Mayo Clinic proceedings
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Dysphagia, which is a geriatric syndrome affecting 10% to 33% of older adults, is commonly seen in older adults who have experienced a stroke or neurodegenerative diseases such as Alzheimer or Parkinson disease. Patients diagnosed as having dysphagia can experience malnutrition, pneumonia, and dehydration. Patients can also experience increased rates of mortality and long-term care admission. ⋯ Patients can be treated for oropharyngeal dysphagia by using compensatory interventions, including behavioral changes, oral care, dietary modification, or rehabilitative interventions such as exercises and therapeutic oral trials. Providers often address treatment of esophageal dysphagia by managing the underlying etiology, which could include removal of caustic medications or using EGD as a therapeutic modality for esophageal rings. High-quality, large research studies are necessary to further manage the diagnosis and appropriate treatment of this growing geriatric syndrome.
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Mayo Clinic proceedings · Feb 2021
ReviewTelemedicine and Team-Based Care: The Perils and the Promise.
The COVID-19 pandemic accelerated adoption of telemedicine visits into American medicine. It is commonly believed that, within a matter of weeks, telemedicine was widely and successfully implemented and that medicine is forever changed. The experience on the ground, however, is more nuanced, with both positive and negative experiences for patients and clinicians. ⋯ Herein, we describe our initial experiences with telemedicine in the context of many years practicing in aTBC models. Our experience demonstrates that when implementing telemedicine visits, it is important to avoid a reflex reversion to the outmoded model of the physician alone in the room with the patient and instead bring forth the safety, quality, and satisfaction advantages associated with aTBC. We provide a practical "how-to" guide for implementing telemedicine visits; outline logistical details of representative video and audio visits from our own practices; describe new opportunities for family engagement, care coordination, and comanagement across specialties; and outline a research agenda going forward to further knowledge of the risks and benefits and optimal application of health care on a telemedicine platform.
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Mayo Clinic proceedings · Feb 2021
Acute Myocardial Infarction in Autoimmune Rheumatologic Disease: A Nationwide Analysis of Clinical Outcomes and Predictors of Management Strategy.
To examine national-level differences in management strategies and outcomes in patients with autoimmune rheumatic disease (AIRD) with acute myocardial infarction (AMI) from 2004 through 2014. ⋯ In a nationwide cohort of AMI hospitalizations we found lower use of invasive management in patients with SLE and worse outcomes after AMI in patients with SLE and SSC compared with those without AIRD.
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Mayo Clinic proceedings · Feb 2021
Disparities in Research Participation by Level of Health Literacy.
To determine at which phase in the recruitment process for participation in clinical research studies do health literacy and other patient characteristics influence recruitment outcomes. ⋯ Because identical variables predicted both research interest and eventual consent, efforts to recruit broad populations must include acceptable methods of approaching potential participants as well as explaining study materials.
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Mayo Clinic proceedings · Feb 2021
The Association Between the Use of Cholinesterase Inhibitors and Cardiovascular Events Among Older Patients With Alzheimer Disease.
To evaluate the association between the use of cholinesterase inhibitors (ChEIs) and incident cardiovascular events (CVEs) among older patients with Alzheimer disease (AD). ⋯ The use of ChEIs was associated with a decreased risk of incident CVEs among patients with AD. The cardioprotective effect of ChEIs showed a dose-response relationship.