Mayo Clinic proceedings. Innovations, quality & outcomes最新文献_第7页

A Systematic Review of Length of Stay Linked to Hospital-Acquired Falls, Pressure Ulcers, Central Line–Associated Bloodstream Infections, and Surgical Site Infections 住院时间与医院获得性跌倒、压疮、中央静脉相关血流感染和手术部位感染相关的系统回顾

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-04-08 DOI: 10.1016/j.mayocpiqo.2025.100607

Bashar Hasan MD , Dima Bechenati MD , Hannah M. Bethel , Sydney Cho , Noora S. Rajjoub , Sammy T. Murad , Adel Kabbara Allababidi MD , Tamim I. Rajjo MD, MPH , Mohammed Yousufuddin MD

Objective

To systematically review hospital length of stay (LOS) associated with falls, pressure ulcers, central line–associated bloodstream infections, and surgical site infections and their potential differences before and after the implementation of the hospital-acquired condition (HAC) reduction program (HACRP).

Methods

We searched PubMed, Embase, and Cochrane databases from January 1, 2000, to May 26, 2024, for studies examining LOS and health care costs in patients with any of the 4 HACs. Studies included prospective and retrospective cohorts and case-control designs across various clinical settings.

Results

Fifty studies involving 45,080,370 patients admitted for medical and surgical conditions met the inclusion criteria, with 1,939,151 patients experiencing 1 or more HACs. Length of stay increased by an average of 5.2 days for falls, 12.9 days for pressure ulcers, 22.1 days for central line–associated bloodstream infections, and 7.9 days for surgical site infections. After HACRP implementation, LOS for falls increased by 4.9 days, whereas LOS for pressure ulcers decreased by 39.1 days.

Conclusion

This systematic review presents detailed data on excess LOS for 4 selected HACs across medical, surgical, intensive care unit, and rehabilitation settings over the past 25 years. The varying impact of HACRP on different HACs highlights the need for targeted prevention strategies.

目的系统评价医院获得性疾病（HAC）减少计划（HACRP）实施前后与跌倒、压疮、中央静脉相关血流感染和手术部位感染相关的住院时间（LOS）及其潜在差异。方法：检索PubMed、Embase和Cochrane数据库，检索2000年1月1日至2024年5月26日4种HACs患者的LOS和医疗费用的相关研究。研究包括前瞻性和回顾性队列，以及不同临床环境下的病例对照设计。结果50项研究纳入45,080,370例因内科和外科条件入院的患者，其中1,939,151例患者经历1次或1次以上HACs。住院时间因跌倒平均增加5.2天，因压疮平均增加12.9天，因中心线相关血流感染平均增加22.1天，因手术部位感染平均增加7.9天。实施HACRP后，跌倒的LOS增加了4.9天，而压疮的LOS减少了39.1天。本系统综述提供了过去25年来医疗、外科、重症监护病房和康复机构中4个选定HACs的过量LOS的详细数据。HACRP对不同HACs的不同影响突出了有针对性的预防战略的必要性。

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引用次数: 0

Assessing the Impact of Post-COVID Clinics on 6-Month Health Care Utilization for Patients With Long COVID: A Single-Center Experience 评估COVID后诊所对长COVID患者6个月医疗保健利用的影响：单中心体验

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-04-05 DOI: 10.1016/j.mayocpiqo.2025.100603

Kirby D. Gong MSE , Ali S. Afshar PhD , Fred Brown MBA , Reza Alavi MD, MBA , Ravindra Ganesh MBBS, MD , Hadi Kharrazi MD, PhD

Objective

To assess the impact of post-COVID clinics by examining the association between their early usage and downstream health care utilization.

Patients and Methods

In a case-control study spanning data from March 11, 2020 to June 1, 2023, patients with Long COVID were identified from a major health system using diagnosis codes. The Fast, Large-Scale Almost Matching Exactly algorithm was used to match patients who presented early to post-COVID clinics with patients with Long COVID who did not attend such clinics. Matching was performed on demographic characteristics, acute COVID severity, comorbidities, diagnosis date, and vaccination, to reduce confounders for the comparison of the health care utilization and mortality between cohorts.

Results

When exactly matching on all 46 features, the algorithm yielded 2814 matched patients, of whom 692 (24.6%; 66.6% females; mean [SD] age, 48.8 [14.5] years) were seen in post-COVID clinics within the first 6 months and 2122 (75.4%; 64.1% females; mean [SD] age, 49.7 [15.2] years) who were not. The average treatment effect (95% CI) of early post-COVID clinic usage was −0.60 (−0.83 to −0.39) on inpatient visits, −0.19 (−0.26 to −0.11) on emergency department visits, 7.62 (6.96-8.56) on outpatient visits, −$3467 (−$6267 to −$754) on estimated costs, and −0.006 (−0.010 to −0.003) on mortality.

Conclusion

Early usage of post-COVID clinics by patients with Long COVID is associated with not only fewer downstream inpatient stays, emergency department visits, estimated costs, and reduced mortality within the first 6 months but also greater outpatient utilization. Results suggest early post-COVID clinic involvement shifts care to outpatient settings, potentially reducing costs and mortality.

目的通过研究新冠肺炎疫情后诊所早期使用新冠病毒与下游医疗保健服务利用的关系，评估新冠肺炎疫情后诊所的影响。在一项涵盖2020年3月11日至2023年6月1日数据的病例对照研究中，使用诊断代码从一个主要卫生系统中识别出Long COVID患者。使用快速，大规模几乎完全匹配算法将早期到COVID后诊所就诊的患者与未到此类诊所就诊的长COVID患者进行匹配。对人口统计学特征、急性COVID严重程度、合并症、诊断日期和疫苗接种进行匹配，以减少队列间卫生保健利用和死亡率比较的混杂因素。结果在46个特征完全匹配的情况下，算法得到2814例匹配患者，其中692例(24.6%；66.6%的女性;平均[SD]年龄48.8[14.5]岁)，前6个月内出现在covid后诊所的2122例(75.4%；64.1%的女性;平均[SD]年龄，49.7[15.2]岁)。covid后早期临床使用的平均治疗效果（95% CI）在住院就诊时为- 0.60(- 0.83至- 0.39)，在急诊科就诊时为- 0.19(- 0.26至- 0.11)，门诊就诊时为7.62(6.96至8.56)，估计成本为- 3467美元（- 6267至- 754美元），死亡率为- 0.006（- 0.010至- 0.003）。结论长冠肺炎患者早期就诊不仅可减少下游住院时间、急诊科就诊次数、减少预估费用、降低前6个月死亡率，而且可提高门诊使用率。结果表明，covid - 19后早期临床参与将护理转移到门诊环境，可能降低成本和死亡率。

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引用次数: 0

Presenting Symptoms and Delayed Diagnosis of Ehrlichiosis 埃利希体病的症状和延迟诊断

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-04-04 DOI: 10.1016/j.mayocpiqo.2025.100608

Aleksandra Murawska Baptista MD , Alicja Kaminska MD , Marko Gorasevic MD , Salvador Alvarez MD , Karthik Gnanapandithan MBBS, MD , Tatjana Gavrancic MD , Michael Smerina MD , Adrian G. Dumitrascu MD , Melissa P. Cortes MD , Ricardo J. Pagan MD , Abhinav Singla MD

Objective

To describe the presenting symptoms, outcomes, and time to diagnosis of ehrlichiosis cases treated at Mayo Clinic, Jacksonville, Florida.

Patients and Methods

We conducted a retrospective analysis of all patients with ehrlichiosis who were treated at Mayo Clinic in Florida from January 1, 2018, to November 1, 2021. Ehrlichiosis was diagnosed via positive serologic or polymerase chain reaction tests. Abstracted variables included patient demographic characteristics, presenting symptoms, outcomes, and time to diagnosis.

Results

Out of 67 patients with ehrlichiosis who were treated at our institution during the study period, 22 were included in our analysis. These patients had diverse presenting symptoms; fever and malaise were common, and severe cases included altered mental status and septic shock. Laboratory test findings included thrombocytopenia, as well as elevated liver enzyme levels and abnormal kidney function. The time to diagnosis varied among the cases studied, with a median time from admission to diagnosis of 4 days.

Conclusion

Prompt treatment with doxycycline was effective, but delayed diagnosis remains a challenge. Our findings underscore the importance of considering ehrlichiosis in differential diagnoses, especially in endemic areas, and emphasize the need for early intervention to prevent severe outcomes.

目的描述在佛罗里达州杰克逊维尔梅奥诊所治疗的埃利希体病病例的表现、结果和诊断时间。患者和方法我们对2018年1月1日至2021年11月1日在佛罗里达州梅奥诊所接受治疗的所有埃利希体病患者进行了回顾性分析。通过血清学或聚合酶链反应试验阳性诊断埃利希体病。抽象变量包括患者人口统计学特征、表现症状、结果和诊断时间。结果研究期间在我院治疗的67例埃利希体病患者中，有22例纳入我们的分析。这些患者有不同的表现症状；常见发热和不适，严重者包括精神状态改变和感染性休克。实验室检查结果包括血小板减少症、肝酶水平升高和肾功能异常。所研究病例的诊断时间各不相同，从入院到诊断的中位时间为4天。结论及时应用强力霉素治疗是有效的，但延迟诊断仍是一个挑战。我们的研究结果强调了在鉴别诊断中考虑埃利希体病的重要性，特别是在流行地区，并强调了早期干预以防止严重后果的必要性。

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引用次数: 0

From Waiting Rooms to Recliners: Smart Heart Rhythm Monitoring in the Home 从候诊室到躺椅：家庭中的智能心律监测

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-04-01 DOI: 10.1016/j.mayocpiqo.2025.100606

Samual Turnbull BSc, Saurabh Kumar BSc(Med)/MBBS, PhD

引用次数: 0

Differential Sources of Distress in Clinical and Research Trainees: A Focus on Work and Role Relationships 临床和研究实习生痛苦的不同来源：工作和角色关系的焦点

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-03-19 DOI: 10.1016/j.mayocpiqo.2025.100601

Laurence M. Boitet PhD , David A. Rogers MD, MHPE , Katherine L. Sweeney MA , Mark C. Schall Jr. PhD , C. Allen Gorman PhD , Bobby Jones PhD

Objective

To examine the experience of clinical and research trainees within an academic medical center setting to identify and compare factors influencing their wellbeing.

Participants and Methods

A cross-sectional, anonymous survey was conducted from June to July 2022 at a large academic medical center. Responses from clinical and research trainees were analyzed for this study. The survey assessed participant wellbeing using the Well-Being Index (WBI), in addition to perceptions of individual and organizational factors. Data were analyzed to identify correlates of elevated WBI scores and differences in clinical and research experience.

Results

Ordinal logistic regression analysis identified low sense of recognition (odds ratio [OR], 0.59; 95% CI, 0.44-0.79), low role clarity (OR, 0.58; 95% CI, 0.42-0.80), moral distress (OR, 1.61; 95% CI, 1.24-2.10), and social isolation or loneliness (OR, 2.79; 95% CI 1.69-4.61) as significantly associated with high WBI scores, accounting for 48.8% of predicted variance. Additionally, distressed clinical trainees (WBI≥2) reported lower control over their work (P<.001) and significantly higher perceived stress from heavy workload (P<.05) and long hours (P<.01), compared with distressed research trainees. Distressed research trainees reported lower levels of trust in their supervisor (P<0.01), lower perceived organizational support (P<.05), and lower role clarity (P<.05), compared with distressed medical trainees. Low recognition, moral distress, and perceived stress from social isolation and loneliness were experienced similarly between groups.

Conclusion

Our study indicates that trainees experience high levels of distress, although the sources differ. To effectively address these challenges, organizations should implement interventions targeted to address specific stressors of each group.

目的探讨学术医疗中心的临床和研究实习生的经历，以确定和比较影响他们幸福感的因素。参与者和方法：一项横断面匿名调查于2022年6月至7月在一家大型学术医疗中心进行。本研究分析了临床和研究学员的反应。除了对个人和组织因素的看法外，该调查还使用幸福感指数（WBI）评估了参与者的幸福感。对数据进行分析，以确定WBI评分升高与临床和研究经验差异的相关性。结果随机logistic回归分析发现识别感低(优势比[OR]， 0.59；95% CI, 0.44-0.79)，角色清晰度低(OR, 0.58；95% CI, 0.42-0.80)，道德困扰(OR, 1.61；95% CI, 1.24-2.10)和社会隔离或孤独(or, 2.79；95% CI 1.69-4.61)与高WBI评分显著相关，占预测方差的48.8%。此外，与痛苦的研究实习生相比，痛苦的临床实习生（WBI≥2）报告对工作的控制较低（P<.001），并且显著高于繁重工作（P<.05）和长时间工作（P<.01）的感知压力。与焦虑的医学实习生相比，焦虑的研究实习生对上级的信任水平较低（P<0.01），感知到的组织支持水平较低（P< 0.05），角色清晰度较低（P< 0.05）。低认知度、道德困境以及来自社会孤立和孤独的感知压力在群体之间也有类似的经历。结论我们的研究表明，受训者经历了高水平的痛苦，尽管来源不同。为了有效地应对这些挑战，组织应该实施针对每个群体特定压力源的干预措施。

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引用次数: 0

A Prospective Randomized Dose-Finding Study of Intrathecal Opioids for Postoperative Analgesia After Minimally Invasive Colorectal Operation 微创结直肠手术后鞘内阿片类药物用于术后镇痛的前瞻性随机剂量研究

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-03-03 DOI: 10.1016/j.mayocpiqo.2025.100600

Patrice A. Vinsard MD , Josef Pleticha MD , Emily E. Sharpe MD , Jason K. Panchamia DO , David A. Olsen MD , Hans P. Sviggum MD , Sherief F. Shawki MB, MD , Kevin T. Behm MD , David W. Larson MD, MBA , Allison M. LeMahieu MS , Adam D. Niesen MD , Adam W. Amundson MD

Objective

To determine the optimal dose of intrathecal morphine and hydromorphone in patients undergoing minimally invasive colorectal operation for postoperative analgesia.

Patients and Methods

The study was a double-blinded clinical dosing trial that randomized patients to intrathecal morphine or hydromorphone from March 12, 2021, to February 17, 2023. Intrathecal dosing was determined by a sequential up-down method using a biased-coin design. Doses of the subsequent patients were stepped up or down based on the success or failure of the previous dose. The primary outcome was the dose effective in 90% of patients (ED₉₀) to achieve numeric rating pain scores ≤4 with postoperative opioid requirements ≤15 oral morphine equivalent at 12 hours.

Results

Eighty patients completed the study with 40 patients in each group. The ED₉₀ for intrathecal morphine and hydromorphone could not be determined for the examined dose ranges. The ED₅₀ for morphine was 100 mcg and for hydromorphone was 75 mcg. Morphine median (interquartile range [IQR]) numeric rating scale scores was 3.0 (1.5-4.5) at 12 hours and 3.0 (2.0-4.0) at 24 hours, whereas hydromorphone median (IQR) numeric rating scale were 3.0 (1.5-5.0) at 12 hours and 3.0 (2.0-5.0) at 24 hours. As the dosage of hydromorphone increased, moderate to severe pruritus increased (P=.009).

Conclusion

The study could not establish an ED₉₀ for IT dosing for minimally invasive colorectal surgical patients. However, we did determine the ED₅₀ for both agents. No serious adverse events were observed throughout the study duration.

Trial Registration

clinicaltrials.gov Identifier: NCT04752033

目的探讨结肠直肠癌微创手术患者鞘内注射吗啡和氢吗啡酮用于术后镇痛的最佳剂量。患者和方法该研究是一项双盲临床给药试验，在2021年3月12日至2023年2月17日期间，将患者随机分配给鞘内吗啡或氢吗啡酮。鞘内给药采用顺序上下法，采用偏置硬币设计。后续患者的剂量根据前一次剂量的成功或失败而增加或减少。主要终点是90%患者的剂量有效（ED90）达到数值分级疼痛评分≤4，术后12小时阿片类药物需要量≤15口服吗啡当量。结果80例患者完成研究，每组40例。鞘内吗啡和氢吗啡酮的ED90在检查剂量范围内无法测定。吗啡的ED50为100微克，氢吗啡酮为75微克。吗啡数值评定量表得分中位数（四分位间距[IQR]）在12小时为3.0(1.5-4.5)，24小时为3.0(2.0-4.0)，氢吗啡酮数值评定量表得分中位数（IQR）在12小时为3.0(1.5-5.0)，24小时为3.0（2.0-5.0）。随着氢吗啡酮用量的增加，中、重度瘙痒症状增加（P= 0.009）。结论本研究无法建立微创结直肠手术患者IT给药的ED90。然而，我们确实确定了两种药物的ED50。在整个研究期间未观察到严重的不良事件。临床试验注册。gov标识符：NCT04752033

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引用次数: 0

A Pilot Study of the Home-Based 12-Lead Electrocardiogram in Clinical Practice 家庭12导联心电图在临床应用中的初步研究

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-02-26 DOI: 10.1016/j.mayocpiqo.2025.100598

Levi W. Disrud CCRC, CRAT, CCT , William H. Swain MD , Halley Davison MBA/HCM , Tara Gosse MS, FACHE , Manfred M. Kubler MD , David M. Harmon MD , Paul A. Friedman MD , Peter A. Noseworthy MD , Anthony H. Kashou MD

Telehealth consultation with a physician can be an attractive option for eligible patients. In this pilot study, we evaluate the feasibility and efficiency of an FDA approved 12-lead electrocardiogram (ECG) device, Smeartheart, that can be used remotely in the patients’ home before telehealth appointments with a cardiac electrophysiologist. We scheduled a phone call with 10 patients who used this device as part of their care. Eight patients were able to obtain a diagnostic quality ECG. Telephone call appointments with ECG technicians took a median of 51 minutes, and it took patients an average of 2.2 attempts to record a usable ECG. We also identified barriers to the use of the Smartheart device, including internet accessibility, training material, patient functional status, and motion artifact that may inform more widespread study and utilization of remote-recorded 12-lead ECGs. We conclude that the Smartheart device may have clinical use with remote use in routine clinical care, although the best use of this technology requires further study.

对符合条件的患者来说，与医生进行远程医疗咨询是一个有吸引力的选择。在这项试点研究中，我们评估了FDA批准的12导联心电图（ECG）设备smearheart的可行性和效率，该设备可以在与心脏电生理学家进行远程医疗预约之前在患者家中远程使用。我们安排了一次电话会议，邀请了10位在治疗过程中使用这种设备的患者。8例患者能够获得诊断质量的心电图。与心电图技术人员的电话预约平均需要51分钟，患者平均需要尝试2.2次才能记录可用的心电图。我们还确定了使用Smartheart设备的障碍，包括互联网可及性、培训材料、患者功能状态和运动假影，这些障碍可能会为远程记录的12导联心电图的更广泛研究和利用提供信息。我们的结论是，尽管这项技术的最佳使用需要进一步研究，但智能心脏设备可以在临床和常规临床护理中远程使用。

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引用次数: 0

Follow-up Colorectal Cancer Screening After Negative-Result and Positive-Result Multitarget Stool DNA Tests: A Population-Based Study in Southeast Minnesota 多靶点粪便DNA检测阴性和阳性结果后的结肠直肠癌随访筛查：明尼苏达州东南部一项基于人群的研究

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-02-26 DOI: 10.1016/j.mayocpiqo.2025.100599

Alanna M. Chamberlain PhD, MPH , Derek W. Ebner MD , Gregory D. Jenkins MS , Mallik Greene PhD , Lila J. Finney Rutten PhD, MPH

Objective

To provide contemporary data on subsequent screening after negative-result multitarget stool DNA (mt-sDNA) tests and follow-up colonoscopy after positive-result mt-sDNA tests.

Patients and Methods

Negative-result mt-sDNA tests (for patients aged 50-72 years) and positive-result mt-sDNA tests (for patients aged 50-75 years) were identified among average risk patients from a 9-county region in Southeast Minnesota from January 1, 2016 to December 31, 2022. Competing risks models of time to subsequent colorectal cancer (CRC) screening were modeled separately for the negative mt-sDNA and positive mt-sDNA cohorts. Multistate Cox proportional hazards models compared rates of CRC screening modality by patient demographic characteristics.

Results

At 3.5 years after a negative-result mt-sDNA test (n=18,739 tests), 55.0% (95% CI, 53.9%-56.3%) of patients were rescreened, which increased to 81.0% (95% CI, 80.0%-82.1%) at 5 years. Most tests were repeat mt-sDNA tests (48.3% at 3.5 years; 95% CI, 47.2%-49.5%). Rescreening with any modality was more likely with older age and among females and less likely among Black persons, Asian persons, and those with other or mixed race. After a positive-result mt-sDNA test (n=2863 tests), 80.9% (95% CI, 79.6%-82.6%) and 84.4% (95% CI, 83.2%-86.0%) of patients completed follow-up colonoscopy by 6 months and 1 year, respectively. Those of other or mixed race had lower rates of follow-up colonoscopy compared with White persons.

Conclusion

Although rates of overall rescreening after a negative-result mt-sDNA test and follow-up colonoscopy after positive-result mt-sDNA tests were high, racial disparities were apparent. Targeted interventions are needed to improve equity in CRC screening adherence and follow-up care across diverse patient populations.

目的为多靶点粪便DNA （mt-sDNA）检测阴性后的后续筛查和mt-sDNA检测阳性后的后续结肠镜检查提供当代资料。患者和方法在2016年1月1日至2022年12月31日期间，对明尼苏达州东南部9个县的平均风险患者进行mt-sDNA检测阴性结果（50-72岁患者）和mt-sDNA检测阳性结果（50-75岁患者）。对mt-sDNA阴性组和mt-sDNA阳性组分别建立到后续结直肠癌（CRC）筛查的时间竞争风险模型。多状态Cox比例风险模型根据患者人口学特征比较CRC筛查方式的比率。结果在mt-sDNA检测为阴性（n=18,739例）后3.5年，55.0% （95% CI, 53.9% ~ 56.3%）的患者进行了重新筛查，5年增加到81.0% （95% CI, 80.0% ~ 82.1%）。大多数检测为重复mt-sDNA检测(3.5岁时48.3%；95% ci, 47.2%-49.5%)。以任何方式进行重新筛查的可能性在老年人和女性中较高，而在黑人、亚洲人、其他种族或混合种族中较低。mt-sDNA检测阳性（n=2863例）后，80.9% （95% CI, 79.6%-82.6%）和84.4% （95% CI, 83.2%-86.0%）的患者分别完成了随访6个月和1年的结肠镜检查。与白人相比，其他种族或混血儿的结肠镜随访率较低。结论：虽然mt-sDNA检测阴性后的总体再筛查率和mt-sDNA检测阳性后的结肠镜随访率很高，但种族差异很明显。需要有针对性的干预措施来提高不同患者群体中CRC筛查依从性和随访护理的公平性。

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引用次数: 0

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-02-20 DOI: 10.1016/j.mayocpiqo.2025.100596

引用次数: 0

Medical Cannabis in the United States: Comparing 2017 and 2024 State Qualifying Conditions to the 2017 National Academies of Sciences Report 美国医用大麻：将2017年和2024年的州资格条件与2017年国家科学院报告进行比较

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-02-20 DOI: 10.1016/j.mayocpiqo.2025.100590

Elena L. Stains BS , Amy L. Kennalley MBS , Maria Tian MBS , Kevin F. Boehnke PhD , Chadd K. Kraus DO, MPH , Brian J. Piper PhD

Objective

To compare the 2017 National Academies of Sciences, Engineering, and Medicine cannabis report to state medical cannabis (MC) laws defining approved qualifying conditions (QC) from 2017 and 2024 and to determine the evidence level of the QCs approved in each state.

Patients and Methods

The 2017 National Academies of Sciences (NAS) report assessed therapeutic evidence for over 20 medical conditions treated with MC. We identified the QCs of 38 states (including Washington DC) where MC was legal in 2024 and compared them to the QCs listed by these states in 2017. The QCs were then categorized on the basis of NAS-established levels of evidence: limited, moderate, or substantial/conclusive evidence of effectiveness, limited evidence of ineffectiveness, or no/insufficient evidence to support or refute effectiveness. This study was completed from January 31, 2023 to June 20, 2024.

Results

Most states listed at least one QC with substantial evidence—80.0% in 2017 and 97.0% in 2024. However, in 2024 only 8.3% of the QCs on states’ QC lists met the standard of substantial/conclusive evidence. Of the 20 most popular QCs in the country in 2017 and 2024, one only (long-term pain) was categorized by the NAS as having substantial evidence for effectiveness. However, 7 were rated as either ineffective (eg, glaucoma) or insufficient evidence.

Conclusion

Most QCs lack evidence for use on the basis of the 2017 NAS report. Many states recommend QCs with little evidence (amyotrophic lateral sclerosis) or even those for which MC is ineffective (depression). These findings highlight a disparity between state-level MC recommendations and the evidence to support them.

目的比较2017年美国国家科学院、工程院和医用大麻报告与各州医用大麻（MC）法律对2017年和2024年批准的合格条件（QC）的定义，并确定各州批准的QC的证据水平。患者和方法2017年美国国家科学院（NAS）报告评估了20多种使用MC治疗的医疗条件的治疗证据。我们确定了38个州（包括华盛顿特区）的qc，其中MC在2024年是合法的，并将其与这些州在2017年列出的qc进行了比较。然后根据nas建立的证据水平对qc进行分类：有限的、中等的或实质性/结论性的有效证据，有限的无效证据，或没有/不足的证据支持或反驳有效性。本研究于2023年1月31日至2024年6月20日完成。结果大多数州至少有一个质控证据确凿，2017年为80.0%，2024年为97.0%。然而，在2024年，各州QC清单上只有8.3%的QC符合实质性/结论性证据的标准。在2017年和2024年全国最受欢迎的20种qc中，只有一种（长期疼痛）被NAS归类为具有实质性证据的有效性。然而，其中7项被评为无效（如青光眼）或证据不足。根据2017年NAS报告，大多数qc缺乏使用证据。许多州推荐缺乏证据的qc（肌萎缩性侧索硬化症），甚至是MC无效的qc（抑郁症）。这些发现突出了州一级MC建议与支持这些建议的证据之间的差距。

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引用次数: 0