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Affirming the Mission of Mayo Clinic Proceedings

      During the summer of 1975, the midpoint of my years in medical school at the University of Edinburgh, Scotland, I returned to the island of my birth and upbringing, Trinidad, West Indies. While there I attended teaching-ward rounds and clinical tutorials at the Port-of-Spain General Hospital, a teaching hospital affiliated with the University of the West Indies Medical School, the latter based in Mona, Jamaica. During this clinical experience in Trinidad, I remember visiting a small library with a select number of journals, which included, alongside the West Indian Medical Journal, the only North American medical journal I can recall seeing there—Mayo Clinic Proceedings. Across the Atlantic, while in clinical training at the University of Edinburgh Medical School, I remember leafing through the pages of the same journal, Mayo Clinic Proceedings. Two places—Trinidad and Edinburgh—and 2 institutions—the Port-of-Spain General Hospital and the University of Edinburgh Medical School—all of which hold such significance for me, are linked in my memory by the cover (brown-orange at the time) and content of Mayo Clinic Proceedings.
      I could never have envisioned during those years that my career would culminate in the exceptional privilege and honor of serving someday as the editor-in-chief of this venerable journal, now in its 92nd year of publication. Begun as an intramural bulletin that would facilitate the sharing of clinical knowledge and experience among physicians of Mayo Clinic, the journal has grown in content, stature, and reach such that it now serves a global readership in general/internal medicine; indeed, at more than 125,000, the print circulation of the Proceedings is the third largest among indexed biomedical journals.
      The success of the Proceedings since 1964 arose in the course of the leadership of 7 previous and eminent editors-in-chief: Drs Edwin D. Bayrd, Alvin B. Hayles, John L. Juergens, Robert G. Siekert, Pasquale J. Palumbo, Udaya B.S. Prakash, and William L. Lanier, all sequentially handing on the experience and achievement of their respective editorship to the colleague that followed.
      • Bayrd E.D.
      • Hayles A.B.
      • Juergens J.L.
      • Siekert R.G.
      • Palumbo P.J.
      • Prakash U.B.S.
      Reflections from past editors.
      • Lanier W.L.
      Leading Mayo Clinic Proceedings into the future.
      I am quite honored to be appointed as the eighth member in this line of editors.
      I am particularly privileged and fortunate to assume this role from Dr William L. Lanier.
      • Lanier W.L.
      Leading Mayo Clinic Proceedings into the future.
      • Lanier W.L.
      The evolution of Mayo Clinic Proceedings.
      • Lanier W.L.
      Celebrating Mayo Clinic Proceedings' 90th anniversary: a story of longevity and progression of mission.
      • Lanier W.L.
      An editor's walk with Mayo Clinic Proceedings, 1999-2017: promises, aspirations, and reflections.
      Under Dr Lanier's groundbreaking, eminently successful 18-year leadership, the Impact Factor of the Proceedings tripled; the number of submissions increased more than 4-fold; the community of submitting authors markedly broadened, with submissions originating from more than 60 nations over a recent 2-year span; and the Proceedings was consistently ranked in the biennial Essential Journal Study, an independent market research report often identified with The New England Journal of Medicine. During Dr Lanier's editorship, Elsevier was engaged as the Proceedings' publisher, an engagement that substantially contributed to the success and growth of the journal. Among other innovating achievements, Dr Lanier's vision and leadership led to the online as well as print publication of the Proceedings; the development of a dynamic and appealing Proceedings website; the use of podcasts and social media to convey information; and the conceptualization and introduction of an offshoot, open-access journal—Mayo Clinic Proceedings: Innovations, Quality & Outcomes—which goes online with its inaugural July 2017 issue.
      From its 1926 beginning, the Proceedings was among the first to report breakthroughs in medicine and surgery.
      Mayo sesquicentennial archive. Mayo Clinic Proceedings website.
      In the first half of the last century, papers in the Proceedings fundamentally contributed to the development of blood banking, oxygen delivery devices to combat hypoxia during high-altitude aviation, and the heart-lung bypass machine (and attendant advances in cardiac surgery). The demonstration of the efficacy of antibiotics in infectious diseases, including streptomycin in the treatment of tuberculosis and penicillin for pyogenic infections, was reported in the Proceedings, as was the reduction in the bleeding complications of liver failure that can be achieved by vitamin K. Notably, important contributions leading to the discovery and clinical introduction of cortisone—a discovery recognized by the Nobel Prize in Physiology or Medicine awarded to Edward C. Kendall and Philip S. Hench of Mayo Clinic—appeared in the Proceedings.
      Mayo sesquicentennial archive. Mayo Clinic Proceedings website.
      This impressive legacy paved the way for the serried procession of advances in medical and surgical knowledge published and highlighted in the Proceedings, so many of which fundamentally inform today's clinical practice. For example, nonalcoholic fatty liver disease, one of the most common forms of liver disease, was first described in the Proceedings,
      • Ludwig J.
      • Viggiano T.R.
      • McGill D.B.
      • et al.
      Non-alcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease.
      as were pioneering developments in echocardiography.
      • Tajik A.J.
      • Seward J.B.
      • Hagler D.J.
      • et al.
      2-dimensional real-time ultrasonic-imaging of the heart and great vessels: technique, image orientation, structure identification, and validation.
      • Seward J.B.
      • Khandheria B.K.
      • Oh J.K.
      • et al.
      Trans-esophageal echocardiography: technique, anatomic correlations, implementation, and clinical-applications.
      The Proceedings was also prominent in publishing diverse landmark contributions related to the Rochester Epidemiology Project,
      • Melton L.J.
      History of the Rochester Epidemiology Project.
      • Rocca W.A.
      • Yawn B.P.
      • St Sauver J.L.
      • Grossardt B.R.
      • Melton L.J.
      History of the Rochester Epidemiology Project: half a century of medical records linkage in a US population.
      lung cancer,
      • Sher T.
      • Dy G.K.
      • Adjei A.A.
      Small cell lung cancer.
      • Molina J.R.
      • Yang P.G.
      • Cassivi S.D.
      • et al.
      Non-small cell lung cancer: epidemiology, risk factors, treatment, and survivorship.
      calcification of the coronary arteries,
      • Maher J.E.
      • Bielak L.F.
      • Raz J.A.
      • et al.
      Progression of coronary artery calcification: a pilot study.
      the prevalence and significance of vitamin D deficiency,
      • Holick M.F.
      High prevalence of vitamin D inadequacy and implications for health.
      functional insulinomas,
      • Service F.J.
      • McMahon M.M.
      • O'Brien P.C.
      • Ballard D.J.
      Functioning insulinoma: incidence, recurrence, and long-term survival of patients: a 60-year study.
      bisphosphonate therapy and the risk of fracture,
      • Siris E.S.
      • Harris S.T.
      • Rosen C.J.
      • et al.
      Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases.
      • Drake M.T.
      • Clarke B.L.
      • Khosla S.
      Bisphosphonates: mechanism of action and role in clinical practice.
      malignant melanoma,
      • Markovic S.N.
      • Erickson L.A.
      • Rao R.D.
      • et al.
      Malignant melanoma in the 21st century, part 1: epidemiology, risk factors, screening, prevention, and diagnosis.
      Churg-Strauss syndrome,
      • Chumbley L.C.
      • Harrison E.G.
      • DeRemee R.A.
      Allergic granulomatosis and angiitis (Churg-Strauss syndrome): report and analysis of 30 cases.
      chronic inflammatory polyradiculoneuropathy,
      • Dyck P.J.
      • Lais A.C.
      • Ohta M.
      • et al.
      Chronic inflammatory polyradiculoneuropathy.
      and organizational initiatives to diminish physician burnout.
      • Shanafelt T.D.
      • Noseworthy J.H.
      Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout.
      Moreover, the Proceedings consistently traced the arc of progress in specific subspecialties and specific diseases. As an example of the former, milestones in neurosurgical practice highlighted in the Proceedings encompass surgical treatment of cerebrovascular disease (1975)
      • Sundt T.M.
      • Sandok B.A.
      • Whisnant J.P.
      Carotid endarterectomy: complications and preoperative assessment of risk.
      ; changes in cerebral blood flow and electroencephalography during carotid endarterectomy (1981)
      • Sundt Jr., T.M.
      • Sharbrough F.W.
      • Piepgras D.G.
      • et al.
      Correlation of cerebral blood-flow and electroencephalographic changes during carotid endarterectomy: with results of surgery and hemodynamics of cerebral-ischemia.
      ; resecting in awake patients tumors in the eloquent brain (2001)
      • Meyer F.B.
      • Bates L.M.
      • Goerss S.J.
      • et al.
      Awake craniotomy for aggressive resection of primary gliomas located in eloquent brain.
      ; and the novel strategy of spinal cord neuromodulation in reversing paraplegia (2017).
      • Grahn P.J.
      • Lavrov I.A.
      • Sayenko D.G.
      • et al.
      Enabling task-specific volitional motor functions via spinal cord neuromodulation in a human with paraplegia.
      As an example of disease-specific content in the Proceedings, progress in plasma cell disorders has been steadily charted by a line of literature linking the definitive descriptions (at the time) of multiple myeloma and its treatment (1968 and 1975)
      • Kyle R.A.
      • Maldonado J.E.
      • Bayrd E.D.
      Treatment of multiple myeloma.
      • Kyle R.A.
      Multiple-myeloma: review of 869 cases.
      ; novel insights regarding monoclonal gammopathy of undetermined significance (2010 and before and after)
      • Wadhera R.K.
      • Rajkumar S.V.
      Prevalence of monoclonal gammopathy of undetermined significance: a systematic review.
      ; the seminal discovery that an engineered measles virus can be used to arrest relapsing myeloma refractory to conventional treatment (2014)
      • Russell S.J.
      • Federspiel M.J.
      • Peng K.W.
      • et al.
      Remission of disseminated cancer after systemic oncolytic virotherapy.
      ; and the latest treatment guidelines from a group of experts dedicated to the study of multiple myeloma and the care of patients with this disorder (2017).
      • Dingli D.
      • Ailawadhi S.
      • Bergsagel P.L.
      • et al.
      Therapy for relapsed multiple myeloma: guidelines from the Mayo stratification for myeloma and risk-adapted therapy.
      As Editor-in-Chief, my every commitment, focus, and effort will be to build upon this unbroken record of success of the Proceedings in publishing content that advances clinical practice and promotes the best interests of patients. While dedicated to internal medicine and its subspecialties, the Proceedings will also feature important articles in surgical and surgical subspecialty practice and in non–internal medicine subspecialties, especially those that evince or underscore a multidisciplinary approach to the diagnosis and management of adult diseases. Relevant articles on medical education, professionalism, ethics, and others that speak to timely issues on the changing landscape of health care, academic medical centers, and biomedical research will also be featured. The current types of articles published by the Proceedings will all be maintained so as to achieve these objectives: providing new knowledge (Original Articles, Special Articles, Brief Reports, and Case Reports); summarizing existing knowledge (Symposia, Clinical Practice Guidelines, Reviews, Concise Reviews for the Clinician, and My Treatment Approach); discussing original findings within the larger context of relevant, existing literature and against the backdrop of relevant controversies (Editorials); voicing views, stimulating dialogue, and making the Proceedings a vibrant forum (Editorials, Commentaries, and Letters-to-the-Editor); and serving specific aspects of medical education (Residents' Clinics and articles offering continuing professional development credits). Outstanding examples of such features are present in this July issue of the Proceedings, offering that diversity of content—and, hopefully, eliciting a broad appeal for its readership—the Proceedings continually strives to achieve.
      I close by discussing how such content for the Proceedings is evaluated and chosen. Relevant to this consideration is a message conveyed in Obliquity, authored by the eminent British economist John Kay.
      • Kay J.
      Obliquity: Why Our Goals Are Best Achieved Indirectly.
      This best-selling book broadly analyzes how goals are generally achieved, including, in particular, how companies and corporations either succeed or fail in their mission. Professor Kay emphasizes that companies that fixate on the financial bottom line, without the requisite attention to the purpose and quality of their specific product, eventually face an uncertain, if not precarious, financial future; conversely, companies that steadfastly focus on the quality of their product and meeting the specific needs of their customers achieve a financial stability and success that no amount of targeted, all-encompassing pecuniary attention can ever hope to attain.
      • Kay J.
      Obliquity: Why Our Goals Are Best Achieved Indirectly.
      The “product” of any journal is its content, and an ever-increasing number of indices are used to assess journal content, value, and ranking: Impact Factor, CiteScore, Eigenfactor, immediacy index, cited half-life, page views and downloads from the journal's website, and journal following on social media. However, there is no consensus regarding what constitutes the preferred index for evaluating journals, and, more specifically, which, if any, index provides a faithful and objective readout on the integrated impact of a journal and its manifold functions. In addition, publishing strategies that may increase the numeric value of one index, such as Impact Factor (which differentiates between “citable” and “noncitable” content), may reduce the numeric value of another index, such as CiteScore (an index in which virtually all content is “citable”). Thus, amid all these uncertainties and vagaries regarding the significance of putative touchstones of journal quality, how does a journal remain unerringly true to its intended mission, to its raison d'être?
      For Mayo Clinic Proceedings, the answer is clear and is one that mirrors the primary value of its sponsoring and sustaining institution—Mayo Clinic—namely, “the needs of the patient come first.” As Editor-in-Chief, I thus affirm and underscore to you, our readers and our submitting authors, that our evaluation and selection of content will be determined by the defining vision and attendant mission of Mayo Clinic Proceedings: “To promote the best interests of patients by advancing the knowledge and professionalism of the physician community.”
      On behalf of our editorial team at the Proceedings, I sincerely thank you for your continued support.

      Acknowledgment

      I dedicate this editorial to the memory of my father-in-law, the late Dr John F. Fairbairn II, who served on the staff of Mayo Clinic from 1956 to 1987.

      References

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        • Hayles A.B.
        • Juergens J.L.
        • Siekert R.G.
        • Palumbo P.J.
        • Prakash U.B.S.
        Reflections from past editors.
        Mayo Clin Proc. 2000; 75: 340-343
        • Lanier W.L.
        Leading Mayo Clinic Proceedings into the future.
        Mayo Clin Proc. 1999; 74: 104
        • Lanier W.L.
        The evolution of Mayo Clinic Proceedings.
        Mayo Clin Proc. 2000; 75: 8-9
        • Lanier W.L.
        Celebrating Mayo Clinic Proceedings' 90th anniversary: a story of longevity and progression of mission.
        Mayo Clin Proc. 2016; 91: 3-9
        • Lanier W.L.
        An editor's walk with Mayo Clinic Proceedings, 1999-2017: promises, aspirations, and reflections.
        Mayo Clin Proc. 2017; 92: 862-869
      1. Mayo sesquicentennial archive. Mayo Clinic Proceedings website.
        (Accessed May 10, 2017)
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        • Viggiano T.R.
        • McGill D.B.
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        Non-alcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease.
        Mayo Clin Proc. 1980; 55: 434-438
        • Tajik A.J.
        • Seward J.B.
        • Hagler D.J.
        • et al.
        2-dimensional real-time ultrasonic-imaging of the heart and great vessels: technique, image orientation, structure identification, and validation.
        Mayo Clin Proc. 1978; 53: 271-303
        • Seward J.B.
        • Khandheria B.K.
        • Oh J.K.
        • et al.
        Trans-esophageal echocardiography: technique, anatomic correlations, implementation, and clinical-applications.
        Mayo Clin Proc. 1988; 63: 649-680
        • Melton L.J.
        History of the Rochester Epidemiology Project.
        Mayo Clin Proc. 1996; 71: 266-274
        • Rocca W.A.
        • Yawn B.P.
        • St Sauver J.L.
        • Grossardt B.R.
        • Melton L.J.
        History of the Rochester Epidemiology Project: half a century of medical records linkage in a US population.
        Mayo Clin Proc. 2012; 87: 1202-1213
        • Sher T.
        • Dy G.K.
        • Adjei A.A.
        Small cell lung cancer.
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        • Molina J.R.
        • Yang P.G.
        • Cassivi S.D.
        • et al.
        Non-small cell lung cancer: epidemiology, risk factors, treatment, and survivorship.
        Mayo Clin Proc. 2008; 83: 584-594
        • Maher J.E.
        • Bielak L.F.
        • Raz J.A.
        • et al.
        Progression of coronary artery calcification: a pilot study.
        Mayo Clin Proc. 1999; 74: 347-355
        • Holick M.F.
        High prevalence of vitamin D inadequacy and implications for health.
        Mayo Clin Proc. 2006; 81: 353-373
        • Service F.J.
        • McMahon M.M.
        • O'Brien P.C.
        • Ballard D.J.
        Functioning insulinoma: incidence, recurrence, and long-term survival of patients: a 60-year study.
        Mayo Clin Proc. 1991; 66: 711-719
        • Siris E.S.
        • Harris S.T.
        • Rosen C.J.
        • et al.
        Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases.
        Mayo Clin Proc. 2006; 81: 1013-1022
        • Drake M.T.
        • Clarke B.L.
        • Khosla S.
        Bisphosphonates: mechanism of action and role in clinical practice.
        Mayo Clin Proc. 2008; 83: 1032-1045
        • Markovic S.N.
        • Erickson L.A.
        • Rao R.D.
        • et al.
        Malignant melanoma in the 21st century, part 1: epidemiology, risk factors, screening, prevention, and diagnosis.
        Mayo Clin Proc. 2007; 82: 364-380
        • Chumbley L.C.
        • Harrison E.G.
        • DeRemee R.A.
        Allergic granulomatosis and angiitis (Churg-Strauss syndrome): report and analysis of 30 cases.
        Mayo Clin Proc. 1977; 52: 477-484
        • Dyck P.J.
        • Lais A.C.
        • Ohta M.
        • et al.
        Chronic inflammatory polyradiculoneuropathy.
        Mayo Clin Proc. 1975; 50: 621-637
        • Shanafelt T.D.
        • Noseworthy J.H.
        Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout.
        Mayo Clin Proc. 2017; 92: 129-146
        • Sundt T.M.
        • Sandok B.A.
        • Whisnant J.P.
        Carotid endarterectomy: complications and preoperative assessment of risk.
        Mayo Clin Proc. 1975; 50: 301-306
        • Sundt Jr., T.M.
        • Sharbrough F.W.
        • Piepgras D.G.
        • et al.
        Correlation of cerebral blood-flow and electroencephalographic changes during carotid endarterectomy: with results of surgery and hemodynamics of cerebral-ischemia.
        Mayo Clin Proc. 1981; 56: 533-543
        • Meyer F.B.
        • Bates L.M.
        • Goerss S.J.
        • et al.
        Awake craniotomy for aggressive resection of primary gliomas located in eloquent brain.
        Mayo Clin Proc. 2001; 76: 677-687
        • Grahn P.J.
        • Lavrov I.A.
        • Sayenko D.G.
        • et al.
        Enabling task-specific volitional motor functions via spinal cord neuromodulation in a human with paraplegia.
        Mayo Clin Proc. 2017; 92: 544-554
        • Kyle R.A.
        • Maldonado J.E.
        • Bayrd E.D.
        Treatment of multiple myeloma.
        Mayo Clin Proc. 1968; 43: 730-737
        • Kyle R.A.
        Multiple-myeloma: review of 869 cases.
        Mayo Clin Proc. 1975; 50: 29-40
        • Wadhera R.K.
        • Rajkumar S.V.
        Prevalence of monoclonal gammopathy of undetermined significance: a systematic review.
        Mayo Clin Proc. 2010; 85: 933-942
        • Russell S.J.
        • Federspiel M.J.
        • Peng K.W.
        • et al.
        Remission of disseminated cancer after systemic oncolytic virotherapy.
        Mayo Clin Proc. 2014; 89: 926-933
        • Dingli D.
        • Ailawadhi S.
        • Bergsagel P.L.
        • et al.
        Therapy for relapsed multiple myeloma: guidelines from the Mayo stratification for myeloma and risk-adapted therapy.
        Mayo Clin Proc. 2017; 92: 578-598
        • Kay J.
        Obliquity: Why Our Goals Are Best Achieved Indirectly.
        Penguin Press, New York, NY2011