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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3 hours ago · Late relapse for breast cancer patients: Scientists work to predict risk

By Sara Nick

Saranya Chumsri, M.D., talking with a patient, graphical images of breast cancer on computer screen at desk behind them.
Saranya Chumsri, M.D., discussions options with a patient. Dr. Chumsri was first author on the study described in this article.

Many breast cancer patients develop recurrence years after the original diagnosis, despite following a long-term medication protocol after initial treatment.

Mayo Clinic scientists are taking a closer look at which factors contribute to risk of recurrence, including the subtype of cancer patients have.

Dr. Thompson at home in his laboratory at Mayo Clinic in Jacksonville, Florida.

“Understanding which patients are still at risk of late recurrence will help ensure that particular patients are getting the long-term treatment that matches their needs,” says E. Aubrey Thompson, Ph.D., a researcher at Mayo Clinic in Florida who specializes in breast cancer genomics. “However, not all patients will need prolonged treatment.”

Dr. Thompson is the senior author of a new study published in the Journal of Clinical Oncology. For this work, his team looked at up to ten years of follow-up data for thousands of patients to assess the risk of breast cancer recurrence after initial cancer treatment.

The researchers were particularly interested in a breast
cancer subtype that is HER2-positive and hormone-receptor positive. HER2-positive
cells produce too much of a protein that promotes the growth of cancer. When a
cancer is also hormone-receptor positive, hormones fuel the growth of its
cells. The HER2-positive subtype, which can be aggressive, accounts for about
25% of female breast cancer cases.

“The risks of late recurrence in HER2-positive breast cancer have been understudied,” the paper’s first author, breast oncologist Saranya Chumsri, M.D., explains. Additionally, while there are multiple effective treatments that target the protein involved in HER-positive cancer, scientists do not know how well these treatments can prevent recurrence long term.

In this research, the investigators found a low risk of
long-term cancer recurrence in patients with this subtype who received
trastuzumab-based chemotherapy after surgery, with 3% incidence of recurrence
between years 5-10 in patients with no lymph node involvement.

Further, their data suggests a long-term benefit of trastuzumab
among patients with this subtype.

“It’s often recommended that hormone-receptor-positive breast cancer patients take medication for many years to prevent breast cancer recurrence,” Dr. Chumsri says. “However, not every patient may need this prolonged therapy. When it comes to preventing late relapse in this group of patients, our data suggest that the benefit of trastuzumab persisted long term and this group of patients may have lower risk of late recurrence. If so, this group of patients may be able to avoid the long-term side effects of endocrine therapy.”

“This research adds to our overall knowledge of risk of late
recurrence in different subtypes of breast cancer,” she adds.

More work is needed to confirm these findings, but the investigators
hope their data will contribute to the development of new models that may
better define the risk of late relapse for breast cancer patients. This would
help doctors make informed decisions about the long-term use of endocrine
therapy to prevent recurrence of this disease.

This study was supported by the National Institutes of
Health, with additional funding from the Breast Cancer Research Foundation, Bankhead-Coley
Research Program, DONNA Foundation, and Genentech.

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1 day ago · DISCOVERY Study Seeks to Learn More About the Causes of Post-Stroke Cognitive Impairment and Dementia

By Mass General Research Communications Staff

Stroke is the leading cause of adult disability in the US, with up to 70% of stroke survivors suffering some degree of post-stroke VCID. Furthermore, some stroke subtypes carry a disproportionate burden of the disability related to stroke.

We are excited to announce that, last month, the National Institute of Neurological Disorders and Stroke (NINDS) awarded Massachusetts General Hospital (MGH) $39M ($62+ million in total direct and indirect costs) for the DISCOVERY (Determinants of Incident Stroke Cognitive Outcomes and Vascular Effects on RecoverY) Network.

This is the largest U19 award across Partners, 3rd among largest NIH awards received by Partners, and FIRST of those received by Mass General.

Supported by the NINDS and National Institute on Aging (NIA), DISCOVERY will become a landmark study to unravel the mechanisms of post-stroke cognitive disability, early stroke recovery, and potential targets for personalized prevention, intervention and rehabilitation.

The vision of DISCOVERY is to dramatically reduce the rates of post-stroke VCID and functional disability in high-risk US populations – specifically including the health disparities populations – based on their stroke subtype or the underlying vulnerability.

“Understanding the mechanisms underlying the process of cognitive and functional recovery after stroke offers a promise of future diagnostic tools, treatment options and rehabilitation strategies that would help abate the burden of disability related to stroke,” says Natalia S. Rost, MD, MPH, who is chief of the MGH Stroke Division, Professor of Neurology at Harvard Medical School and 2019-2024 Samana Cay MGH Research Scholar.

Led by Prof. Rost and Steven M. Greenberg, MD, PhD, of the MGH J. Philip Kistler Stroke Research Center, this new collaborative network consists of four novel cores and 30 premier academic clinical sites with access to acute stroke populations and the expertise and capacity for systematic assessment of post-stroke cognitive impairment and dementia.

“It takes a village to solve a problem of such complexity as post-stroke cognitive disability,” says Rost. “Not only have we embarked on the greatest current challenge in the field of stroke outcomes and recovery, we are aiming to understand the mechanistic details that have never been tackled before at the depth and the scope proposed in DISCOVERY.”

The complex interplay between life exposure to multiple vascular risk factorsThe DISCOVERY team will investigate the mechanisms of brain resilience and susceptibility to post-stroke VCID in a representative population of white, black and Hispanic stroke survivors in the US based on:

  • Pre-existing burden of microvascular and neurodegenerative pathology
  • The effect of strategic acute stroke lesions
  • The mediating effect of genomic/epigenomic variation

Under the leadership of the Administrative Core (Dr. Rost, MGH) and guided by the research strategy delineated by the Recruitment and Retention (Dr. James Meschia, Mayo Clinic), Statistics (Drs. Rebecca Gottesman, Johns Hopkins University and Lisa Wruck, Duke University), and Repository (Dr. Helmer, MGH) Cores, the DISCOVERY team will conduct a prospective, multi-center, observational, nested-cohort study of 8,000 nondemented ischemic and hemorrhagic stroke patients.

Study participants will be enrolled during their acute hospital admission and followed for a minimum of two years, with serial cognitive evaluations and assessments of functional post-stroke outcome. Subsets of participants will undergo research-based MRI and PET scans and comprehensive genetic/genomic and fluid biomarker testing.

“We will translate this new knowledge into practical tools for identifying patients at high risk for post-stroke VCID and propose targeted interventions for prevention, treatment, and rehabilitation of post-stroke cognitive impairment and dementia,” says Rost. “Ultimately, I see a world where each patient has a chance at successful recovery after stroke.”

The key scientific leadership of DISCOVERY consists of a team of recognized experts in:

Scientific Expertise Investigators
Acute Stroke/Big Data Science Natalia Rost, MGH; Polina Golland, MIT; Jayashree Kalpathy-Cramer, MGH Martinos Center
Vascular Contributions to Impairment and Dementia Steven Greenberg, MGH; Rebecca Gottesman, JHU; Lisa Wruck, Duke; Thomas Mosley, U of Mississippi; Jennifer Manly, Columbia U
Alzheimer’s Disease David Knopman, Ronald Petersen, Jonathan Graff-Radford, Mayo Clinic
Multi-Center Stroke Clinical Trials James Meschia, Kevin Barrett, Mayo Clinic
MRI Analysis Bruce Fischl, MGH Martinos Center; Prashanthi Vemuri, Cliff Jack Jr, Mayo Clinic
PET Imaging Keith Johnson, MGH; Val Lowe, Mayo Clinic
Hemorrhagic Stroke Alessandro Biffi, Anand Viswanathan, MGH
Genetics/Genomics Sudha Seshadri, UT-San Antonio; Myriam Fornage, UT-Houston
Fluid Biomarkers Jason Hinman, UCLA; Robert Rissman, UCSD; Len Petrucelli, Mayo Clinic
Health Disparities Bernadette Boden-Albala, UC-Irvine; Steven Kittner, U of Maryland
Large-Scale Databases/State-of-the-Art Biobanking Alex Sherman, Karl Helmer, MGH; Robert Rissman, UCSD


The proposal was developed in response to the RFA NS-19-012 (U19) (https://grants.nih.gov/grants/guide/rfa-files/RFA-NS-19-012.html) and is jointly supported by the NINDS and NIA (U19NS115388).

This article was originally published by Mass General Research Institute, Oct. 15, 2019.

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Editor’s Note: At Mayo Clinic, research drives everything we do for patients, staff and caregivers. We have a unique culture of collaboration that extends beyond our walls as we seek to discover ways to improve health, and the experience of health care, for people everywhere.

The teamwork within the DISCOVERY Network is one such example that we hope will lead to better understanding of the mechanisms of post-stroke related disabilities and ways to treat, reduce or prevent them.

3 days ago · Mayo student a finalist in Collegiate Inventors Competition

Meet Allisa Song: medical student, inventor, and startup company co-founder.

Allisa Song, a second-year medical student at Mayo Clinic Alix School of Medicine, and her teammates will head to Virginia this month as graduate finalists in the 2019 Collegiate Inventors Competition.

This competition brings together the nation’s most creative students to showcase and compete with their research and discoveries, and offers networking opportunities, market exposure, mentorship, and more.

Song and her team — which includes Elias Baker, Jennifer Steger, and Mackenzie Andrews — are bringing their invention, the Nanodropper, a universal eyedrop bottle adapter that eliminates eyedrop medication waste.

Creating a solution for eyedrop medication waste

Allisa song holds Nanodropper in her hand and demonstrates its use.
Allisa Song demonstrates the use of Nanodropper

Before Song came to Mayo Clinic Alix School of Medicine in Rochester, Minnesota, she could already say she was a CEO and co-founder of a startup, Nanodropper, LLC.

In 2017, after reading an article that reported how drug companies manufacture eyedrop bottles that produce eyedrops far too large for the eye to absorb, Song knew she could create a solution. She assembled a team composed of people she met while completing her undergraduate degree in biology and psychology at the University of Washington. With backgrounds in bioengineering, pharmacology, and mechanical engineering, they were well-equipped to get to work and the Nanodropper was born.

The Nanodropper is a small, screw-on attachment that fits onto any standard eyedrop bottle and better controls the size of the eyedrop. It is easy to use, cost effective, and allows the patient to dispense a far-smaller drop, which improves the medication’s effectiveness and reduces side effects.

The device also enables the patient to get more doses per bottle. This might not be a large concern for those thinking of traditional, over-the-counter eyedrops, but in the case of expensive prescription eye medication, such as eyedrops used to treat glaucoma, this device can eliminate medication waste and result in significant savings for the patient.

Patients also often miss their eye when instilling eyedrops and chronically run out of their medications before insurance will cover the next refill. One study found that up to 25% of patients experience this “bottle exhaustion,” which creates a barrier to medication adherence.

Song and her team created the adapter with the goal of providing a solution available directly to patients.

“Our main goal has always been to help empower patients to take back control of their eye health in our complicated health care system.”

Balancing medical school and a startup

Since 2017, the Nanodropper has been widely recognized. The team was voted “audience favorite” at the Walleye Tank life sciences pitching competition in 2018. Earlier this year, the team filed for a patent and has a website that is accepting preorders. Song says the Nanodropper is “promising because there is very little out there like this. It’s unique.”

As a second-year medical student, Song is challenged by having to balance her school work and her role in the startup. However, she said, “Hearing patient stories through my work with Nanodropper reminds me every day of why I went into medicine. It’s been so rewarding and it keeps me motivated in the classroom.”

Song added that she is grateful for the help of Baker, Steger, and Andrews. “I wouldn’t be able to do it without my team,” she said.

As for what’s next after medical school, Song has yet to commit to a medical specialty. She says she might consider ophthalmology, but she is “keeping her options open.”


This article originally appeared on the Mayo Clinic Alix School of Medicine News page.


Wed, Nov 6 6:00am · Precision genomics may offer clues to unexplained low blood cell counts

By Jay Furst

Precision genomics
has opened the door to identifying the drivers for cancer and other diseases.
Its value as a diagnostic tool isn’t limited to the underlying disease biology,
however. It also can help diagnose and determine targeted therapies for
patients with unexplained illnesses.

Mrinal Patnaik, M.B.B.S.

Mrinal Patnaik, M.B.B.S., a Mayo Clinic hematologist, and
colleagues conducted research with patients who had unexplained low blood cell
counts, or cytopenias, and found that a precision genomics approach has the
potential to change clinical treatments and enable personalized care. Dr. Patnaik
is associate professor of medicine and assistant professor of oncology, Mayo
Clinic College of Medicine and Science.

This research was part
of a study that was published in Mayo Clinic
Proceedings

in September.

“Adult
patients with unexplained cytopenias need appropriate testing before subjecting
them to trial-and-error therapies,” says Dr. Patnaik, corresponding author
of the study. “A significant proportion of these patients could have
genetically defined inherited bone marrow failure syndromes, which need specialized
treatment. Precision medicine testing has the potential to alter their clinical
management.”

The study evaluated
68 patients with unexplained cytopenias. About one-third of patients were found
to have inherited bone marrow failure syndromes, while 44% did not fit under a known
clinical syndrome, diagnosed as clonal or idiopathic cytopenias of undetermined
significance. The remaining patients didn’t fit either category.

Dr. Patnaik and
colleagues then conducted a chart review to determine how the information was
applied later in the clinical setting. In 25% of the cases, doctors and
patients made changes in clinical management, including decisions regarding
therapeutic interventions, donor choice and conditional regimens for stem cell
transplantation.

Even when a
definite diagnosis couldn’t be reached, patients received a tailored follow-up
plan that was informed by the genomic work.

“Clearly the
information was of value and led to changes in treatment,” says Dr. Patnaik,
who has a special research interest in blood cancers called myelodysplastic and
myeloproliferative neoplasms. “Our data suggests that it is possible to
use this testing in routing clinical practice, and the results should encourage
clinicians to consider these tests.”

The study was funded in part by the Center for Individualized Medicine’s Gerstner Family Career Development Award and a grant from the National Center for Advancing Translational Science, which is part of the National Institutes of Health.

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Wed, Oct 30 6:00am · Giving women the tools to take off

Jennifer Westendorf, Ph.D., director of the Mayo Clinic Office of Research Diversity and Inclusion, says there’s a strong need to help women advance their projects involving research, patents and intellectual property. She cites statistics from the National Science Foundation, Association of American Medical Colleges and U.S. Patent and Trademark Office, which show that:

  • Women receive more than half of all doctoral degrees in the U.S., and hold 42% of full-time faculty positions at U.S. medical schools but lead only 19% of departments.
  • In 2016, only 12% of inventors listed on patents were women. Patents attract venture capital.
  • Female business founders receive only 2% of venture capital financing.

The Office of Research Diversity and Inclusion is collaborating with the Mayo Clinic Office of Entrepreneurship and Center for Biomedical Discovery to give women at Mayo Clinic the tools they need to advance their research for scientific excellence, entrepreneurship and innovation. The two groups have engaged a Minneapolis-based consulting company, Capita3, in this effort.

Capita3 provides the Leader Launch Program designed to enhance women leaders’ confidence and effectiveness to help them deliver on their business, research or technology projects. Participants meet four times for three-hour sessions over three weeks to address the fears that hold them back from achieving their goals. They then develop a process to accomplish a near-future milestone related to an entrepreneurial or research project.

“Diversity of thought and experience are important for advancing research to application,” says Dr. Westendorf, Department of Orthopedic Surgery and Department of Biochemistry and Molecular Biology at Mayo Clinic in Rochester and the Margaret Amini Professor of Orthopedic Regenerative Medicine Research. “Teams with diverse perspectives are more productive and more likely to address problems in new ways. This program aims to provide women with the tools they need to advance their ideas.”

Jennifer Westendorf, Ph.D.

Teams with diverse perspectives are more productive and more likely to address problems in new ways.”

Jennifer Westendorf, Ph.D.

To date, 36 Mayo Clinic staff members and students have participated in Leader Launch, with more cohorts planned. The Office of Research Diversity and Inclusion will track participants’ outcomes to determine the program’s effectiveness.

How it’s helping

Luz Cumba-Garcia (left) and Yuguang Liu, Ph.D. (right)

Senior research fellow Yuguang Liu, Ph.D., trained as an electrical engineer but has worked extensively on biological projects in the last few years. She hopes to transition to a junior faculty position in the biomedical engineering track in the near future. She describes Leader Launch as a self discovery program well suited to her needs as she starts this journey.

“The program helped me look at myself and my career goals differently, discover my strengths and weaknesses, and improve how I position my skills and abilities in the best light,” says Dr. Liu. “The knowledge I gained from the program will help as I reach out to people for faculty opportunities, present my work and approach collaborators for grant applications.”

Mayo Clinic Graduate School of Biomedical Sciences Ph.D. student Luz Cumba-Garcia participated in Leader Launch to organize her journey toward a patent.

“I’m aiming to patent my research focused on a noninvasive way to diagnose brain tumors such as glioblastomas (GBM) and monitor treatment outcomes with a simple blood draw,” says CumbaGarcia. “The technology is a diagnostic tool to analyze small particles in blood called extracellular vesicles that are shed from brain tumors and can be found in the plasma of GBM patients. We plan to develop a kit that anyone could use to screen for brain tumors and assess therapy outcomes. We envision that this kit also could be used to monitor other kinds of tumors. I would like to start a company around this technology.”

Cumba-Garcia says the course taught her how to be more specific in her goals, establish task deadlines and accountability measures to achieve them, identify and learn from her strengths and weakness, and be a professional leader.

“Patents can take a long time, but we’re making progress. I’m doing a lot of networking and contacting potential investors,” she says. “I feel more empowered and optimistic about my project after participating in this amazing women leadership program.”

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Tue, Oct 29 6:00am · New Study Highlights Need for Healthcare Providers to Engage Alzheimer's Caregivers

Mayo Clinic and UsAgainstAlzheimer’s research paper published in  Journal of Applied Gerontology

By Roger K. Lowe, USAgainstAlzheimer’s Chief Communications Officer

A new study spotlights the often-overlooked need for family caregivers of people with Alzheimer’s disease to be more engaged by physicians during medical appointments with their loved ones. The research by Mayo Clinic and UsAgainstAlzheimer’s was published in the Journal of Applied Gerontology.

The paper identified seven best practices to bring family caregivers more into the clinical appointments of people with Alzheimer’s and dementia.

This research provides a unique perspective on the often-overlooked views of patients and their caregivers of a medical appointment experienced through the lens of people with Alzheimer’s and dementia, their caregivers and physicians. Previously, studies in this area typically have centered on the view of medical providers of how to engage caregivers and people with Alzheimer’s and dementia, with the expectations of caregivers and those with the disease not considered.

“Our study gives voice to people with mild cognitive impairment and their caregivers and identifies potential best practices to integrate caregivers of people with Alzheimer’s disease and related dementias into clinical appointments through individual and systemic adoption,” said Joan Griffin, Ph.D., study co-author and the Robert D. and Patricia E. Kern Scientific Director for Care Experience at Mayo Clinic. “These practices are rarely assessed but critical for developing models of care that meet the needs of people with Alzheimer’s and related dementias and their caregivers, who remain the cornerstones to the health and well-being of this growing population.”

Family members caring for people with Alzheimer’s disease and related dementias are often responsible for a significant share of care, including medications, support with behavior and impaired memories, healthcare and mitigating risks associated with the progression of the disease. The role and importance of the caregivers in medical appointments increases over time; it is beneficial in earlier stages of Alzheimer’s to provide clinical support for sustaining the patient’s autonomy, but becomes imperative when a person with the disease has decreased capacity to reliably articulate personal health information, independently make treatment decisions, or communicate preferences.

The research team recommends as best practices that healthcare providers recognize the important perspectives of both the patient and the caregiver, the need to communicate directly with patient and provide opportunities for caregivers to have separate interactions with the providers. They also report that healthcare providers should be trained in shared decision-making as the patient’s condition evolves and to remember there are different perspectives from the caregivers and the people with Alzheimer’s and dementia. 

“When doctors don’t actively engage family members in the patient conversation during an appointment, it creates a void of vital information that could help the patient’s care,” said Meryl Comer, a 22-year at-home caregiver and an UsAgainstAlzheimer’s co-author of the study.

The study was based on online focus groups of people with mild cognitive impairment, as well as spousal and non-spousal caregivers. Participants were recruited through UsAgainstAlzheimer’s A-LIST®, a unique online network of over 8,000 people, including those with Alzheimer’s or another dementia, or at risk for the disease, and current or former caregivers.

“The UsAgainstAlzheimer’s A-List® online community gives voice to those living with Alzheimer’s and their caregivers and validates what matters most for people across the disease spectrum,” Comer said “Sharing the research survey results back with the patients and caregivers provides priceless feedback that you are not alone in your journey and that your insights help advance research to improve quality of life.” 

Other best practices in the paper included ways for healthcare providers to build trust with caregivers and people with dementia, increased coordination among healthcare providers on care, and greater use of a “family-centered” approach to care, where the caregiver’s well-being is considered an important part of the care for the person with Alzheimer’s and dementia.

The people with Alzheimer’s and dementia and caregivers participating in the study also wanted additional training on the disease, effective treatments and what behaviors to expect. And the caregivers and patients wanted providers to communicate better and help set the expectations about how changes in cognition will begin a shift in the autonomy and safety of the person with Alzheimer’s and dementia to the caregiver – and how both roles will change over time.

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This article was originally published Oct. 15, 2019, on the UsAgainstAlzheimer’s website.

Mon, Oct 21 6:00am · AskMayoExpert: Driving Practice Transformation through Unparalleled Knowledge Management

sleeping child in hospital bed with iv

For the past decade, AskMayoExpert has served as a central repository to capture, organize and deliver concise, Mayo-vetted medical knowledge for Mayo Clinic and Mayo Clinic Care Network providers at the point of care. Much has changed since its inception, with more providers looking to AskMayoExpert and its care process models as not only vital information on what type of care to deliver, but also as change agents for improved and consensual practice standards leading to better patient care.

AskMayoExpert is an online point-of-care tool that gives health
care providers access to Mayo-vetted information, including disease management
protocols, care guidelines, treatment recommendations and reference materials.

Recently, a study published in the Journal of Oncology Practice, Standardizing Febrile Neutropenia Management: Antimicrobial Stewardship in the Hematologic Malignancy Population validated AskMayoExpert as a quality improvement tool in clinical practice.

“AskMayoExpert has previously been shown to be an effective tool for rapid, point-of-care access to accurate clinical data. Our study, to our knowledge, is the first to demonstrate a clinical outcome related to AskMayoExpert,” says John (Jack) C. O’Horo, M.D., an internal medicine doctor and health care delivery researcher at Mayo Clinic, in Rochester, Minn.

This is the top screen of the care process model/algorithm for diagnosis and treatment of febrile neutropenia.

Through the creation of a care process model on febrile neutropenia, Dr. O’Horo and his research team hoped to standardize the way doctors treat febrile neutropenia. They sought to improve the appropriate use of antimicrobials and diagnostic tests for patients with this condition. (Febrile neutropenia refers to a high fever coupled with low levels of neutrophils, a type of white blood cell important for fighting certain infections.)

Throughout
a yearlong period, the care process model helped guide providers through evidence-based antimicrobial selection and
diagnostic evaluation of patients with febrile neutropenia.

The end result? Improved adherence to best practices.

“At baseline, 71% of patients with febrile neutropenia
had at least one critical deviation from best practice. During the project, the
percentage decreased to 27.3%; 4 months after the project was completed, the
percentage was 33.3%,” says Dr. O’Horo.

Building the Evidence Base and Care
Process, Determining Best Practice

Initially,
the team developed a care process model based on available information about
febrile neutropenia diagnosis and treatment, along with expert infectious
disease physician inputs.

This new care process model for Mayo Clinic, and other
AskMayoExpert users, was reviewed monthly for clinical errors or adverse
outcomes and refined and updated every other month on both the AskMayoExpert
site as well as the Mayo Clinic intranet site for the Department of Hematology.
Ongoing improvements to the care process model were based on input from Mayo
Clinic’s hospital internal medicine, hematology, and oncology disease-oriented
groups. Concurrently, key metrics were identified for monitoring of adherence to best practices.

Drop-downs at each decision point aid clinicians in choosing appropriate course of action.

“When
we were trying to determine the best way to reduce antibiotic overuse in patients
with febrile neutropenia, we thought the best thing would be to provide some
guidance for how an infectious disease expert would approach a specific patient,”
says Dr. O’Horo. “The care process model in AskMayoExpert provided the perfect
platform for delivering this data in a step-by-step approach. The model allowed
for a virtual consult, identifying the key decision points a specialist would
address in the first 24 hours of care for this vulnerable population.

“This
also allowed us to converge medical practice across the enterprise and tap into
the expertise of the entire institution, which ultimately reduced antimicrobial
overuse,” he says.

The
ability to reach across all of Mayo Clinic and gain the input from many experts
in a particular disease or condition is what makes AskMayoExpert an exceptional
resource for clinicians.

Dr. O’Horo’s study illustrates illustrates both how to build a treatment algorithm and care process model, optimizing consensus-based, best-practice evaluation and treatment knowledge, as well as successful dissemination and implementation. It further highlights the successful implementation of this algorithm to modify clinician practices and to standardize care across a large, disperse organization.    

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This study was supported by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and the Center for Clinical and Translational Science.

Fri, Oct 18 6:00am · Mayo colleagues design adjustable fracture nail to improve patient outcomes

Christine Mehner, M.D., and Toni Turnbull, Ph.D., teamed up to help orthopedic patients. Why? Because ‘there must be something better’.

By Sandy Shortridge

Prompted by a health care innovation competition at Mayo
Clinic’s Jacksonville, Florida, campus, two innovators recently joined forces
and developed a new tool designed to reduce pain and shorten recovery time for
patients with long bone fractures.

The idea for their adjustable fracture nail started when Christine
Mehner, M.D., a predoctoral Ph.D. student, and Toni Turnbull, Ph.D., a
neuroscience research fellow, heard about the Alligator
Tank competition
. Modeled after TV’s “Shark Tank,” the Alligator Tank
competition is where aspiring Mayo entrepreneurs and inventors get a chance to
pitch ideas to a panel of expert judges — alligators instead of sharks — to
secure funding for their projects.

Drs. Mehner and Turnbull started brainstorming potential solutions
to problems that they had faced in their work. From her time as an orthopedic
surgery resident, Dr. Mehner had experienced firsthand the challenges surgeons
encounter when setting fractures to long bones such as the tibia. She thought
to herself, “There must be a better way.”

A better way

Tibia fractures are difficult to set. In addition to the broken
bone, the foot often is rotated out of alignment with the rest of the leg.
Rotating the foot into an ideal position requires extensive manipulation in the
operating room and, depending on the complexity of the fracture, adjustments
can be challenging, especially for less-experienced surgeons.

“Unfortunately, in more than 50% of cases, patients have a
rotation error after surgery, so the foot on the injured leg no longer mirrors
the position of the healthy side,” Dr. Mehner says.

If a patient’s foot is rotated inward or outward beyond 30
degrees from its original position, over time it can severely affect the
adjacent joints, including the knee, hip and ankle.

“Millions of patients worldwide suffer from this condition
after surgery to repair a tibia fracture,” Dr. Mehner says.

“Currently there’s not a lot that can be done to help,
except prescribing pain-reducing drugs and rehabilitation,” Dr. Turnbull
says.

Drs. Mehner and Turnbull set out to solve this problem by
designing an adjustable nail that can be used in orthopedic surgery to
stabilize long bone fractures. The nail allows for guided adjustment for each
patient, resulting in better long-term outcomes. The adjustable nail uses internal
rotation to open the fracture, move the alignment so the foot is in place, and
then close the fracture. It provides for simple and fast fine-tuning of a
fractured limb.

Though this work was a departure from their day-to-day duties, it is driven by an overarching interest in solving problems and helping patients. Dr. Mehner is a predoctoral student in molecular biology and biochemistry whose research focuses on ovarian cancer. Dr. Turnbull is a neuroscientist studying stroke and degenerative mechanisms in the brain.

A tale of 2 tanks: Swimming with alligators, walleyes

In October 2018, it was time for the innovators to share their
solution at the event that inspired their big idea: the Alligator Tank
competition in Florida. Dr. Mehner described the pitch competition as the
“biggest rallying of support” and a great opportunity for exposure.

“After our two-minute pitch, it was clear this idea was
going somewhere, which was really fantastic. It was a great feeling,” she
says.

The adjustable fracture nail was chosen as one of three winners in the 2018 Alligator Tank competition and advanced to the Walleye Tank competition in Rochester, Minnesota.

Following the Walleye Tank competition, enthusiasm continued to
build. Mayo Clinic connected Drs. Mehner and Turnbull with a Minnesota-based
engineering company that is creating a prototype of the adjustable fracture
nail to be tested at Mayo Clinic in Florida later this year.

Both inventors say they are grateful for the support they’ve received, including guidance from Magdalena Cichon, Ph.D., of Mayo Clinic Ventures, as well as funding and encouragement from Jordan D. Miller, Ph.D., and Mayo Clinic’s Surgery Research Center. Since the Walleye Tank competition counts as a public disclosure, Mayo helped secure a provisional patent for the adjustable fracture nail.

While Dr. Turnbull describes the past year as a huge learning
curve, she’s grateful for the backing from colleagues across Mayo Clinic.
“It’s really amazing because where else can you get this kind of opportunity
to see something from an idea all the way through to prototype?” she says.

Drs. Mehner and Turnbull now have set their sights on helping
surgeons and patients worldwide with the adjustable fracture nail. Once they
have a functional prototype, they’ll approach a surgical device company to
develop the nail for broad use to repair varying types of long bone fractures,
including the humerus and femur. They believe the adjustable fracture nail has
the potential to completely replace current versions of intramedullary nails,
making surgery easier and faster for surgeons, and helping patients by reducing
pain, shortening recovery time, lessening rehab needs, and reducing permanent
chronic pain and injury.

Thinking differently to meet patient needs

Dr. Mehner and Dr. Turnbull encourage fellow innovators.

“Learning to think innovatively is like all things — the
more you do it, the better you get at it,” Dr. Turnbull says. “The
first time someone presents you with a problem, it’s harder to get to a
potential solution. But the more you do it, the easier it becomes.”

Dr. Mehner agrees. “Almost any system, method or technology
that we work with can be improved. For us, the need for improvement is driven
by an unmet patient need,” she says. “The goal of this invention is
better patient outcomes, faster and improved healing, shorter surgery times,
and a universally easier application.”

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