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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Thu, May 9 6:00am · How can we get better outcomes for our patients? Research.

In the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, every project is inspired by real-world challenges experienced by patients at Mayo Clinic and elsewhere. Together with Mayo Clinic‘s health care providers, center experts research ways to improve outcomes for patients across all of medicine, from Alzheimer’s disease to cancer and beyond.

Illustration of liver, bile ducts, gall bladder, stomach

Illustration of liver, bile ducts, gall bladder, stomach

“When” matters, for chemotherapy

In a research study published in March 2019 in the European Journal of Surgical Oncology, a center team reported on its investigation into whether patients should receive chemotherapy before or after surgery to remove cholangiocarcinoma (cancer in the bile ducts).

Chemotherapy is often used in treating cholangiocarcinoma, but until this study, no one could say for certain whether there was any benefit to receiving chemotherapy before, as opposed to after surgery.

Using the National Cancer Database, the team looked at the records of 1,450 patients who received both surgery and chemotherapy for stage I-III cholangiocarcinoma between 2006 and 2014. They found that about 21% of the patients received chemotherapy before surgery. However, they found that patients who received chemotherapy before surgery lived on average 7.5 months longer than those who received it after surgery (median overall survival 40.3 versus 32.8 months).

These findings will assist physicians to develop treatment plans resulting in the best possible outcomes for their patients. They also will affect future research, as the paper’s authors state, “Our findings have implications in designing future clinical trials.”

Cholangiocarcinoma is associated with poor prognosis, and there is limited data on how best to treat this disease. This study provides preliminary data for benefit of chemotherapy prior to surgery, and currently Mayo Clinic is participating in a clinical trial evaluating the potential effectiveness of a combination of chemotherapy drugs given prior to surgery.

Keeping people out of the hospital

With a similar goal of achieving the best possible outcomes for patients, another team of researchers quantified the risk of readmission to the hospital within 30 days, specifically when discharged to a skilled nursing facility. Their findings were published in the Journal of the American Medical Directors Association.

Repeated hospitalizations can be harmful, especially for elderly patients. 30-day readmissions are a widely accepted measurement of hospital quality, and something that health care providers continuously strive to minimize. The researchers evaluated the records of 6,032 patients, age 55 or older, discharged to a skilled nursing facility between January 1, 2009, and June 30, 2014.

Across the group, there were 8,616 discharges to skilled nursing facilities. Of these, 1,568 needed readmittance to the hospital within 30 days.

They found some significant predictors of readmittance:

  • Prolonged initial hospital stays
  • Need for ICU-level care in the initial hospitalization
  • Abnormal levels of laboratory parameters such as hemoglobin, creatinine, sodium and potassium before discharge

Additionally, medically complex patients – with multiple chronic conditions or a complex medical situation – were more likely to be readmitted, along with those who had needed frequent emergency department visits and/or hospitalizations in the preceding 6 months.

Armed with this information, they created a prediction tool to identify patients who are most likely to end up back in the hospital – for any reason. This tool can help both hospitals and skilled nursing facilities identify individuals at greater risk of readmission, who may then be prioritized for greater clinical monitoring and targeted interventions.

At Mayo Clinic research drives everything we do for patients. The Mayo Clinic Kern Center for the Science of Health Care Delivery in particular works with Mayo’s medical practice to continuously reimagine and improve the way we collect, store, analyze and use health and disease information. These studies are two examples of the kinds of contributions health care delivery research brings to bear as we build the evidence base for best practices and personalized care.

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Wed, May 1 6:00am · Research News Roundup-April 2019


The Mayo Clinic Research News Roundup includes brief summaries and links to research news releases from the past month. It also connects readers to related resources. Read on for more information from Mayo Clinic Research.

In collaboration with the University of Kentucky, the University of Texas Southwest Medical Center, Rush University Medical Center, the University of Cambridge in the U.K., and other institutions, Mayo Clinic researchers helped to establish a name for a degenerative brain disease that afflicts the elderly and mimics features of Alzheimer’s disease. This working group describes “limbic-predominant age-related TDP-43 encephalopathy,” or LATE, as an underrecognized risk for public health and calls for an urgent focus on research to improve prevention, diagnosis and treatment of the disease. The report appears in the journal, Brain.

“LATE is a prevalent but underrecognized condition in the elderly,” says Dennis Dickson, M.D., a Mayo Clinic neuropathologist. “We have been studying this protein for many years, but now we have a common goal to target, which is something we want to make clinicians aware of. LATE needs to be recognized and differentiated from Alzheimer’s disease.”


Cancer cells have various tricks up their metaphorical sleeves to survive in the face of chemotherapy, radiotherapy and other cancer treatments. Now researchers at Mayo have decoded one of those tricks using cell lines and patient-derived cancer cells, and proposed a way to resensitize breast cancer cells to treatment.

Cells have proteins on their outer surface that provide information to the body. Some cancer cells have a protein called “PD-L1” on their surface, and it links up with a protein called “PD-1” on the surface of an immune cell called a “T cell.” On the T cell, PD-1 acts as a brake on the immune response. When PD-L1 and PD-1 link, T cells gets the message that the cell they’re linked to is normal, and no immune response is necessary. Tumor cells, however, use increased PD-L1 on their surface to evade immune surveillance. Today, drugs that target these checkpoints are among the most promising forms of cancer immunotherapy.

But in a new publication in Molecular Cell, a team of researchers at Mayo Clinic are sharing another way that PD-L1 helps cancer cells.


Half of all U.S. states have laws on the books that invalidate a pregnant woman’s advance directive if she becomes incapacitated, and a majority of states don’t disclose these restrictions in advance directive forms, according to a study by physicians and bioethicists at Mayo Clinic and other institutions.

The report, published this month in the Journal of the American Medical Association, reviewed statutes in effect as of February in all 50 states and the District of Columbia. All states have laws regarding decision-making for individuals who can’t make their own medical decisions, but the content of statutes and advance directive documents for “decisionally incapacitated” pregnant women nationwide varies widely.

An advance directive is a legal document completed by a patient that appoints a surrogate to make health care decisions if a person becomes incapacitated and unable to participate, and it indicates what the person’s health care preferences would be.


“Magic mouthwash,” an oral rinse containing diphenhydramine, lidocaine and antacids, significantly reduced pain from oral mucositis, mouth sores, in patients receiving radiation therapy for cancers of the head and neck when compared to placebo. These were the findings of a multi-institution, randomized, double-blind, placebo-controlled, phase III clinical trial, led by Robert Miller, M.D., an emeritus Mayo Clinic radiation oncologist. Dr. Miller and his colleagues published their findings on Tuesday, April 16, in JAMA.

Research was conducted through the Alliance for Clinical Trials in Oncology and included investigators from several institutions.


Mayo Clinic’s Todd and Karen Wanek Family Program for Hypoplastic Left Heart Syndrome and The Children’s Hospital at OU Medicine are collaborating within a consortium to provide solutions for patients with hypoplastic left heart syndrome (HLHS), a rare and complex form of congenital heart disease in which the left side of the heart is severely underdeveloped.

The consortium aligns regional centers into a collaboration led by the Todd and Karen Wanek Family Program for Hypoplastic Left Heart Syndrome at Mayo Clinic to accelerate innovation on hypoplastic left heart syndrome, discovery sciences and clinical expertise by investing local resources back into research.


Recent research led by Andrea Cheville, M.D., a Mayo Clinic physical medicine and rehabilitation physician, suggests that remotely delivering rehabilitation services to patients with late-stage cancer improves their physical function, pain and quality of life while allowing them to spend less time in hospitals and nursing homes. The findings are published in the online issue of JAMA Oncology.

Telerehabilitation research like this is one of the many ways Mayo Clinic extends knowledge and care to more people through innovative telemedicine platforms that improve access and outcomes for patients, and collaboration with other providers and researchers.


Historically, most pancreatic cancer patients whose tumors grow outside the pancreas to encompass veins and arteries have been told the cancer is inoperable and they should prepare for an average survival time of 12 to 18 months. A newly published Mayo Clinic study finds that a pre-surgery treatment plan focused on three factors can extend life years beyond that. The findings are published in the Annals of Surgerythe journal of the American Surgical Association and European Surgical Association.

“We now have more advanced surgical techniques and more effective chemotherapy and radiation therapy. We can take all of these advances and put them together to get the outcomes we are looking for,” says Mark Truty, M.D., an oncologic surgeon at Mayo Clinic in Rochester, Minnesota. “The goal is to extend patients’ lives and maintain or improve their quality of life.”

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At Mayo Clinic, research is integral to everything we do. From the laboratory bench to each patient’s bedside, from training our own care providers to improving health for our global community, we are continuously striving to transform the practice of medicine, one piece of evidence at a time. Read about the Mayo Model of Research.

Thu, Apr 18 6:00am · Research driving improvements in the health care experience

Staff touchpoint meeting in ICUExperts in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery collaborate within Mayo’s medical practice to rapidly discover solutions to the most pressing problems in health care, and to find ways to improve the health care experience.

Addressing disparities in care

This experience is different for each person – be they patient, family member, care provider or hold another role. One of the things Mayo Clinic researches is disparities in care, or differences in the care received based on sex, age, race, body size and other characteristics of patients; as well as differences based on where people live, how much education they’ve had, and so forth.

A recent center publication in the American Journal of Surgery identifies disparities for patients having diverticulitis surgery. This surgery may be conducted by opening the abdomen, or through minimally invasive surgery. In general, minimally invasive surgery is associated with less pain, a shorter hospital stay and fewer complications.

Mayo researchers reviewed Florida inpatient discharge data for 5,857 patients with diverticulitis undergoing elective surgery between 2013 and 2015. The team found that older, sicker patients, residing in rural areas or with Medicaid insurance were less likely to receive minimally invasive surgery. The choice of surgeon affected this as well. Being treated by general surgeons who had a high volume practice or colorectal specialty-trained surgeons made it more likely that patients would receive minimally invasive surgery.

The paper reports “as expected, minimally invasive surgery is associated with decreased odds of developing a post-operative complication.” However, it goes on to note that there are specific patient characteristic that reduce access to minimally invasive surgery, increasing the odds of complications.

Older, sicker patients, as well as patients who live in rural or lower income areas, or had Medicaid, were less likely to receive minimally invasive surgery. While these findings are from Florida alone, it does shine the light on a wider national problem – the need for improved access to trained and experienced surgeons.

Improving experience for ICU patients, caregivers

Another study published in Chest in March 2019 looked at patient experience in intensive care units. The research team examined whether patients and family members agreed with treatment intensity, and if there was disagreement, did it affect actual outcomes for the patient?

The team already knew from existing research that physicians and nurses delivering treatment they perceive as inappropriate are at increased risk for distress and burnout. However, until now, no one had looked at whether patient and/or family perceptions of appropriateness of treatment affected outcomes.

They collected 1,332 surveys reflecting the experience of 151 patients. These surveys were collected from patients, family members (or other patient surrogates), nurses and physicians from six adult ICUs in the U.S. and Hungary. The researchers found that for approximately one third of ICU patients there was a disagreement between the health care providers and the patient/surrogate regarding the appropriateness of treatment. This appeared substantially connect to prognostic discordance. (This refers to when patient/surrogate had different expectations as compared to the physician regarding whether and when death was imminent.)

When these mismatches in expectations occurred, patients/surrogates simultaneously reported lower satisfaction and trust of the ICU team. The researchers did not find any emerging symptoms of depression or anxiety in these patients/surrogates. However, as the paper states, “these findings highlight the importance of improving prognostic communication and understanding.”

The research team recommends building and implementing collaborative decision-making processes for the ICU. These should include regular, structured communications and strive for a shared understanding of the goals of care and how to achieve those goals.

One of the Mayo Clinic Kern Center for the Science of Health Care Delivery key competencies is the center’s ability to take massive amounts of data and rapidly convert that into innovative solutions to problems people find in health care. Much of this work is designed to assist physicians in decision-making, improving health care experience for both patients and providers.

Improving experience for those who care for veterans

Research into what works best for individuals in similar situations sometimes focuses on the patient, but in other projects, Mayo Clinic researchers look at what might improve experiences for the family or other caregivers of patients.

According to AARP, more than 40 million adults in the United States act as caregivers to a family member. Some 5 million of these Americans care for injured, sick or disabled veterans. These caregivers form an important part of the health care continuum for patients. Thus, protecting their health and wellbeing is as important as improving the health of their loved ones.

Another center-led study published in PLOS One, in March 2019, examined the satisfaction of family caregivers regarding inpatient care for veterans with traumatic brain injuries and polytrauma.

Using fixed information, such as caregiver and care recipient demographics, and details of care recipients’ military service and injury; along with responses to a national Veterans Administration-led Family and Caregiver Experience survey, the research team hoped to identify caregiver subgroups who would benefit from customized interventions.

They found a majority (75%) of the 524 caregivers in the study group reported being mostly or very satisfied with their care recipient’s inpatient care. The paper states, “Higher satisfaction with inpatient care was significantly associated with greater caregiver social support, receipt of training from the VA, and perceptions of being valued by the VA.”

In contrast, caregiver dissatisfaction was associated with some fixed factors such as relationship to the care recipient, but also with a number of factors that health care organizations could address. These included “lack of social support, lack of caregiver training received, and low caregiver perceptions of being valued by the health care system.”

The lessons in this study could apply to the greater community of caregivers. A support network and training for family caregivers are programs that organizations can build or strengthen. Further, letting those caregivers know they are appreciated as a valuable part of the health care continuum for their family member could improve caregiver satisfaction.

NOTE: This study was a secondary analysis of de-identified data from the Family and Caregiver Experience Study. Joan Griffin, Ph.D., Robert D. and Patricia E. Kern Scientific Director for Care Experience, was the principal investigator of the parent study and a research scientist at the Minneapolis VA Health Care System when data were collected. The study was originally funded by a grant from the Department of Veteran Affair’s Health Services Research and Development service.

These three research papers illustrate a small percentage of the research done every day at Mayo Clinic. For more than 150 years, Mayo Clinic has pursued continuous improvements in health and health care delivery. Since our beginning, we have collected, organized and analyzed patient health care data as well as global health care knowledge to build the evidence base for best practices and personalized care.

Visit the websites for more information about Mayo Clinic Research and Education – the driving forces behind our ability to provide the best possible care for patients.

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Jul 9, 2018 · A revolution in pancreatic cancer treatment

Thank you for reading Advancing the Science. As you might imagine, we are unable to recount in this forum everything we are working on with respect to pancreatic cancer, but this article may give you a bit of insight.

As you mentioned, we are researching vaccines/vector-delivered viruses for the treatment of a variety of cancers. This video tells a bit more about that work: https://www.mayoclinic.org/diseases-conditions/cancer/multimedia/vid-20078288

For more information on more of the medical research being conducted at Mayo Clinic, please visit the website http://www.mayo.edu/research.

Mon, Apr 8 12:01am · The newest building block for understanding rare disease

hands playing with Lego blocks

One of the basic building blocks of understanding disease is epidemiologic research. In this science, researchers seek to understand how often a condition occurs in a particular population, and to identify successful ways to treat or prevent disease.

In a study published April 8 in Arthritis & Rheumatology, a team of Mayo Clinic researchers led by rheumatologist Ali Duarte-Garcia, M.D., described the epidemiology of antiphospholipid syndrome. This is the first ever publication characterizing this disease – the newest building block in understanding this rare disease.

Antiphospholipid syndrome is an autoimmune disorder that can occur by itself or with diseases such as systemic lupus. “It is a complex disease which leads to a tendency to form blood clots because the immune system mistakenly attacks certain fats, called phospholipids,” says Eric Matteson, M.D., a Mayo Clinic emeritus rheumatologist and senior author on the study. “These fats are present in all body tissues including the membranes around blood cells. In addition to blood clots, patients can suffer pregnancy loss, kidney failure, and strokes as a result of the disease.”

The symptoms of antiphospholipid syndrome can mimic many other conditions, says Dr. Duarte. “The most important factor in making the diagnosis is to test for the autoantibodies associated with the disease, and then confirm with a second test 12 weeks later.”

However, in the case of a rare disease such as antiphospholipid syndrome, physicians may not even recognize the need for a particular test. The Mayo research team hoped that defining this particular disease would assist physicians in identifying where a set of symptoms pointed.

Understanding rare disease

International Rare Disease Day was February 28, 2019. This provided a chance for Laurie Edwards, a professor at Northeastern University in Boston, to acknowledge the difficulties people with rare conditions face – including her – and to bring attention to nationwide efforts to address rare diseases. (Read her commentary post on WBUR.org, Boston’s National Public Radio news station).

As part of its continued promise to provide the best possible care for patients, Mayo Clinic researches, diagnoses, and – when options exist – treats rare conditions such as Edwards’.

“By knowing which populations and age groups more frequently get the disease,” says Dr. Duarte, “Clinicians can more accurately select diagnostic tests and increase diagnosis likelihood in those populations where the disease occurs more often.”

Research findings

Using the Rochester Epidemiology Project to examine an entire community’s health information, the researchers found that antiphospholipid syndrome occurs each year in about two people out of every 100,000.

In that same 100,000 people, the team estimates that about 50 people have the condition at any given time (including chronic and new diagnoses).

They were pleased to discover that while antiphospholipid syndrome may cause a variety of health concerns, it did not seem to hasten death in the patient group as a whole.

Dr. Duarte says, “Knowing the frequency of a disease, and who it affects, informs policy and practice. This information is essential for policy makers, as well as government and funding agencies, to decide how to allocate clinical and research resources for the treatment and study of a disease.”

He also adds, “We did not know it was a rare disease before this study, because there was no existing data about the frequency of antiphospholipid syndrome.”

Drs. Duarte and Matteson and their colleagues decided to research antiphospholipid syndrome primarily because it had no epidemiologic data. They had noticed it seemed to appear often with lupus and other rheumatic diseases, but had no information about how often or what other factors might contribute to occurrence.

Unlike some rare conditions, antiphospholipid syndrome has treatment options, albeit no cure. “Antiphospholipid syndrome can usually be managed with blood thinners,” says Dr. Matteson. “But in some patients with more severe disease, drugs that suppress or alter the immune system may be needed.”

Dr. Matteson says that although researchers do not know what causes this disease, Mayo Clinic’s most recent contribution to understanding antiphospholipid syndrome helps build the evidence base needed for better understanding of the causes, disease burden and management of this syndrome.

Dr. Duarte conducted this research as a Kern Health Care Delivery Scholar in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. His education and research are also supported by the  Center for Clinical and Translational Science.

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About the Rochester Epidemiology Project

The Rochester Epidemiology Project (REP) is a collaboration of clinics, hospitals, and other medical facilities in Minnesota and Wisconsin and involves community members who have agreed to share their medical records for research. Using medical record information, medical scientists can discover what causes the diseases, how patients respond to medical and surgical therapies, and what will happen to patients in the future. Research studies conducted in the local community may improve the health of people both locally and globally. https://rochesterproject.org

Related resources:

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Wed, Apr 3 6:00am · Research News Roundup-March 2019

The Mayo Clinic Research News Roundup includes brief summaries and links to research news releases from the past month. It also connects readers to related resources. Read on for more information from Mayo Clinic Research.

Mayo Clinic researchers and their collaborators have shown that when senescent cells — also known as “zombie cells” — are removed from fat tissue in obese mice, severity of diabetes and a range of its causes or consequences decline or disappear. The findings appear in Aging Cell.

Inflammation and dysfunction of fat tissue cause some of the insulin resistance in obese people. In many cases, that dysfunction is caused by zombie cells that already have been shown to be responsible for conditions related to aging and illness, including osteoporosis, muscle weakness, nerve degeneration and heart disease. These cells also accumulate in the fat tissues of obese and diabetic people and mice.


Drug therapy may effectively treat a potentially life-threatening condition associated with cirrhosis and other chronic liver diseases, according to a new study by Mayo Clinic researchers. The study was posted in March on Gastroenterology, the online journal of the American Gastroenterological Association. Print publication is scheduled for July.

While therapies have been available to treat some forms of liver disease, including hepatitis C and autoimmune hepatitis, options have been more limited for treating portal hypertension, a condition where there is an increase in pressure within the portal vein that carries blood from abdominal organs to the liver. Portal hypertension is associated with cirrhosis and other chronic liver diseases.

According to the study, the drug sivelestat may effectively lower portal hypertension, improving symptoms and outcomes for those patients. The study results were obtained from mouse models but have since been confirmed in liver samples from humans, according to Vijay Shah, M.D., a Mayo Clinic gastroenterologist and senior author.


Atrial fibrillation is a common arrhythmia that affects an estimated 30 million people worldwide. New research published in the March 15 issue of JAMA, shows that catheter ablation, a common cardiovascular procedure, appears no more effective than drug therapy to prevent strokes, deaths and other complications in patients with atrial fibrillation. But patients who receive catheter ablation experience much greater symptom relief and long-term improvements in quality of life. And they have fewer recurrences of their atrial fibrillation and fewer hospitalizations than those who receive only drugs.


However, a related study, published in the European Heart Journal, displays how massive amounts of data collected from routine clinical practice can help transform care when put in the hands of researchers. This observational study, conducted in parallel to the clinical trial mentioned above, replicated the trial in a real-world patient population and compared the treatments in patients who would have been excluded from the trial.

Examining a cohort nearly 84 times larger, and during the same time period of the clinical trial, another Mayo Clinic-led research team found that ablation was associated with a lower likelihood of patients experiencing one or more of the most serious outcomes: all-cause mortality, stroke, major bleeding and cardiac arrest, although the benefit associated with ablation was smaller in patients who would have been excluded from the trial.


Mayo Clinic researchers answered that question on Thursday, March 7, at the Society of Behavioral Medicine’s 40th Annual Meeting & Scientific Sessions.

People living in rural areas are more likely to have ambiguous beliefs and fears about getting cancer, as well as more fatalistic viewpoints, than urban dwellers.

“Having these kinds of pessimistic beliefs toward cancer prevention may discourage participation in cancer prevention and screening, which could contribute to health disparities,” says lead author Kristin Harden.


People who stop breathing during sleep may have higher accumulations of the toxic protein tau, a biological hallmark of Alzheimer’s disease, in part of the brain that manages memory, navigation and perception of time.

A preliminary Mayo Clinic study released Sunday, March 3, will be presented at the American Academy of Neurology’s 71st Annual Meeting in Philadelphia May 410.


Find other research feature stories, videos and more news on Discovery’s Edge, Mayo Clinic’s online research magazine.

Mayo Clinic Radio‘s 1-minute and in-depth discussions of research and practical patient information can be found online or via your local radio station.

Information about many of the clinical trials available across Mayo Clinic is online as well.

Much of our content is available in Spanish, and we also have news and patient resources in PortugueseMandarin Chinese and Arabic.

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Wed, Mar 27 7:31am · 'Gut touch?' Mayo Clinic researchers discover important trigger for serotonin release

@magoo
We asked to Dr. Beyder, and he replied:

"It’s a great question. Unfortunately, as you found, we do not know whether there is a significant loss of body serotonin when we remove the colon. We are also interested but do not yet know how much the serotonin from the gut influences brain activity. Both are outstanding questions that we hope to answer with our research." — Arthur Beyder, M.D., Ph.D.

Mon, Mar 25 8:10am · Business innovation with an eye on improving vision

@gradykelley If you would like to seek help from Mayo Clinic, please call one of our appointment offices (Arizona: 800-446-2279, Florida: 904-953-0853, Minnesota: 507-538-3270) or request an appointment online: http://www.mayoclinic.org/appointments.

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