Abstract:
:Clinical decisions are increasingly driven by evidence-based recommendations of guideline groups, which aim to be based on the highest quality knowledge-randomized clinical trials (RCTs) and meta-analyses. Although RCTs provide the best assessment of the overall value of a therapy, high-quality evidence from RCTs is often incomplete, contradictory, or absent even in areas that have been most exhaustively studied. Moreover, the likelihood of the success or failure of a therapy is not identical in all the individuals treated in any trial because therapy is not the only determinant of outcome. Therefore, the overall results of a trial cannot be assumed to apply to any particular individual, not even someone who corresponds to all the entry criteria for the trial. In addition, the potential for bias due to financial conflicts remains in many guideline groups. Guidelines are key sources of knowledge. Nevertheless, limitations in the extent, quality, generalizability, and transferability of evidence mean that we clinicians must still reason through the best choices for an individual because even in the absence of full and secure knowledge, clinical decisions must still be made. Clinical reasoning is the pragmatic, tried-and-true process of expert clinical problem solving that does value mechanistic reasoning and clinical experience as well as RCTs and observational studies. Clinicians must continue to value clinical reasoning if our aim is the best clinical care for all the individuals we treat.
journal_name
Mayo Clin Procjournal_title
Mayo Clinic proceedingsauthors
Sniderman AD,LaChapelle KJ,Rachon NA,Furberg CDdoi
10.1016/j.mayocp.2013.07.012subject
Has Abstractpub_date
2013-10-01 00:00:00pages
1108-14issue
10eissn
0025-6196issn
1942-5546pii
S0025-6196(13)00612-5journal_volume
88pub_type
杂志文章abstract:OBJECTIVE:To compare coronary artery bypass grafting (CABG) with percutaneous transluminal coronary angioplasty (PTCA) in patients with proximal, isolated de novo left anterior descending coronary artery disease and left ventricular ejection fraction of 45%. PATIENTS AND METHODS:In the multicenter Stenting vs Internal...
journal_title:Mayo Clinic proceedings
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.4065/75.11.1116
更新日期:2000-11-01 00:00:00
abstract::Advances in liver transplantation continue to evolve but are hampered by continued increasing shortages in donor organs. This has resulted in a high incidence of patients dying while on the United Network for Organ Sharing waiting list. Indeed, we continue to assess ways of expanding the donor pool by using marginal d...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.4065/78.2.197
更新日期:2003-02-01 00:00:00
abstract::By identifying structural chromosome anomalies, the clinical cytogenetics laboratory can play a critical role in the diagnosis and treatment of patients with birth defects. Although many new staining techniques have been developed throughout the years to aid in the detection of anomalous chromosomes, some abnormalitie...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)60721-6
更新日期:1992-07-01 00:00:00
abstract::The first 100 liver transplantations at the Mayo Clinic were performed in 83 patients, who required a total of 917 patient days in the intensive-care unit (ICU). The mean duration of stay in the ICU was 5.91 days after liver transplantation and 6.15 days for patients who subsequently required readmission to the ICU. D...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)65734-6
更新日期:1989-04-01 00:00:00
abstract:OBJECTIVE:To record long-term follow-up data on patients with chronic idiopathic meningitis. DESIGN:We retrospectively reviewed the outcome of 49 patients who were examined at the Mayo Clinic between 1978 and 1990. MATERIAL AND METHODS:For all patients, symptoms, signs, laboratory values, results of imaging studies, ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)62246-0
更新日期:1994-06-01 00:00:00
abstract:OBJECTIVE:To examine whether the outcome of patients with primary systemic amyloidosis (AL) has improved over time and to identify predictors of early mortality in patients with AL. PATIENTS AND METHODS:We studied 2 separate cohorts of patients. The first cohort, consisting of 1998 patients with AL seen at Mayo Clinic...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/mcp.2010.0480
更新日期:2011-01-01 00:00:00
abstract:OBJECTIVE:To assess the pharmacokinetics, toxicity, and efficacy of antineoplastons A10 (NSC 648539) and AS2-1 (NSC 620261). DESIGN:We initiated a phase II trial in order to determine whether evidence of antitumor activity of A10 and AS2-1 could be documented. MATERIAL AND METHODS:Patients with anaplastic astrocytoma...
journal_title:Mayo Clinic proceedings
pub_type: 临床试验,杂志文章
doi:10.4065/74.2.137
更新日期:1999-02-01 00:00:00
abstract::Cardiorespiratory fitness (CRF) is an established risk factor for cardiovascular disease outcomes. However, the relationship of CRF with risk of ventricular arrhythmias (VAs) is unknown. We aimed to assess the prospective association of CRF with the risk of serious VAs. Cardiorespiratory fitness, as measured by maxima...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2018.11.027
更新日期:2019-05-01 00:00:00
abstract::Wide-angle two-dimensional echocardiography was used to establish criteria for recognition of ventricular situs and ventricular morphology in 27 patients (ages 2 month to 58 years) with atrioventricular amd ventriculoarterial discordance (corrected transposition of the great arteries). The morphologic left ventricle w...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:
更新日期:1981-10-01 00:00:00
abstract::Many misconceptions continue to persist in both the lay and the professional literature regarding the proper approach to the diagnosis and treatment of hypoglycemia. Often, patients with a symptom complex suggestive of hypoglycemia have normal levels of plasma glucose in association with these symptoms. The major diag...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.1016/s0025-6196(12)64790-9
更新日期:1985-12-01 00:00:00
abstract:OBJECTIVE:To investigate whether patients with traumatic brain injury (TBI) have an increased risk of stroke or poststroke mortality. PARTICIPANTS AND METHODS:Using Taiwan's National Health Insurance Research Database, we conducted a retrospective cohort study of 30,165 patients with new TBI and 120,660 persons withou...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2013.09.019
更新日期:2014-02-01 00:00:00
abstract::Eleven patients with Alport's syndrome had renal transplantation between 1963 and 1980. The mean follow-up is 6 years (6 months to 14 years). All 11 patients are currently alive. Ten have functioning grafts, and in nine the serum creatinine concentration is less than 2 mg/dl. Three patients received a second allograft...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:
更新日期:1982-01-01 00:00:00
abstract:OBJECTIVE:To estimate the magnitude of association between intraoperative hyperglycemia and perioperative outcomes in patients who underwent cardiac surgery. PATIENTS AND METHODS:We conducted a retrospective observational study of consecutive adult patients who underwent cardiac surgery between June 10, 2002, and Augu...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/80.7.862
更新日期:2005-07-01 00:00:00
abstract::Because fasting nerve myo-inositol (myo-Ins) is not decreased in patients with diabetes treated conventionally, in whom neuropathy may develop or may have already developed, it seems unlikely that myo-Ins is the metabolic abnormality that initiates diabetic neuropathy, if nerve myo-Ins is not spuriously high during fa...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)61217-8
更新日期:1989-08-01 00:00:00
abstract:OBJECTIVE:To present a multiyear clinical experience with intravenous bevacizumab for the management of severe gastrointestinal bleeding and/or epistaxis in patients with hereditary hemorrhagic telangiectasia (HHT). PATIENTS AND METHODS:All patients treated with intravenous bevacizumab for severe hereditary hemorrhagi...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2017.11.013
更新日期:2018-02-01 00:00:00
abstract:OBJECTIVE:To evaluate the prognostic impact of Holter findings in patients with light chain amyloidosis. PATIENTS AND METHODS:We evaluated 239 patients in whom light chain amyloidosis was diagnosed from January 1, 2010, through December 31, 2015, who underwent 24-hour Holter monitoring. RESULTS:Holter testing was don...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2018.08.039
更新日期:2019-03-01 00:00:00
abstract::Primary sclerosing cholangitis (PSC) predisposes to the development of cholangiocarcinoma, a usually fatal complication that is difficult to diagnose. Serum concentrations of CA 19-9, a tumor-associated antigen, are frequently increased in patients with only cholangiocarcinoma. The aim of this study was to assess the ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)60696-x
更新日期:1993-09-01 00:00:00
abstract::Carcinoid tumor of the thymus is a rare neoplasm. Formerly confused with thymoma, a tumor of thymic epithelial cells, carcinoid tumor of the thymus has recently been shown to arise from cells of neuroendocrine origin that are normally present in the thymus. About half of the tumors are either functionally active (usua...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:
更新日期:1980-04-01 00:00:00
abstract:OBJECTIVE:To determine the sensitivity and specificity of a quantitative plasma fibrin D-dimer latex immunoassay (LIA) for the diagnosis of acute pulmonary embolism. SUBJECTS AND METHODS:Study subjects were Mayo Clinic Rochester inpatients and outpatients with suspected acute pulmonary embolism; all had undergone quan...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/82.5.556
更新日期:2007-05-01 00:00:00
abstract::Vancomycin is a glycopeptide antibiotic that is active against staphylococci, streptococci, and other gram-positive bacteria. It is the drug of choice for the treatment of infections due to methicillin-resistant staphylococci, Corynebacterium jeikeium, and multiply resistant strains of Streptococcus pneumoniae. Vancom...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.1016/s0025-6196(12)65799-1
更新日期:1991-11-01 00:00:00
abstract::A 27-year-old man was treated for an aggressive cerebellar medulloblastoma that, at operation, exhibited dural invasion. Six months after gross total resection and radiation therapy, a "surgical metastasis" developed in the lower portion of the surgical scar. The tumor grew rapidly down into the right side of his neck...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)62221-6
更新日期:1994-04-01 00:00:00
abstract::Pulmonary hypertension (PH) in patients with interstitial lung diseases (ILDs) is not well recognized and can occur in the absence of advanced pulmonary dysfunction or hypoxemia. To address this topic, we identified relevant studies in the English language by searching the MEDLINE database (1966 to November 2006) and ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.4065/82.3.342
更新日期:2007-03-01 00:00:00
abstract:OBJECTIVE:To determine and quantify the in vivo effects of octreotide on the cell cycle kinetics of growth hormone-producing pituitary adenomas. DESIGN:A multicenter randomized trial had been conducted to assess the clinical efficacy of octreotide, and we studied tissue specimens from pituitary macroadenomas in 32 pat...
journal_title:Mayo Clinic proceedings
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/S0025-6196(11)63358-2
更新日期:1997-10-01 00:00:00
abstract:OBJECTIVE:To characterize the findings associated with acute febrile neutrophilic dermatosis (Sweet's syndrome [SS]) and the response of SS to treatment. DESIGN:We retrospectively reviewed 48 cases of SS encountered at the Mayo Clinic between 1980 and 1992. MATERIAL AND METHODS:Histopathologic specimens and medical r...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/70.3.234
更新日期:1995-03-01 00:00:00
abstract::The issue of whether patients who have invasive carcinoma in an otherwise benign polyp should undergo surgical resection of that bowel segment is controversial. We examined the records of 83 patients with such polyps that were removed endoscopically between 1978 and 1981. After exclusion of 18 patients from the study ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)65198-2
更新日期:1986-02-01 00:00:00
abstract:OBJECTIVE:To examine the relationship of age and clinical factors to postoperative cardiovascular events in a cohort of diabetic patients undergoing peripheral vascular surgery. PATIENTS AND METHODS:In this cohort study, 316 diabetic patients were followed up prospectively after femoral-to-distal artery bypass surgery...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/76.1.34
更新日期:2001-01-01 00:00:00
abstract:OBJECTIVE:To evaluate, in this before-and-after study, the results of 5 strategies for improving attendance at medical grand rounds at a tertiary care academic medical center. METHODS:The strategies included (1) using electronic card readers to improve understanding of attendance patterns, (2) conducting yearly needs ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/78.5.549
更新日期:2003-05-01 00:00:00
abstract:OBJECTIVE:To determine the incidence and temporal trends of food allergies. PATIENTS AND METHODS:We performed a historical cohort study to describe the epidemiology of food allergies among residents of all ages in Olmsted County, Minnesota, during a 10-year period from January 2, 2002, through December 31, 2011, using...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2018.05.031
更新日期:2018-10-01 00:00:00
abstract::Risedronate sodium is a pyridinyl bisphosphonate effective for treatment and prevention of postmenopausal and glucocorticoid-induced osteoporosis. Some bisphosphonates have been associated with upper gastrointestinal (GI) tract adverse effects. The objective of this study was to determine the frequency of upper GI tra...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,meta分析
doi:10.4065/77.3.262
更新日期:2002-03-01 00:00:00
abstract::A 33-year-old woman with acute idiopathic postganglionic panautonomic neuropathy experienced prompt recovery of all dysautonomic symptoms after receiving high-dose intravenous immunoglobulin therapy. Her recovery was complete within 6 months after onset of disease. This unusually rapid and complete recovery in compari...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/72.4.333
更新日期:1997-04-01 00:00:00