Mayo Clinic proceedings
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Systemic sclerosis (scleroderma) is unique among the rheumatic diseases because it presents the challenge of managing a chronic multisystem autoimmune disease with a widespread obliterative vasculopathy of small arteries that is associated with varying degrees of tissue fibrosis. The hallmark of scleroderma is clinical heterogeneity with subsets that vary in the degree of disease expression, organ involvement, and ultimate prognosis. Thus, the term scleroderma is used to describe patients who have common manifestations that link them together, whereas a highly variable clinical course exists that spans from mild and subtle findings to aggressive, life-threatening multisystem disease. ⋯ Scleroderma is a multisystem disease with variable expression; thus, any treatment plan must be holistic, yet at the same time focus on the dominant organ disease. The goal of therapy is to improve quality of life by minimizing specific organ involvement and subsequent life-threatening disease. At the same time the many factors that alter daily function need to be addressed, including nutrition, pain, deconditioning, musculoskeletal disuse, comorbid conditions, and the emotional aspects of the disease, such as fear, depression, and the social withdrawal caused by disfigurement.
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Mayo Clinic proceedings · Apr 2013
Diagnostic yield of electroencephalography in a general inpatient population.
To determine the frequency and clinical predictors of seizures and markers of epileptiform activity in a non-critically ill general inpatient population. ⋯ Seizures occurred at a high frequency in hospitalized patients with spells and altered mental status. The EEG may be an underused investigative tool in the hospital with the potential to identify treatable causes of these common disorders.
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Mayo Clinic proceedings · Apr 2013
Practice GuidelineManagement of newly diagnosed symptomatic multiple myeloma: updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) consensus guidelines 2013.
Multiple myeloma remains an incurable neoplasm of plasma cells that affects more than 20,000 people annually in the United States. There has been a veritable revolution in this disease during the past decade, with dramatic improvements in our understanding of its pathogenesis, the development of several novel agents, and a concomitant doubling in overall survival. ⋯ A risk-adapted approach provides optimal therapy to patients, ensuring intense therapy for aggressive disease and minimizing toxic effects, providing sufficient but less intense therapy for low-risk disease. This consensus statement reflects recommendations from more than 20 Mayo Clinic myeloma physicians, providing a practical approach for newly diagnosed patients with myeloma who are not enrolled in a clinical trial.
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Mayo Clinic proceedings · Apr 2013
Computerized bar code-based blood identification systems and near-miss transfusion episodes and transfusion errors.
To determine whether the use of a computerized bar code-based blood identification system resulted in a reduction in transfusion errors or near-miss transfusion episodes. ⋯ Institution of a computerized bar code-based blood identification system was associated with a large increase in discovered near-miss events.
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Mayo Clinic proceedings · Apr 2013
Institution-wide QT alert system identifies patients with a high risk of mortality.
To determine the phenotype and outcome of patients with QTc of at least 500 ms and to create a pro-QTc risk score for mortality. ⋯ This novel institution-wide QT alert system identified patients with a high risk of mortality. The pro-QTc score, reflecting patients' multimorbidity and multipharmacy, was an independent predictor of mortality. The QT alert system may increase a physician's awareness of a high-risk patient. Potentially lifesaving interventions can be facilitated by reducing the modifiable factors of the pro-QTc score.