Mayo Clinic proceedings最新文献

{"title":"Barriers and Facilitators to Innovation: A Qualitative Study in a Non-Profit Health Care System.","authors":"Melissa Gulden, Pierre Noel, Christopher Russi, Amy Low, Brian Kilen, Erik Hollander","doi":"10.1016/j.mayocp.2026.08.014","DOIUrl":"https://doi.org/10.1016/j.mayocp.2026.08.014","url":null,"abstract":"<p><strong>Objective: </strong>To explore how users within a non-profit healthcare system perceive, navigate, and engage with the organization's innovation management process and to identify barriers and facilitators influencing innovation participation PATIENTS AND METHODS: A qualitative study using Constructivist Grounded Theory was conducted at Mayo Clinic from May 1, 2025, through June 30, 2025. Thirteen semi-structured interviews were completed with team members representing multiple innovation adopter categories. Interview transcripts were analyzed using Constructivist Grounded Theory methods, including open, axial, and selective coding to identify recurring patterns related to innovation barriers and facilitators.</p><p><strong>Results: </strong>Thematic analysis identified six primary barriers to innovation engagement: fragmented pathways, siloed communication, limited resources, lack of clarity, cultural inertia, and leadership inconsistency. Five primary facilitators emerged: leadership support, mentorship, collaboration, recognition, and risk tolerance. Participants emphasized the importance of transparent innovation pathways, organizational alignment, and psychological safety in supporting innovation efforts and advancing ideas toward implementation.</p><p><strong>Conclusion: </strong>Innovation within large non-profit healthcare systems is shaped by both structural and cultural factors. Findings suggest that formalized, transparent innovation frameworks supported by leadership engagement, collaboration, and resource accessibility may strengthen participation, improve navigation of innovation processes, and facilitate the translation of ideas into meaningful organizational outcomes.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873751","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":"Frailty Attenuates the Prognostic Value of Multimorbidity in Heart Failure - Insights From the Largest Tertiary Center in the Middle East.","authors":"Viana Copeland, Boris Fishman, Shir Elimeleh, Ranel Loutati, Noam Makmal, Assi Milwidsky, Yishay Wasserstrum, Yariv Gerber, Elad Maor","doi":"10.1016/j.mayocp.2026.07.030","DOIUrl":"https://doi.org/10.1016/j.mayocp.2026.07.030","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether frailty modifies the association of multimorbidity in HF.</p><p><strong>Methods: </strong>A retrospective cohort study of HF patients. Multimorbidity was quantified using 26 conditions and categorized as low (≤4), intermediate (5-7), or high (>8). Frailty was defined using a multimodal construct integrating functional, nutritional, and biochemical domains. All-cause mortality was assessed using cox models with frailty-multimorbidity interaction testing. Charlson Comorbidity Index (CCI) was used for validation.</p><p><strong>Results: </strong>Among 18,058 patients (median age 74 years; 62% male; 64% frail), 57% died over a median follow-up of 4.0 years (IQR 1.3-7.7). Multimorbidity burden comprised 30.5% low, 48% intermediate, and 21.5% high. Frailty was associated with a 91% higher mortality risk (adjusted HR 1.91; 95% CI 1.85-2.00). Compared with low multimorbidity, intermediate and high burden were associated with an independent 8% and 20% higher mortality risks, respectively (95% CI 1.02-1.14 and 1.13-1.27; both p<.001). However, the association of multimorbidity differed by frailty such that among non-frail patients, intermediate and high multimorbidity increased mortality by 18% and 42% whereas in frail patients, the association was attenuated, with no excess risk for intermediate burden and only 13% increase for high burden (p-for-interaction <.001). CCI analyses was consistent, though differed among females and HFpEF.</p><p><strong>Conclusion: </strong>Frailty fundamentally attenuates risk in HF, while multimorbidity stratifies prognosis only when physiological reserve is preserved.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865660","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":"Impact of a Nationwide Remote Patient Care Hypertension Program on Clinical and Health Care Cost and Utilization Outcomes.","authors":"David I Feldman, Spencer Reynolds, Theodore Feldman, Randall Curnow, Eve Cunningham, Marat Fudim","doi":"10.1016/j.mayocp.2026.07.015","DOIUrl":"https://doi.org/10.1016/j.mayocp.2026.07.015","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether a remote patient care (RPC) hypertension program, which leverages remote patient monitoring and a technology-enabled, proactive care model, can not only improve clinical outcomes at scale for Medicare patients with hypertension but also reduce health care costs and utilization.</p><p><strong>Patients and methods: </strong>From February 1 2022 to October 31 2023, Medicare patients with hypertension were enrolled into a technology-enabled RPC hypertension program, which leveraged automatically transmitted blood pressure (BP) from a cellular-enabled BP cuff and clinical visits, to optimize patient engagement and increase BP control. Mean reduction in BP and percentage of individuals at BP goal (BP <130/80 mm Hg) were evaluated using a paired t test and McNemar test, respectively. Using Medicare claims data, a retrospective difference-in-differences analysis was conducted to assess the impact of an RPC hypertension program on total health care costs and resource utilization over a 12-month period following program activation when compared with a propensity score-matched control group.</p><p><strong>Results: </strong>The clinical analysis included 7256 enrolled patients (mean ± SD age, 73±9 years; BP, 142/81±16/9 mm Hg; rural/underserved, 3957 [54.5%]) followed up for a mean ± SD of 49±20 weeks. The mean ± SD reduction in BP was 8/4±16/9 mm Hg (P<.001 for both systolic and diastolic BP) with an 89% relative increase in the number of patients at goal BP at follow-up (36.1% [2619 of 7256] vs 19.1% [1386]; P<.001). The cost and utilization analysis included 3936 enrolled and 7671 control patients who were followed up for an average of 10±2 months and had similar baseline demographic clinical, cost, and utilization data. The RPC hypertension program decreased total cost of care (-$57.89 per patient per month; P=.07) over 12 months, primarily due to a reduction in inpatient costs (-$87.50 per patient per month; P<.001) and admissions (-6 per 1000 patients per year vs +44 per 1000 patients per year, 26.5% reduction; P<.01). Clinical, costs, and utilization results were similar among patients living in rural/underserved areas.</p><p><strong>Conclusion: </strong>An RPC hypertension program can positively impact the management of hypertension in the United States by improving BP control while also reducing inpatient spending and admissions.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148829909","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":"69-Year-Old Man With Fever of Unknown Origin.","authors":"Miguel E Gomez, Khalid Abu-Zeinah, Richard C Godby","doi":"10.1016/j.mayocp.2026.03.027","DOIUrl":"https://doi.org/10.1016/j.mayocp.2026.03.027","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819043","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":"63-Year-Old Man With Blurred Vision, Headache, and Pulsatile Tinnitus.","authors":"Kevin Chung, Wallace Klein Schwengber, Nathan L Delafield","doi":"10.1016/j.mayocp.2026.04.025","DOIUrl":"https://doi.org/10.1016/j.mayocp.2026.04.025","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819082","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":"84-Year-Old Man With Progressive Dyspnea on Exertion.","authors":"Clayton T Brady, Victoria E Kusztos, Thais D Coutinho","doi":"10.1016/j.mayocp.2026.05.023","DOIUrl":"https://doi.org/10.1016/j.mayocp.2026.05.023","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819036","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":"\"You'll be Fine. Probably.\" Communicating Risk in Clinical Medicine.","authors":"Douglas E Wright, Camille Nelson Kotton, Benjamin P Geisler, Jeffrey L Greenwald","doi":"10.1016/j.mayocp.2026.08.008","DOIUrl":"https://doi.org/10.1016/j.mayocp.2026.08.008","url":null,"abstract":"<p><p>Communicating risk is fundamental to informed consent and shared medical decision-making, yet it presents challenges in clinical practice. This review examines the major barriers to effective risk communication between clinicians and patients, including linguistic ambiguities, numeracy challenges, the influence of emotion, and cognitive biases. Without addressing these barriers, patients may misinterpret risk information, leading to decisions that do not align with their values and goals. Descriptive risk terms (such as \"likely,\" \"rare,\" or \"common\") are ambiguous, with wide variations in interpretation and, notably, between patients and clinicians. Medical professionals consistently assign lower numerical probabilities to risk terms than patients do, creating potential misalignment. Numerical expressions of risk - while seemingly more precise - assume patient numeracy; yet approximately 30% of U.S. adults lack basic numeracy skills needed to understand percentages and probabilities. Visual aids such as pictographs improve comprehension and accuracy of risk perception for most patients. Pre-existing biases, personal experiences, and emotional factors significantly influence how patients interpret risk information, regardless of how it is presented. Effective risk communication requires a multilayered individualized approach tailored to patients' understanding, experiences, and values. When important risk discussions are occurring, clinicians should consider using a combination of descriptive terms, numerical expressions, and visual representations, while remaining attentive to emotional factors and patient values that influence risk perception. To support more effective risk discussions, we introduce the RISKS framework (Recognize risk communication, Identify patient understanding and priorities, Self-assess for clinician biases, Key in on appropriate communication strategies, Solicit patient comprehension).</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819077","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":"The Optimal Timing for Patients With Acute Myocardial Infarction to Safely Undergo Elective Non-Cardiac Surgery: A Retrospective Cohort Study.","authors":"Chien-Chang Liao, Chuen-Chau Chang, Chun-Chieh Yeh, Ta-Liang Chen, Li-Chin Sung","doi":"10.1016/j.mayocp.2026.08.007","DOIUrl":"https://doi.org/10.1016/j.mayocp.2026.08.007","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the optimal timing of non-cardiac surgery for patients to achieve acceptable postoperative outcomes after acute myocardial infarction (AMI).</p><p><strong>Methods: </strong>We used a health insurance database to identify patients aged > 40 years who underwent non-cardiac surgery between 2010 and 2021 in Taiwan. Through frequency matching by age and sex at a 1:10 ratio, patients with and without AMI within 12 months before non-cardiac surgery were selected as study subjects. We compared postoperative complications and mortality between patients with and without a prior AMI by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs) using multiple logistic regression models.</p><p><strong>Results: </strong>Compared with 103880 people without AMI, the 10388 patients with a prior AMI had increased risks of 30-day mortality (OR 6.93, 95% CI 5.78-8.29), pulmonary embolism, acute renal failure, pneumonia, septicemia, and stroke after non-cardiac surgery. Patients who underwent non-cardiac surgery within 1 month after AMI had a higher risk of postoperative 30-day mortality (OR 10.8, 95% CI 9.03-12.8), which decreased in those who underwent surgery within 13-24 months (OR 2.44, 95% CI 1.82-3.26).</p><p><strong>Conclusion: </strong>Patients with a history of AMI within 12 months had a higher risk of complications and mortality after non-cardiac surgery. The risk of postoperative 30-day mortality was highest within 1 month after prior AMI and significantly decreased at the 1-year mark, nearing a return to baseline at 3 years. The timing of elective surgery should be individualized and determined by the surgical care team according to the patient's medical condition.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795126","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":"Suzetrigine for Refractory Pain in Guillain-Barré Syndrome.","authors":"David O Sohutskay, Carmen R Holmes, Eelco F M Wijdicks","doi":"10.1016/j.mayocp.2026.08.006","DOIUrl":"10.1016/j.mayocp.2026.08.006","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795047","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":"78-Year-Old Presenting With Aphasia and Visual Hallucination.","authors":"Jairo S Hernandez, Jennae N Shelby, Brenden S Ingraham","doi":"10.1016/j.mayocp.2025.12.025","DOIUrl":"https://doi.org/10.1016/j.mayocp.2025.12.025","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713104","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}