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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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Mon, Mar 4 6:00am · Research News Roundup-February 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 have identified a gene called “UCP-1” that may predict the development of pancreatic cancer in people with type 2 diabetes. Their findings are published in Gastroenterology.

“Developing strategies for the early detection of pancreatic cancer in people without symptoms is critical for improving survival,” says Suresh Chari, M.D., a Mayo Clinic gastroenterologist and senior author of the study.

The good news is that physician burnout appears to be improving, along with indicators for physician well-being. However, physicians remain at high risk for burnout, depression and depersonalization, compared to other professionals. Those are the updated findings from Mayo Clinic researchers and their collaborators that are published in Mayo Clinic Proceedings.

“This is good news. It shows that burnout is being addressed nationally and programs are having some impact,” says Lotte Dyrbye, M.D., Mayo Clinic researcher and senior author of the paper. “Clearly more organizational change and more research is needed to sustain this trajectory.”

Here are some earlier stories on some of the physician wellbeing work and programs at Mayo Clinic:

Leprosy has a history that has spanned centuries and societies across the globe. Yet, it continues to be a problem — even in the modern era. Sufferers from the chronic and infectious skin disease still face the social stigma and lack of medical care that people have endured since the origins of the disease itself. Although leprosy can be treated, the World Health Organization reported 216,108 cases in 2016, with some of these patients seeking treatment at Mayo Clinic’s Rochester campus.

Looking at risk factors and demographic information of sufferers, researchers discuss local case studies of leprosy in the upcoming issue of Mayo Clinic Proceedings.

Yoga postures that flex the spine beyond its limits may raise the risk of compression fractures in people with thinning bones, according to research from Mayo Clinic. The results appear in Mayo Clinic Proceedings.

Researchers at Mayo Clinic and elsewhere have described injuries from yoga. This study examines injuries in people with osteoporosis and osteopenia — conditions characterized by low bone density.

This research project was just one of many at Mayo Clinic looking at complementary and integrated medicine treatments

Healthy white blood cells, called “T-cells,” play a crucial role in how the body fights follicular lymphoma. That’s according to the results of a study led by Mayo Clinic hematologists Zhi Zhang Yang, M.D., and Stephen Ansell, M.D., Ph.D., that was published in Cell Reports. T-cells are a key part of the immune system and protect the body by fighting infections and cancer.

“Follicular lymphoma is a type of blood cancer that mainly involves the lymph nodes in the body,” says Dr. Yang. He says that, while the disease is quite common and has a relatively better prognosis than other cancers, it is not curable. Although many patients respond to treatment, it is common for the cancer to return after treatment.

Dr. Yang and his colleagues were interested in understanding why some patients with follicular lymphoma fare better than others with the disease. Their study found that patients who had a poor immune response to the disease exhibited a reduction in costimulatory receptors on their T-cells.

A team of Mayo Clinic researchers found Hispanic-American patients with Alzheimer’s tend to survive significantly longer with the disease than other ethnoracial groups, according to a study in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. Hispanic-Americans were found to live an average of 12 years with the disease from the time of the onset of symptoms.

This is just one of a myriad of studies that show ethnoracial differences in response to different diseases and/or treatments. The more we know about these differences – and those between men and women – the more we reinforce the idea that participation in medical research must be increased. If a study does not have enough participants to examine outcomes between different groups, results cannot be assumed to be completely generalizable.

Visit this site for more information on clinical trials at Mayo Clinic.

Induced pluripotent stem cells, the workhorse of many regenerative medicine projects, start out as differentiated cells that are reprogrammed to pluripotent stem cells by exposure to a complex set of genetic cocktails. Mayo researchers now report that using the measles virus vector; they’ve trimmed that multi-vector process with four reprogramming factors down to a single “one cycle” vector process. They say the process is safe, stable, faster and usable for clinical translation. The findings appear in the journal Gene Therapy.

In this time when the measles disease is having an unfortunate resurgence, it’s nice to know that something so powerful and positive can come from the deadly virus.

If this topic interests you, here’s information about some other measles virology work at Mayo Clinic:

An individualized diet based on a person’s genetics, microbiome and lifestyle is more effective in controlling blood glucose (sugar) levels than one that considers only nutritional composition of food, Mayo Clinic researchers have confirmed. The research published in the Feb. 8 edition of JAMA Network Open demonstrates that each person’s body responds differently to similar foods, due to the unique composition of each person’s gut microbiome — the complex community of trillions of bacteria within the digestive tract.

Mayo Clinic’s ability to personalize medicine and identify the best treatment for each patient comes about because of integrated research and education programs, a collegial team environment, and the application of cutting edge knowledge and technologies. If you’d like to add some no-calorie content to your diet, you can read about these programs here:

Kidney stones are a common and painful condition, with many sufferers experiencing recurrent episodes. Most people who pass an initial stone want to know their chances of future episodes, but this has not always been easy to predict. Now Mayo Clinic researchers are tracking the familiar characteristics of kidney stone formers in an online prediction tool that could help sufferers anticipate if they’ll experience future episodes. The study was published in Mayo Clinic Proceedings.

The researchers used linked medical records from the Rochester Epidemiology Project to conduct this study.

It may be both exciting and a bit depressing for people who will use this tool to determine when they may suffer from another kidney stone. However, Mayo’s researchers are also working on ways to treat them. Here’s two other recent stories describing an emerging hope in kidney stone treatment research:


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Fri, Mar 1 9:56am · Mayo Clinic advancing the science of health care delivery at the Society of Behavioral Medicine's 40th Annual Meeting & Scientific Sessions

African American female doctor sitting at desk talking with unidentified woman.

For more than 150 years, Mayo Clinic has pursued continuous improvements in health and health care delivery. The Mayo Clinic Robert D. Patricia E. Kern Center for the Science of Health Care Delivery is Mayo’s innovative driver for change, building on this strong history of taking a scientific approach to compassionate care. It brings together a unique, multidisciplinary team with experts from within health care and beyond, to partner with clinicians. Together they translate ideas and findings into real-world applications, and build on these findings to transform the practice of medicine.

A variety of Mayo’s work will be presented March 6-9 at the Society of Behavioral Medicine’s 40th Annual Meeting & Scientific Sessions, in Washington, D.C. If you happen to be there, you can meet some of our researchers at Booth #7, or at their presentations, which are noted below (all times are Eastern Time Zone:

Wednesday, March 6

Two teams have research to discuss during Wednesday’s poster session:

6:30 – 7:30 p.m., Exhibit Hall

Thursday, March 7

Symposium 25: Making Their Voices Heard: Health Effects of Stigma and Discrimination in Understudied Populations
2:15 – 3:30 p.m., Georgetown West
Several institutions have speakers in this symposium, which includes Mayo Clinic’s Sean Phelan, Ph.D.

On Thursday you’ll also have a chance to learn more about some other work from Mayo from these teams:

6:30 – 7:30 p.m., Exhibit Hall

Friday, March 8

You might be starting off your day at a special interest group breakfast. Mayo Clinic’s Shawna Ehlers, Ph.D., will be moderating this breakfast roundtable:

At the end of the day, take the opportunity to meet some more of our research teams:

6:30 – 7:30 p.m., Exhibit Hall

Saturday, March 9

You’ll have one last chance before the conference is over to take a look at Mayo Clinic research:

10:30 – 11:30 a.m., Exhibit Hall


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Thu, Feb 28 6:00am · Feeling lonely in the emergency department? It may matter more than you think.

Waiting in the emergency room is not only frustrating for patients, but could contribute to future hospitalizations, shows new research.

A collaborative team within the Mayo Clinic Emergency Department Clinical Engineering Learning Laboratory is working to improve the quality of care in emergency medicine. Researchers and health care providers work hand-in-hand in this embedded research lab to enhance patient and provider experiences, increase efficiency and improve outcomes for patients everywhere.

In their current study, led by Mustafa Sir, Ph.D., the team observed 13,714 adult and 2,854 pediatric patients placed in an acute care room for treatment in the Emergency Department at Mayo Clinic in Rochester, Minn., between May 1 and July 31, 2016.

“It appears that the length of time patients spend in a treatment room without hospital staff present is related to hospitalization within 30 days following their ED visit,” says Dr. Sir. “Our data shows that every hour a patient spends alone increases the likelihood of hospitalization within 30 days by approximately 6 percent.”

Of all the patients, 22.8 percent were admitted to the hospital during the initial emergency visit, with 13.8 percent (523) of those patients then re-admitted within 30 days.

Of the 12,786 patients discharged from the emergency department, 6.2 percent were subsequently admitted during the following 30 days. Patients that were not hospitalized in 30 days had on average about 25 minutes less alone time compared to those who were hospitalized.

Making connections

The team measured this “patient alone time” three different ways:

  • Total: cumulative time spent alone throughout visit, excluding any portions during which the patient was under observation or in isolation
  • Maximum: longest individual length of time spent alone
  • Percentage: total alone time divided by total treatment room time

They found that pediatric (ages 0-17) patients have the lowest total and maximum alone times, but the highest percentage patient alone time of all patients.

Among adult patients only, seniors (age > 65) stood out, with higher total and maximum alone times. There were no significant differences in percentage alone.

The study results also include information on potential correlations among factors including marital status; patient geographic home – local, regional, national, international; and sex.

What does it mean?

Adjusting for a number of different factors that could potentially influence 30-day hospital admission; the team found that total patient alone time was the only one of the three measurements that was statistically significant.

“Our findings indicate that for every hour a patient spends alone in the ED treatment room, they are 5.6 percent more likely to be admitted, or readmitted, to the hospital within 30 days,” says Heather Heaton, M.D., an emergency medicine physician at Mayo Clinic and study co-author.

“How long patients spend alone, in general, is influenced by how full our ED is,” she says. “Effective triaging and initial physician evaluations seem to reduce alone time for patients with more complex medical situations.”

While the team still has more research they need to do, Dr. Heaton says that she believes even brief check-ins by the physician or other member of the care team could make a difference.

“Although we don’t understand the causal pathway yet, it’s sometimes the simplest things that make a difference,” she says.

“We don’t have the evidence yet to develop evidence-based interventions,” says Dr. Sir, “but we are working on it. This is one of the first studies to examine patient alone time in the ED, and provides critical information for our understanding of ways to improve patient outcomes.”

Future work planned by the Mayo Clinic Emergency Department Clinical Engineering Learning Laboratory team includes analyzing a broader set of characteristic and clinical outcome variables, Dr. Sir says.

Also involved in this study was Adam VanDeusen (@adam_vandeusen), University of Michigan; and from Mayo Clinic: Kalyan Pasupathy, Ph.D.; Todd Huschka; and Thomas Hellmich, M.D. (@Thellmich)

The embedded research model used in the lab was developed within the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. Center researchers collaborate with clinical care and administrative colleagues from across Mayo Clinic and beyond, to discover new ways to improve health; translate those discoveries into evidence-based, actionable treatments, processes and procedures; and apply this new knowledge to improve care for patients everywhere.


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Tue, Feb 19 6:00am · It takes a village

Home-based palliative care may not be a simple doctor-patient relationship, but the value it adds is simple to understand

It takes a village to raise a child. The inputs and interactions with many adults across their community serve to usher children through the ups and downs of life into adulthood and aid them to live well, and become a productive member of society.

This same analogy is used by Christina Y. Chen, M.D., a community medicine physician at Mayo Clinic in Rochester, Minn., when describing home-based palliative care.

“It takes a village – a community of caregivers,” she says, “to provide high quality, patient-centered care for people in our aging population, to help them live well throughout their lives.”

She is part of an interdisciplinary team that has been researching and developing home-based care programs designed to meet people where they are, especially older members of the community. An extension of Mayo Clinic’s Care Transitions Program, home-based palliative care, which Mayo Clinic began in 2011, has always been cutting edge, she says.

“From the beginning, patients who were in this program experienced fewer hospitalizations and fewer days spent in the hospital. Plus, almost 100 percent of patients took advantage of advance care planning,” says Dr. Chen. These outcomes are described in an earlier study.

World Health Organization

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

In their most recent study, the team describes the financial success of the program.

Published in the Journal of Pain and Symptom Management, the report shows annual Medicare expenditures were reduced by $18,251 per program participant compared with matched control patients.

“This supports the role of home-based palliative medicine in delivering high-value care to high-risk older adults,” says Dr. Chen.

“It’s not just about the financial sustainability of this program itself – although the numbers speak for themselves,” she continues. “The beauty of this program is that it carries substantial value across the continuum of health care. It addresses patient needs, improves quality of life for patients and caregivers, reduces hospital stays and clarifies the patients’ wishes in the context of health decline, all while reducing costs.”

Understanding care needs in the community

Gregory Hanson, M.D., another community medicine physician at Mayo Clinic, is the lead champion for the home-based palliative care program and other related ones that are being developed and tested.

“In 2011, approximately 2 million people in the U.S. were over the age of 65 and homebound,” says Dr. Hanson. “Current estimates indicate there could easily be twice that many homebound elders by 2035.”

“One of our main goals for our practice is to find the best person-centered ways to care for elders in our community,” he says. “This is about engaging the whole team, meeting the patients where they are, and finding the best ways to improve quality of life and the value of health care.”

“In addition to palliative care, we offer hospital at home, primary care at home and a care transitions program designed to enable patients to recover at home after hospitalization, improving their overall wellbeing in the process,” says Dr. Hanson.

“We continue to study the needs in our community in a holistic manner, looking at physical, emotional and spiritual needs,” he says. “We are committed to finding the best ways to address those needs.”

It takes a village … or a team

“This vision and these programs didn’t just develop overnight,” says Dr. Hanson. “We have team members from across health care – care coordinators, nurses, physicians, nurse practitioners, social workers and pharmacists – coming together to build and deliver these new care models.”

“While we developed these for our patients, we also hope that our research findings will spark practice changing strategies across the nation,” he says.

“The research team provides a critical component to our ability to meet the needs of patients here and afar,” echoes Dr. Chen. “We’ve partnered with Mayo’s Center for the Science of Health Care Delivery all along. They have mentored us in our research and program development, and without their skills in data extrapolation and analysis, as well as expertise in defining the research questions, we wouldn’t be able to share the successes we have thus far.”

“It takes a village to do research, and it takes a village to take care of one patient,” she says. “It’s all in the spirit of advancing practice, education and research, so that we may all continue to do better as providers and as people.”


The authors of the current study include two physician alumnae of the Kern Health Care Delivery Scholars mentored training program within the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, as well as other center experts. The center is an innovative driver of change for Mayo Clinic, and transforming the experience of health care for all patients. To grow the ranks of experts in this field, the center also trains researchers and providers to solve the complexities of the health care system from within.

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Tue, Feb 5 6:00am · Research News Roundup-January 2019

Zombie cells, anxious mice, safer hockey, women’s health (and men’s), artificial intelligence, and more in this month’s roundup.

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

Diabetes, stress-induced aging and Alzheimer’s disease, immigration-related obesity, and implantable drug testing devices are the targets of the research awards from the Minnesota Partnership for Biotechnology and Medical Genomics in 2019. This marks the partnership’s 16th year of spearheading new scientific ideas from Minnesota to improve health care for Minnesotans. The state-funded grants for these team science proposals total nearly $5.2 million.

Each team includes investigators from Mayo Clinic and the University of Minnesota, and must demonstrate true collaboration.

Mindfulness may be associated with fewer menopausal symptoms for women, according to a Mayo Clinic study recently published in Climacteric: The Journal of the International Menopause Society. Researchers discovered that being mindful may be especially helpful for menopausal women struggling with irritability, anxiety and depression.

In the event you want to know more about mindfulness, here are some related resources to get you started:

Hockey researchers at Mayo Clinic and their colleagues are unveiling new recommendations that seek to ensure the well-being of hockey players, and lower the risk, severity and consequences of concussion in the sport.

In a rare arrangement, the recommendations are being published in Current Sports Medicine Reports, Advances in Orthopaedics and Sports Medicine, Annals of Sports Medicine and Research, and the Clinical Journal of Sports Medicine.

Mayo Clinic researchers, along with collaborators, have published findings from a safety and feasibility clinical trial on the removal of senescent cells from a small group of patients with pulmonary fibrosis. The findings appear in EBioMedicine.

“This was a short safety trial to determine if we should move ahead with actual large-scale human trials,” says senior author James Kirkland, M.D., Ph.D., head of the Robert and Arlene Kogod Center on Aging. “It’s important to emphasize that, while some measurable improvement was noted in all the participants, this is simply the start of human studies. We don’t know what lies ahead.”

A Mayo Clinic study finds that applying artificial intelligence (AI) to a widely available, inexpensive test – the electrocardiogram (EKG) – results in a simple, affordable early indicator of asymptomatic left ventricular dysfunction, which is a precursor to heart failure. The research team found that the AI/EKG test accuracy compares favorably with other common screening tests, such as mammography for breast cancer. The findings were published in Nature Medicine.

Asymptomatic left ventricular dysfunction is characterized by the presence of a weak heart pump with a risk of overt heart failure. It affects 7 million Americans, and is associated with reduced quality of life and longevity. But asymptomatic left ventricular dysfunction is treatable when identified.

However, until now, there was no inexpensive, noninvasive, painless screening tool for asymptomatic left ventricular dysfunction available for diagnostic use.

The percentage of women who are screened for cervical cancer may be far lower than national data suggests, according to a Mayo Clinic study recently published in the Journal of Women’s Health. Less than two-thirds of women ages 30 to 65 were up-to-date with cervical cancer screenings in 2016. The percentage is even lower for women ages 21 to 29, with just over half current on screenings. Those figures are well below the 81 percent screening compliance rate self-reported in the 2015 National Health Interview Survey.

“These cervical cancer screening rates are unacceptably low,” says Mayo Clinic family medicine specialist Kathy MacLaughlin, M.D., the study’s lead author.

This study is just one of hundreds that have used the linked medical records of the Rochester Epidemiology Project to discover what causes diseases, how patients respond to medical and surgical therapies, and what will happen to patients in the future.

Mayo Clinic researchers and collaborators have shown in mice that obesity increases the level of “zombie” or senescent cells in the brain, and that those cells, in turn, are linked to anxiety. When senolytic drugs are used to clear those cells, the anxious behaviors in the mice dissipate. These findings appear in Cell Metabolism. 

In their paper the authors say, “Our data demonstrating a link between obesity, senescence and anxietylike behavior provide critical support for the potential feasibility of administering senolytics to treat obesity-associated anxietylike behavior, provided that clinical trials validate this approach.”

Read more senescent cell news from Mayo Clinic.

Genetic alterations in low-risk prostate cancer diagnosed by needle biopsy can identify men that harbor higher-risk cancer in their prostate glands, Mayo Clinic has discovered. The research, which is published in the January edition of Mayo Clinic Proceedings, found for the first time that genetic alterations associated with intermediate- and high-risk prostate cancer also may be present in some cases of low-risk prostate cancers.

The study found the needle biopsy procedure may miss higher-risk cancer that increases the risk of disease progression. Researchers say that men diagnosed with low-risk cancer may benefit from additional testing for these chromosomal alterations.


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, Jan 31 6:00am · New data gives clarity to allergy doctors and their patients

In a new study published in Mayo Clinic Proceedings, Mayo Clinic researchers present the first population-based evidence showing how often food allergies are diagnosed in people. The study also determined which foods are most likely to cause allergic reactions in different age groups.

“There were no previous population-based estimates for food allergies in the U.S.,” says Avni Joshi, M.D., a pediatric allergy and immunology doctor at Mayo Clinic, and the study’s lead researcher. “We didn’t feel that the random surveys previously conducted provided adequate clarity for the growing epidemic of food allergies.”

Knowing that they had access to a unique population health resource, Dr. Joshi and her team decided to answer these questions in a more definitive manner.

The researchers used the linked medical records of the Rochester Epidemiology Project to examine the incidence of food allergies of people of all ages during the 10-year period Jan. 2, 2002, through Dec. 31, 2011.

Research findings

What the researchers found was that males were much more likely to be diagnosed with a food allergy than females, with the difference becoming evident in diagnoses in children ages 1-4. Other age groups did not have significant differences between the sexes.

Between these 2-year periods 2002-2003 and 2006-2007, the likelihood of being diagnosed with food allergies increased nearly two fold. However, this rate stabilized during the years 2009-2011.

Babies (< 1 year) were most likely to be diagnosed with a milk allergy, whereas children ages 1-4 were most likely to be diagnosed with a peanut allergy. Adults’ most common diagnosis was a seafood allergy.

What causes these shifts?

Dr. Joshi and her team have some theories about why the rates increased so dramatically and then stabilized. Now, they are looking at the period 2012-2017, and expect to see a decrease in incidence.

“So many things are different today than they were 40 or 50 years ago,” says Dr. Joshi. “We have antibiotics in our meat, and antibacterial cleaners and sanitizers everywhere. There are more pesticides and other chemicals being introduced, while at the same time we are ‘hyper clean.’

“Reducing the number of different bacteria we are exposed to actually makes our microbiome less diverse, and subsequently it seems we are developing allergic reactions to things that should not cause a response.”

In addition to less protective gut bacteria and appropriate immune responses, the team noted that the evidence in this study shows a pattern that emerged due to what seems an overabundance of caution.

In 2000, the American Academy of Pediatrics recommended delaying introduction of allergenic food in babies and small children.

By 2006, Mayo’s current research shows that the overall incidence of allergies had risen.

In 2008, the Academy reversed its earlier recommendation, and in 2013 went further, and recommended early introduction of allergenic foods.

The 2013 recommendations resulted from data collected in two studies conducted overseas: Learning Early About Peanut Allergy (LEAP), and Persistence of Oral Tolerance to Peanut (LEAP-On), says Dr. Joshi.

“Not surprisingly, we saw a stabilization of allergy diagnoses about 1-2 years after the reversed recommendation in 2008,” she says, “and in our current research project, we believe we’ll see a decline, commencing about two years after the 2013 recommendations.”

“One to two years is about how long it takes for guidelines from advisory bodies, such as the American Academy of Pediatrics, to be widely accepted in practice.”

Avni Joshi, M.D., discusses her most recent research on Mayo Clinic Radio.

What comes next?

“As we build the evidence base surrounding our knowledge of food sensitization trends, as well as when and why allergies emerge, we hope to find ways to intervene earlier and prevent development of food allergies,” says Dr. Joshi.

She and her team have a number of different research projects underway, including:

  • Studying the microbiome of children with food allergies compared to that of at least one biological parent
  • Studying infant microbiomes from umbilical cord blood, along with Vitamin D levels; and comparing it to changes over the first year of life
  • Determining the likelihood of progression from eczema to food allergy, hay fever and then asthma (in collaboration with the Department of Dermatology)

The researchers hope to determine things such as the likeliness of developing multiple food allergies or of outgrowing allergies. They also hope their research leads to potential interventions and preventive strategies to mitigate the atopic march (progression of allergic diseases).

This study was made possible by the Rochester Epidemiology Project (National Institutes of Health grant number R01-AG034676).


About Mayo Clinic Proceedings

One of the premier peer-reviewed clinical journals in general and internal medicine, Mayo Clinic Proceedings is among the most widely read and highly cited scientific publications for physicians, with a circulation of approximately 127,000. While the Proceedings is sponsored by Mayo Clinic, it welcomes submissions from authors worldwide, publishing articles that focus on clinical medicine and support the professional and educational needs of its readers. Read more on the website.

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Wed, Jan 9 6:00am · Why doctors might need to go back to 6th grade

When you leave the hospital, following an injury, stroke, surgery or other event, you are loaded down with paper. You receive instructions on how to take care of your body. They tell you how to prepare your home and your family. Other pages include directions on what medication to take, when and how. For example, take one in the morning with breakfast; or three times a day, at least one hour before meals. The papers describe any special equipment or supplies you may need, as well as how to use them. Other pages discuss possible side effects, and still more share tips for prevention or better health in the future.

Likely you are feeling tired a sick. Now you are supposed to read and understand all this writing, with its complicated medical language.

Asad Choudhry, M.B.B.S.

Asad Choudhry, M.B.B.S. (@choasad), was a trauma research fellow at Mayo Clinic, when he started thinking about this.

While collecting data for another research study, he noticed that many patients tended to call back for the same few reasons. These reasons largely included clarification of written instructions provided to patients in their discharge summaries.

“After discharge, different patients tended to ask the same questions repeatedly related to instructions given; time and time again,” he says.

Dr. Choudhry and his mentor Martin Zielinski, M.D. (@ZielinskiTrauma), put together a research team to examine this.

Initial findings

Their initial study looked at the readability of discharge instructions, to see what grade level the Trauma Center used when writing the instructions. They were quick to note that it was much higher than recommendations from the National Institutes of Health and American Medical Association. (Both groups recommend a 6th grade reading level). In fact, they found the current instructions were written at around a 10th grade level.

After reviewing the records of nearly 500 patients, they found 27 percent received instructions that were difficult to read. They also found that 65 percent of the patients had reading skills below the level of their discharge summary.

Example Readability Edit

You had an Inferior Vena Cava (IVC) filter placed during this hospitalization: this was done for the prevention of respiratory sequelae of thromboembolic disease which commonly occurs after extremity trauma. (Grade 20.4)

You had an Inferior Vena Cava (IVC) filter placed during this hospitalization.

This was done to prevent the formation of clots in the blood vessels of your lungs. This is common after an injury to your extremities. (Grade 8.3)

Forty patients were readmitted within 30 days, and of those, 65 percent had reading skills below the level of their original discharge instructions.

“At the time there were some guidelines on the appropriate reading level of discharge information,” says Dr. Choudhry. “However, there was little information about the effect of improved readability on patient return phone calls as well as readmissions.”

The research then became a two-part effort. First, to understand the level of information patients received upon discharge, compared to national guidelines. Second, analyzing the effect on patient care outcomes after receiving more readable discharge instructions.

“It was an area lacking in quality data,” says Dr. Zielinski, “and there were outstanding opportunities to improve patient care and understanding.”

Following the trail

The team recently published their findings from the second part of this research.

In this project, the Trauma Center revised the way they wrote discharge instructions. They rewrote the information to a reading level of grade 6. Then they compared 1,072 patients, 493 who had received the old instructions, and 579 who received the new ones.

The researchers found that this change transformed outcomes for patients. Not only were there many less phone calls from patients asking for clearer instructions, but there were less readmissions.

They also found that by improving readability of instructions for pain medication, they reduced questions related to pain.

“Health care systems are trying to find ways to reduce opioid misuse,” says Dr. Choudhry. “By enhancing the readability of pain management and medication instructions, patients are better able to understand how to control their pain. This leads to fewer questions or confusion around pain and potentially better pain control.”

Dr. Choudhry has since moved on from Mayo Clinic, and is in his third year of general surgical training at the State University of New York Upstate Medical School, Syracuse, New York.

Martin Zielinski, M.D.

Meanwhile, Dr. Zielinski and the team are continuing this research. They revised all templates for discharge instructions in the Division of Trauma, Critical Care and General Surgery to reach a less than 8th grade reading level.

“Our current trauma research fellow, Dr. Joy Hughes, is leading a study on the effects that learning disabilities have on understanding discharge instructions,” says Dr. Zielinski. “We are developing methods to enhance patient understanding such as 3-D models on the patient’s specific wound and how best to care for it at home, as well as videos teaching these methods.”

The team is pleased with results so far, he says. “We can indeed enhance patient understanding, and this leads to positive outcomes for both the patients and the providers.”


This research is in collaboration with the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

“The Kern Center provides outstanding resources with knowledgeable people who are on the cutting edge of the science of health care delivery,” says Dr. Zielinski. “Dr. Habermann and her team are invaluable contributors without whom we could not have been successful on ensuring our patients receive the best care possible.”

Elizabeth Habermann, Ph.D. (@EBHabermann), is the Robert D. and Patricia E. Kern Scientific Director for Surgical Outcomes. Surgical Outcomes is one of several focus areas in the Kern Center for the Science of Health Care Delivery.  Center members collaborate to discover new ways to improve health; translate those discoveries into evidence-based, actionable treatments, processes and procedures; and apply this new knowledge to improve care for patients everywhere.

Editor’s Note: This post has a Flesch-Kincaid grade level of 10.5, as measured in Microsoft Word.

Tue, Jan 8 6:00am · Research News Roundup-December 2018

Each month, we publish Mayo Clinic’s Research News Roundup. This post includes brief summaries and links to news releases from the preceding month that discuss some of our latest medical research. It also connects readers to related resources.

December’s news releases highlight some of the wide variety of research being conducted in Mayo Clinic Cancer Center. The below findings were presented at two of the top annual international cancer symposia.

Read on for recent findings of Mayo Clinic Research:

Research led by oncologists Roberto Leon-Ferre, M.D. and Charles Loprinzi, M.D. of Mayo Clinic has found that the drug oxybutynin helps to reduce the frequency and intensity of hot flashes in women who are unable to take hormone replacement therapy, including breast cancer survivors. These findings were presented at the 2018 San Antonio Breast Cancer Symposium.

“Hot flashes are a common symptom of menopause and can be even more severe in breast cancer survivors than they are in the general population,” says Dr. Leon-Ferre. He says several factors contribute to the increased severity of hot flashes in breast cancer survivors including exposure to chemotherapy, which may bring on early menopause; the use of antiestrogen drugs, such as tamoxifen or aromatase inhibitors; and the use of medications or procedures to suppress the function of the ovaries. Hormone replacement therapy, which is sometimes used to treat hot flashes, is generally not recommended for breast cancer survivors. “Hot flashes not only impact a patient’s quality of life, they are associated with patients prematurely discontinuing breast cancer treatment, which may increase the risk of breast cancer recurrence and mortality,” says Dr. Leon-Ferre. “It is important for physicians to have effective options to treat hot flashes.”

Mayo Clinic researchers have developed two new strategies that may improve the performance of chimeric antigen receptor therapy (CAR-T cell therapy) in treating cancer. They are presenting results of their preclinical research at the 2018 annual meeting of the American Society of Hematology in San Diego.

Read more about CAR-T cell therapy at Mayo Clinic.

Mayo Clinic researchers have found that an oral drug, apixaban, used to treat blood clots in patients undergoing cancer therapy, is safe and effective. The drug was associated with fewer major bleeding events and fewer recurrent blood clots, compared to low-molecular- weight heparin. Their findings were presented at the annual meeting of the American Society of Hematology by Robert McBane II M.D., a Mayo Clinic cardiologist.

“Nearly 1 in 5 patients with cancer will develop a clot in the veins, referred to as either a deep vein thrombosis or pulmonary embolism,” says Dr. McBane. “Clotting events can be deadly with pulmonary embolism being the second most common cause of death in cancer patients.”


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