Advancing the Science

Mayo Clinic Medical Science Blog – an eclectic collection of research- and research education-related stories: feature stories, mini news bites, learning opportunities, profiles and more from Mayo Clinic.

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4 days ago · Can BioBanks Help Close Gaps in Health Outcomes?

By Barbara J. Toman

By definition, personalized medicine requires diversity. One-size-fits-all doesn’t work for every individual, especially members of groups that are medically underserved.

In collaboration with Arizona State University and Mountain Park Health Center (MPHC) in Phoenix, Mayo Clinic’s Center for Individualized Medicine has created a biobank to enhance the diversity of Mayo’s medical research. Sangre Por Salud (Spanish for Blood for Health) contains samples and health information from 3,756 people who self-identify as Latino and receive care at Mountain Park. As a Federally Qualified Health Center, MPHC provides comprehensive health services to underserved populations, including Latinos and African-Americans, independent of their immigration status.

“To practice individualized medicine, we need to understand all individuals. We cannot generalize that whatever is discovered in Caucasians is applicable to Latinos or other populations. Our intent is to close these gaps,” says Giovanna Moreno Garzon, Mayo Clinic’s senior research coordinator for Sangre Por Salud.

Giovanna Moreno Garzon

Sangre Por Salud is more than a biobank. “With the consent of participants at Mountain Park, we collected blood samples, plasma and DNA, as well as responses to health questionnaires,” Moreno Garzon says. “We have access to the participants’ electronic medical records at Mountain Park and permission to contact the participants again if needed for research. This is a great resource for investigators to add diversity to their current research activities.”

When Mayo Clinic launched its biobank in Rochester, Minnesota, most of the samples were from Caucasians. Only 0.4% came from Latino donors. Mayo Clinic is now at the forefront of efforts to increase research in minority populations, to address health disparities.

“A lot of patients in the population we serve are disease-burdened. Obesity, diabetes, high blood pressure and the risk of heart problems are common,” says Valentina Hernandez, director of integrated nutrition services at MPHC. “We started working with Mayo Clinic to create the biobank so that these patients could contribute to the science of genomics. We hope these patients will be better represented in research to help ease the burden of disease in this population.”

Data from Sangre Por Salud is available to Mayo Clinic researchers and their collaborators. The Center for Individualized Medicine reviews all requests for data. Among the research projects using Sangre Por Salud data is a study led by Richard Caselli, M.D., involving APOE4, a form of a gene that increases the risk of Alzheimer’s disease.

Valentina Hernandez

In addition to facilitating diversity in medical research, Sangre Por Salud is directly benefitting Mountain Park patients. Samples from 500 of the donors were genetically sequenced to detect mutations associated with various conditions.

“We were able to identify 10 individuals who have a gene mutation that could be a predictor of a future disease — such as the BRCA gene and breast cancer,” Hernandez says. “We could then counsel these individuals on their risks and how they might help prevent the development of disease.” Both MPHC and Mayo Clinic are committed to developing further strategies and infrastructure for patients’ follow-up care.

Beyond those specific findings, information from the biobank is changing clinical practice at Mountain Park. “We learned a lot about our patients from the lab work that was done to get baseline measures from the donors,” Hernandez says. “Although these donors were young and nondiabetic, many of them had high cholesterol or prediabetes. We wouldn’t have known that without the lab testing.”

Prediabetes means that blood sugar levels are higher than normal but not yet high enough to be type 2 diabetes. With prediabetes, the long-term damage of diabetes to the heart, blood vessels and kidneys might already be starting.

“We had a lot of our patients see a dietitian to talk about diet and lifestyle,” Hernandez says. “We’re more aware that a seemingly healthy person might have something we can catch early, and prevent bigger problems later. Sangre Por Salud has really changed medical practice in our clinic.”

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5 days ago · Inspired to innovate: Detecting heart disease earlier with the help of artificial intelligence

By Nicole Sisk

Paul Friedman, M.D., explains some of the AI work in to colleagues in the Department of Cardiovascular Medicine.

Artificial intelligence will play a key role in Mayo Clinic’s future and that of health care worldwide. The Department of Cardiovascular Medicine is combining artificial intelligence with standard tests to improve patient care.


Each year at Mayo Clinic, 250,000 patients have an electrocardiogram, or ECG. It’s a common, inexpensive test designed to detect heart rhythm and other abnormalities.

But what if that common, inexpensive test could reveal more? Could the humble ECG, developed more than 100 years ago and readily available nearly everywhere, uncover deeper insights about a patient’s heart and health?

Physicians and scientists in the Department of Cardiovascular Medicine wanted to find out. They believed that the ECG and other data-rich exams held the potential to provide a wealth of information that could open up new ways of diagnosing and treating heart conditions. And those insights, the team suspected, were hiding in plain sight.

It would just take a new way of seeing to find them.

Innovation through collaboration

That new view began coming into focus when Itzhak Zachi Attia joined the Department of Cardiovascular Medicine. Attia isn’t a cardiologist. But with degrees in electrical and electronics engineering, and expertise in machine learning, he had the perfect pedigree for a department eager to explore the potential of data science and artificial intelligence.

Itzhak Attia

“We have a long history at Mayo Clinic of sharing ideas across specialties,” says Paul Friedman, M.D., chair of the Department of Cardiovascular Medicine in Rochester. “Adding a new group of specialists to the mix — AI engineers — is building on that tradition. They see the work we do with fresh eyes and ask questions that help us reexamine how and why we do things.”

Attia and his colleagues — there are now five data scientists working in Cardiovascular Medicine — attend rounds, observe procedures and have office space alongside clinicians. “We have the ability to share ideas on a daily basis,” Attia says. “We hear medical conversations and share new things that are happening in tech.”

That’s led to some fruitful cross-pollination. Attia, Dr. Friedman and others in the department have been exploring the possibilities created by merging their unique perspectives.

“The ideas started from sitting and brainstorming how we could use the huge amount of data that we have to help patients get better care and a faster diagnosis,” Attia says. “I think being embedded in Cardiology is one of the key elements of our success.”

Beyond the basic ECG

The close collaboration between clinicians and data scientists has revealed that there is much more information that can be gleaned from an ECG than once believed. Applying artificial intelligence to the test has given the team the ability to gauge high potassium levels and detect previously “invisible” long QT syndrome, a heart rhythm condition that can potentially cause fast, chaotic heartbeats that may lead to fainting, seizures or sudden death.

“The old paradigm has been that you wait until you feel sick before you see a doctor and have diagnostic tests,” Dr. Friedman says. “But sometimes that’s too late. In cardiovascular medicine, the first sign that something is wrong may be a heart attack or stroke. But the conditions leading up to that may be going on for decades.”

The old paradigm has been that you wait until you feel sick before you see a
doctor and have diagnostic tests. But sometimes that’s too late.

Paul
Friedman, M.D.

“Our bodies are giving off invisible signals all the time. We’re finding ways
to use technology to pick up those signals,” he says. “The goal is to detect
problems early so we can intervene sooner and prevent bad things from
happening.”

Perhaps the most promising finding to emerge from the group’s work so far is a method for detecting a weak heart pump long before a patient experiences any symptoms. By applying artificial intelligence to ECG data, the team can pick up signals indicating a patient has asymptomatic left ventricular dysfunction, or a weak heart pump. Left untreated, the condition can progress to heart failure. Results of the study were published in Nature Medicine earlier this year. (Read related news release.)

Putting artificial intelligence into practice

The discovery could have a significant impact on patient care. Asymptomatic left ventricular dysfunction affects more than 7 million Americans — 2% of the population and up to 9% of people 60 and older. Early diagnosis can lead to effective treatment that reduces the likelihood of heart failure. But until now, there hasn’t been an affordable, noninvasive screening test for the condition. The team’s findings could change that.

Peter Noseworthy, M.D.

“We hope this will be in clinical use by the end of the year,” says Peter Noseworthy, M.D., a cardiac electrophysiologist who has been involved with the study.

Before that can happen, Dr. Noseworthy and his colleagues will review the results of a randomized clinical trial set to launch soon throughout Mayo Clinic’s community practices in Minnesota and Wisconsin. The algorithm to detect asymptomatic left ventricular dysfunction has been embedded in Mayo’s ECG analysis, and half of the eligible patients who screen positive for the condition will have a report generated in their health record. The study will examine what clinicians do with the information provided.

“We’re now going to see how humans and machines come together,” Dr.
Noseworthy says.

It’s a new question — and not one Dr. Noseworthy anticipated asking as
recently as two years ago. “I didn’t envision AI being part of my work,” he
says. The new focus has been a welcome — and exciting — surprise.

Ensuring smart, equal data

That excitement is understandable. Artificial intelligence has the potential
to transform health care in countless ways. But its potential depends on the
human intelligence that informs it.

“You have to pick the right question and make sure you have the data to support it,” Dr. Noseworthy says. “You want to avoid the problem of garbage in, garbage out by doing the work beforehand to make sure you’re setting your study up right.”

Sharonne Hayes, M.D.

That includes determining whether artificial intelligence algorithms apply
equally to all people.

“AI is not biased, but we could potentially create biases as humans who input bad data,” says Sharonne Hayes, M.D., a preventive cardiologist and director of the Office of Diversity and Inclusion. “As Mayo is moving forward and working to be a leader in AI, we want to make sure that we’re not perpetuating stereotypes or delivering unequal care through our work.”

Dr. Hayes notes that medical research has a long history of focusing solely
on the majority, often white men. That lack of diversity has contributed to
health care disparities. Artificial intelligence, she says, “has the potential
to make things better — if we are smart about using it.”

The great thing about this study is that people with a diversity of expertise were brought in to be part of the conversation. It’s how science should work.

Sharonne Hayes, M.D.

LaPrincess Brewer, M.D.

Dr. Hayes and LaPrincess Brewer, M.D., another preventive cardiologist with expertise in health disparities research, were invited to review the artificial intelligence algorithm used in the ECG study. They determined that the algorithm worked equally well for women and men, and across racial groups.

“In other AI algorithms, we might find one that doesn’t work for different
groups or works differently for different types of patients,” Dr. Hayes says.
“The great thing about this study is that people with a diversity of expertise
were brought in to be part of the conversation. It’s how science should work.”

Dr. Hayes says she can’t imagine a study like this happening anywhere other than Mayo Clinic.

“In addition to brilliant colleagues doing the work, the fact that we have
access to Mayo’s data resources is significant,” she says. “Other places are
doing AI, but no one else has access to patient populations and records that we
do.”

Attia agrees that Mayo Clinic has a unique advantage in the field of
artificial intelligence.

“In industry, the product is the main thing. In academia, research is the main thing,” he says. “But here at Mayo, we are finding the middle ground and using solid research to create products. We’re eager to take things to practice and translate research to actual tools for helping patients. I think the fact that we all have the same goal — the needs of the patients come first — really helps focus our effects.”

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Related resources


Thu, Aug 8 6:00am · We are the world

Charanjit Rihal, M.D. and Yan Bi, M.D., Ph.D.

From the earliest days, physicians and scientists have flocked to Mayo Clinic from all over the world to learn: Foreign-born physicians in the early days at Mayo Clinic included Donald Balfour, M.D., of Canada, arriving in 1907; Gordon New, M.D., of Canada, 1910; Frank Smithies, M.D., from England in 1910; Russell Carman, M.D., of Canada, 1913; Samuel Amberg, M.D., of Germany, 1921; Ambrose Lockwood, M.D., from Canada, 1921; Georgine Luden, M.D., Ph.D., who came from the Netherlands in 1924; and James Learmonth, M.D., of Scotland, arriving in 1929.

Today is no different. Thousands of international physicians and scientists have trained or worked at Mayo Clinic. The new president and CEO, Gianrico Farrugia, M.D., is from Malta.

Here are the stories of two Mayo Clinic scientists who came to Mayo from opposite sides of the globe.

Charanjit Rihal, M.D. (Canada)

Charanjit Rihal, M.D. (left) with Thomas Foley (right) examining a 3-D model of a heart
Charanjit Rihal, M.D. (left) with Thomas Foley (right) examine a 3-D model of a heart

Chair of Mayo Clinic’s Personnel Committee Charanjit Rihal, M.D., says Mayo looks for the best of the best regardless of where physicians and scientists are from. “Whether physicians and scientists are foreign or domestically trained, we seek excellence in patient care and contributions to education and research. We’re fortunate to have outstanding applicants for our education programs and staff positions from around the world.”

Dr. Rihal came to Mayo Clinic in Rochester from Winnipeg, Manitoba, Canada, in 1986 for residency and fellowship. “Mayo Clinic offers the best in training — that’s what attracted me,” says Dr. Rihal, the William S. and Ann Atherton Professor of Cardiology Honoring Robert L. Frye, M.D. “Homestead Village, where I lived as a trainee, was like a microcosm of the U.S. I loved being around people from so many places who represented a variety of experiences and perspectives. It was tremendously fun and exciting.”

He returned to Canada for three years after training and came back to Rochester when he was invited to join the staff in 1995. “Having had the Mayo experience spoils you for all other places,” he says. “In the Department of Cardiovascular Medicine alone, we have staff from all over the U.S. and Canada as well as Mexico, Venezuela, Brazil, Uruguay, Colombia, France, the U.K., Germany, Nigeria, South Africa, Pakistan, India, China, Korea, Singapore and Australia. Other large departments are much the same — a collection of the ‘best of the best’ from around the world.

“Mayo Clinic considers itself to be a resource for humanity. The patients we serve are international. Having staff who represent countries around the globe adds to the richness of the Mayo Clinic tapestry.”

Yan Bi, M.D., Ph.D. (China)

Yan Bi poses, arms folded
Yan Bi, M.D., Ph.D

Yan Bi, M.D., Ph.D., Division of Gastroenterology and Hepatology at Mayo Clinic in Florida, received her medical degree in China but was dismayed by the medical system there.

“I wasn’t very happy,” she says. “I had a young patient with pancreatic cancer who was in great pain. He had two little children and wanted treatment to extend his life. We had nothing to offer him. He died on my shift, and it was a great shock to me. I was at the best hospital in China, but we had nothing to offer this patient. I’d wanted to be a doctor since I was 5 or 6 years old and never considered another path, but I wanted to find ways to better understand disease so I could help patients in the clinic. I decided to go to the U.S. for more training.”

Dr. Bi completed a Ph.D. focused on pancreatic physiology at the University of Michigan in Ann Arbor, followed by a postdoctoral fellowship at Baylor College of Medicine in Houston, Texas, studying pancreatic and breast cancer.

“Armed with more basic science knowledge, I decided to return to clinical care,” says Dr. Bi.

She completed an internal medicine residency at the University of Texas Southwestern Medical Center Brackenridge Hospital in Austin and still wasn’t done. “My interest in the pancreas hadn’t waned, and I wanted more advanced training,” she says. In 2011 Dr. Bi joined the lab of Vijay Shah, M.D., chair, Division of Gastroenterology and Hepatology at Mayo Clinic in Rochester, studying the microenvironment of pancreatic cancer in a clinical fellowship.

“I was offered a fellowship at another leading academic medical center, but their research ‘shield’ was not as strong as Mayo’s, and I wanted to be a physician-scientist,” says Dr. Bi. “I also believed I couldn’t find better mentors than those at Mayo Clinic. Choosing Mayo was the best decision I’ve ever made. Mayo has such a collegial environment. It’s not a hierarchy like most universities. Regardless of your rank, everyone treats you with respect. The first time I visited Mayo Clinic, Dr. Shah, the fellowship program director, escorted me to the shuttle to the Minneapolis airport rather than send me on my own, which was amazing. I can easily talk with my department chair without any concern. At Mayo we value everyone on the patient care team equally.

“Mayo allows me as much time as I need with patients, which is perhaps unique in the world. Mayo’s culture is exceptional. I’ve been at 10 institutions during my career, so I have a good basis for comparison.”

Two years ago Dr. Bi relocated to Mayo’s Florida campus when her husband accepted a job in the state. She recently started a clinical trial of a therapy for acute pancreatitis and is building her own translational research program, describing herself as a “cross-talker between the bench and bed.”

“My experiences at Mayo have been the most exciting of my career,” says Dr. Bi. “I am grateful for the opportunities I’ve had to practice medicine the right way.”


Wed, Aug 7 6:00am · Researcher challenges her team to develop solution for DRC health crisis

Marina Walther-Antonio, Ph.D.

Marina Walther-Antonio, Ph.D., has a full plate. An associate consultant in surgical research in the departments of Surgery and Obstetrics and Gynecology at Mayo Clinic in Rochester, she studies the microbiome role in human health and disease, particularly endometrial and ovarian cancer. She also develops technology in her lab, including microbial single-cell technologies for point-of-care applications. And Dr. Walther-Antonio is actively involved in astrobiological research, with projects involving NASA and the European Space Agency. A full load for any researcher.

In spring 2016 Dr. Walther-Antonio’s plate got a bit fuller, thanks to a lunchtime talk she attended. Sean Dowdy, M.D., chair of the Division of Gynecologic Surgery; along with Deborah Rhodes, M.D., Division of General Internal Medicine, presented about their experiences in the Democratic Republic of Congo (DRC) through Mayo Clinic Global Health. The talk included a discussion of the widespread sexual violence in the DRC, where four women are raped every five minutes in what is referred to as the rape capital of the world. In part as a result of this humanitarian crisis, cervical cancer — caused by human papillomavirus (HPV) — is the leading cause of cancer-related death among women in the area.

If you just stick to your own thing in your own little corner, you might miss an opportunity to do something that changes health care and helps others around the world.

Marina Walther-Antonio, Ph.D.

When they were in the DRC, Drs. Dowdy and Rhodes met with Denis Mukwege, M.D., Ph.D., a gynecologist at and founder of Panzi Hospital in Bukavu, who specializes in the treatment of women who require surgery due to injuries sustained during rape. Many of the women have been assaulted by multiple men and with sticks, knives and bullets. Dr. Mukwege received the Nobel Peace Prize in 2018, in conjunction with Nadia Murad, for efforts to end the use of sexual violence as a weapon of war and armed conflict. Dr. Mukwege said what’s most needed in his country is medical research, including knowledge to combat the high rates of cervical cancer at an early stage. To be tested for HPV requires women to make long trips to hospitals, crossing dangerous areas and risking more violence. Could a self-test be developed that wouldn’t require a visit to a lab and a provider for medical interpretation — similar to a home pregnancy test?

Dr. Walther-Antonio was moved to tears by her colleagues’ talk. “Dr. Dowdy said the DRC experience was traumatic, and he became quite emotional when discussing it,” she says. “It was remarkable to see him so affected because he’s usually quite reserved.” Dr. Walther-Antonio did her homework and created a brief presentation for her lab staff about what she’d learned. “I told them it seemed like something we could help with if we put our heads together — that we had the right people in the room. Fortunately they were all on board.

“I feel if I can help, it’s my responsibility to do so. You never know when a problem could go unsolved if you do not help. My team agreed to move ahead with a solution — a MacGyver (in reference to the TV character known for creatively engineering his way out of predicaments). We called this the MacGyver Project.”

Dr. Walther-Antonio and her research team.

Fast forward three years, and Dr. Walther-Antonio’s team has made great strides in developing an easy-to-use, affordable home urine test that provides immediate positive or negative results for HPV detection. The team is working with Sam Kounaves, Ph.D., at Tufts University in Boston, Massachusetts, to develop test prototypes and is enrolling patients in a phase 1 test.

Dr. Walther-Antonio’s research is supported by Mayo’s KL2 mentored career development program and by a Mayo Clinic Discovery Translation Program grant. Her work on HPV test has benefited from a Mayo Clinic benefactor gift, and she received a market assessment from Mayo Clinic Ventures to explore applications of the test for the U.S. market. Within a year, her team plans to begin phase 2 testing and next steps — identifying a company to license the test and, eventually, selecting a partner to distribute the test in the DRC.

This whirlwind effort is Dr. Walther-Antonio’s first foray into test development. She met with colleague David Ahlquist, M.D., who developed the Cologuard colorectal cancer test. “Dr. Ahlquist was very helpful, sharing his experiences and advising about how to navigate the road ahead,” says Dr. Walther-Antonio.

While her motivation to develop the test was related to the crisis in the DRC, Dr. Walther-Antonio is excited about other applications for the test. Women around the world lack easy access to, time for and resources to pay for preventive health care. Some cultures consider it taboo for a male physician to perform a Pap test. And diseases associated with sexual transmission cause shame and, therefore, inaction, among some people. “It bothers me that many people die from preventable diseases for no logical reason every year,” she says. “In my work, I try to think of simpler ways to solve complex problems. I knew my team was resourceful enough to solve this problem for a vastly underserved part of the world. I can’t say enough about my team.”

Heidi Nelson, M.D., was Dr. Walther-Antonio’s Department of Surgery chair and a chief supporter. “The development of this HPV test kit is a great example of what happens at Mayo Clinic when clinicians and scientists come together and solve a complex problem,” she says. “A compelling human problem engages with a thoughtful, motivated leader such as Dr. Walther-Antonio, a team of experts creates a brilliant technical plan and health care gets a little bit better.”

Realistically, within a few years, a woman in the DRC could be handed a test kit from a worker in a humanitarian aid mobile unit and shown how to use the kit in the privacy of her home — without having to make an often-dangerous trip to a medical facility. The test strip will indicate whether or not she needs to seek lifesaving medical care.

About that scenario, Dr. Walther-Antonio says she’ll be able to retire happy (one day) knowing she accomplished something meaningful. “My background is in astrobiology. When you work in a field such as that, you do it for future generations — often you know you won’t see your work come to fruition in your lifetime. In comparison, I hope to see the impact of the HPV detection kit — saving lives and improving the world.”

When asked what would have happened had she not attended the lunchtime talk by Drs. Dowdy and Rhodes, Dr. Walther-Antonio says, “I often go to these kinds of talks because I have to eat anyway — I may as well learn at the same time. It’s important to keep your eyes and ears open and learn what else is going on around Mayo Clinic. If you just stick to your own thing in your own little corner, you might miss an opportunity to do something that changes health care and helps others around the world.”

Wed, Jul 31 6:00am · Identifying hereditary cancer risk: genetic testing can lead to better screening, earlier treatment

By Sharon Rosen

Do you have family members who have been diagnosed with gastrointestinal, breast or ovarian cancer? According to a recent Mayo Clinic study, nearly 5% to 10% of these cancers can be hereditary.

That’s why it is important to share your family medical history with your physician, who can determine if you and your family members may be candidates for genetic testing to identify cancer risk.

Niloy Jewel Samadder, M.D.

“Hereditary predisposition syndromes have been associated with a markedly increased lifetime risk of cancer, some approaching 100%,” says Niloy Jewel Samadder, M.D., a gastroenterologist in the Department of Clinical Genomics at Mayo Clinic’s Arizona campus.

This makes genetic testing critical to early detection of cancer risks and decisions about screening and treatment.

“Genetic testing has become a key tool to help identify syndromes and conditions that predispose a person to gastrointestinal and breast-ovarian cancer,” says Dr. Samadder, lead author of the study published in June in Mayo Clinic Proceedings. “Identifying these patients through family history and genetic testing allows physicians and patients to talk about cancer risks, and make decisions about appropriate screening, surveillance and interventions.”

Infrastructure support and early funding efforts for this study were provided by Mayo Clinic Center for Individualized Medicine.

Learn more

Read the full story about the study.

In this video, Dr. Samadder explains how genetic testing helps guide the diagnosis and management of hereditary gastrointestinal cancers.

The latest advances in cancer

Hereditary cancer syndromes will be among the topics discussed at Individualizing Medicine 2019 Conference: Precision Cancer Care through Immunotherapy and Genomics on Sept. 20-21, in Scottsdale, Arizona. 

The conference brings together experts from Mayo Clinic and across the country to present and discuss case-based approaches to using genomics and new immunotherapies that oncologists and their teams can bring back to their own patients.

Other key conference themes include:

  • CAR-T cell therapy
  • Clonality
  • Pharmacogenomics
  • Lineage Plasticity
  • National Cancer Institute

Preview the conference program.

Join the conversation in individualized medicine

For more information on the Mayo Clinic Center for Individualized Medicine, visit our blogFacebookLinkedIn or Twitter at @MayoClinicCIM.

Tue, Jul 30 6:00am · New Ph.D. students pledge to uphold biomedical ethics in new scientist's oath

Karen Dsouza, left, and Raini Heyblom pledge to “perform my professional activities with the highest rigor” as part of the new Scientist’s Oath at Mayo Clinic Graduate School of Biomedical Sciences. Both are first-year students pursuing a Ph.D. in biomedical science.

By Jon Holten

Just as aspiring physicians pledge to uphold medical ethics in the Hippocratic Oath, incoming Ph.D. students at Mayo Clinic Graduate School of Biomedical Sciences for the first time recently pledged to uphold biomedical ethics.

As part of orientation, 52 students pursuing a doctoral
degree in biomedical science started their research training by committing to
the school’s new Scientist’s Oath, a pledge to:

  1. Conduct myself at all
    times with personal integrity
  2. Perform my
    professional activities with the highest rigor
  3. Work for the
    advancement of all humanity

In one of his first actions after becoming dean of the graduate school in May, Stephen Ekker, Ph.D., decided to incorporate the Scientist’s Oath into Ph.D. training. He and Bruce Horazdovsky, Ph.D., the school’s assistant dean, wrote the 44-word pledge to emphasize the standards that Mayo Clinic expects students to meet during their training and as future research scientists.

“I thought we needed to begin a new tradition to establish
our expectations and impress upon incoming Ph.D. candidates that they must meet
certain ethical responsibilities when they decide to become scientists,” Dr.
Ekker says.  

Dr. Ekker says he wanted to reinforce the vital nature of integrity
in response to surveys indicating a decline in the public’s trust of scientists
and in segments of the population that refuse to believe evidence-based
research.

The students received a frameable certificate of the oath
signed by Dr. Ekker. They also received a lapel pin designed to resemble a
strand of DNA bearing the words Integrity, Rigor and For All.

Mayo’s graduate school is one of the few in the nation to
adopt an oath for doctoral candidates. Boston University School of Medicine introduced
an oath during the Ph.D. graduation ceremony in 2012. Johns Hopkins University
School of Medicine in 2014 added an oath to its coating ceremony for Ph.D.
candidates who pass written and oral qualifying exams, typically as second-year
students.

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Mayo Clinic College of Medicine and Science has 5 schools:

Mon, Jul 29 6:00am · Handling a critical drug shortage: The case of the effect of Hurricanes Maria and Irma on liquid nutrition

National Weather Center rendering of Hurricane Irma passing over the Dominican Republic, Puerto Rico and surrounding areas.

By Adolfo Espitia, Jr., undergraduate public affairs intern

Hurricanes Irma and Maria struck back-to-back in Puerto Rico on Sept. 6 and 20, 2017, destroying pharmaceutical manufacturing plants that long supplied Mayo Clinic. Puerto Rico-based factories were the clinic’s single source of an amino acid solution required for preparation of liquid nutrition administered intravenously (called “parenteral nutrition,” or PN) necessary for some of Mayo Clinic’s most vulnerable patients.

Erin Nystrom, Pharm.D.

With patients of all ages needing the amino solution to meet nutrition requirements, Erin Nystrom, Pharm.D., a clinical pharmacist specialist in Nutrition Support at Mayo Clinic, recognized the need to act quickly to protect patients. Working together with Dr. Nystrom was Whitney Bergquist, Pharm.D., senior clinical pharmacy manager, and Molly McMahon, M.D., endocrinology consultant and Hospital Nutrition Core Group chair. The team began responding to the crisis by brainstorming operational needs, including who should be involved in the plan to safely meet patient needs.

The unexpected shortage required a
collaborative effort combining administration, pharmacy technicians,
pharmacists, physicians, nurses and staff from other disciplines. Most
importantly, Dr. Nystrom says, “We needed to ensure that no PN-dependent
patient went without PN.”

She and her colleagues recently published a paper on their experience in rapid change management, “Parental Nutrition Drug Shortages: A Single-Center Experience With Rapid Process Change,” in the Journal of Parenteral and Enteral Nutrition.

Before the disaster, PN solutions were
customized for each patient, to provide daily requirements for calories,
protein, fat, and electrolytes for individuals. Mayo Clinic pharmacy staff
compounded (mixed) each patient’s PN in custom preparations, as ordered by the
care team, to meet individual needs based on clinical status and lab test
results.

With the base amino acid solution supply
suddenly rationed across the country and dwindling rapidly, Drs. Bergquist and
Nystrom realized an alternative would be needed quickly.

Collaborating for a quick and safe solution

Iv pole with several different solutions hanging from it, including liquid nutrition.

Working with Supply Chain Management, a potential substitute product from another supplier was identified. “Our Supply Chain team was critical to identifying an alternative, and did so in an environment where available options were rapidly dwindling,” says Dr. Nystrom.

This alternative was a commercially-prepared
multi-chamber bag of parenteral nutrition (MCB-PN), from a new supplier. As the
PN source supply became compromised, Dr. Nystrom and her colleagues defined
criteria to conserve limited remaining supplies for use in custom compounded PN
for children and adult patients with the most critical need. They established
new clinical ordering criteria and pharmacy preparation processes incorporating
the MCB-PN for patients who were metabolically stable and considered lower risk.
These new criteria were communicated to providers from top leadership.

After establishing MCB-PN as a safe
alternative, nursing staff—in particular—were trained on the new product and
associated processes through presentations, group training and hands-on
demonstrations. Talking with affected departments helped the team discover gaps
and identify solutions. Within two weeks, Mayo Clinic had started the substitute
processes.

“Within the first day, the use of custom
PN dropped to our target of 25% of usual” Dr. Nystrom says. As the product was
incorporated into clinical practice, additional feedback from providers involved
in the process helped refine MCB-PN pharmacy preparation and clinical use.

As hurricane season fast approaches, Dr.
Nystrom says reviewing this scenario encourages a discussion of future
disasters and how the downstream effects could possibly wreak havoc among
medications, medical devices and other critical components of patient care. “Drug
shortages are becoming much more common,” she says, necessitating preplanning
and ongoing discussions about potential mitigation strategies.

In publishing the article, the team
hopes other hospitals take time to consider how to address future drug shortages.
Dr. Nystrom highlights the “well-oiled” team that assisted in addressing the
compounded PN shortage, researching alternatives and determining how to
effectively use MCB-PN among patients.

Communication was critical

“Our communication was done in a way
that basically said if you are experiencing a shortage here is a tool kit for
how you would need to address this,” Dr. Nystrom says. “These are the criteria
for patients who would qualify for MCB-PN and these are the things you would
need to provide the nurse to give your patient MCB-PN. It wasn’t prescriptive
for them, but supportive.”

Dr. Nystrom applauds Dr. Bergquist as well as Dr. McMahon and others up and down the organization, for allotting time to handle the shortage. “Dr. McMahon was a tireless champion not only locally but at national level,” says Dr. Nystrom. “She recognized the value of including all disciplines and engaging practice leadership to actively communicate and educate.”

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Thu, Jul 25 6:00am · Undergraduate students participate in Mayo research, develop careers, collaborations

Timothy Nelson, M.D., Ph.D., works on a research project with a student.

Advancements in the field of medical research don’t always follow a straight line. Obstacles, challenges and questions arise. When researchers reach an impasse, what can they do?

They can start with a new question.

If everyone in the room is saying, “Yes, but …,” then it may be time to find someone who is asking, “Why not?”

That’s the idea behind Mayo Clinic’s Innovative Minds Partnering to Advance Curative Therapies program, also known as IMPACT. The program brings together undergraduates from all fields of study, from colleges and universities around the Midwest. The students form teams with a faculty mentor to take on a single, shared research question.

The question is different each year, but it always points to a real issue facing researchers.

The program was created by Timothy J. Nelson, M.D., Ph.D., director of the Todd and Karen Wanek Family Program for Hypoplastic Left Heart Syndrome at Mayo Clinic, and Katherine Campbell, Ph.D., a former graduate student and research fellow in Dr. Nelson’s lab, to bring fresh and creative ideas to research labs.

“Sometimes they commit to an interpretation of data that is 180 degrees from the way we interpret that data,” Dr. Nelson says of the students who participate in the program. “When that happens — and that happens every year — as researchers, we get to sit back and say, ‘Why did we think that was wrong, and why did we think we were right?’ It creates a wonderful dialog that allows us experts to fundamentally challenge the dogma we live by every day.”

Since the program’s inception, the research questions have been focused on hypoplastic left heart syndrome. Funding has come in part from the philanthropy of the Todd and Karen Wanek Family Program for Hypoplastic Left Heart Syndrome.

Collaborative research

The research on hypoplastic left heart syndrome takes place at the campuses of the colleges the students attend. At the end of the program, the students and researchers  gather for a symposium to share their hypotheses. This year, the symposium was held in Eau Claire, Wisconsin, where Mayo Clinic Health System and the University of Wisconsin — Eau Claire recently established a collaborative research agreement.

“This is a chance for students to get involved with a project that definitely has a direct application, in this case to quality of life and improved patient outcomes,” says Michael Carney, Ph.D., associate vice chancellor of academic affairs at the university. “I think that’s a real big benefit to this collaboration.”

“What we’ve seen year after year is that the students are becoming confident experts in the field and asking questions that are extremely well-informed,” Dr. Campbell says.

Dr. Campbell, the original director of the Innovative Partnership to Advance Curative Therapies program, is mentoring a team for the first time in 2019. She is now an assistant professor in the Department of Interprofessional Education at St. Catherine University in St. Paul, Minnesota.

“I think what’s exciting from an educator’s standpoint is that this really allows students an opportunity they don’t often get to tackle — the first part of the scientific method — and that is that idea-generation phase,” Dr. Campbell says.

Developing careers, connections

In addition to presenting their hypotheses to their peers and faculty mentors, a few student groups from the program will conduct their research in a Mayo Clinic laboratory.

“We’ve actually tested some ideas that we never would have tested before because we brought those students into our lab,” Dr. Nelson says.

The program isn’t just about idea generation and research creativity. It also serves as a talent development program that includes hundreds of students who get a chance to experience Mayo Clinic as a potential place to continue their studies or start their careers.

“It gives them a meaningful exposure to who we are as an organization,” Dr. Nelson says. “We’ve had students who have done this program, and are graduate students today and stay connected with us. They’re so grateful for this program because it sparked in them something new.”


A version of this story originally appeared in Mayo Clinic Magazine.

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