Mayo Clinic proceedings
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Mayo Clinic proceedings · Oct 2020
ReviewA Universally Accepted Definition of Gender Will Positively Impact Societal Understanding, Acceptance, and Appropriateness of Health Care.
When individuals do not conform to stereotypes associated with "male" or "female," they are often ridiculed, bullied, and rejected, which leads to depression, psychological problems, and even suicide. The number of individuals who identify themselves as transgender, gender queer, or who do not conform to societal norms with respect to gender appears to be increasing. Despite this apparent increase, clinicians and health care facilities are ill-prepared to meet the needs of these individuals in a professional and appropriate manner. ⋯ We highlight the fact that the biological definition of gender remains elusive in part because molecular and biological techniques have not been available to accurately probe the development of gender identity. We therefore advocate for the importance of enhancing our knowledge of the origins of gender identity with advanced scientific tools. Enhancing scientific understanding of the biological origins of gender identity may reduce stigma and barriers to care.
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Mayo Clinic proceedings · Oct 2020
ReviewHospital to Community Transitions for Older Adults: An Update for the Practicing Clinician.
Spurred by changes in both population demographics and health care reimbursement, health care providers are responding by using new models to more fully support the posthospital transition. This paper reviews common models for posthospital transition and also describes the Mayo Clinic model for care transition. Models are designed with the intent of managing the cost of health care by reducing 30-day hospital readmissions and improving management of chronic disease. ⋯ In patients experiencing the highest deciles of cost (8th decile), enrollment in a care transitions program reduced their overall cost by $2700. This cost savings was statistically significant. Both patients and caregivers participating in the program appreciated the home visits and felt more comfortable communicating at home.
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Mayo Clinic proceedings · Oct 2020
ReviewEnsuring Patient Protections When Tapering Opioids: Consensus Panel Recommendations.
Long-term opioid therapy has the potential for serious adverse outcomes and is often used in a vulnerable population. Because adverse effects or failure to maintain benefits is common with long-term use, opioid taper or discontinuation may be indicated in certain patients. Concerns about the adverse individual and population effects of opioids have led to numerous strategies aimed at reductions in prescribing. ⋯ Key questions remain about when and how to safely reduce or discontinue opioids in different patient populations. Thus, health care professionals who reduce or discontinue long-term opioid therapy require a clear understanding of the associated benefits and risks as well as guidance on the best practices for safe and effective opioid reduction. An interdisciplinary panel of pain clinicians and one patient advocate formulated recommendations on tapering methods and ongoing pain management in primary care with emphasis on patient-centered, integrated, comprehensive treatment models employing a biopsychosocial perspective.
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Mayo Clinic proceedings · Oct 2020
ReviewForgotten Technology in the COVID-19 Pandemic: Filtration Properties of Cloth and Cloth Masks-A Narrative Review.
Management of the global crisis of the coronavirus disease 2019 pandemic requires detailed appraisal of evidence to support clear, actionable, and consistent public health messaging. The use of cloth masks for general public use is being debated, and is in flux. We searched the MEDLINE and EMBASE databases and Google for articles reporting the filtration properties of flat cloth or cloth masks. ⋯ Although this is not a systematic review, we included all the articles that we identified in an unbiased way. We did not include gray literature or preprints. A plain language summary of these data and recommendations, as well as information on making, wearing and cleaning cloth masks is available at www.clothmasks.ca.
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Men are consistently overrepresented in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and coronavirus disease 2019 (COVID-19) severe outcomes, including higher fatality rates. These differences are likely due to gender-specific behaviors, genetic and hormonal factors, and sex differences in biological pathways related to SARS-CoV-2 infection. Several social, behavioral, and comorbid factors are implicated in the generally worse outcomes in men compared with women. ⋯ Such biomarkers may offer plausible explanations for the worse COVID-19 outcomes seen in men. There is the need for larger studies with sex-specific reporting and robust analyses to elucidate how sex modifies cellular and molecular pathways associated with SARS-CoV-2. This will improve interpretation of biomarkers and clinical management of COVID-19 patients by facilitating a personalized medical approach to risk stratification, prevention, and treatment.