Mayo Clinic proceedings最新文献

{"title":"A Primer on Carceral Health for Clinicians: Care Delivery, Regulatory Oversight, Legal and Ethical Considerations, and Clinician Responsibilities","authors":"Nicholas V. Nguyen BA ,&nbsp;Kirsten A. Riggan MS, MA ,&nbsp;Gabriel B. Eber JD, MPH ,&nbsp;Brie A. Williams MD, MS ,&nbsp;Erin S. DeMartino MD","doi":"10.1016/j.mayocp.2024.09.009","DOIUrl":"10.1016/j.mayocp.2024.09.009","url":null,"abstract":"<div><div>The United States has one of the highest incarceration rates in the world, with approximately 1.7 million individuals detained in jails or federal or state prisons. Chronic medical conditions are more prevalent among adults in custody than among their nonincarcerated counterparts, resulting in needs that often surpass the on-site medical treatment capabilities of carceral facilities. For this reason, many community-based health care professionals will encounter incarcerated patients in an ambulatory or inpatient setting. Yet, although carceral status engenders pragmatic and ethical complexities in patient care, health care professionals in academic and community settings receive little or no education about correctional health. This special article seeks to address this knowledge gap by providing demographic and patient characteristics of this population, describing health care delivery in the criminal legal system, summarizing incarcerated patients’ health care rights, conveying the current state of oversight and regulation for correctional health care, and presenting the role of health care professionals in advocating for the ethical care of incarcerated patients. By equipping themselves with this knowledge, clinicians may provide holistic and ethical care for persons involved in the criminal legal system.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Pages 292-303"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964701","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":"In the Limelight: February 2025","authors":"Karl A. Nath MBChB (Editor-in-Chief)","doi":"10.1016/j.mayocp.2024.12.012","DOIUrl":"10.1016/j.mayocp.2024.12.012","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Pages 175-177"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143129768","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":"Mayo Clinic Proceedings and Medical Education—Medical Journals as the Partitur of Medical Knowledge","authors":"Fredric B. Meyer MD,&nbsp;Rafael Fonseca MD","doi":"10.1016/j.mayocp.2024.12.010","DOIUrl":"10.1016/j.mayocp.2024.12.010","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Pages 178-180"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143129769","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":"Valvular Heart Disease—A New Evolving Paradigm","authors":"Rick A. Nishimura MD,&nbsp;Steve R. Ommen MD,&nbsp;Joseph A. Dearani MD,&nbsp;Hartzell V. Schaff MD","doi":"10.1016/j.mayocp.2024.11.001","DOIUrl":"10.1016/j.mayocp.2024.11.001","url":null,"abstract":"<div><div>Valvular heart disease is one of the most common cardiovascular diseases today and may result in severe limiting symptoms, a shortened lifespan, and, in some cases, sudden death. It is important to identify significant valve disease because intervention can restore quality of life and in many instances increase longevity. In most patients, the diagnosis of significant valvular heart disease can be made on the basis of a physical examination, yet nearly half of the patients who could benefit from interventions are not being recognized or referred. There have been major improvements in both the diagnosis and treatment of patients with valvular heart disease, with noninvasive echocardiography available to confirm the presence and severity of valve disease, better and more durable surgical procedures, and the advent of catheter-based therapies. There are now national guidelines to aid clinicians in the optimal timing of the intervention, which are presented. However, it is now recognized that the long-standing volume or pressure overload from valve disease can result in incipient ventricular dysfunction even before the onset of symptoms or a drop in ejection fraction; therefore, there is an impetus to recognize and to treat these patients earlier and earlier in the disease natural history. A shared decision-making process should play a key role in the final decision for therapy, outlining the goals and risks of possible intervention coupled with the patient’s own needs and expectations.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Pages 358-379"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149565","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":"Effect of Tirzepatide on Body Weight and Diabetes Control in Adults With Type 1 Diabetes and Overweight or Obesity","authors":"Rene Rivera Gutierrez MD ,&nbsp;Elif Tama MD ,&nbsp;Dima Bechenati MD ,&nbsp;Regina Castañeda Hernandez MD ,&nbsp;Pamela K. Bennett APRN, DNP ,&nbsp;Allyson W. McNally APRN, DNP ,&nbsp;Sima Fansa MD ,&nbsp;Diego Anazco MD ,&nbsp;Andres Acosta MD, PhD ,&nbsp;Maria D. Hurtado Andrade MD, PhD","doi":"10.1016/j.mayocp.2024.07.006","DOIUrl":"10.1016/j.mayocp.2024.07.006","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the effect of tirzepatide on weight, diabetes control, and insulin requirements, and its safety profile in adults with type 1 diabetes (T1D) and overweight or obesity.</div></div><div><h3>Patients and Methods</h3><div>This is a retrospective study of adults with T1D using tirzepatide for overweight/obesity treatment between June 1, 2022, and October 31, 2023<strong>,</strong> at Mayo Clinic. Fifty-one patients fulfilled inclusion and exclusion criteria (adults with established T1D diagnosis and a body mass index ≥27 kg/m² using tirzepatide for 3 months or longer and without a history of bariatric surgery or active malignancy). Data were collected from the electronic medical record and reported as median (Q1-Q3).</div></div><div><h3>Results</h3><div>Most individuals were female (30, 58.8%), White (49, 96.1%), and with obesity class III (21, 41.2%). During a median follow-up time of 8.0 (Q1-Q3: 4.0-10.0) months, the total body weight loss was 8.5% (Q1-Q3: 5.3%-13.8%) (<em>P</em>&lt;.01). At 12 months, total body weight loss was 12.2% (Q1-Q3: 7.3%-19.8%) (n=26). By the last follow-up, hemoglobin A_1c decreased by 0.9% (Q1-Q3: 0.3%-1.1%) (<em>P</em>&lt;.0001) and daily insulin requirements by 31.6% (Q1-Q3: –48.0% to –10.9% (<em>P</em>&lt;.01). Basal and bolus insulin doses decreased proportionally, with a more precipitous decline during the first 6 months of tirzepatide therapy. The use of tirzepatide was associated with an improvement of cardiometabolic parameters. There was no increased incidence of hypoglycemia. The most common side effect was nausea (7, 13.7%).</div></div><div><h3>Conclusion</h3><div>Tirzepatide for the treatment of overweight and obesity in adults with T1D leads to substantial weight loss, improved diabetes control, and decreased insulin requirements, without worsening hypoglycemia. Future studies are needed to ascertain the long-term effect of tirzepatide in this population, ideally focusing on cardiovascular outcomes.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Pages 265-275"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142730124","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":"General Information","authors":"","doi":"10.1016/S0025-6196(25)00008-4","DOIUrl":"10.1016/S0025-6196(25)00008-4","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Page A7"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143135074","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":"Peristomal Ecthyma Gangrenosum","authors":"Frank Z. Jing MD,&nbsp;Afsaneh Alavi MD,&nbsp;Jenny L. Link MD","doi":"10.1016/j.mayocp.2024.11.004","DOIUrl":"10.1016/j.mayocp.2024.11.004","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Pages 190-191"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932299","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":"Excessive Initial Renal Function Decline Following Sodium-Glucose Cotransporter-2 Inhibitor Treatment Predicts Major Adverse Cardiorenal Outcomes","authors":"Chi-Yu Chen MD ,&nbsp;Shao-Sung Huang MD ,&nbsp;Shuo-Ming Ou MD, PhD ,&nbsp;Yang Ho MD ,&nbsp;Tz-Heng Chen MD ,&nbsp;Kuo-Hua Lee MD ,&nbsp;Yuan-Chia Chu PhD ,&nbsp;Yao-Pin Lin MD, PhD ,&nbsp;Wei-Cheng Tseng MD, PhD ,&nbsp;Der-Cherng Tarng MD, PhD","doi":"10.1016/j.mayocp.2024.08.028","DOIUrl":"10.1016/j.mayocp.2024.08.028","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate how estimated glomerular filtration rate (eGFR) decline following sodium-glucose cotransporter-2 inhibitors (SGLT2i) initiation predicts long-term cardiorenal outcomes.</div></div><div><h3>Methods</h3><div>From 2016 to 2020, a longitudinal cohort of 4942 diabetic patients treated with SGLT2i were enrolled and followed until December 2021. Patients were categorized into mild (≤30%), moderate (&gt;30%∼≤40%) and severe (&gt;40%) decline groups by the maximal eGFR change between 2 to 12 weeks after SGLT2i treatment. Cox regression was used to explore the association between eGFR decline and risks of a composite outcome of all-cause mortality, major adverse cardiovascular events (MACE), and major adverse renal events (MARE) after comprehensively adjusting for clinical and laboratory confounders.</div></div><div><h3>Results</h3><div>After a median follow-up of 2.57 years, 125 deaths, 192 MACE, and 247 MARE occurred. Severe and moderate eGFR decline groups showed higher risks of composite outcome (severe adjusted hazard ratio [aHR], 4.56; 95% CI, 2.70 to 7.70; moderate aHR, 1.94; 95% CI, 1.17 to 3.24) and death (severe aHR, 3.54; 95% CI, 1.16 to 10.83; moderate aHR, 3.63; 95% CI, 1.22 to 10.77) vs mild decline group. The severe decline group also had higher MACE (aHR, 3.65; 95% CI, 1.76 to 7.59) and MARE (aHR, 4.94; 95% CI 2.71 to 9.01) risks, whereas the moderate decline group only demonstrated higher MARE risk (aHR, 2.25; 95% CI, 1.22 to 4.14). The results were consistent in restricted cubic spline and sensitivity analyses.</div></div><div><h3>Conclusion</h3><div>An excessive eGFR decline greater than 30% after SGLT2i initiation was progressively associated with higher hazards of major adverse cardiorenal events. Careful and vigilant surveillance with timely treatment in such patients are suggested.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Pages 204-219"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965311","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":"79-Year-Old Woman With Nausea and Diarrhea","authors":"Omar Baqal MBBS ,&nbsp;Holly M. Thomson MD ,&nbsp;Mira T. Keddis MD","doi":"10.1016/j.mayocp.2024.02.028","DOIUrl":"10.1016/j.mayocp.2024.02.028","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Pages 352-357"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932292","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 Randomized, Controlled Trial of In-Hospital Use of Virtual Reality to Reduce Preoperative Anxiety Prior to Cardiac Surgery","authors":"Thirusivapragasam Subramaniam MBBS ,&nbsp;Joseph A. Dearani MD ,&nbsp;John M. Stulak MD ,&nbsp;Brian Lahr MS ,&nbsp;Alex Lee BS ,&nbsp;Jordan D. Miller PhD","doi":"10.1016/j.mayocp.2024.08.027","DOIUrl":"10.1016/j.mayocp.2024.08.027","url":null,"abstract":"<div><h3>Objective</h3><div>To study the effectiveness of virtual reality (VR) in reducing anxiety levels in patients undergoing first-time sternotomy for cardiac surgery.</div></div><div><h3>Patients and Methods</h3><div>A total of 100 adult patients scheduled for cardiac surgery at Mayo Clinic in Rochester, Minnesota, USA, was recruited from April 19, 2022, to October 12, 2022. Before surgery, patients wore a physiological monitor to record vital signs. On the day of surgery, patients completed the State-Trait Anxiety Inventory (STAI) and were randomized into two groups: one receiving a tablet-based intervention (control) and the other an immersive VR experience in the preoperative holding area. After the interventions, patients repeated the state anxiety component of the STAI.</div></div><div><h3>Results</h3><div>The results showed that overall state anxiety scores decreased an average of 2.0 points with tablet treatment, but this change failed to reach statistical significance. However, 6 of 20 specific state anxiety features significantly improved with tablet treatment whereas 1 feature significantly worsened. With the VR experience, overall state anxiety scores were significantly reduced by an average of 2.9 points, with improvement in seven state anxiety features (three of which did not overlap with the tablet intervention). Despite a greater reduction in the STAI score with the VR experience, there were no significant differences in the anxiolytic responses between groups. Physiologically, both tablet and VR treatments slightly but significantly reduced pulse rate, with no difference between the groups.</div></div><div><h3>Conclusion</h3><div>Overall, the findings suggest that treatment of older adults with an immersive VR experience before cardiac surgery can significantly reduce overall anxiety. Further investigation determining how such interventions can be optimally implemented in surgical practices and whether such interventions reduce the need for anxiolytic medications and improve the overall patient experience is needed.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Pages 220-234"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932295","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}