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Singla A, Anstine CV, Huang L, Rosedahl JK, Mohabbat AB, Philpot LM. A Cross-Sectional Survey Study of Cannabis Use for Fibromyalgia Symptom Management. Mayo Clin Proc 2024; 99:542-550. [PMID: 38569809 DOI: 10.1016/j.mayocp.2023.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/29/2023] [Accepted: 12/26/2023] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To assess the use of cannabis as a symptom management strategy for patients with fibromyalgia. PATIENTS AND METHODS An electronic, cross-sectional survey was conducted among patients diagnosed with fibromyalgia and treated in Integrative Medicine & Health at Mayo Clinic, Rochester, Minnesota. The survey was constructed with the Symptom Management Theory tool and was sent anonymously via web-based software to patients with a diagnosis of fibromyalgia. RESULTS Of 5234 patients with fibromyalgia sent the online survey, 1336 (25.5%) responded and met the inclusion criteria. Survey respondents had a median age of 48 (Q1-Q3: 37.5-58.0) years, and most identified as female. Nearly half of respondents (49.5%, n=661) reported cannabis use since their fibromyalgia diagnosis. The most common symptoms for which respondents reported using cannabis were pain (98.9%, n=654); fatigue (96.2%; n=636); stress, anxiety, or depression (93.9%; n=621); and insomnia (93.6%; n=619). Improvement in pain symptoms with cannabis use was reported by 82.0% (n=536). Most cannabis-using respondents reported that cannabis also improved symptoms of stress, anxiety, and depression and of insomnia. CONCLUSION Considering that cannabis is a popular choice among patients for managing fibromyalgia symptoms, clinicians should have adequate knowledge of cannabis when discussing therapeutic options for fibromyalgia with their patients.
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Affiliation(s)
- Abhinav Singla
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
| | | | - Linda Huang
- Pharmacy Services, Mayo Clinic, Rochester, MN, USA
| | - Jordan K Rosedahl
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Arya B Mohabbat
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lindsey M Philpot
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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Ahmad A, Corban MT, Moriarty JP, Kanaji Y, Rosedahl JK, Gulati R, Rihal CS, Prasad A, Sara JD, Toya T, Ter Horst I, Lerman LO, Borah B, Lerman A. Coronary Reactivity Assessment Is Associated With Lower Health Care-Associated Costs in Patients Presenting With Angina and Nonobstructive Coronary Artery Disease. Circ Cardiovasc Interv 2023:e012387. [PMID: 37417227 DOI: 10.1161/circinterventions.122.012387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND The financial burden linked to the diagnosis and treatment of patients with chest pain on the health care system is considerable. Angina and nonobstructive coronary artery disease (ANOCA) is common, associated with adverse cardiovascular events, and may lead to repeat testing or hospitalizations. Diagnostic certainty can be achieved in patients with ANOCA using coronary reactivity testing (CRT); however, its financial effect on the patient has not been studied. Our goal was to assess the effect of CRT on health care-related cost in patients with ANOCA. METHODS Patients with ANOCA who underwent diagnostic coronary angiography (CAG) and CRT (CRT group) were matched to controls who had similar presentation but only underwent a CAG without CRT (CAG group). Standardized inflation-adjusted costs were collected and compared between the 2 groups on an annual basis for 2 years post the index date (CRT or CAG). RESULTS Two hundred seven CRT and 207 CAG patients were included in the study with an average age of 52.3±11.5 years and 76% females. The total cost was significantly higher in the CAG group as compared with the CRT group ($37 804 [$26 933-$48 674] versus $13 679 [$9447-$17 910]; P<0.001). When costs are itemized and divided based on the Berenson-Eggers Type of Service categorization, the largest cost difference occurred in imaging (any type, including CAG; P<0.001), procedures (eg, percutaneous coronary intervention/coronary artery bypass grafting/thrombectomy) (P=0.001), and test (eg, blood tests, EKG; P<0.001). CONCLUSIONS In this retrospective observational study, assessment of CRT in patients with ANOCA was associated with significantly reduced annual total costs and health care utilization. Therefore, the study may support the integration of CRT into clinical practice.
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Affiliation(s)
- Ali Ahmad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.A., M.T.C., Y.K., R.G., C.S.R., A.P., J.D.S., L.O.L., A.L.)
- Department of Internal Medicine, Saint Louis University School of Medicine, MO (A.A.)
| | - Michel T Corban
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.A., M.T.C., Y.K., R.G., C.S.R., A.P., J.D.S., L.O.L., A.L.)
- Division of Cardiology, Department of Medicine, University of Arizona College of Medicine, Tucson (M.T.C.)
| | - James P Moriarty
- Economic Evaluation Unit, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN (J.P.M., J.K.R., B.B.)
| | - Yoshihisa Kanaji
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.A., M.T.C., Y.K., R.G., C.S.R., A.P., J.D.S., L.O.L., A.L.)
| | - Jordan K Rosedahl
- Economic Evaluation Unit, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN (J.P.M., J.K.R., B.B.)
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.A., M.T.C., Y.K., R.G., C.S.R., A.P., J.D.S., L.O.L., A.L.)
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.A., M.T.C., Y.K., R.G., C.S.R., A.P., J.D.S., L.O.L., A.L.)
| | - Abhiram Prasad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.A., M.T.C., Y.K., R.G., C.S.R., A.P., J.D.S., L.O.L., A.L.)
| | - Jaskanwal D Sara
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.A., M.T.C., Y.K., R.G., C.S.R., A.P., J.D.S., L.O.L., A.L.)
| | - Takumi Toya
- Division of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan (T.T.)
| | - Iris Ter Horst
- Philips Medical Systems, Eindhoven, the Netherlands (I.t.H.)
| | - Lilach O Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.A., M.T.C., Y.K., R.G., C.S.R., A.P., J.D.S., L.O.L., A.L.)
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (L.O.L.)
| | - Bijan Borah
- Economic Evaluation Unit, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN (J.P.M., J.K.R., B.B.)
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN (B.B.)
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.A., M.T.C., Y.K., R.G., C.S.R., A.P., J.D.S., L.O.L., A.L.)
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Wang XJ, Ebbert JO, Loftus CG, Rosedahl JK, Philpot LM. Comorbid extra-intestinal central sensitization conditions worsen irritable bowel syndrome in primary care patients. Neurogastroenterol Motil 2023; 35:e14546. [PMID: 36807964 DOI: 10.1111/nmo.14546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 11/25/2022] [Accepted: 01/24/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is characterized as a central sensitization syndrome (CSS), a group of conditions including fibromyalgia, chronic fatigue, and restless leg syndrome (RLS) among others with frequent comorbidities of anxiety, depression, and chemical sensitivity. The prevalence of comorbid conditions and their impact on IBS symptom severity and quality of life in rural community populations has not been described. METHODS We administered a cross-sectional survey to patients with a documented CSS diagnosis in rural primary care practices to evaluate the relationship between CSS diagnoses, quality of life, symptom severity, and interactions with healthcare providers utilizing validated questionnaires. Subgroup analysis was performed on the IBS cohort. Mayo Clinic IRB approved the study. KEY RESULTS Seven hundred seventy-five individuals out of 5000 completed the survey (15.5% response rate) with 264 (34%) reporting IBS. Only 3% (n = 8) of IBS patients reported IBS alone without comorbid CSS condition. Most respondents reported overlapping migraine (196, 74%), depression (183, 69%), anxiety (171, 64%), and fibromyalgia (139, 52%). IBS patients with more than two comorbid CS condition showed significantly higher symptom severity with linear increase. Quality of life was lower in IBS with comorbid conditions, particularly in patients with IBS and RLS (mean EQ5-D 0.36 vs. 0.8 in IBS only, p < 0.01). Quality of life declined as number of comorbid conditions increased. CONCLUSIONS & INFERENCES Patients with IBS often have multiple CS disorders which increases symptom severity and lowers quality of life. Understanding the impact of multiple CSS diagnoses and treating these as a global condition may improve patient experience.
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Affiliation(s)
- Xiao Jing Wang
- Gastroenterology and Hepatology, Mayo Clinic, Minnesota, Rochester, USA
| | - Jon O Ebbert
- Community Internal Medicine, Mayo Clinic, Minnesota, Rochester, USA
| | - Connor G Loftus
- Gastroenterology and Hepatology, Mayo Clinic, Minnesota, Rochester, USA
| | - Jordan K Rosedahl
- Quantitative Health Sciences, Mayo Clinic, Minnesota, Rochester, USA
| | - Lindsey M Philpot
- Community Internal Medicine, Mayo Clinic, Minnesota, Rochester, USA
- Quantitative Health Sciences, Mayo Clinic, Minnesota, Rochester, USA
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Barwise AK, Moriarty JP, Rosedahl JK, Soleimani J, Marquez A, Weister TJ, Gajic O, Borah BJ. Comparative costs for critically ill patients with limited English proficiency versus English proficiency. PLoS One 2023; 18:e0279126. [PMID: 37186248 PMCID: PMC10132690 DOI: 10.1371/journal.pone.0279126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 11/30/2022] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES To conduct comparative cost analysis of hospital care for critically ill patients with Limited English Proficiency (LEP) versus patients with English proficiency (controls). PATIENTS AND METHODS We conducted a historical cohort study using propensity matching at Mayo Clinic Rochester, a quaternary care academic center. We included hospitalized patients who had at least one admission to ICU during a 10-year period between 1/1/2008-12/31/2017. RESULTS Due to substantial differences in baseline characteristics of the groups, propensity matching for the covariates age, sex, race, ethnicity, APACHE 3 score, and Charlson Comorbidity score was used, and we achieved the intended balance. The final cohort included 80,404 patients, 4,246 with LEP and 76,158 controls. Patients with LEP had higher costs during hospital admission to discharge, with a mean cost difference of $3861 (95% CI $822 to $6900, p = 0.013) and also higher costs during index ICU admission to hospital discharge, with a mean cost difference of $3166 (95% CI $231 to $6101, p = 0.035). A propensity matched cohort including only those that survived showed those with LEP had significantly greater mean costs for all outcomes. Sensitivity analysis revealed that international patients with LEP had significantly greater overall hospital costs of $9,240 than patients with LEP who resided in the US (95% CI $3341 to $15,140, p = 0.002). CONCLUSION This is the first study to demonstrate significantly higher costs for patients with LEP experiencing a critical illness. The causes for this may be increased healthcare utilization secondary to communication deficiencies that impede timely decision making about care.
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Affiliation(s)
- Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Bioethics Research Program, Mayo Clinic, Rochester, Minnesota, United States of America
| | - James P Moriarty
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jordan K Rosedahl
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jalal Soleimani
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Alberto Marquez
- Anesthesia Clinical Research Unit (ACRU), Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Timothy J Weister
- Anesthesia Clinical Research Unit (ACRU), Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Bijan J Borah
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
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Gordon JE, Belford SM, Aranguren DL, Blair D, Fleming R, Gajarawala NM, Heiderscheit J, Laabs SB, Looft KA, Rosedahl JK, O'Horo JC. Outcomes of Mayo Clinic reBoot camps for postimplementation training in the electronic health record. J Am Med Inform Assoc 2022; 29:1518-1524. [PMID: 35799373 PMCID: PMC9382368 DOI: 10.1093/jamia/ocac107] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/05/2022] [Accepted: 06/29/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE After a new electronic health record (EHR) was implemented at Mayo Clinic, a training program called reBoot Camp was created to enhance ongoing education in response to needs identified by physician leaders. MATERIALS AND METHODS A reBoot camp focused on EHR topics pertinent to ambulatory care was offered from April 2018 through June 2020. There were 37 2-day sessions and 43 1-day sessions, with 673 unique participants. To evaluate outcomes of the reBoot camp, we used survey data to study baseline, immediate, and long-term perceptions of program satisfaction and self-assessed skills with the EHR. The study was conducted among practitioners at a large ambulatory practice network based in several states. Data were collected from April 2018 through January 2021. We analyzed automatically collected metadata and scores that evaluated the amount of personalization and proficiency of use. RESULTS Confidence in skills increased by 13.5 points for general EHR use and was significant in 5 subdomains of use (13-18 point improvement). This degree of user confidence was maintained at the 6-month reassessment. The outcomes of configuration and proficiency scores also improved significantly. DISCUSSION Ongoing education regarding EHR tools is necessary to support continued use of technology. This study was novel because of the amount and breadth of data collected, diversity of user participation, and validation that improvements were maintained over time. CONCLUSIONS Participating in a reBoot camp significantly improved user confidence in each domain of the EHR and demonstrated use of best-practice tools. Users maintained gains at the 6-month evaluation phase.
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Affiliation(s)
- Joel E Gordon
- Chief Medical Information Officer, Mayo Clinic Health System Administration, Rochester, Minnesota, USA.,Family Practice, Mayo Clinic Health System-Southwest Minnesota Region, Mankato, Minnesota, USA
| | - Sylvia M Belford
- Clinical Systems Education, Mayo Clinic, Rochester, Minnesota, USA
| | - Dawn L Aranguren
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - David Blair
- Family Medicine, Mayo Clinic Health System-Northwest Wisconsin Region, Bloomer, Wisconsin, USA
| | - Richard Fleming
- Family Practice, Mayo Clinic Health System-Southwest Minnesota Region, Mankato, Minnesota, USA
| | | | - Jon Heiderscheit
- Chief Information Officer, Mayo Clinic Health System-Southwest Wisconsin Region, Onalaska, Wisconsin, USA.,Family Medicine, Mayo Clinic Health System-Southwest Wisconsin Region, Onalaska, Wisconsin, USA
| | - Susan B Laabs
- Family Practice, Mayo Clinic Health System-Southwest Minnesota Region, Mankato, Minnesota, USA
| | - Kathryn A Looft
- Clinical Systems Education, Mayo Clinic Health System-Southwest Minnesota Region, Mankato, Minnesota, USA
| | - Jordan K Rosedahl
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - John C O'Horo
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Wang XJ, Ebbert JO, Gilman EA, Rosedahl JK, Ramar P, Philpot LM. Central Sensitization Symptom Severity and Patient-Provider Relationships in a Community Setting. J Prim Care Community Health 2021; 12:21501327211031767. [PMID: 34235997 PMCID: PMC8273518 DOI: 10.1177/21501327211031767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Central sensitization syndromes (CSS) comprise an overlapping group of clinical conditions with the core feature of “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system.” Patients with CSS are known to have challenging interactions with healthcare providers contributing to psychological distress and increased healthcare utilization. CSS symptom severity has been associated with psychologic comorbidities, but little is known about how symptom severity relates to provider interactions. Methods We performed a cross-sectional survey among patients with CSS in our primary care practices to examine the relationship between CSS symptom severity and experiences with doctors. Results A total of 775 respondents completed the survey (775/5000; 15.5%) with 72% reporting high CSS symptom severity. About 44% of respondents had a prior diagnosis of fibromyalgia, 72% had migraines, and 28% had IBS. Patients with high CSS symptom severity were more likely to report that doctor(s) had often/always told them that they don’t need treatment when they feel like they do (OR = 3.6, 95% CI 1.9-7.5), that doctor(s) often/always don’t understand them (OR = 3.1, 95% CI 1.9-5.4), and that doctor(s) often/always seem annoyed with them when compared with respondents with low-moderate CSS symptom severity (OR = 4.8, 95% CI 2.2-12.5). Patients with high CSS symptom severity were at greater than 5 times odds of reporting being told that their symptoms were “all in their head” when compared to patients with low-moderate symptom severity (OR = 5.4, 95% CI 3.3-9.0). Conclusion Patients with CSS spectrum disorders experience frequent pain and decreased quality of life. A high degree of CSS symptom severity is associated with negative experiences with healthcare providers, which deters the establishment of a positive provider-patient relationship. Further research is needed to help understand symptom severity in CSS and harness the power of the therapeutic alliance as a treatment modality.
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Sami SS, Moriarty JP, Rosedahl JK, Borah BJ, Katzka DA, Wang KK, Kisiel JB, Ragunath K, Rubenstein JH, Iyer PG. Comparative Cost Effectiveness of Reflux-Based and Reflux-Independent Strategies for Barrett's Esophagus Screening. Am J Gastroenterol 2021; 116:1620-1631. [PMID: 34131096 PMCID: PMC8315187 DOI: 10.14309/ajg.0000000000001336] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/12/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Minimally invasive tests for Barrett's esophagus (BE) detection have raised the prospect of broader nonreflux-based testing. Cost-effectiveness studies have largely studied men aged 50 years with chronic gastroesophageal reflux disease (GERD) symptoms. We evaluated the comparative cost effectiveness of BE screening tests in GERD-based and GERD-independent testing scenarios. METHODS Markov modeling was performed in 3 scenarios in 50 years old individuals: (i) White men with chronic GERD (GERD-based); (ii) GERD-independent (all races, men and women), BE prevalence 1.6%; and (iii) GERD-independent, BE prevalence 5%. The simulation compared multiple screening strategies with no screening: sedated endoscopy (sEGD), transnasal endoscopy, swallowable esophageal cell collection devices with biomarkers, and exhaled volatile organic compounds. A hypothetical cohort of 500,000 individuals followed for 40 years using a willingness to pay threshold of $100,000 per quality-adjusted life year (QALY) was simulated. Incremental cost-effectiveness ratios (ICERs) comparing each strategy with no screening and comparing screening strategies with each other were calculated. RESULTS In both GERD-independent scenarios, most non-sEGD BE screening tests were cost effective. Swallowable esophageal cell collection devices with biomarkers were cost effective (<$35,000/QALY) and were the optimal screening tests in all scenarios. Exhaled volatile organic compounds had the highest ICERs in all scenarios. ICERs were low (<$25,000/QALY) for all tests in the GERD-based scenario, and all non-sEGD tests dominated no screening. ICERs were sensitive to BE prevalence and test costs. DISCUSSION Minimally invasive nonendoscopic tests may make GERD-independent BE screening cost effective. Participation rates for these strategies need to be studied.
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Affiliation(s)
- Sarmed S. Sami
- Division of Surgery and Interventional Science, University College London, London, UK;
| | - James P. Moriarty
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jordan K. Rosedahl
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bijan J. Borah
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
| | - David A. Katzka
- Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kenneth K. Wang
- Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - John B. Kisiel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Joel H. Rubenstein
- Veterans Affairs Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Prasad G. Iyer
- Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Ganesh R, Philpot LM, Bierle DM, Anderson RJ, Arndt LL, Arndt RF, Culbertson TL, Destro Borgen MJ, Hanson SN, Kennedy BD, Kottke BB, Larsen JJ, Ramar P, Rosedahl JK, Seville MT, Speicher LL, Tulledge-Scheitel SM, Wilker CG, Razonable RR. Real-World Clinical Outcomes of Bamlanivimab and Casirivimab-Imdevimab among High-Risk Patients with Mild to Moderate Coronavirus Disease 2019. J Infect Dis 2021; 224:1278-1286. [PMID: 34279629 PMCID: PMC8344643 DOI: 10.1093/infdis/jiab377] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/17/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Bamlanivimab and casirivimab-imdevimab are authorized for treatment of high-risk patients with mild to moderate coronavirus disease-2019 (COVID-19). We compared the outcomes of patients who received these therapies to identify factors associated with hospitalization and other clinical outcomes. METHODS Adult patients who received monoclonal antibody from November 19, 2020 to February 11, 2021 were selected and divided into those who received bamlanivimab (n=2747) and casirivimab-imdevimab (n=849). The 28-day all-cause and COVID-19-related hospitalizations were compared between the groups. RESULTS The population included 3596 patients; median age was 62 years; and 50% were female. All had ≥1 medical comorbidity; 55% had multiple comorbidities. All cause- and COVID-19-related hospitalization rates at 28 days were 3.98% and 2.56%, respectively. After adjusting for medical comorbidities, there was no significant difference in all cause- and COVID-19-related hospitalization rates between bamlanivimab and casirivimab-imdevimab (adjusted HR, 1.4, 95% CI 0.9-2.2 and 1.6, 95% CI 0.8-2.7, respectively). Chronic kidney, respiratory and cardiovascular diseases, and immunocompromised status were associated with higher likelihood of hospitalization. CONCLUSION This observational study on the use of bamlanivimab and casirivimab-imdevimab in high-risk patients showed similarly low rates of hospitalization. The number and type of medical comorbidities are associated with hospitalizations after monoclonal antibody treatment.
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Affiliation(s)
| | | | | | | | - Lori L Arndt
- Mayo Clinic Health System - Eau Claire, Wisconsin, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Caroline G Wilker
- Mayo Clinic Health System - Franciscan Healthcare, La Crosse, Wisconsin, USA
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Bierle DM, Ganesh R, Wilker CG, Hanson SN, Moehnke DE, Jackson TA, Ramar P, Rosedahl JK, Philpot LM, Razonable RR. Influence of Social and Cultural Factors on the Decision to Consent for Monoclonal Antibody Treatment among High-Risk Patients with Mild-Moderate COVID-19. J Prim Care Community Health 2021; 12:21501327211019282. [PMID: 34032171 PMCID: PMC8155772 DOI: 10.1177/21501327211019282] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The clinical outcomes of patients who decline anti-spike monoclonal antibody therapies for coronavirus disease-2019 (COVID-19) is not known. Factors associated with the decision to accept or decline the offer for anti-spike monoclonal antibody therapies are not established. This study aimed to identify factors impacting the decision to consent for monoclonal antibody therapies and assess the differences in clinical outcomes of patients who accepted compared to those who declined these therapies. METHODS This retrospective cohort study enrolled 2820 adult patients who were offered monoclonal antibody therapies, bamlanivimab and casirivimab-imdevimab, for COVID-19 at Mayo Clinic in the Midwest between 11/19/2020 and 12/31/2020. The primary endpoint is the decision to accept or decline monoclonal antibody treatment. Secondary endpoints were patient-level factors that could have impacted the decision to accept treatment (age, gender, race, ethnicity, primary language spoken, and medical comorbidities). The main clinical endpoint was hospitalization within 28 days of COVID-19 diagnosis. RESULTS 59.1% (n = 1669) chose to accept monoclonal antibody therapy, and 40.9% (n = 1151) chose to decline the offer for treatment. Patients were more likely to accept treatment if they were non-Hispanic White, English speaking, identified a spouse or life partner, had a religious affiliation, and possessed more medical comorbidities. Overall, 28-day hospitalization rate was 2.6% (n = 72/2820) and was higher among those who declined (3.3%) than those who accepted monoclonal antibody therapy (2.0%; Rate Ratio = 0.62, 95% Confidence Interval, 0.39-0.98). CONCLUSIONS Despite having more comorbidities, patients who accepted monoclonal antibody treatments had a lower rate of hospitalization compared to patients who declined treatment. Several social and cultural factors were associated with the decision to decline therapy, including race, language, ethnicity, and lack of social support. These findings can inform public health efforts to reduce social disparities in the treatment of COVID-19 and increase utilization of monoclonal antibody therapies in high risk populations.
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Ebbert JO, Ramar P, Tulledge-Scheitel SM, Njeru JW, Rosedahl JK, Roellinger D, Philpot LM. Patient preferences for telehealth services in a large multispecialty practice. J Telemed Telecare 2021; 29:298-303. [PMID: 33461397 DOI: 10.1177/1357633x20980302] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Telehealth service provision has accelerated during the Coronavirus disease 2019 (COVID-19) pandemic. As the pandemic continues, clinical practices have discovered ways to resume operations. Opportunities exist to understand patient preferences for telehealth clinical services and to tailor offerings to different demographic groups. METHODS We conducted a survey of patients receiving telehealth services through our outpatient practice to understand the types of healthcare services for which patients report preferences for telehealth. RESULTS We received 551 survey responses (response rate = 20.8%; 551/2650). More than half of patients indicated being 'very likely' to use telehealth services to refill medication(s) (67.3%), prepare for an upcoming visit (66.1%), review test results (60.3%), or receive education (54.2%). Males had lower odds of preferring telehealth services for reviewing test results (odds ratio (OR) = 0.57; 95% confidence interval (CI): 0.34-0.94) or mental health issues (OR = 0.54; 95% CI: 0.38-0.77). Respondents who received a video visit were significantly more likely than those who received a telephone visit to report preferences for using telehealth for education, care plan discussions, long-term health issues, and mental health. DISCUSSION Patient preferences for telehealth services vary by services provided and respondent demographics. Experience with telehealth increases the likelihood for future use of these services.
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Affiliation(s)
- Jon O Ebbert
- Community Internal Medicine, Mayo Clinic College of Medicine, USA
| | - Priya Ramar
- Department of Medicine, Mayo Clinic College of Medicine, USA
| | | | - Jane W Njeru
- Community Internal Medicine, Mayo Clinic College of Medicine, USA
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Abstract
Background: National estimates of electronic vaping product (EVP) use exist, but little is known about young adult EVP users who interact with the healthcare setting. Methods: Cross-sectional survey of 18-25 year olds receiving care in our ambulatory medical practice. Population differences were evaluated with the chi square test reporting unadjusted odds ratios (ORs). Results: Response rate was 16.6% (n = 1,017/6,119). The prevalence of ever EVP use was 46.0% of whom 13.9% used every day. Each additional day of alcohol use (past 30 days) was associated with increased odds of being an EVP user (OR = 1.06, 95% CI 1.02-1.09), and cannabis use (past 30 days) was associated with a higher odds of being an EVP user compared to non-cannabis users (OR = 40.0, 95% CI 17.4 - 111.8). Observing a biological parent (OR = 2.89, 95% CI 1.98-4.24), step parent (OR = 2.03, 95% CI 1.02-4.19) and full sibling (OR = 2.31, 95% CI 1.78-3.00) using inhaled substances (past 30 days) was associated with increased odds of being an ever EVP user. Ever EVP users had lower odds than never users to report that EVPs with nicotine are "a little" or "a lot" more harmful than smoking "regular" tobacco cigarettes (OR = 0.53, 95% CI 0.37 - 0.76). Conclusion: Our survey is limited by a low response rate but confirms observed associations between EVP use and substance use and social influences. Our data also suggest that professionals should regularly screen for EVP use among young people, especially those with exposure to family members who used inhaled substances.
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Affiliation(s)
- Pravesh Sharma
- Department of Psychiatry, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| | | | | | - Thulasee Tulsi Jose
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jon O Ebbert
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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12
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Sharma P, Ebbert JO, Rosedahl JK, Philpot LM. Changes in substance use among young adults during a respiratory disease pandemic. SAGE Open Med 2020; 8:2050312120965321. [PMID: 33133603 PMCID: PMC7576913 DOI: 10.1177/2050312120965321] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/18/2020] [Indexed: 12/23/2022] Open
Abstract
Background: News articles, commentaries, and opinion articles have suggested that ongoing social distancing measures coupled with economic challenges during COVID-19 may worsen stress, affective state, and substance use across the globe. We sought to advance our understanding of the differences between individuals who change their substance use patterns during a public health crisis and those who do not. Methods: Cross-sectional survey of young adults (18–25 years of age) assessing respondent characteristics and vaping, tobacco, alcohol, and/or marijuana use. We calculated prevalence estimates, prevalence changes, and prevalence ratios with associated 95% confidence intervals and looked for differences with the chi-square test. Results: Of the total sample, 53.2% (n = 542/1018) young adults reported vaping or using tobacco, alcohol, and/or marijuana. Among the 542 respondents reporting use, 34.3% reported a change in their use patterns. Among respondents reporting changes in substance use patterns during the pandemic (n = 186), 68.8% reported an increase in alcohol use, 44.0% reported a decrease in vaping product use, and 47.3% reported a decrease in tobacco product use due to COVID-19. Substance use changed significantly for respondents with increasing degree of loneliness (continuous loneliness score: prevalence ratio = 1.12, 95% confidence interval = 1.01–1.25), anxiety (prevalence ratio = 1.45, 95% confidence interval = 1.14–1.85), and depression (prevalence ratio = 1.44, 95% confidence interval = 1.13–1.82). Conclusion: Self-reported substance use among young adults was observed to change during a pandemic, and the degree of loneliness appears to impact these changes. Innovative strategies are needed to address loneliness, anxiety, depression, and substance use during global health crises that impact social contact.
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Affiliation(s)
- Pravesh Sharma
- Department of Psychiatry, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Jon O Ebbert
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jordan K Rosedahl
- Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Lindsey M Philpot
- Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
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13
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Lui JZ, Young NP, Ebbert JO, Rosedahl JK, Philpot LM. Loneliness and Migraine Self-Management: A Cross-Sectional Assessment. J Prim Care Community Health 2020; 11:2150132720924874. [PMID: 32484017 PMCID: PMC7268119 DOI: 10.1177/2150132720924874] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Chronic illness is often comorbid with the psychological state of loneliness. Models of care for patients who experience chronic migraines may often lack an understanding of psychosocial influences of the illness. Addressing the effects of loneliness on the health behaviors of chronic migraine patients may further elucidate gaps in care that exist beyond the biomedical approach to migraine treatment. The primary aim of this study was to assess the relationship between loneliness and behavioral health decisions in chronic migraine patients, specifically patient ability to self-manage, and effectiveness of treatments. Methods: We conducted a cross-sectional survey among patients (n = 500) with migraine and assessed for the experience of loneliness by using the University of California, Los Angeles-Revised (UCLA-R) Three-item Loneliness Scale and the extent of migraine-related disability via the Migraine Disability Assessment (MIDAS). Furthermore, we evaluated patients for their ability to self-manage their migraines, and perceived effectiveness of treatment. Results: Nearly half of our population reported at least one measure of loneliness (230/500, 46.0%). Patients experiencing chronic migraine were statistically more likely to report feeling lonely when compared to patients with episodic migraines (P < .001). Patients who report loneliness had lower odds of feeling 'very satisfied" with their ability to self-manage their migraine symptoms (aOR = 0.34, 95% CI 0.14-0.81) and had lower odds of feeling "very satisfied" with their ability to avoid conditions that cause their headache (aOR = 0.39, 95% CI 0.16-0.91). Conclusions: Loneliness has significant effects on the illness experience of patients with chronic migraines, including their ability to self-manage or be satisfied with their current state of care. Psychosocial models of care that address loneliness among patients with chronic migraine may help improve health outcomes and management.
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14
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Young NP, Philpot LM, Vierkant RA, Rosedahl JK, Upadhyaya SG, Harris A, Ebbert JO. Episodic and Chronic Migraine in Primary Care. Headache 2019; 59:1042-1051. [PMID: 31032913 DOI: 10.1111/head.13543] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To inform migraine care model development by assessing differences between patients with chronic migraine (CM) and episodic migraine (EM) in the current state of treatment, disability, patient satisfaction, and quality improvement opportunities. BACKGROUND Efficient and focused use of scarce resources will be needed to address challenges within large populations of migraine patients. METHODS We deployed a cross-sectional survey study of randomly selected migraine patients within a community primary care practice. RESULTS There were 516 survey respondents (516/1804 [30%] response rate). CM patients were more likely than EM patients to report care from a neurologist (76/110 [69%] vs 229/406 [56%]; P = .0026), and higher disability according to the Migraine Disability Assessment and Headache Impact Test - 6 questionnaires (P < .0001). CM patients were less likely than EM patients to report overall satisfaction with care (16/110 [38%] vs 156/406 [66%], P = .0002), satisfaction with access to care (17/110 [33%] vs 176/406 [68%], P < .0001), and advice they needed (16/110 [31%] vs 160/406 [62%], P < .0001). Most patients with migraine had been offered triptan medications 377/516 (78%). Overall, 156/516 (31%) of individuals were currently taking any medication for migraine prevention, and 208/516 (40%) including botulinum toxin injections. CM patients were more likely to be taking preventive medication (39/110 [36%] vs 117/406 [29%], P = .0191) and report familiarity with the diagnosis of medication-overuse headache than patients with EM (80/110 [81%] vs 256/406 [69%], P = .0178). CONCLUSIONS We observed differences between patients with chronic and EM and expected care delivery improvement opportunities for migraine patients in primary care. CM patients report higher levels of disability and less satisfaction with access to perceived needed medical advice and care. These findings support the need to further develop and study novel care models to efficiently and effectively deliver high-quality care and expertise in limited supply to a diverse migraine population.
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Affiliation(s)
- Nathan P Young
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Lindsey M Philpot
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Robert A Vierkant
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Jordan K Rosedahl
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Sudhindra G Upadhyaya
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Ann Harris
- Mayo Clinic Survey Research Center, Mayo Clinic, Rochester, MN, USA
| | - Jon O Ebbert
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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15
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Rieck TM, Gaz DV, Peterson NW, Jenkins SM, Rosedahl JK, Krzoska AA, Mansukhani MP, Clark MM, Kolla BP, Morgenthaler TI, Hagen PT. 1005 Comparison of Commercially-Available Sleep Tracking Devices With Sleep Diary and Actigraphy. Sleep 2019. [DOI: 10.1093/sleep/zsz067.1002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Casey LJ, Van Rooy KM, Sutherland SJ, Jenkins SM, Rosedahl JK, Wood NG, Ebbert JO, Lopez-Jimenez F, Egginton JS, Sim LA, Clark MM. Improved Self-Acceptance, Quality of Life, and Stress Level from Participation in a Worksite Yoga Foundations Program: A Pilot Study. Int J Yoga Therap 2018; 28:15-21. [PMID: 29596005 DOI: 10.17761/2018-00013r2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Yoga is increasing in popularity in the United States and across the globe. However, most yoga programs are provided outside the worksite; although many companies offer worksite wellness programs, at present there is limited documentation regarding the potential benefits of participating in a worksite yoga program. Therefore, the purpose of this project was to examine the potential effect of a worksite yoga program on self-acceptance, quality of life, and perceived stress. A prospective cohort pilot study that examined a structured worksite yoga program was designed and tailored to individuals new to yoga. The 8-week Yoga Foundations program was conducted at an academic medical center's worksite wellness center with 86 subjects. Outcome measures were the 36-item Self-Acceptance Scale; a six-item quality-of-life measure that assesses overall, social, mental, physical, emotional, and spiritual well-being; and the ten-item Perceived Stress Scale. Participants demonstrated significant improvement in their overall self-acceptance ( p < 0.001), quality of life ( p < 0.001), and perceived stress ( p < 0.001) levels. They also highly rated the yoga instructors and the weekly format of the program. Participation in a Yoga Foundations program was associated with improvements in self-acceptance, quality of life and stress levels in worksite wellness center members. Future studies should use randomized designs and examine other wellness domains to learn more about the potential benefits of worksite yoga programs.
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Affiliation(s)
- Lori J Casey
- 1. Dan Abraham Healthy Living Center, Mayo Clinic, Rochester, Minn
| | - Kimberly M Van Rooy
- 1. Dan Abraham Healthy Living Center, Mayo Clinic, Rochester, Minn.,2. Volunteer Programs, Mayo Clinic, Rochester, Minn
| | | | - Sarah M Jenkins
- 3. Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Jordan K Rosedahl
- 3. Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Nadia G Wood
- 5. Information Technology, Mayo Clinic, Rochester, Minn
| | - Jon O Ebbert
- 6. Department of Internal Medicine, Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minn
| | - Francisco Lopez-Jimenez
- 7. Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Jason S Egginton
- 4. Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn
| | - Leslie A Sim
- 8. Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn
| | - Matthew M Clark
- 8. Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn
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17
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Werneburg BL, Jenkins SM, Friend JL, Berkland BE, Clark MM, Rosedahl JK, Preston HR, Daniels DC, Riley BA, Olsen KD, Sood A. Improving Resiliency in Healthcare Employees. Am J Health Behav 2018; 42:39-50. [PMID: 29320337 DOI: 10.5993/ajhb.42.1.4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The high prevalence of stress at the workplace has been well documented; however, few studies have investigated the efficacy of worksite resiliency programs. Therefore, the objec- tive of this project was to examine the impact of a worksite resilience training program on improving resiliency and health behaviors in healthcare employees. METHODS Between 2012 and 2016, 137 adult wellness center members of a healthcare institution participating in a single-arm cohort study of a 12-week resiliency training program were assessed at baseline, end of intervention, and at 3-month follow-up. RESULTS Statistically significant (p ≤ .01) improvements were seen at the end of the intervention and extending to 3 months follow-up for resiliency, perceived stress, anxiety level, quality of life, and health behaviors. CONCLUSIONS These results support the premise that worksite programs designed to improve resiliency in healthcare employees have efficacy in improving resiliency, quality of life and health behaviors. Given the importance of stress and burnout in healthcare employees, future randomized studies are warranted to determine more clearly the impacts of this type of resiliency intervention for improving the wellness of healthcare workers.
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Affiliation(s)
- Brooke L. Werneburg
- Department of Medicine, Healthy Living Program, Dan Abraham Healthy Living Center, Mayo Clinic, Rochester, MN, USA
| | - Sarah M. Jenkins
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jamie L. Friend
- Department of Medicine, Healthy Living Program, Dan Abraham Healthy Living Center, Mayo Clinic, Rochester, MN, USA
| | - Bridget E. Berkland
- Department of Human Resources-Employee Wellness, Dan Abraham Healthy Living Center, Mayo Clinic, Rochester, MN, USA
| | - Matthew M. Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Beth A. Riley
- Department of Human Resources-Employee Wellness, Dan Abraham Healthy Living Center, Mayo Clinic, Rochester, MN, USA
| | - Kerry D. Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Amit Sood
- DeDepartment of General Internal Medicine and Complementary and Integrative Medicine, Mayo Clinic, Rochester, MN, USA
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18
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Rogers EA, Yost KJ, Rosedahl JK, Linzer M, Boehm DH, Thakur A, Poplau S, Anderson RT, Eton DT. Validating the Patient Experience with Treatment and Self-Management (PETS), a patient-reported measure of treatment burden, in people with diabetes. Patient Relat Outcome Meas 2017; 8:143-156. [PMID: 29184456 PMCID: PMC5687778 DOI: 10.2147/prom.s140851] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims To validate a comprehensive general measure of treatment burden, the Patient Experience with Treatment and Self-Management (PETS), in people with diabetes. Methods We conducted a secondary analysis of a cross-sectional survey study with 120 people diagnosed with type 1 or type 2 diabetes and at least one additional chronic illness. Surveys included established patient-reported outcome measures and a 48-item version of the PETS, a new measure comprised of multi-item scales assessing the burden of chronic illness treatment and self-care as it relates to nine domains: medical information, medications, medical appointments, monitoring health, interpersonal challenges, health care expenses, difficulty with health care services, role activity limitations, and physical/mental exhaustion from self-management. Internal reliability of PETS scales was determined using Cronbach’s alpha. Construct validity was determined through correlation of PETS scores with established measures (measures of chronic condition distress, medication satisfaction, self-efficacy, and global well-being), and known-groups validity through comparisons of PETS scores across clinically distinct groups. In an exploratory test of predictive validity, step-wise regressions were used to determine which PETS scales were most associated with outcomes of chronic condition distress, overall physical and mental health, and medication adherence. Results Respondents were 37–88 years old, 59% female, 29% non-white, and 67% college-educated. PETS scales showed good reliability (Cronbach’s alphas ≥0.74). Higher PETS scale scores (greater treatment burden) were correlated with more chronic condition distress, less medication convenience, lower self-efficacy, and worse general physical and mental health. Participants less (versus more) adherent to medications and those with more (versus fewer) health care financial difficulties had higher mean PETS scores. Medication burden was the scale that was most consistently associated with well-being and patient-reported adherence. Conclusion The PETS is a reliable and valid measure for assessing perceived treatment burden in people coping with diabetes.
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Affiliation(s)
- Elizabeth A Rogers
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.,Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kathleen J Yost
- Department of Health Services Research, Mayo Clinic, Rochester, MN, USA
| | - Jordan K Rosedahl
- Department of Health Services Research, Mayo Clinic, Rochester, MN, USA
| | - Mark Linzer
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Deborah H Boehm
- Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Azra Thakur
- Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Sara Poplau
- Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Roger T Anderson
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - David T Eton
- Department of Health Services Research, Mayo Clinic, Rochester, MN, USA
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19
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Berkland BE, Werneburg BL, Jenkins SM, Friend JL, Clark MM, Rosedahl JK, Limburg PJ, Riley BA, Lecy DR, Sood A. A Worksite Wellness Intervention: Improving Happiness, Life Satisfaction, and Gratitude in Health Care Workers. Mayo Clin Proc Innov Qual Outcomes 2017; 1:203-210. [PMID: 30225418 PMCID: PMC6132199 DOI: 10.1016/j.mayocpiqo.2017.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective To assess the effect of a 12-week Stress Management and Resilience Training (SMART) program on happiness, life satisfaction, gratitude, mindfulness, spirituality, and stress in health care workers. Participants and Methods Participants were members of an employee wellness center at an academic health care center. Participants were enrolled as cohorts of 12 to 18 individuals and received the intervention at an employee wellness center from February 19, 2013, to February 27, 2017. The study was designed as a prospective, nonrandomized, single-arm clinical trial that included a 3-month in-person SMART program (defined as the intervention), with an additional 3-month postintervention follow-up period (6 months total). Outcomes were assessed at baseline (T0), end of intervention (T3), and after the postintervention follow-up period (T6) and included Subjective Happiness Survey, Satisfaction with Life Scale, Gratitude Scale, Mindful Attention Awareness Scale, Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being, and Perceived Stress Scale. Results Of the 110 participants who enrolled and provided consent, 98 participants (89%) completed the T0 and T3 assessments and 85 participants (77%) completed the T0, T3, and T6 assessments. On comparing the T0 and T6 responses, we observed statistically significant improvements (P<.001) in all the domains studied: subjective happiness (baseline average, 4.6; T6 average, 5.5; average difference, 0.9; 95% CI, 0.6-1.0), life satisfaction (baseline average, 22.8; T6 average, 27.5; average difference, 4.7; 95% CI, 3.6-5.9); gratitude (baseline average, 35.8; T6 average, 39.3; average difference, 3.5; 95% CI, 2.6-4.5), mindfulness (baseline average, 3.5; T6 average, 4.2; average difference, 0.7; 95% CI, 0.6-0.9), Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being (baseline average, 29.9; T6 average, 37.4; average difference, 7.5; 95% CI, 6.0-9.2), and percentage of people reporting high stress (baseline, 97.6%; T6, 67.1%). Similar results were observed when comparing the T0 and T3 responses. Conclusion In health care workers, training in the SMART program was associated with statistically significant improvements in happiness, satisfaction with life, gratitude, mindfulness, spirituality, and stress (P<.001). Given the importance of stress in the workplace, larger randomized trials and broader dissemination of the program in health care workers is warranted.
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Affiliation(s)
- Bridget E Berkland
- Department of Human Resources-Employee Wellness, Dan Abraham Healthy Living Center, Mayo Clinic, Rochester, MN
| | - Brooke L Werneburg
- Department of Medicine, Healthy Living Program, Dan Abraham Healthy Living Center, Mayo Clinic, Rochester, MN
| | - Sarah M Jenkins
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Jamie L Friend
- Department of Medicine, Healthy Living Program, Dan Abraham Healthy Living Center, Mayo Clinic, Rochester, MN
| | - Matthew M Clark
- Department of Medicine, Healthy Living Program, Dan Abraham Healthy Living Center, Mayo Clinic, Rochester, MN.,Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Jordan K Rosedahl
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Paul J Limburg
- Department of Human Resources-Employee Wellness, Dan Abraham Healthy Living Center, Mayo Clinic, Rochester, MN.,Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN
| | - Beth A Riley
- Department of Human Resources-Employee Wellness, Dan Abraham Healthy Living Center, Mayo Clinic, Rochester, MN
| | - Denise R Lecy
- Department of Human Resources-Employee Wellness, Dan Abraham Healthy Living Center, Mayo Clinic, Rochester, MN
| | - Amit Sood
- Department of General Internal Medicine and Complementary and Integrative Medicine, Mayo Clinic, Rochester, MN
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20
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Eton DT, Yost KJ, Lai JS, Ridgeway JL, Egginton JS, Rosedahl JK, Linzer M, Boehm DH, Thakur A, Poplau S, Odell L, Montori VM, May CR, Anderson RT. Development and validation of the Patient Experience with Treatment and Self-management (PETS): a patient-reported measure of treatment burden. Qual Life Res 2016; 26:489-503. [PMID: 27566732 DOI: 10.1007/s11136-016-1397-0] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of this study was to develop and validate a new comprehensive patient-reported measure of treatment burden-the Patient Experience with Treatment and Self-management (PETS). METHODS A conceptual framework was used to derive the PETS with items reviewed and cognitively tested with patients. A survey battery, including a pilot version of the PETS, was mailed to 838 multi-morbid patients from two healthcare institutions for validation. RESULTS A total of 332 multi-morbid patients returned completed surveys. Diagnostics supported deletion and consolidation of some items and domains. Confirmatory factor analysis supported a domain model for scaling comprised of 9 factors: medical information, medications, medical appointments, monitoring health, interpersonal challenges, medical/healthcare expenses, difficulty with healthcare services, role/social activity limitations, and physical/mental exhaustion. Scales showed good internal consistency (α range 0.79-0.95). Higher PETS scores, indicative of greater treatment burden, were correlated with more distress, less satisfaction with medications, lower self-efficacy, worse physical and mental health, and lower convenience of healthcare (Ps < 0.001). Patients with lower health literacy, less adherence to medications, and more financial difficulties reported higher PETS scores (Ps < 0.01). CONCLUSION A comprehensive patient-reported measure of treatment burden can help to better characterize the impact of treatment and self-management burden on patient well-being and guide care toward minimally disruptive medicine.
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Affiliation(s)
- David T Eton
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. .,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Kathleen J Yost
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jin-Shei Lai
- Department of Medical Social Sciences, Northwestern University School of Medicine, 633 St. Clair, 19th Floor, Chicago, IL, USA
| | - Jennifer L Ridgeway
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jason S Egginton
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jordan K Rosedahl
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mark Linzer
- Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, USA
| | - Deborah H Boehm
- Minneapolis Medical Research Foundation, 701 Park Avenue, Minneapolis, MN, USA
| | - Azra Thakur
- Amherst H. Wilder Foundation, 451 Lexington Parkway N, Saint Paul, MN, 55104, USA
| | - Sara Poplau
- Minneapolis Medical Research Foundation, 701 Park Avenue, Minneapolis, MN, USA
| | - Laura Odell
- Pharmacy Services, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Victor M Montori
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Knowledge Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Carl R May
- Knowledge Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Roger T Anderson
- Department of Public Health Sciences, University of Virginia School of Medicine, 6203E, West Complex, Charlottesville, VA, USA
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Allen AM, Kim WR, Larson JJ, Rosedahl JK, Yawn BP, McKeon K, Hay JE. The Epidemiology of Liver Diseases Unique to Pregnancy in a US Community: A Population-Based Study. Clin Gastroenterol Hepatol 2016; 14:287-94.e1-2. [PMID: 26305066 PMCID: PMC4718803 DOI: 10.1016/j.cgh.2015.08.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Little is known in the United States about the epidemiology of liver diseases that develop only during (are unique to) pregnancy. We investigated the incidence of liver diseases unique to pregnancy in Olmsted County, Minnesota, and long-term maternal and fetal outcomes. METHODS We identified 247 women with liver diseases unique to pregnancy from 1996 through 2010 using the Rochester Epidemiology Project database. The crude incidence rate was calculated by the number of liver disease cases divided by 35,101 pregnancies. RESULTS Of pregnant women with liver diseases, 134 had preeclampsia with liver dysfunction, 72 had hemolysis-associated increased levels of liver enzymes and low-platelet (HELLP) syndrome, 26 had intrahepatic cholestasis of pregnancy, 14 had hyperemesis gravidarum with abnormal liver enzymes, and 1 had acute fatty liver of pregnancy. The crude incidence of liver diseases unique to pregnancy was 0.77%. Outcomes were worse among women with HELLP or preeclampsia than the other disorders--of women with HELLP, 70% had a premature delivery, 4% had abruptio placentae, 3% had acute kidney injury, and 3% had infant death. Of women with preeclampsia, 56.0% had a premature delivery, 4% had abruptio placentae, 3% had acute kidney injury, and 0.7% had infant death. After 7 median years of follow-up (range, 0-18 years), 14% of the women developed recurrent liver disease unique to pregnancy; the proportions were highest in women with initial hyperemesis gravidarum (36%) or intrahepatic cholestasis of pregnancy (35%). Women with preeclampsia were more likely to develop subsequent hepatobiliary diseases. CONCLUSIONS We found the incidence of liver disease unique to pregnancy in Olmsted County, Minnesota, to be lower than that reported from Europe or US tertiary referral centers. Maternal and fetal outcomes in Olmsted County were better than those reported from other studies, but fetal mortality was still high (0.7%-3.0%). Women with preeclampsia or HELLP are at higher risk for peripartum complications and subsequent development of comorbidities.
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Affiliation(s)
- Alina M Allen
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - W Ray Kim
- Gastroenterology and Hepatology, Stanford University, Stanford, California.
| | - Joseph J Larson
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Jordan K Rosedahl
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Barbara P Yawn
- Department of Research, Olmsted Medical Center, Rochester, Minnesota
| | - Kimberly McKeon
- Department of Obstetrics and Gynecology, Olmsted Medical Center, Rochester, Minnesota
| | - J Eileen Hay
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Abstract
The major cycling "Grand Tours" have shown an attenuation of performance over the last decade. This has been interpreted as circumstantial evidence that newer anti-doping strategies have reduced the use of performance-enhancing drugs. To examine this idea under more controlled conditions, speed trends for world class 5000 m, 10000 m, and marathon performances by men from 1980 to 2013 were analyzed. We obtained comprehensive records from the International Association of Athletics Federations, Association of Road Racing Statisticians, and the Track and Field All-time Performances database webpages. The top 40 performances for each event and year were selected for regression analysis. For the three distances, we noted cumulative performance improvements in the 1990s thru the mid-2000s. After the peak speed years of the mid 2000 s, there has been limited improvement in the 5000 m and 10,000 m and world records set during that time remain in place today, marking the longest period of time between new records since the early 1940s. By contrast marathon speed continues to increase and the world record has been lowered four times since 2007, including in 2013. While the speed trends for 5000 m and 10000 m track results parallel those seen in elite cycling, the marathon trends do not. We discuss a number of explanations other than improved anti-doping strategies that might account for these divergent findings.
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Affiliation(s)
- Timothy N. Kruse
- The University of Washington School of Medicine, 1959 N. E. Pacific Street, Seattle, WA, 98195, United States of America
| | - Rickey E. Carter
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States of America
| | - Jordan K. Rosedahl
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States of America
| | - Michael J. Joyner
- Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States of America
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23
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Sabate Rotes A, Eidem BW, Connolly HM, Bonnichsen CR, Rosedahl JK, Schaff HV, Dearani JA, Burkhart HM. Long-term follow-up after pulmonary valve replacement in repaired tetralogy of Fallot. Am J Cardiol 2014; 114:901-8. [PMID: 25087464 DOI: 10.1016/j.amjcard.2014.06.023] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 06/10/2014] [Accepted: 06/10/2014] [Indexed: 11/16/2022]
Abstract
Surgical pulmonary valve replacement (PVR) in previously repaired tetralogy of Fallot (TOF) is frequently required. There are few data in large series of patients with long-term follow-up. Our aim was to review our 40-year experience with PVR after TOF repair and to evaluate prognostic factors for reintervention and death. Between 1973 and 2012, 278 patients with repaired TOF (53% men; 31.4 ± 16.4 years) underwent first PVR 24 ± 13 years after TOF repair. Three or more previous operations were performed in 17% of the patients, and 42% were in New York Heart Association (NYHA) class III/IV. PVR types included porcine (n = 211), pericardial (n = 37), homograft (n = 27), and mechanical (n = 3). Early mortality was 1.4%. Mean follow-up was 7.3 ± 6.8 years (maximum, 34 years). Overall survival at 5, 10, and 15 years was 93%, 83%, and 80% compared with 99%, 97%, and 95% in a gender- and age-matched US population, p <0.001. Independent risk factors for death were older age at complete repair (hazards ratio [HR] 1.2, p = 0.012), ≥ 3 previous cardiac operations (HR 1.9, p = 0.019), NYHA class III/IV at PVR (HR 2.7, p = 0.019), and large body surface area at PVR (HR 1.9, p <0.001). Reintervention after initial PVR occurred in 25 patients. Overall 5, 10, and 15 years freedom from pulmonary valve reintervention was 97%, 85%, and 75%, respectively. Multivariate analysis demonstrated older age at PVR to be protective from reintervention (HR 0.7, p <0.001). In conclusion, PVR is a safe operation with a low rate of reintervention in repaired TOF. The total number of cardiac operations, surgical timing, and the NYHA classification before PVR are important prognostic factors.
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Affiliation(s)
- Anna Sabate Rotes
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota; Departament de Pediatria, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Benjamin W Eidem
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Heidi M Connolly
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | | | - Jordan K Rosedahl
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Hartzell V Schaff
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Harold M Burkhart
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
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