Mayo Clinic proceedings
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Mayo Clinic proceedings · May 2023
ReviewOral Anticoagulation in Patients With Advanced Chronic Kidney Disease and Atrial Fibrillation: Beyond Anticoagulation.
The optimal approach to prevent stroke and systemic embolism in patients with advanced chronic kidney disease (CKD) and atrial fibrillation remains unresolved. We conducted a narrative review to explore areas of uncertainty and opportunities for future research. First, the relationship between atrial fibrillation and stroke is more complex in patients with advanced CKD than in the general population. ⋯ The VKAs may be harmful in CKD patients, in particular in patients with a high bleeding risk and labile international normalized ratio. The better safety and efficacy of NOACs as opposed to VKAs may be particularly evident in advanced CKD as a result of better on-target anticoagulation with NOACs, harmful off-target vascular effects of VKAs, and beneficial off-target vascular effects of NOACs. The intrinsic vasculoprotective effects of NOACs are supported by animal experimental evidence as well as by findings of large clinical trials and may result in use of NOACs beyond their anticoagulant properties.
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Mayo Clinic proceedings · May 2023
Clinical Implementation of an Artificial Intelligence Algorithm for Magnetic Resonance-Derived Measurement of Total Kidney Volume.
To evaluate the performance of an internally developed and previously validated artificial intelligence (AI) algorithm for magnetic resonance (MR)-derived total kidney volume (TKV) in autosomal dominant polycystic kidney disease (ADPKD) when implemented in clinical practice. ⋯ Performance of an AI algorithm in real-life clinical practice can be preserved if there is careful development and validation and if the implementation environment closely matches the development conditions.
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Mayo Clinic proceedings · May 2023
Increasing Incidence and Decreasing Mortality of Cutaneous Melanoma in Middle-Aged Adults: An Epidemiologic Study in Olmsted County, Minnesota.
To identify changes in the incidence and mortality of cutaneous melanoma in the fastest-growing segment of the US population, middle-aged adults. ⋯ Melanoma incidence has significantly increased since 1970. During the past 15 years, the incidence has continued to rise in middle-aged women (approximately 50% rise in incidence) but has stabilized in men. Mortality decreased in a linear fashion throughout this time.
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Mayo Clinic proceedings · May 2023
Racial and Gender Differences in Medical Student Burnout: A 2021 National Survey.
To measure racial and gender differences in medical student burnout and identify possible contributing factors. ⋯ Burnout (75.6%) was higher than historical norms, and female students reported higher burnout than male students. There was no difference in burnout prevalence by race. There were racial and gender differences in self-identified contributors of burnout. Additional research is needed to confirm whether stressors were contributors to or consequences of burnout, as well as how to address them.