The role of the purposeful shared decision making model in vascularized composite allotransplantation.

For some patients who have lost the lower part of an arm, hand transplant offers the possibility of receiving a new limb with varying degrees of sensation and function. This procedure, Vascularized Composite Allotransplantation (VCA), is demanding for patients and their care community and comes with significant risks. As a high-stakes decision, patients interested in VCA are subject to extensive clinical evaluation and eligibility decision making.

A Delphi Approach to Define Lucid Episodes in People Living With Dementia.

Purpose: Lucid episodes (LEs: unexpected episodes of spontaneous, meaningful, and relevant communication or behavior) in Alzheimer disease and related dementias are a new area of scientific inquiry that lacks clinical consensus and require more conceptual attention.

Methods: We aimed to measure consensus from an expert group on: (1) potential medical or clinical explanations for LEs; (2) necessary medical and clinical context to LEs; and (3) interpretation of LEs.

Patients: We convened 13 experts from different disciplines (neurology, psychiatry, psychology, pharmacy, palliative care, hospice, nursing, social work, primary care, geriatrics, and professional home caregivers) to identify elements of LEs.

Developing and describing a typology of lucid episodes among people with Alzheimer's disease and related dementias.

Introduction: This study examined lucid episodes among people living with late-stage Alzheimer's disease and related dementias (PLWD) and then developed a typology of these episodes to help characterize them.

Methods: Family caregivers of PLWD provided information about witnessed episodes, including proximity to death, cognitive status, duration, communication quality, and circumstances prior to lucid episodes on up to two episodes (caregiver N = 151; episode N = 279). Latent class analysis was used to classify and characterize empirically distinct clusters of lucid episodes.

A Single-Center Retrospective Evaluation of Decision-Making and Factors Motivating Hand Transplant Candidates.

Introduction: Advancements in vascularized composite allotransplantation have made hand transplants possible for persons living with upper limb loss. Hand transplantation is not a life-saving procedure, but rather a quality-of-life enhancing procedure; hence the risk of morbidity and mortality must be weighed against improvements in function and appearance. This study explored the decision-making process of patients evaluated for hand transplantation.

Acute Kidney Injury Survivor Care Following Hospital Discharge: A Mixed-Methods Study of Nephrologists and Primary Care Providers.

Rationale & Objective: Widespread delivery of high-quality care for acute kidney injury (AKI) survivors after hospital discharge requires a multidisciplinary team. We aimed to compare management approaches between nephrologists and primary care providers (PCPs) and explored strategies to optimize collaboration.

Study Design: Explanatory sequential mixed-methods study using a case-based survey followed by semi-structured interviews.

Education for patients with limb loss or absence: Aging, overuse concerns, and patient treatment knowledge gaps.

The goals of vascular composite allotransplantation (VCA) for hand are to maximize functional status and psychosocial wellbeing and to improve quality of life. Candidates are carefully vetted by transplant programs through an extensive evaluation process to exclude those patients with contraindications and to select those that are most likely to attain functional or quality of life benefit from transplant. Patient choice for any treatment, however, requires that candidates be able to understand the risks, benefits, and alternatives before choosing to proceed.

Caregiver appraisals of lucid episodes in people with late-stage Alzheimer's disease or related dementias.

Introduction: Little is known about how family caregivers who witness unexpected and spontaneous communication among people in late stages of Alzheimer's disease and related dementias (ADRD) appraise these episodes of lucidity (EL).

Methods: In an electronic, cross-sectional survey for former and current caregivers who participate in UsAgainstAlzheimer's A-LIST, participants who reported witnessing an EL were asked how positive and stressful ELs were, if they made or changed decisions based on an EL, and what resources they sought out to explain ELs.

Results: Caregivers reported 72% of ELs to be quite a bit or very positive, 17% to be stressful, and 10% to be both stressful and positive.

Optimising transitions of care for acute kidney injury survivors: protocol for a mixed-methods study of nephrologist and primary care provider recommendations.

Introduction: Acute kidney injury (AKI) affects nearly 20% of all hospitalised patients and is associated with poor outcomes. Long-term complications can be partially attributed to gaps in kidney-focused care and education during transitions. Building capacity across the healthcare spectrum by engaging a broad network of multidisciplinary providers to facilitate optimal follow-up care represents an important mechanism to address this existing care gap.

Development and Feasibility of a Multidisciplinary Approach to AKI Survivorship in Care Transitions: Research Letter.

Background: Acute kidney injury (AKI) survivors are at heightened risk for poor short- and long-term health outcomes. Even among those who recover after an AKI episode, the risk for chronic kidney disease is 4- to 6-fold higher than in patients without AKI, underscoring the importance of identifying methods to improve AKI survivorship.

Objective: The purpose of this report was to describe the development and feasibility of a novel multidisciplinary approach to caring for AKI survivors at care transitions (ACT).

The System Is Broken: A Qualitative Assessment of Opioid Prescribing Practices After Spine Surgery.

Objective: To elucidate factors that influence opioid prescribing behaviors of key stakeholders after major spine surgery, with a focus on barriers to optimized prescribing.

Methods: In-person semi-structured interviews were performed with 20 surgical and medical professionals (January 23, 2019 to June 11, 2019) at a large academic medical center, including resident physicians, midlevel providers, attending physicians, and clinical pharmacists. Interviews centered on perceptions of postoperative prescribing practices were coded and analyzed using a qualitative inductive approach.

Randomized comparison of a reduced-visit prenatal care model enhanced with remote monitoring.

Background: Standard prenatal care, consisting of 12-14 visits per pregnancy, is expensive and resource intensive, with limited evidence supporting the structure, rhythm, or components of care. Some studies suggest a reduced-frequency prenatal care model is as safe as the standard model of care for low-risk pregnant women, but evidence is limited. We developed and evaluated an innovative, technology-enhanced, reduced prenatal visit model (OB Nest).

Sustainable care coordination: a qualitative study of primary care provider, administrator, and insurer perspectives.

Background: Care coordination has been a common tool for practices seeking to manage complex patients, yet there remains confusion about the most effective and sustainable model. Research exists on opinions of providers of care coordination but there is limited information on perspectives of those in the insurance industry about key elements. We sought to gather opinions from primary care providers and administrators in Minnesota who were involved in a CMS (Center for Medicare and Medicaid Services) transformational grant implementing COMPASS (Care Of Mental, Physical And Substance-use Syndromes), an evidence-based model of care coordination for depressed patients comorbid with diabetes and/or cardiovascular disease.

Native American patients' perception and attitude about kidney transplant: a qualitative assessment of patients presenting for kidney transplant evaluation.

Objective: Native Americans suffer from lower rates of kidney transplantation compared with whites. Our goal was to elicit patients' perceptions of and attitudes about kidney transplant and the impact of financial burden and cultural taboos.

Design: This is an exploratory qualitative interview study of 12 Native American patients recruited after completion of the kidney transplant evaluation.

Understanding experiences of patients and family caregivers in the Mayo Clinic Care Transitions program: a qualitative study.

Background: Care transitions programs are increasingly used to improve care and reduce re-admission of patients after hospitalization. To learn from the experience of patients who have participated in the Mayo Clinic Care Transitions (MCCT) program and to understand the patient experience, we sought perspectives of patients, caregivers, and providers who worked with participants of the MCCT program.

Methods: Investigators interviewed 17 patients and nine of their caregivers about their experience with the MCCT program.

Choosing a women's health career.

Background: In 2005, in response to a decline in residency applications in obstetrics and gynecology (OB GYN), the American College of Obstetrics and Gynecology Presidential Task Force outlined strategies for attracting medical students to OB GYN. Application rates have increased since then, but little is known about which interventions are effective. We aimed to identify modifiable and nonmodifiable variables that may contribute to students choosing OB GYN for their careers; this information could be used to inform curriculum design, faculty development, and innovative exposures to women's health.

Increasing the Connectivity and Autonomy of RNs with Low-Risk Obstetric Patients.

Unlabelled: : Objective: RNs are adopting an ever-larger role in health care models designed to reduce costs, increase patient satisfaction, and improve patient outcomes. Most research exploring such models has focused on those involving physicians or advanced practice nurses rather than RNs. This study explored the perspectives of patients, RNs, and other providers regarding a new prenatal connected care model for low-risk patients aimed at reducing in-office visits and creating virtual patient-RN connections.

Impact of childhood psoriasis on parents of affected children.

Background: Childhood diseases, such as atopic dermatitis, have a negative impact on quality of life (QoL) of parents. How pediatric psoriasis affects a parent's QoL is unknown.

Objective: To explore the impact of childhood psoriasis on the lives of the parents.

Patient quality of life in the Mayo Clinic Care Transitions program: a survey study.

Background: Transitional care programs are common interventions aimed at reducing medical complications and associated readmissions for patients recently discharged from the hospital. While organizations strive to reduce readmissions, another important related metric is patient quality of life (QoL).

Aims: To compare the relationship between QoL in patients enrolled in the Mayo Clinic Care Transitions (MCCT) program versus usual care, and to determine if QoL changed in MCCT participants between baseline and 1-year follow-up.

Short-term and long-term effectiveness of a post-hospital care transitions program in an older, medically complex population.

Background: Care transition programs can potentially reduce 30 day readmission; however, the effect on long-term hospital readmissions is still unclear.

Objective: We compared short-term (30 day) and long-term (180 day) utilization of participants enrolled in care transitions versus those matched referents eligible but not enrolled.

Design: This cohort study was conducted from January 1, 2011 until June 30, 2013 within a primary care academic practice.

Implementation of a new prenatal care model to reduce office visits and increase connectivity and continuity of care: protocol for a mixed-methods study.

Background: Most low-risk pregnant women receive the standard model of prenatal care with frequent office visits. Research suggests that a reduced schedule of visits among low-risk women could be implemented without increasing adverse maternal or fetal outcomes, but patient satisfaction with these models varies. We aim to determine the effectiveness and feasibility of a new prenatal care model (OB Nest) that enhances a reduced visit model by adding virtual connections that improve continuity of care and patient-directed access to care.

A qualitative study of traditional healing practices among American Indians with chronic pain.

Objective: Although chronic pain is prevalent among American Indian (AI) populations, the use of traditional healing practices has not been widely investigated. The aim of this qualitative study was to solicit information from adult AIs with chronic pain regarding use of traditional health practices (THPs) for chronic pain and pain reduction.

Design: Prospective qualitative design.

Effect of multiple chronic diseases on health care expenditures in childhood.

Objectives: To examine multiple chronic conditions and related health care expenditures in children.

Methods: Retrospective cohort study of all dependents of Mayo Clinic employees aged 0-17 on Jan 1, 2004 with continuous health benefits coverage for 4 years (N=14,727). Chronic conditions, health care utilization, and associated expenditures were obtained from medical and pharmacy claims.

Application of a novel socioeconomic measure using individual housing data in asthma research: an exploratory study.

Background: A housing-based socioeconomic index (HOUSES) was previously developed to overcome an absence of socioeconomic status (SES) measures in common databases. HOUSES is associated with child health outcomes in Olmsted County, Minnesota, USA, but generalisability to other geographic areas is unclear.

Aim: To assess whether HOUSES is associated with asthma outcomes outside Olmsted County, Minnesota, USA.

Risk-stratification methods for identifying patients for care coordination.

Background: Care coordination is a key component of the patient-centered medical home. However, the mechanism for identifying primary care patients who may benefit the most from this model of care is unclear.

Objectives: To evaluate the performance of several risk-adjustment/stratification instruments in predicting healthcare utilization.