Pub Date : 2024-11-01DOI: 10.1016/j.mayocp.2024.08.017
Bonnie C. Sohn MD , Ericka E. Tung MD, MPH , Paul Y. Takahashi MD, MPH , Brandon P. Verdoorn MD
The population of older adults is rapidly growing worldwide. Because of the substantial shortage of geriatricians, all clinicians need basic fluency in older adult care. In our approach to evaluating an older adult in the clinic or at the bedside, we apply the “Geriatric 5Ms” framework to manage the patient’s care. The Geriatric 5Ms consist of the following key steps. First, consider the mind: the cognitive and psychological domains of a patient’s health. Second, evaluate mobility and fall risk. Third, review and reconcile medications, particularly high-risk medications. Fourth, ask what matters most to the patient. Fifth, assess multicomplexity: how the intersection of multiple chronic conditions and social determinants of health influence the patient’s health care management. Herein, we provide clinicians with practical suggestions and resources for quickly and effectively applying the Geriatric 5Ms to the care of older adults.
{"title":"Clinician’s Guide to Geriatric Assessment","authors":"Bonnie C. Sohn MD , Ericka E. Tung MD, MPH , Paul Y. Takahashi MD, MPH , Brandon P. Verdoorn MD","doi":"10.1016/j.mayocp.2024.08.017","DOIUrl":"10.1016/j.mayocp.2024.08.017","url":null,"abstract":"<div><div>The population of older adults is rapidly growing worldwide. Because of the substantial shortage of geriatricians, all clinicians need basic fluency in older adult care. In our approach to evaluating an older adult in the clinic or at the bedside, we apply the “Geriatric 5Ms” framework to manage the patient’s care. The Geriatric 5Ms consist of the following key steps. First, consider the <em>mind</em>: the cognitive and psychological domains of a patient’s health. Second, evaluate <em>mobility</em> and fall risk. Third, review and reconcile <em>medications</em>, particularly high-risk medications. Fourth, ask what <em>matters most</em> to the patient. Fifth, assess <em>multicomplexity</em>: how the intersection of multiple chronic conditions and social determinants of health influence the patient’s health care management. Herein, we provide clinicians with practical suggestions and resources for quickly and effectively applying the Geriatric 5Ms to the care of older adults.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"99 11","pages":"Pages 1773-1784"},"PeriodicalIF":6.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469470","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":"Establishment of an Atherosclerosis and Dyslipidemia Program in Kazakhstan","authors":"Makhabbat Bekbossynova MD, PhD, Tatiana Ivanova-Razumova MD, PhD, Ayana Ablayeva MPH, Zhansaya Oralbekova BS","doi":"10.1016/j.mayocp.2024.05.023","DOIUrl":"10.1016/j.mayocp.2024.05.023","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"99 11","pages":"Pages 1698-1701"},"PeriodicalIF":6.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.mayocp.2024.05.027
Marta Figueiral MD , Alessia Paldino MD , Matheus Vernet Machado Bressan Wilke MD, PhD , Joseph D. Farris PhD , Jan Verheijen PhD , John R. Giudicessi MD, PhD , Michael J. Ackerman MD, PhD , Janet E. Olson PhD , Jennifer Arroyo PhD , Rory J. Olson PhD , Eric W. Klee PhD , Naveen L. Pereira MD
Objective
To determine the prevalence, penetrance, and disease expression of cardiomyopathy-related genetic variants in an unselected, richly phenotyped Mayo Clinic population in the setting of preemptive sequencing, with return of incidental findings following the American College of Medical Genetics and Genomics recommendations.
Patients and Methods
We analyzed a quaternary medical center–based biobank cohort (n=983) for reportable variants in 15 cardiomyopathy genes. Prioritization of genetic variants was performed using an internally developed pipeline to identify potentially reportable variants. Prioritized variants were then manually curated. The correlation of likely pathogenic/pathogenic (LP/P) variants with clinical phenotypes and outcomes was established. Artificial intelligence–enabled electrocardiographic predictions of reduced left ventricular ejection fraction and hypertrophic cardiomyopathy were applied to genotype-positive (G+) participants.
Results
Of the 983 patients, 11 (1%) were G+, with 11 LP/P variants found in the MYBPC3, DSG2, MYH7, DSP, and PKP2 genes. All G+ participants underwent electrocardiography, and 10 (90%) underwent echocardiography. Most patients (10 [90%]) did not have a prior diagnosis of cardiomyopathy. Definitive disease penetrance (heart failure or cardiomyopathy) was present in 4 (36%), while 3 (27%) had possible penetrance (structural heart disease identified by echocardiography). Arrhythmias and/or cardiac conduction disease was present in 4 of 11 G+ individuals (36%). Artificial intelligence–electrocardiography was positive for hypertrophic cardiomyopathy or reduced left ventricular ejection fraction in 5 of the G+ participants (45%), of whom 4 (80%) had definitive or possible disease penetrance.
Conclusion
Cardiomyopathy-associated LP/P variants are present in a small subset of a quaternary medical center population, and disease penetrance in G+ individuals is high in the form of cardiac structural abnormalities and heart failure.
{"title":"Prevalence, Penetrance, and Phenotypic Manifestation of Cardiomyopathy-Associated Genetic Variants in the General Population: Insights from a Mayo Clinic Biobank Study","authors":"Marta Figueiral MD , Alessia Paldino MD , Matheus Vernet Machado Bressan Wilke MD, PhD , Joseph D. Farris PhD , Jan Verheijen PhD , John R. Giudicessi MD, PhD , Michael J. Ackerman MD, PhD , Janet E. Olson PhD , Jennifer Arroyo PhD , Rory J. Olson PhD , Eric W. Klee PhD , Naveen L. Pereira MD","doi":"10.1016/j.mayocp.2024.05.027","DOIUrl":"10.1016/j.mayocp.2024.05.027","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the prevalence, penetrance, and disease expression of cardiomyopathy-related genetic variants in an unselected, richly phenotyped Mayo Clinic population in the setting of preemptive sequencing, with return of incidental findings following the American College of Medical Genetics and Genomics recommendations.</div></div><div><h3>Patients and Methods</h3><div>We analyzed a quaternary medical center–based biobank cohort (n=983) for reportable variants in 15 cardiomyopathy genes. Prioritization of genetic variants was performed using an internally developed pipeline to identify potentially reportable variants. Prioritized variants were then manually curated. The correlation of likely pathogenic/pathogenic (LP/P) variants with clinical phenotypes and outcomes was established. Artificial intelligence–enabled electrocardiographic predictions of reduced left ventricular ejection fraction and hypertrophic cardiomyopathy were applied to genotype-positive (G+) participants.</div></div><div><h3>Results</h3><div>Of the 983 patients, 11 (1%) were G+, with 11 LP/P variants found in the <em>MYBPC3</em>, <em>DSG2</em>, <em>MYH7</em>, <em>DSP</em>, and <em>PKP2</em> genes. All G+ participants underwent electrocardiography, and 10 (90%) underwent echocardiography. Most patients (10 [90%]) did not have a prior diagnosis of cardiomyopathy. Definitive disease penetrance (heart failure or cardiomyopathy) was present in 4 (36%), while 3 (27%) had possible penetrance (structural heart disease identified by echocardiography). Arrhythmias and/or cardiac conduction disease was present in 4 of 11 G+ individuals (36%). Artificial intelligence–electrocardiography was positive for hypertrophic cardiomyopathy or reduced left ventricular ejection fraction in 5 of the G+ participants (45%), of whom 4 (80%) had definitive or possible disease penetrance.</div></div><div><h3>Conclusion</h3><div>Cardiomyopathy-associated LP/P variants are present in a small subset of a quaternary medical center population, and disease penetrance in G+ individuals is high in the form of cardiac structural abnormalities and heart failure.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"99 11","pages":"Pages 1732-1743"},"PeriodicalIF":6.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469473","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}
Pub Date : 2024-11-01DOI: 10.1016/j.mayocp.2023.12.017
Sabrina A. Billings MD , Mary S. Hedges MD
{"title":"61-Year-Old Woman With Hip and Knee Pain","authors":"Sabrina A. Billings MD , Mary S. Hedges MD","doi":"10.1016/j.mayocp.2023.12.017","DOIUrl":"10.1016/j.mayocp.2023.12.017","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"99 11","pages":"Pages 1815-1820"},"PeriodicalIF":6.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381251","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}
Pub Date : 2024-11-01DOI: 10.1016/j.mayocp.2024.07.003
Francis A. Jefferson MD , Brian J. Linder MD
Female stress urinary incontinence, the loss of urine with transient increases in abdominal pressure, is a common condition that can profoundly impact a patient’s quality of life. The diagnosis is most commonly made via clinical history, including the subjective degree of bother, and physical examination evidence of urinary leakage with cough or Valsalva maneuver. A variety of treatment options exist for stress incontinence, ranging from observation, pelvic floor physical therapy, vaginal inserts, or continence pessaries to procedural interventions. Observation and conservative measures (eg, pads) can be used if the patient is not bothered by their symptoms. Nonsurgical management options include pelvic floor physical therapy, vaginal inserts, or continence pessaries. Procedural interventions include urethral bulking agent injection, synthetic mesh midurethral sling placement, autologous fascial pubovaginal sling placement, or retropubic colposuspension. Each procedure has a unique set of risks and benefits, with the choice of operation depending on a variety of factors including severity of stress incontinence, anatomy, medical and surgical comorbidities, and patient preferences. Ultimately, shared decision-making between the patient and the physician is used to decide the management strategy. This collaborative approach facilitates alignment of the chosen intervention with the patient's unique circumstances and preferences. We review relevant clinical considerations in the evaluation and management of female stress incontinence.
{"title":"Evaluation and Management of Female Stress Urinary Incontinence","authors":"Francis A. Jefferson MD , Brian J. Linder MD","doi":"10.1016/j.mayocp.2024.07.003","DOIUrl":"10.1016/j.mayocp.2024.07.003","url":null,"abstract":"<div><div>Female stress urinary incontinence, the loss of urine with transient increases in abdominal pressure, is a common condition that can profoundly impact a patient’s quality of life. The diagnosis is most commonly made via clinical history, including the subjective degree of bother, and physical examination evidence of urinary leakage with cough or Valsalva maneuver. A variety of treatment options exist for stress incontinence, ranging from observation, pelvic floor physical therapy, vaginal inserts, or continence pessaries to procedural interventions. Observation and conservative measures (eg, pads) can be used if the patient is not bothered by their symptoms. Nonsurgical management options include pelvic floor physical therapy, vaginal inserts, or continence pessaries. Procedural interventions include urethral bulking agent injection, synthetic mesh midurethral sling placement, autologous fascial pubovaginal sling placement, or retropubic colposuspension. Each procedure has a unique set of risks and benefits, with the choice of operation depending on a variety of factors including severity of stress incontinence, anatomy, medical and surgical comorbidities, and patient preferences. Ultimately, shared decision-making between the patient and the physician is used to decide the management strategy. This collaborative approach facilitates alignment of the chosen intervention with the patient's unique circumstances and preferences. We review relevant clinical considerations in the evaluation and management of female stress incontinence.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"99 11","pages":"Pages 1802-1814"},"PeriodicalIF":6.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469471","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}
Pub Date : 2024-11-01DOI: 10.1016/j.mayocp.2024.09.021
Karl A. Nath MBChB (Editor-in-Chief)
{"title":"In the Limelight: November 2024","authors":"Karl A. Nath MBChB (Editor-in-Chief)","doi":"10.1016/j.mayocp.2024.09.021","DOIUrl":"10.1016/j.mayocp.2024.09.021","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"99 11","pages":"Pages 1679-1681"},"PeriodicalIF":6.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142572288","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}
Pub Date : 2024-11-01DOI: 10.1016/j.mayocp.2024.05.029
Rami H. Ben-Joseph PhD , Virend K. Somers MD, PhD , Jed Black MD , Ralph B. D’Agostino Jr. PhD , Mat Davis PhD , Wayne Macfadden MD , Katherine E. Mues PhD, MPH , Clark Jackson MPH , Weiyi Ni PhD , Michael N. Cook PhD , William B. White MD
Objective
To compare intermediate-term risk of new-onset hypertension between normotensive patients with narcolepsy initiating sodium oxybate (SXB cohort) and those not initiating sodium oxybate (control cohort).
Patients and Methods
This retrospective cohort study used MarketScan administrative claims data from January 1, 2014, to February 29, 2020. Eligible patients were 18 years of age or older with continuous enrollment (≥180 days before and after cohort entry), had one or more narcolepsy claims or a prescription fill for sodium oxybate, had no history of hypertension or antihypertensive medication use, and had no use of sodium oxybate within 13 months before cohort entry. Patients in the SXB and control cohorts were matched 1:2 for the propensity score to balance baseline characteristics. End points were (1) a composite of new-onset hypertension diagnosis or antihypertensive medication initiation and (2) new-onset hypertension diagnosis. Patients were monitored for 180 days, until outcome occurrence, sodium oxybate discontinuation (SXB cohort), or sodium oxybate initiation (control cohort). Risk per 100 patients was reported; differences were evaluated using logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).
Results
The SXB and control cohorts included 954 and 1908 patients, respectively. Risk of new-onset hypertension diagnosis or antihypertensive medication initiation was higher in the SXB cohort than in the control cohort (6.60 vs 4.20 per 100 patients; OR, 1.61; 95% CI, 1.15 to 2.27). Risk of a new-onset hypertension diagnosis only in the SXB cohort was 0.94 per 100 patients and 0.52 per 100 patients in the control cohort (OR, 1.81; 95% CI, 0.73 to 4.46).
Conclusion
In this study, sodium oxybate use was associated with a new-onset hypertension diagnosis or antihypertensive medication initiation in normotensive patients with narcolepsy.
{"title":"Increased Risk of New-Onset Hypertension in Patients With Narcolepsy Initiating Sodium Oxybate: A Real-World Study","authors":"Rami H. Ben-Joseph PhD , Virend K. Somers MD, PhD , Jed Black MD , Ralph B. D’Agostino Jr. PhD , Mat Davis PhD , Wayne Macfadden MD , Katherine E. Mues PhD, MPH , Clark Jackson MPH , Weiyi Ni PhD , Michael N. Cook PhD , William B. White MD","doi":"10.1016/j.mayocp.2024.05.029","DOIUrl":"10.1016/j.mayocp.2024.05.029","url":null,"abstract":"<div><h3>Objective</h3><div>To compare intermediate-term risk of new-onset hypertension between normotensive patients with narcolepsy initiating sodium oxybate (SXB cohort) and those not initiating sodium oxybate (control cohort).</div></div><div><h3>Patients and Methods</h3><div>This retrospective cohort study used MarketScan administrative claims data from January 1, 2014, to February 29, 2020. Eligible patients were 18 years of age or older with continuous enrollment (≥180 days before and after cohort entry), had one or more narcolepsy claims or a prescription fill for sodium oxybate, had no history of hypertension or antihypertensive medication use, and had no use of sodium oxybate within 13 months before cohort entry. Patients in the SXB and control cohorts were matched 1:2 for the propensity score to balance baseline characteristics. End points were (1) a composite of new-onset hypertension diagnosis or antihypertensive medication initiation and (2) new-onset hypertension diagnosis. Patients were monitored for 180 days, until outcome occurrence, sodium oxybate discontinuation (SXB cohort), or sodium oxybate initiation (control cohort). Risk per 100 patients was reported; differences were evaluated using logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).</div></div><div><h3>Results</h3><div>The SXB and control cohorts included 954 and 1908 patients, respectively. Risk of new-onset hypertension diagnosis or antihypertensive medication initiation was higher in the SXB cohort than in the control cohort (6.60 vs 4.20 per 100 patients; OR, 1.61; 95% CI, 1.15 to 2.27). Risk of a new-onset hypertension diagnosis only in the SXB cohort was 0.94 per 100 patients and 0.52 per 100 patients in the control cohort (OR, 1.81; 95% CI, 0.73 to 4.46).</div></div><div><h3>Conclusion</h3><div>In this study, sodium oxybate use was associated with a new-onset hypertension diagnosis or antihypertensive medication initiation in normotensive patients with narcolepsy.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"99 11","pages":"Pages 1710-1721"},"PeriodicalIF":6.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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