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  1. Article ; Online: Comparison of Ambulatory Quality Measures Between Shared Practice Panels and Independent Practice Panels.

    Whiting, Adria / Poolman, April E / Misra, Artika / Gordon, Joel E / Angstman, Kurt B

    Mayo Clinic proceedings. Innovations, quality & outcomes

    2023  Volume 7, Issue 4, Page(s) 256–261

    Abstract: Objective: To assess for differences in patient care outcomes in the primary care setting for patients assigned to an independent practice panel (IPP) or a shared practice panel (SPP).: Patients and methods: We retrospectively reviewed the electronic ...

    Abstract Objective: To assess for differences in patient care outcomes in the primary care setting for patients assigned to an independent practice panel (IPP) or a shared practice panel (SPP).
    Patients and methods: We retrospectively reviewed the electronic health records of patients of 2 Mayo Clinic family medicine primary care clinics from January 1, 2019 to December 31, 2019. Patients were assigned to either an IPP (physician or advanced practice provider [APP]) or an SPP (physician and ≥1 APP). We assessed 6 measures of quality care and compared them between IPP and SPP groups: diabetes optimal care, hypertension control, depression remission at 6 months, breast cancer screening, cervical cancer screening, and colon cancer screening.
    Results: The study included 114,438 patients assigned to 140 family medicine panels during the study period: 87 IPPs and 53 SPPs. The IPP clinicians showed improved quality metrics compared with the SPP clinicians for the percentage of assigned patients achieving depression remission (16.6% vs 11.1%;
    Conclusion: This study shows a considerable improvement in depression remission among IPP panels and in cervical cancer screening rates among SPP panels. This information may help to inform primary care team configuration.
    Language English
    Publishing date 2023-06-18
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2542-4548
    ISSN (online) 2542-4548
    DOI 10.1016/j.mayocpiqo.2023.05.005
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  2. Article ; Online: Outcomes of Mayo Clinic reBoot camps for postimplementation training in the electronic health record.

    Gordon, Joel E / Belford, Sylvia M / Aranguren, Dawn L / Blair, David / Fleming, Richard / Gajarawala, Nikunj M / Heiderscheit, Jon / Laabs, Susan B / Looft, Kathryn A / Rosedahl, Jordan K / O'Horo, John C

    Journal of the American Medical Informatics Association : JAMIA

    2022  Volume 29, Issue 9, Page(s) 1518–1524

    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 ... ...

    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.
    MeSH term(s) Ambulatory Care Facilities ; Electronic Health Records ; Humans
    Language English
    Publishing date 2022-07-07
    Publishing country England
    Document type Journal Article
    ZDB-ID 1205156-1
    ISSN 1527-974X ; 1067-5027
    ISSN (online) 1527-974X
    ISSN 1067-5027
    DOI 10.1093/jamia/ocac107
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  3. Article ; Online: Durability analysis of the highly effective BNT162b2 vaccine against COVID-19.

    Puranik, Arjun / Lenehan, Patrick J / O'Horo, John C / Pawlowski, Colin / Niesen, Michiel J M / Virk, Abinash / Swift, Melanie D / Kremers, Walter / Venkatakrishnan, A J / Gordon, Joel E / Geyer, Holly L / Speicher, Leigh Lewis / Soundararajan, Venky / Badley, Andrew D

    PNAS nexus

    2022  Volume 1, Issue 3, Page(s) pgac082

    Abstract: COVID-19 vaccines are effective, but breakthrough infections have been increasingly reported. We conducted a test-negative case-control study to assess the durability of protection after full vaccination with BNT162b2 against polymerase chain reaction ( ... ...

    Abstract COVID-19 vaccines are effective, but breakthrough infections have been increasingly reported. We conducted a test-negative case-control study to assess the durability of protection after full vaccination with BNT162b2 against polymerase chain reaction (PCR)-confirmed symptomatic SARS-CoV-2 infection, in a national medical practice from January 2021 through January 2022. We fit conditional logistic regression (CLR) models stratified on residential county and calendar time of testing to assess the association between time elapsed since vaccination and the odds of symptomatic infection or non-COVID-19 hospitalization (negative control), adjusted for several covariates. There were 5,985 symptomatic individuals with a positive test after full vaccination with BNT162b2 (cases) and 32,728 negative tests contributed by 27,753 symptomatic individuals after full vaccination (controls). The adjusted odds of symptomatic infection were higher 250 days after full vaccination versus at the date of full vaccination (Odds Ratio [OR]: 3.62, 95% CI: 2.52 to 5.20). The odds of infection were still lower 285 days after the first BNT162b2 dose as compared to 4 days after the first dose (OR: 0.50, 95% CI: 0.37 to 0.67), when immune protection approximates the unvaccinated status. Low rates of COVID-19 associated hospitalization or death in this cohort precluded analyses of these severe outcomes. The odds of non-COVID-19 associated hospitalization (negative control) decreased with time since vaccination, suggesting a possible underestimation of waning protection by this approach due to confounding factors. In summary, BNT162b2 strongly protected against symptomatic SARS-CoV-2 infection for at least 8 months after full vaccination, but the degree of protection waned significantly over this period.
    Language English
    Publishing date 2022-06-08
    Publishing country England
    Document type Journal Article
    ISSN 2752-6542
    ISSN (online) 2752-6542
    DOI 10.1093/pnasnexus/pgac082
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  4. Article ; Online: Surveillance of Safety of 3 Doses of COVID-19 mRNA Vaccination Using Electronic Health Records.

    Niesen, Michiel J M / Pawlowski, Colin / O'Horo, John C / Challener, Doug W / Silvert, Eli / Donadio, Greg / Lenehan, Patrick J / Virk, Abinash / Swift, Melanie D / Speicher, Leigh L / Gordon, Joel E / Geyer, Holly L / Halamka, John D / Venkatakrishnan, A J / Soundararajan, Venky / Badley, Andrew D

    JAMA network open

    2022  Volume 5, Issue 4, Page(s) e227038

    Abstract: Importance: Recent reports on waning of COVID-19 vaccine-induced immunity have led to the approval and rollout of additional doses and booster vaccinations. Individuals at increased risk of SARS-CoV-2 infection are receiving additional vaccine doses in ... ...

    Abstract Importance: Recent reports on waning of COVID-19 vaccine-induced immunity have led to the approval and rollout of additional doses and booster vaccinations. Individuals at increased risk of SARS-CoV-2 infection are receiving additional vaccine doses in addition to the regimen that was tested in clinical trials. Risks and adverse event profiles associated with additional vaccine doses are currently not well understood.
    Objective: To evaluate the safety of third-dose vaccination with US Food and Drug Administration (FDA)-approved COVID-19 mRNA vaccines.
    Design, setting, and participants: This cohort study was conducted using electronic health record (EHR) data from December 2020 to October 2021 from the multistate Mayo Clinic Enterprise. Participants included all 47 999 individuals receiving 3-dose COVID-19 mRNA vaccines within the study setting who met study inclusion criteria. Participants were divided into 2 cohorts by vaccine brand administered and served as their own control groups, with no comparison made between cohorts. Data were analyzed from September through November 2021.
    Exposures: Three doses of an FDA-authorized COVID-19 mRNA vaccine, BNT162b2 or mRNA-1273.
    Main outcomes and measures: Vaccine-associated adverse events were assessed via EHR report. Adverse event risk was quantified using the percentage of study participants who reported the adverse event within 14 days after each vaccine dose and during a 14-day control period, immediately preceding the first vaccine dose.
    Results: Among 47 999 individuals who received 3-dose COVID-19 mRNA vaccines, 38 094 individuals (21 835 [57.3%] women; median [IQR] age, 67.4 [52.5-76.5] years) received BNT162b2 (79.4%) and 9905 individuals (5099 [51.5%] women; median [IQR] age, 67.7 [59.5-73.9] years) received mRNA-1273 (20.6%). Reporting of severe adverse events remained low after the third vaccine dose, with rates of pericarditis (0.01%; 95% CI, 0%-0.02%), anaphylaxis (0%; 95% CI, 0%-0.01%), myocarditis (0%; 95% CI, 0%-0.01%), and cerebral venous sinus thrombosis (no individuals) consistent with results from earlier studies. Significantly more individuals reported low-severity adverse events after the third dose compared with after the second dose, including fatigue (2360 individuals [4.92%] vs 1665 individuals [3.47%]; P < .001), lymphadenopathy (1387 individuals [2.89%] vs 995 individuals [2.07%]; P < .001), nausea (1259 individuals [2.62%] vs 979 individuals [2.04%]; P < .001), headache (1185 individuals [2.47%] vs 992 individuals [2.07%]; P < .001), arthralgia (1019 individuals [2.12%] vs 816 individuals [1.70%]; P < .001), myalgia (956 individuals [1.99%] vs 784 individuals [1.63%]; P < .001), diarrhea (817 individuals [1.70%] vs 595 individuals [1.24%]; P < .001), fever (533 individuals [1.11%] vs 391 individuals [0.81%]; P < .001), vomiting (528 individuals [1.10%] vs 385 individuals [0.80%]; P < .001), and chills (224 individuals [0.47%] vs 175 individuals [0.36%]; P = .01).
    Conclusions and relevance: This study found that although third-dose vaccination against SARS-CoV-2 infection was associated with increased reporting of low-severity adverse events, risk of severe adverse events remained comparable with risk associated with the standard 2-dose regime. These findings suggest the safety of third vaccination doses in individuals who were eligible for booster vaccination at the time of this study.
    MeSH term(s) Aged ; BNT162 Vaccine ; COVID-19/prevention & control ; COVID-19 Vaccines/adverse effects ; Cohort Studies ; Electronic Health Records ; Female ; Humans ; Male ; RNA, Messenger ; SARS-CoV-2 ; Vaccination/adverse effects ; Vaccines, Synthetic ; mRNA Vaccines
    Chemical Substances COVID-19 Vaccines ; RNA, Messenger ; Vaccines, Synthetic ; mRNA Vaccines ; BNT162 Vaccine (N38TVC63NU)
    Language English
    Publishing date 2022-04-01
    Publishing country United States
    Document type Journal Article
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2022.7038
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  5. Article ; Online: Durability analysis of the highly effective mRNA-1273 vaccine against COVID-19.

    Puranik, Arjun / Lenehan, Patrick J / O'Horo, John C / Pawlowski, Colin / Virk, Abinash / Swift, Melanie D / Kremers, Walter / Venkatakrishnan, A J / Challener, Doug W / Breeher, Laura / Gordon, Joel E / Geyer, Holly L / Speicher, Leigh Lewis / Soundararajan, Venky / Badley, Andrew D

    PNAS nexus

    2022  Volume 1, Issue 2, Page(s) pgac058

    Abstract: COVID-19 vaccines are effective, but breakthrough infections have been increasingly reported. We conducted a test-negative case-control study to assess the durability of protection against symptomatic infection after vaccination with mRNA-1273. We fit ... ...

    Abstract COVID-19 vaccines are effective, but breakthrough infections have been increasingly reported. We conducted a test-negative case-control study to assess the durability of protection against symptomatic infection after vaccination with mRNA-1273. We fit conditional logistic regression (CLR) models stratified on residential county and calendar date of SARS-CoV-2 PCR testing to assess the association between the time elapsed since vaccination and the odds of symptomatic infection, adjusted for several covariates. There were 2,364 symptomatic individuals who had a positive SARS-CoV-2 PCR test after full vaccination with mRNA-1273 ("cases") and 12,949 symptomatic individuals who contributed 15,087 negative tests after full vaccination ("controls"). The odds of symptomatic infection were significantly higher 250 days after full vaccination compared to the date of full vaccination (Odds Ratio [OR]: 2.47, 95% confidence interval [CI]: 1.19-5.13). The odds of non-COVID-19 associated hospitalization and non-COVID-19 pneumonia (negative control outcomes) remained relatively stable over the same time interval (Day 250 OR
    Language English
    Publishing date 2022-05-20
    Publishing country England
    Document type Journal Article
    ISSN 2752-6542
    ISSN (online) 2752-6542
    DOI 10.1093/pnasnexus/pgac058
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  6. Article ; Online: Comparative effectiveness of mRNA-1273 and BNT162b2 against symptomatic SARS-CoV-2 infection.

    Puranik, Arjun / Lenehan, Patrick J / Silvert, Eli / Niesen, Michiel J M / Corchado-Garcia, Juan / O'Horo, John C / Virk, Abinash / Swift, Melanie D / Gordon, Joel E / Speicher, Leigh Lewis / Geyer, Holly L / Kremers, Walter / Halamka, John / Badley, Andrew D / Venkatakrishnan, A J / Soundararajan, Venky

    Med (New York, N.Y.)

    2021  Volume 3, Issue 1, Page(s) 28–41.e8

    Abstract: Background: mRNA coronavirus disease 2019 (COVID-19) vaccines are safe and effective, but increasing reports of breakthrough infections highlight the need to vigilantly monitor and compare the effectiveness of these vaccines.: Methods: We ... ...

    Abstract Background: mRNA coronavirus disease 2019 (COVID-19) vaccines are safe and effective, but increasing reports of breakthrough infections highlight the need to vigilantly monitor and compare the effectiveness of these vaccines.
    Methods: We retrospectively compared protection against symptomatic infection conferred by mRNA-1273 and BNT162b2 at Mayo Clinic sites from December 2020 to September 2021. We used a test-negative case-control design to estimate vaccine effectiveness (VE) and to compare the odds of symptomatic infection after full vaccination with mRNA-1273 versus BNT162b2, while adjusting for age, sex, race, ethnicity, geography, comorbidities, and calendar time of vaccination and testing.
    Findings: Both vaccines were highly effective over the study duration (VE
    Conclusions: Both mRNA-1273 and BNT162b2 strongly protect against symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. It is imperative to continue monitoring and comparing available vaccines over time and with respect to emerging variants to inform public and global health decisions.
    Funding: This study was funded by nference.
    MeSH term(s) 2019-nCoV Vaccine mRNA-1273 ; BNT162 Vaccine ; COVID-19/prevention & control ; COVID-19 Vaccines/therapeutic use ; Humans ; Retrospective Studies ; SARS-CoV-2/genetics
    Chemical Substances COVID-19 Vaccines ; 2019-nCoV Vaccine mRNA-1273 (EPK39PL4R4) ; BNT162 Vaccine (N38TVC63NU)
    Language English
    Publishing date 2021-12-11
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ISSN 2666-6340
    ISSN (online) 2666-6340
    DOI 10.1016/j.medj.2021.12.002
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  7. Article ; Online: Durability analysis of the highly effective BNT162b2 vaccine against COVID-19

    Puranik, Arjun / Lenehan, Patrick / O'Horo, John C / Niesen, Michiel JM / Virk, Abinash / Swift, Melanie D / Kremers, Walter / Venkatakrishnan, AJ / Gordon, Joel E / Geyer, Holly L / Speicher, Leigh Lewis / Soundararajan, Venky / Badley, Andrew D

    medRxiv

    Abstract: SARS-CoV-2 breakthrough infections have been increasingly reported in fully vaccinated individuals. We conducted a test-negative case-control study to assess the durability of protection after full vaccination with BNT162b2, defined as 14 days after the ... ...

    Abstract SARS-CoV-2 breakthrough infections have been increasingly reported in fully vaccinated individuals. We conducted a test-negative case-control study to assess the durability of protection after full vaccination with BNT162b2, defined as 14 days after the second dose, against polymerase chain reaction (PCR)-confirmed symptomatic SARS-CoV-2 infection, in a national medical practice between February 1, 2021 and August 22, 2021. We fit conditional logistic regression (CLR) models stratified on residential county and calendar time of testing to assess the association between time elapsed since vaccination and the odds of symptomatic infection or non-COVID-19 hospitalization (negative control), adjusted for several covariates. The primary population included 652 individuals who had a positive symptomatic test after full vaccination with BNT162b2 (cases) and 5,946 individuals with at least one negative symptomatic test after full vaccination (controls). The adjusted odds of symptomatic infection were higher 120 days after full vaccination versus at the date of full vaccination (Odds Ratio [OR]: 3.21, 95% confidence interval [CI]: 1.33-7.74). Importantly, the odds of infection were still lower 150 days after the first BNT162b2 dose as compared to 4 days after the first dose (OR: 0.3, 95% CI: 0.19-0.45), when immune protection approximates the unvaccinated status. Low rates of COVID-19 associated hospitalization or death in this cohort precluded analyses of these severe outcomes. The odds of experiencing a non-COVID-19 hospitalization decreased with time since vaccination, suggesting a possible underestimation of waning protection by this approach due to confounding factors. Taken together, these data constitute an early signal for waning protection against symptomatic illness while also providing reassurance that BNT162b2 continues to protect against symptomatic SARS-CoV-2 infection several months after full vaccination. Continued surveillance of COVID-19 vaccine durability, particularly against severe disease, is critical to guide effective and equitable strategies to respond to the pandemic, including distribution of booster doses, development of new vaccines, and implementation of both pharmaceutical and nonpharmaceutical interventions.
    Keywords covid19
    Language English
    Publishing date 2021-09-07
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2021.09.04.21263115
    Database COVID19

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  8. Article ; Online: Outcomes of COVID-19 With the Mayo Clinic Model of Care and Research.

    O'Horo, John Charles / Cerhan, James R / Cahn, Elliot J / Bauer, Philippe R / Temesgen, Zelalem / Ebbert, Jon / Abril, Andy / Abu Saleh, Omar M / Assi, Mariam / Berbari, Elie F / Bierle, Dennis M / Bosch, Wendelyn / Burger, Charles D / Cano Cevallos, Edison J / Clements, Casey M / Carmona Porquera, Eva M / Castillo Almeida, Natalia E / Challener, Douglas W / Chesdachai, Supavit /
    Comba, Isin Y / Corsini Campioli, Cristina G / Crane, Sarah J / Dababneh, Ala S / Enzler, Mark J / Fadel, Hind J / Ganesh, Ravindra / De Moraes, Alice Gallo / Go, John R / Gordon, Joel E / Gurram, Pooja R / Guru, Pramod K / Halverson, Erika L / Harrison, Michael F / Heaton, Heather A / Hurt, Ryan / Kasten, Mary J / Lee, Augustine S / Levy, Emily R / Libertin, Claudia R / Mallea, Jorge M / Marshall, William F / Matcha, Gautam / Meehan, Anne M / Franco, Pablo Moreno / Morice, William G / O'Brien, Jennifer J / Oeckler, Richard / Ommen, Steve / Oravec, Caitlin P / Orenstein, Robert / Ough, Natalie J / Palraj, Raj / Patel, Bhavesh M / Pureza, Vincent S / Pickering, Brian / Phelan, David M / Razonable, Raymund R / Rizza, Stacey / Sampathkumar, Priya / Sanghavi, Devang K / Sen, Ayan / Siegel, Jason L / Singbartl, Kai / Shah, Aditya S / Shweta, Fnu / Speicher, Leigh L / Suh, Gina / Tabaja, Hussam / Tande, Aaron / Ting, Henry H / Tontz, Russell C / Vaillant, James J / Vergidis, Paschalis / Warsame, Mohamed Y / Yetmar, Zachary A / Zomok, Catherine Cate D / Williams, Amy W / Badley, Andrew D

    Mayo Clinic proceedings

    2020  Volume 96, Issue 3, Page(s) 601–618

    Abstract: Objective: To report the Mayo Clinic experience with coronavirus disease 2019 (COVID-19) related to patient outcomes.: Methods: We conducted a retrospective chart review of patients with COVID-19 diagnosed between March 1, 2020, and July 31, 2020, at ...

    Abstract Objective: To report the Mayo Clinic experience with coronavirus disease 2019 (COVID-19) related to patient outcomes.
    Methods: We conducted a retrospective chart review of patients with COVID-19 diagnosed between March 1, 2020, and July 31, 2020, at any of the Mayo Clinic sites. We abstracted pertinent comorbid conditions such as age, sex, body mass index, Charlson Comorbidity Index variables, and treatments received. Factors associated with hospitalization and mortality were assessed in univariate and multivariate models.
    Results: A total of 7891 patients with confirmed COVID-19 infection with research authorization on file received care across the Mayo Clinic sites during the study period. Of these, 7217 patients were adults 18 years or older who were analyzed further. A total of 897 (11.4%) patients required hospitalization, and 354 (4.9%) received care in the intensive care unit (ICU). All hospitalized patients were reviewed by a COVID-19 Treatment Review Panel, and 77.5% (695 of 897) of inpatients received a COVID-19-directed therapy. Overall mortality was 1.2% (94 of 7891), with 7.1% (64 of 897) mortality in hospitalized patients and 11.3% (40 of 354) in patients requiring ICU care.
    Conclusion: Mayo Clinic outcomes of patients with COVID-19 infection in the ICU, hospital, and community compare favorably with those reported nationally. This likely reflects the impact of interprofessional multidisciplinary team evaluation, effective leveraging of clinical trials and available treatments, deployment of remote monitoring tools, and maintenance of adequate operating capacity to not require surge adjustments. These best practices can help guide other health care systems with the continuing response to the COVID-19 pandemic.
    MeSH term(s) Adolescent ; Biomedical Research ; COVID-19/epidemiology ; COVID-19/therapy ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Hospitalization/trends ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units/statistics & numerical data ; Male ; Pandemics ; Retrospective Studies ; SARS-CoV-2
    Language English
    Publishing date 2020-12-26
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 124027-4
    ISSN 1942-5546 ; 0025-6196
    ISSN (online) 1942-5546
    ISSN 0025-6196
    DOI 10.1016/j.mayocp.2020.12.006
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