be considered. Evolution of SARS-CoV-2 could change the effect observed. Survey completion was higher in the intervention group.</div></div><div><h3>Conclusion</h3><div>In immunocompromised individuals and those at least aged 65 years, access to at-home COVID tests, telemedicine, and rapid Paxlovid delivery reduced the severity of COVID-19 infections, as reflected by a reduced need for intensive care unit admissions; this has the potential to reduce the cost of COVID care.</div></div><div><h3>Trial Registration</h3><div><span><span>clinicaltrials.gov</span><svg><path></path></svg></span> Identifier: <span><span>NCT05655546</span><svg><path></path></svg></span></div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 3","pages":"Article 100627"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114829","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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