Mayo Clinic proceedings
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Mayo Clinic proceedings · May 2020
Review Comparative StudyComparison of Transatlantic Approaches to Lipid Management: The AHA/ACC/Multisociety Guidelines vs the ESC/EAS Guidelines.
The 2018 American Heart Association/American College of Cardiology/Multisociety (AHA/ACC) guidelines and the 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines on lipid management were published less than a year apart. Both guidelines focus on reducing cardiovascular risk, but they follow different approaches in terms of methods of risk estimation, definitions of at-risk groups, and treatment goals to achieve this common underlying objective. Both recommend achieving risk-based percentage reductions of low-density lipoprotein cholesterol (LDL-C) levels with statin therapy. ⋯ The AHA/ACC guidelines may be considered more conservative, reserving the addition of nonstatins to maximally tolerated statins for only select patient groups based on specific LDL-C thresholds. One of the main reasons for these differences is incorporation of cost value considerations by the AHA/ACC guidelines, whereas the ESC/EAS guidelines consider an ideal setting with unlimited resources while making recommendations. In this review, we discuss similarities and differences between the 2 lipid guidelines to help clinicians become more cognizant of these recommendations and provide the best individualized patient care.
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Major adverse cardiac events are common causes of perioperative mortality and major morbidity. Preventing these complications requires thorough preoperative risk assessment and postoperative monitoring of at-risk patients. Major guidelines recommend assessment based on a validated risk calculator that incorporates patient- and procedure-specific factors. ⋯ Favoring cost-effectiveness, Canadian guidelines instead recommend obtaining brain natriuretic peptide or N-terminal prohormone of brain natriuretic peptide levels to guide postoperative screening for myocardial injury or infarction. When conditions such as acute coronary syndrome, severe pulmonary hypertension, and decompensated heart failure are identified, nonemergent surgery should be postponed until the condition is appropriately managed. There is an evolving role of biomarkers and myocardial injury after noncardiac surgery to enhance risk stratification, but the effect of interventions guided by these strategies is unclear.
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Mayo Clinic proceedings · May 2020
ReviewNuances of the Female Nurse-Physician Relationship: An Evolution Across Time.
Gender bias in academic medicine is increasingly recognized as a widespread phenomenon and has generated substantial research and discussion in recent years. Gender bias goes beyond leadership positions and financial compensation and extends to interprofessional relationships, including relationships with allied staff. Few studies have examined the female nurse-physician relationship, and the goal of this review is to consolidate the existing evidence and gaps in the literature with regard to this dyad. ⋯ The reported female nurse perspective of this relationship has been overall more positive, but recent studies have had a stronger focus on the physician perspective. Several hypotheses are discussed as to why such an evolution has occurred in the female nurse-physician relationship. There continue to be important gaps in the literature, including more in-depth evaluations of the female nurse perspective and investigation of the male perspective of the nurse-physician relationship.
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Mayo Clinic proceedings · May 2020
ReviewArtificial Intelligence in Cardiology: Present and Future.
Artificial intelligence (AI) is a nontechnical, popular term that refers to machine learning of various types but most often to deep neural networks. Cardiology is at the forefront of AI in medicine. For this review, we searched PubMed and MEDLINE databases with no date restriction using search terms related to AI and cardiology. ⋯ Artificial intelligence requires a close collaboration among computer scientists, clinical investigators, clinicians, and other users in order to identify the most relevant problems to be solved. Best practices in the generation and implementation of AI include the selection of ideal data sources, taking into account common challenges during the interpretation, validation, and generalizability of findings, and addressing safety and ethical concerns before final implementation. The future of AI in cardiology and in medicine in general is bright as the collaboration between investigators and clinicians continues to excel.
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The opioid crisis is a major concern of most health care institutions, including our large academic center. In this article, an organized approach to managing the epidemic institutionally is discussed. ⋯ The development of an Opioid Stewardship Program resulted in: (1) an understanding of our diverse prescribing practices and the formation of patient- and procedure-specific guidelines to manage them, (2) education tools for our patients and providers, and (3) workflows and practice advisories within the electronic health record to support appropriate prescribing and monitoring of patients. This ongoing work continues to evolve in response to the needs of our patients, changing regulatory environments, and our improved understanding of our practices.