Mayo Clinic proceedings
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Mayo Clinic proceedings · Feb 2021
ReviewDetecting the Dark Matter of Unpublished Clinical Cancer Studies: An Analysis of Phase 3 Randomized Controlled Trials.
Unpublished randomized controlled trial (RCT) frequency, correlates, and financial impact are not well understood. We sought to characterize the nonpublication of peer-reviewed manuscripts among interventional, therapeutic, multi-arm, phase 3 oncology RCTs. Trials were identified by searching ClinicalTrials.gov, while publications and abstracts were identified through PubMed and Google Scholar. ⋯ Direct contact with sponsors/investigators led to a 50.0% response rate (n=23 of 46); manuscript in preparation and/or in submission (n=10 of 23) was the most commonly cited reason for nonpublication. In conclusion, approximately 1 in 15 clinical oncology RCTs are unpublished and this has a profound impact on the research enterprise. The cooperative group infrastructure may serve as a blueprint to reduce nonpublication.
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Mayo Clinic proceedings · Feb 2021
ReviewCOVID-19: Understanding Inter-Individual Variability and Implications for Precision Medicine.
Coronavirus disease 2019 (COVID-19) is characterized by heterogeneity in susceptibility to the disease and severity of illness. Understanding inter-individual variation has important implications for not only allocation of resources but also targeting patients for escalation of care, inclusion in clinical trials, and individualized medical therapy including vaccination. In addition to geographic location and social vulnerability, there are clear biological differences such as age, sex, race, presence of comorbidities, underlying genetic variation, and differential immune response that contribute to variability in disease manifestation. ⋯ Enrollment of patients at low risk for progression of disease and hospitalization would likely not result in such therapy demonstrating efficacy. There are efforts to use artificial intelligence to integrate digital data from smartwatch applications or digital monitoring systems and biological data to enable identification of the high risk COVID-19 patient. The ultimate goal of precision medicine using such modern technology is to recognize individual differences to improve health for all.
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Mayo Clinic proceedings · Feb 2021
ReviewThe Pursuit of Training Meritorious Learners of Diverse Backgrounds: Mayo Clinic College of Medicine and Science.
The doors of the Mayo Clinic College of Medicine and Science (MCCMS) are open to all meritorious learners, including learners who come from communities that have endured longstanding and profound health and economic disparities. In our contemporary world, upward mobility in socioeconomic status is often a function of successful attainment of higher education. ⋯ In this article, our earlier experiences are analyzed with the goal of offering insights into novel approaches to train meritorious learners from all sociodemographic groups, including those who come from underserved communities. In addition, we highlight an apolitical and academically rigorous social cognition model that informs the contemporary academic agenda of diversity and inclusion, and we trace its root to the work of the founding father of experimental social psychology.
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Mayo Clinic proceedings · Feb 2021
ReviewBronchoscopic Lung Volume Reduction: A New Hope for Patients With Severe Emphysema and Air Trapping.
Chronic obstructive pulmonary disease (COPD) is common and has significant morbidity and mortality as the fourth leading cause of death in the United States. In many patients, particularly those with emphysema, COPD is characterized by markedly increased residual volume contributing to exertional dyspnea. Current therapies have limited efficacy. ⋯ Two reviewers evaluated potential references. A total of 27 references were included in our review. Included studies report experience in the diagnosis and bronchoscopic treatment for emphysema; case reports and non-English or non-Spanish studies were excluded.
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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.