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Rochester, MN, United States

Dankbar G.C.,Mayo Medical School | Hayward M.J.,Center for the Science of Healthcare Delivery
Operations Research for Health Care | Year: 2012

In this report, we share highlights of the fourth annual Mayo Clinic Systems Engineering and Operations Research conference. The conference provided a forum for system engineers, operations researchers, clinicians, managers and administrators to share experiences, learning and success stories from their work in applying analytical and modeling tools to a range of problems. This report represents a snapshot of the challenges faced in acute health care, the techniques being deployed and the progress being made by engineers and operations researchers in helping to improve the quality and value of services. © 2012 Elsevier Ltd. Source

Gou S.,Mayo Medical School | Oxentenko S.C.,Mayo Medical School | Eldrige J.S.,Mayo Medical School | Xiao L.,Nanshan Hospital | And 5 more authors.
American Journal of Physical Medicine and Rehabilitation | Year: 2014

Intervertebral disk degeneration has been considered an irreversible process characterized by a decrease in cell viability, attenuation of proteoglycan and type II collagen synthesis, and dehydration of nucleus pulposus. Stem cell therapy specifically addresses the degenerative process and offers a potentially effective treatment modality. Current preclinical studies show that mesenchymal stem cells have the capacity to repair degenerative disks by differentiation toward chondrocyte-like cells, which produce proteoglycans and type II collagen. There has been evidence that mesenchymal stem cell transplantation into the intervertebral disk increases the intradiskal magnetic resonance imaging T2 signal intensity, increases the disk height, and decreases the degenerative grade in animal models. Appropriate selection of cell carriers/matrix is important because it may prevent cell leakage into the spinal canal and provide an environment that facilitates cell proliferation and differentiation. Although human cell therapy trials for degenerative disk disease are on the horizon, potential issues might arise. The authors hereby review the current state of regenerative cell therapy in degenerative disk disease, with emphasis in cell source, techniques for cellular expansion, induction, transplantation, potential benefit, and risks of the use of this novel medical armamentarium in the treatment of degenerative disk disease. Copyright © 2014 by Lippincott Williams & Wilkins. Source

Brinjikji W.,Mayo Medical School | Murad M.H.,Center for the Science of Healthcare Delivery | Rabinstein A.A.,Mayo Medical School | Cloft H.J.,Mayo Medical School | And 2 more authors.
American Journal of Neuroradiology | Year: 2015

BACKGROUND AND PURPOSE: A number of studies have suggested that anesthesia type (conscious sedation versus general anesthesia) during intra-arterial treatment for acute ischemic stroke has implications for patient outcomes. We performed a systematic review and meta-analysis of studies comparing the clinical and angiographic outcomes of the 2 anesthesia types. MATERIALS AND METHODS: In March 2014, we conducted a computerized search of MEDLINE and EMBASE for reports on anesthesia and endovascular treatment of acute ischemic stroke. Using random-effects meta-analysis, we evaluated the following outcomes: recanalization rate, good functional outcome (mRS ≤ 2), asymptomatic and symptomatic intracranial hemorrhage, death, vascular complications, respiratory complications, procedure time, time to groin, and time from symptom onset to recanalization. RESULTS: Nine studies enrolling 1956 patients (814 with general anesthesia and 1142 with conscious sedation) were included. Compared with patients treated by using conscious sedation during stroke intervention, patients undergoing general anesthesia had higher odds of death (OR = 2.59; 95% CI, 1.87-3.58) and respiratory complications (OR = 2.09; 95% CI, 1.36 -3.23) and lower odds of good functional outcome (OR = 0.43; 95% CI, 0.35-0.53) and successful angiographic outcome (OR = 0.54; 95% CI, 0.37-0.80). No difference in procedure time (P = .28) was seen between the groups. Preintervention NIHSS scores were available from 6 studies; in those, patients receiving general anesthesia had a higher average NIHSS score. CONCLUSIONS: Patients with acute ischemic stroke undergoing intra-arterial therapy may have worse outcomes with general anesthesia compared with conscious sedation. However, the difference in stroke severity at the onset may confound the comparison in the available studies; thus, a randomized trial is necessary to confirm this association. © 2015, American Society of Neuroradiology. All rights reserved. Source

Shippee N.D.,University of Minnesota | Domecq Garces J.P.,Knowledge and Evaluation Research Unit | Domecq Garces J.P.,Ford Motor Company | Prutsky Lopez G.J.,Knowledge and Evaluation Research Unit | And 12 more authors.
Health Expectations | Year: 2015

Background: There is growing attention towards increasing patient and service user engagement (PSUE) in biomedical and health services research. Existing variations in language and design inhibit reporting and indexing, which are crucial to comparative effectiveness in determining best practices. Objective: This paper utilizes a systematic review and environmental scan to derive an evidence-based framework for PSUE. Design: A metanarrative systematic review and environmental scan/manual search using scientific databases and other search engines, along with feedback from a patient advisory group (PAG). Eligible sources: English-language studies, commentaries, grey literature and other sources (including systematic and non-systematic reviews) pertaining to patient and public involvement in biomedical and health services research. Data extracted: Study description (e.g. participant demographics, research setting) and design, if applicable; frameworks, conceptualizations or planning schemes for PSUE-related endeavours; and methods for PSUE initiation and gathering patients'/service users' input or contributions. Results: Overall, 202 sources were included and met eligibility criteria; 41 of these presented some framework or conceptualization of PSUE. Sources were synthesized into a two-part framework for PSUE: (i) integral PSUE components include patient and service user initiation, reciprocal relationships, colearning and re-assessment and feedback, (ii) sources describe PSUE at several research stages, within three larger phases: preparatory, execution and translational. Discussion and Conclusions: Efforts at developing a solid evidence base on PSUE are limited by the non-standard and non-empirical nature of much of the literature. Our proposed two-part framework provides a standard structure and language for reporting and indexing to support comparative effectiveness and optimize PSUE. © 2015 John Wiley & Sons Ltd. Source

Elraiyah T.,Molecular Therapeutics | Elraiyah T.,Knowledge and Evaluation Research Unit | Gionfriddo M.R.,Knowledge and Evaluation Research Unit | Gionfriddo M.R.,Mayo Medical School | And 3 more authors.
Journal of Clinical Epidemiology | Year: 2015

Objectives To assess how well do the black box warnings present and communicate evidence in a way that is consistent with evidence-based patient-centered practice, through evaluating the boxed warning on teriparatide-induced osteosarcoma. Study Design and Setting We critically appraised teriparatide black box warning for osteosarcoma by reviewing human and animal studies that were used as basis for the warning. We also evaluated the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. Results We found that this warning was based on very low-quality evidence that was derived primarily from animal studies. The quality of evidence was rated down because of high risk of bias in addition to inconsistency, indirectness, and imprecision of the estimates. The warning does not provide sufficient guidance for practice like an implementation tool or an evidence profile to clarify the limitations of the evidence. Conclusion Black box warning for teriparatide-associated osteosarcoma does not explicitly present the quality of evidence, and therefore, it could be of limited use in evidence-based practice. We propose that black box warnings should include an evidence profile and an implementation guide to be more useful in evidence-based patient-centered practice. © 2015 Elsevier Inc. All rights reserved. Source

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