Mayo Clinic proceedings最新文献

{"title":"Prevalence and Incidence of Type 1 Brugada Pattern: A 30-Year Experience at Mayo Clinic.","authors":"Pattara Rattanawong, Carolyn Mead-Harvey, Olubadewa A Fatunde, Charles Van Der Walt, Nway Ko Ko, Patrick Hooke, Thanaboon Yinadsawaphan, Narathorn Kulthamrongsri, Win-Kuang Shen, Dan Sorajja","doi":"10.1016/j.mayocp.2024.05.028","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.05.028","url":null,"abstract":"<p><strong>Objective: </strong>To identify the incidence and prevalence of type 1 Brugada pattern at Mayo Clinic during 30 years.</p><p><strong>Methods: </strong>We retrospectively reviewed the electronic medical records from 1992 to 2021 at Mayo Clinic Enterprise. Patients with type 1 Brugada pattern electrocardiogram (ECG) were identified by a systematic keyword search. Incidences are calculated by decade. The incidence rate ratios (IRRs) between races were then calculated. Analysis of the association between groups and major arrhythmic event-free survival was conducted.</p><p><strong>Results: </strong>The study analyzed 5,381,186 ECGs from 2,304,809 patients; 150 patients had at least 1 ECG with a type 1 Brugada pattern (76.0% Brugada syndrome, 62.0% spontaneous, 18.7% fever induced, and 10.7% drug induced). The mean follow-up was 6.6±6.7 years. The incidence (per 100,000 person-years) of type 1 Brugada pattern increased during the past 3 decades (0.505 [95% CI, 0.203 to 1.040], 3.015 [95% CI, 2.272 to 3.925], and 3.916 [95% CI, 3.128 to 4.842]). The incidence in Black patients was approximately 1.5-fold higher compared with non-Hispanic White patients (IRR, 1.492 [95% CI, 0.610 to 3.649]; P=.38). The incidence in Hispanic White patients was 3-fold higher than in non-Hispanic White patients (IRR, 3.021 [95% CI, 1.410 to 6.474]; P=.005). The incidence in Asian patients was 2-fold higher than in Hispanic patients (IRR, 1.894 [95% CI, 0.705 to 5.086]; P=.21). The overall prevalence of the type 1 Brugada pattern between 2010 and 2021 was 10.094 per 100,000. The major arrhythmic events occurred in 8.6%, 7.1%, 12.5%, and 7.7% for spontaneous, fever-induced, drug-induced, and other type 1 Brugada patterns, respectively, during follow-up.</p><p><strong>Conclusion: </strong>The incidence of type 1 Brugada pattern at Mayo Clinic has increased during 3 decades. The prevalence of type 1 Brugada pattern in the United States is higher than previously reported. Type 1 Brugada pattern in Black and Hispanic populations is more common than previously suspected.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Cardiology Certification Using the ACCSAP Question Bank: Large Language Models vs Physicians.","authors":"Abdulla Shahid, Naman S Shetty, Nirav Patel, Mokshad Gaonkar, Garima Arora, Pankaj Arora","doi":"10.1016/j.mayocp.2024.07.030","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.07.030","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Quadruple-Valve Endocarditis.","authors":"Jonah A Kan, Corrie R Bach, Christopher R Stephenson","doi":"10.1016/j.mayocp.2024.09.013","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.09.013","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Enrollment to a Decentralized Study.","authors":"Adil E Bharucha, Michelle L Bublitz, Robert A Vierkant, Tony C Luehrs, Karen A Konzen, David A Weiss, Tony A Hart, Christine M Boos, Alina M Allen, Kent R Bailey, Konstantinos N Lazaridis","doi":"10.1016/j.mayocp.2024.03.022","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.03.022","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether the mode and formatting of invitations affect enrollment in a large, decentralized study.</p><p><strong>Patients and methods: </strong>Between July 1, 2022, and October 30, 2022, we prospectively compared various approaches to enroll patients in the Tapestry DNA Sequencing Research Study, a decentralized exome-sequencing study. In phase 1, patients were randomized to receive invitations via the electronic health record (EHR) patient portal or email (cohort 1, 69,852 patients). Phase 2 randomized in a 2×2 factorial design to receive (by portal or email) standard or enhanced (ie, more visually appealing) invitations (cohort 2, 26,198 patients). Factors that predicted enrollment rates were analyzed.</p><p><strong>Results: </strong>The enrollment rate was greater in cohort 2 (1,785 of 24,550, 7.27%) than 1 (1,758 or 69,765, 2.52%) and remained significant after multivariable adjustment (odds ratio, 1.31; 95% CI, 1.19-1.45). Enrollment rates were greater in women than men, patients 50 to 70 years of age than younger patients, White or non-Hispanic or Latino patients than those in other racial categories, urban than rural residents, and patients who had more health care encounters or more recent health care before this study (P<.02). The enrollment rate was also greater when invitations were delivered via EHR than email (odds ratio, 1.56; 95% CI, 1.44-1.68; P<.001).</p><p><strong>Conclusion: </strong>Invitations via EHR rather than email facilitate enrollment to large, decentralized studies. Enhanced display of invitation material did not increase enrollment. Lower enrollment rates in men, younger individuals, non-White and Hispanic individuals, and rural residents highlight a continued need to focus enrollment strategies on these subgroups.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender-Affirming Hormone Therapy for Breast Cancer in Transgender and Gender-Diverse Individuals: Unresolved and Unaddressed Issues.","authors":"Sanjna Rajput, Aminah Jatoi, Caroline Davidge-Pitts, Elizabeth J Cathcart-Rake","doi":"10.1016/j.mayocp.2024.10.002","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.10.002","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Difficult Encounters in Chronic Pain Patients: A Cohort Study.","authors":"Steven P Cohen, Winnie L Liu, Tina L Doshi, Eric J Wang, Evelien van Gelderen, Resham Mawalkar, Eellan Sivanesan, Kayode A Williams, Paul J Christo, Shravani Durbhakula, Glenn Treisman, Annie Hsu","doi":"10.1016/j.mayocp.2024.08.010","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.08.010","url":null,"abstract":"<p><strong>Objective: </strong>To determine variables associated with difficult clinical encounters.</p><p><strong>Patients and methods: </strong>This was a cross-sectional study of 428 new patients evaluated from 2022 to 2023. Demographic, clinical, social (eg, missed appointments, prior felony conviction, prior pain physicians, medical assistance) and visit-related (eg, visit took longer than expected, difficulty communicating) information was recorded, supplemented by in-person history gathered by the trainee and attending whose demographic data were also recorded. Physicians independently rated the \"difficulty\" of the encounter on a 6-point Likert scale from 1 = very easy/pleasant, 2 = easy/pleasant, 3 = neutral/average, 4 = difficult, 5 = very difficult, to 6 = extremely difficult. A difficult encounter was a combined trainee and attending rating of one IQR above the median of 2.0±1.75.</p><p><strong>Results: </strong>Among 428 participants, mean ± SD age was 54.2±15.8 years and 261 (61.0%) were female. Attending gender, gender concordance, race and racial concordance, and years of physician experience were not associated with difficulty. In multivariable analysis, requesting opioids (P=.001), lengthier than expected visit (P<.001), hostile/demanding behavior (P=.003), refusal to try recommended treatment (P=.002), unrealistic expectations (P<0.001), and difficulty communicating (P=.02) were associated with difficult encounters.</p><p><strong>Conclusion: </strong>Most variables associated with physician impressions of difficult encounters were visit-related, suggesting some patient-related factors (eg, prior substance abuse, translator requirement) may be less relevant in pain patients. Future research should evaluate interventions designed to decrease the difficulty of encounters and determine their effect on patients and physicians.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long Dosing Intervals of Parenteral Antiosteoporosis Medications and the Decrease in Societal Fracture Risk: A 11-Year Nationwide Population-Based Cohort Study.","authors":"Shau-Huai Fu, Hung-Kuan Yen, Rong-Sen Yang, Chih-Chien Hung, Jou-Wei Lin, Ming-Tsung Lee, Ho-Min Chen, Chih-Hsing Wu, Chih-Cheng Hsu, Chung-Yi Li, Olivier Q Groot, Chen-Yu Wang","doi":"10.1016/j.mayocp.2024.05.002","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.05.002","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the relationship between different dosing intervals of antiosteoporosis medications (AOMs) and the subsequent fracture risk among patients with newly initiated AOM therapies.</p><p><strong>Patients and methods: </strong>In a nationwide population-based cohort study based on Taiwan's National Health Insurance Research Database, osteoporosis patients with 50 years of age or older who newly initiated AOM from January 1, 2008, to December 31, 2018 (n=336,229) were included. We categorized AOMs into short dosing intervals (oral AOMs) or long dosing intervals (parenteral AOMs). The adherence of treatment by medication possession ratio and subsequent fracture after treatment for 3 years were measured.</p><p><strong>Results: </strong>Among patients who initiated parenteral AOMs, the percentage of patients with high adherence (medication possession ratio ≥75%) increased from 33% in 2008 to 69% in 2018. However, among patients who initiated oral AOMs, the percentage of high adherence remained stable (30%) between 2008 and 2018. The use of parenteral AOMs increased from 1% in 2008 to 62% in 2018. At the same time, the percentage of high adherence of those initiated AOMs significantly increased from 34% in 2008 to 61% in 2018. The risk of subsequent fracture decreased significantly between 2008 and 2018 after controlling for all potential confounders (HR, 0.85; 95% CI, 0.81 to 0.89).</p><p><strong>Conclusion: </strong>AOMs with long dosing intervals not only increased adherence but also associated with the decrease in subsequent fracture risk at a nationwide scale.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eculizumab Improves Renal Survival in Complement-Mediated TMA Secondary to SLE.","authors":"Yakai Fu, Zhiwen Chen, Jie Chen, Fangfang Sun, Ting Li, Nan Shen, Xiaodong Wang, Shuang Ye","doi":"10.1016/j.mayocp.2024.10.001","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.10.001","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decoding Obesity Management Medications and the Journey to Informed Treatment Choices for Patients.","authors":"Afton M Koball, Gretchen E Ames, Karen B Grothe, Matthew M Clark, Maria L Collazo-Clavell, Enrique F Elli","doi":"10.1016/j.mayocp.2024.10.003","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.10.003","url":null,"abstract":"<p><p>Incretin-based obesity management medications (OMMs) fill a treatment gap in a stepped-care model between lifestyle change alone and metabolic bariatric surgery, resulting in weight loss of 15% to 20% of body weight. Public interest in and demand for OMMs has recently increased dramatically. Unfortunately, cost and access to OMMs remain a significant barrier for many patients. Although these medications have the potential to produce large weight loss outcomes, many unanswered questions remain regarding informed choice and optimization of obesity care protocols, especially for patients with a body mass index of 35 kg/m² or higher who may be considering various intervention options such as lifestyle changes, OMMs, endoscopic weight loss procedures, and/or metabolic bariatric surgery. When considering strategies to aid patients in decision making about obesity treatment, several considerations warrant discussion because patients may have unrealistic perceptions about risk vs efficacy and may hold numerous misconceptions about long-term behavior change and outcomes. This article outlines considerations for informed obesity treatment decision making and reviews aspects of obesity treatment specific to OMMs, including adverse effects, patient expectations for treatment outcome, equitable access to care, the impact of weight bias on patient care, the risk of weight recurrence, and the need for long-term multicomponent treatment to achieve weight loss and weight maintenance.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Health Considerations for Primary Care Physicians Treating Breast Cancer Survivors.","authors":"Redet D Kidane, Kathryn J Ruddy, Grace Lin, Nicole P Sandhu","doi":"10.1016/j.mayocp.2024.08.014","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.08.014","url":null,"abstract":"<p><p>Breast cancer (BC) survivors are at increased risk for cardiovascular disease (CVD) and require their primary care physicians to manage their long-term general medical care, including cardiovascular (CV) health. Yet, evidence exists that some primary care physicians possess insufficient knowledge about survivorship care. With the goal of bridging these knowledge gaps, a PubMed review was conducted from July 7, 2020, through October 2, 2020, with an updated PubMed review from January 3, 2024, through April 28, 2024, focusing on CV health considerations in the primary care of BC survivors. Search terms included variations of \"breast cancer survivors\" and \"cardiovascular.\" In total, 152 publications were included. Breasts cancer survivors may have increased CVD risk because some anticancer therapies are cardiotoxic and risk factors for BC often also increase the risk for CVD. Multiple risk factors overlap for BC and CVD such as older age, Western diet, early menarche, physical inactivity, high body mass index, and smoking. In this review, results are summarized from studies that report the presence of CV risk factors and CVD in BC survivors. Also described are the CV effects of BC therapies (chemotherapy, hormonal agents, targeted therapies, and radiotherapy) and the type of CV evaluation (cardiac imaging and measurement of biomarkers) that these patients may need. Primary care physicians have an important role in managing the CV health of BC survivors from preventing, assessing, and managing CV risk factors to referring patients to appropriate specialists when needed.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}