OBJECTIVE:To determine the incidence and predictors of severe postoperative hypotension (SPOH) among patients in general care wards. PATIENTS AND METHODS:We performed a retrospective study of adult patients who underwent general anesthesia at Mayo Clinic between May 5, 2018, and December 31, 2020, and were discharged from the postanesthesia care unit (PACU) to general care wards. Multivariable logistic regression models were used to identify potential predictors of SPOH (defined as mean arterial pressure [MAP] ≤55 mm Hg within 48 hours after a surgical procedure that resulted in rapid response team activation or advanced interventions). RESULTS:Among 23,656 eligible patients, 172 (0.7%; 95% CI, 0.6-0.9) had SPOH. Independent predictors included lower body mass index (OR, 0.83 per 5-unit increase; 95% CI, 0.73-0.95; P=.006), longer procedure duration (OR, 1.14 per 1 hour; 95% CI, 1.07-1.22; P<.001), and intraoperative blood transfusion (OR, 4.32; 95% CI, 2.92-6.38; P<.001). A significant interaction was observed between preoperative and lowest PACU MAPs (P=.04); SPOH risk was highest for patients with low preoperative and PACU MAPs. Patients with a preoperative MAP of 70 mm Hg or less and a PACU MAP of 60 mm Hg or less had 9.84-fold higher odds of SPOH (reference, 93.3 mm Hg). CONCLUSION:Lower preoperative and PACU MAPs are associated with higher odds of SPOH. These findings highlight the need for greater postoperative surveillance of surgical patients with low perioperative blood pressure.
Ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment of patients with ulcerative colitis and familial adenomatous polyposis. As the incidence of ulcerative colitis rises globally, increasing numbers of patients live long term with IPAA. Whereas most patients with IPAA achieve good functional outcomes, studies suggest that up to 80% will experience pouchitis during their lifetime, among other inflammatory and structural pouch-related complications. Patients with pouch disorders present with nonspecific gastrointestinal symptoms that may include increased stool frequency, urgency, abdominal or pelvic discomfort, tenesmus, rectal bleeding, and difficulty in evacuating the pouch. Common inflammatory conditions include acute or intermittent pouchitis, chronic antibiotic-dependent pouchitis, chronic antibiotic-refractory pouchitis, cuffitis, and Crohn-like disease of the pouch. Structural complications, such as anastomotic leaks, strictures, and fistulas, may also occur and be manifested with obstructive or infectious symptoms. Primary care clinicians play an important role in the early recognition and initial management of pouch-related complications. For example, patients with mild suspected pouchitis and no alarm features may be treated with empirical antibiotic therapy with close follow-up. Topical mesalamine may be used for suspected cuffitis. However, persistent symptoms, recurrent pouchitis, suspected Crohn-like disease of the pouch, or signs of structural complications warrant prompt referral to subspecialist care.
Objective To explore how users within a non-profit healthcare system perceive, navigate, and engage with the organization's innovation management process and to identify barriers and facilitators influencing innovation participation Patients and Methods A qualitative study using Constructivist Grounded Theory was conducted at Mayo Clinic from May 1, 2025, through June 30, 2025. Thirteen semi-structured interviews were completed with team members representing multiple innovation adopter categories. Interview transcripts were analyzed using Constructivist Grounded Theory methods, including open, axial, and selective coding to identify recurring patterns related to innovation barriers and facilitators. Results Thematic analysis identified six primary barriers to innovation engagement: fragmented pathways, siloed communication, limited resources, lack of clarity, cultural inertia, and leadership inconsistency. Five primary facilitators emerged: leadership support, mentorship, collaboration, recognition, and risk tolerance. Participants emphasized the importance of transparent innovation pathways, organizational alignment, and psychological safety in supporting innovation efforts and advancing ideas toward implementation. Conclusion Innovation within large non-profit healthcare systems is shaped by both structural and cultural factors. Findings suggest that formalized, transparent innovation frameworks supported by leadership engagement, collaboration, and resource accessibility may strengthen participation, improve navigation of innovation processes, and facilitate the translation of ideas into meaningful organizational outcomes.
Art is integrated into the Mayo Clinic environment. Since the original Mayo Clinic Building was finished in 1914, many pieces have been donated or commissioned for patients and staff to enjoy. Each issue of Mayo Clinic Proceedings features a work of art (as interpreted by the author) that is displayed in a building or on the grounds of Mayo Clinic campuses.
OBJECTIVE:To evaluate whether frailty modifies the association of multimorbidity in HF. METHODS:A retrospective cohort study of HF patients. Multimorbidity was quantified using 26 conditions and categorized as low (≤4), intermediate (5-7), or high (>8). Frailty was defined using a multimodal construct integrating functional, nutritional, and biochemical domains. All-cause mortality was assessed using cox models with frailty-multimorbidity interaction testing. Charlson Comorbidity Index (CCI) was used for validation. RESULTS:Among 18,058 patients (median age 74 years; 62% male; 64% frail), 57% died over a median follow-up of 4.0 years (IQR 1.3-7.7). Multimorbidity burden comprised 30.5% low, 48% intermediate, and 21.5% high. Frailty was associated with a 91% higher mortality risk (adjusted HR 1.91; 95% CI 1.85-2.00). Compared with low multimorbidity, intermediate and high burden were associated with an independent 8% and 20% higher mortality risks, respectively (95% CI 1.02-1.14 and 1.13-1.27; both p<.001). However, the association of multimorbidity differed by frailty such that among non-frail patients, intermediate and high multimorbidity increased mortality by 18% and 42% whereas in frail patients, the association was attenuated, with no excess risk for intermediate burden and only 13% increase for high burden (p-for-interaction <.001). CCI analyses was consistent, though differed among females and HFpEF. CONCLUSION:Frailty fundamentally attenuates risk in HF, while multimorbidity stratifies prognosis only when physiological reserve is preserved.
Communicating risk is fundamental to informed consent and shared medical decision-making, yet it presents challenges in clinical practice. This review examines the major barriers to effective risk communication between clinicians and patients, including linguistic ambiguities, numeracy challenges, the influence of emotion, and cognitive biases. Without addressing these barriers, patients may misinterpret risk information, leading to decisions that do not align with their values and goals. Descriptive risk terms (such as "likely," "rare," or "common") are ambiguous, with wide variations in interpretation and, notably, between patients and clinicians. Medical professionals consistently assign lower numerical probabilities to risk terms than patients do, creating potential misalignment. Numerical expressions of risk - while seemingly more precise - assume patient numeracy; yet approximately 30% of U.S. adults lack basic numeracy skills needed to understand percentages and probabilities. Visual aids such as pictographs improve comprehension and accuracy of risk perception for most patients. Pre-existing biases, personal experiences, and emotional factors significantly influence how patients interpret risk information, regardless of how it is presented. Effective risk communication requires a multilayered individualized approach tailored to patients' understanding, experiences, and values. When important risk discussions are occurring, clinicians should consider using a combination of descriptive terms, numerical expressions, and visual representations, while remaining attentive to emotional factors and patient values that influence risk perception. To support more effective risk discussions, we introduce the RISKS framework (Recognize risk communication, Identify patient understanding and priorities, Self-assess for clinician biases, Key in on appropriate communication strategies, Solicit patient comprehension).
Parkinson disease (PD) is a progressive neurodegenerative disorder affecting 2% of the population over 70 with onset typically between 65 and 70 years. A group of proteins (principally alpha-synuclein in insoluble plaques) deposited in the central nervous system throughout the lifespan of patients are responsible for PD and related diseases. The clinical presentation of PD varies among individuals with differences in symptoms, severity, progression, and prognosis. In addition, PD bears a social stigma that presents a number of difficulities in disease management. Recent changes in PD management have created further challenges for general internal medicine providers. The goal of this review is to update general practitioners on current state-of-the-art diagnostic tools and practice strategies for PD.
